US20050015093A1 - Plating system with compression drill guide - Google Patents
Plating system with compression drill guide Download PDFInfo
- Publication number
- US20050015093A1 US20050015093A1 US10/837,085 US83708504A US2005015093A1 US 20050015093 A1 US20050015093 A1 US 20050015093A1 US 83708504 A US83708504 A US 83708504A US 2005015093 A1 US2005015093 A1 US 2005015093A1
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- United States
- Prior art keywords
- plate
- bone
- hole
- guide
- stem
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- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
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Classifications
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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
-
- 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
- A61B17/8052—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded
- A61B17/8057—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded the interlocking form comprising a thread
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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
- A61B17/16—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
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/72—Intramedullary pins, nails or other devices
-
- 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
Definitions
- the present invention relates to a bone fixation system including a plate and surgical drill guide that are releasably attachable to each other for providing a precise alignment therebetween. More particularly, the present invention relates to a bone plate having fastener holes oriented at predetermined angles with respect to the plate and a plate holder and surgical drill guide assembly with at least one alignment drill guiding barrel that is aligned with the respective fastener holes in a bone plate for drilling the holes at the proper angle.
- the use of surgical fixation plates for a variety of orthopedic applications is widely accepted.
- the plates are used by surgeons to mend, align, and alter compression of patient's bones, and are typically fastened to the bones with a plurality of fasteners such as screws that are installed through holes in the plate.
- Proper orientation and alignment of fasteners and secure surgical fixation of the plates is advantageous in avoiding future complications after implantation.
- Bone plates used in spinal applications must be installed with special care, as the plates are used for long term, intervertebral fixation, bone-fragment fixation, and anterior decompression in the cervical region of the spine.
- the margin for error in spinal surgery is quite small, particularly because of the sensitivity of the spinal cord and the risk inherent with invasive procedures around the spinal cord.
- the dimensions of vertebral bone available for setting fasteners are fairly limiting.
- Each fixation fastener should properly align with its associated plate hole so that each screw is seated correctly with the plate and enters the bone at an appropriate angle. Any misalignment of the screw within the plate hole risks tissue damage. In addition, improperly seated screws may result in an unstable or insecure connection of the plate to the bony material, thus potentially defeating the usefulness of the plate. Locking plates, in particular, demand precise fastener alignment.
- the invention relates to a bone plate, a surgical drill guide assembly comprising at least one alignment drill tube configured to receive and guide a surgical drill bit; and a plate holder that couples to the plate and to the drill guide assembly.
- the drill guide assembly is configured and dimensioned to allow it to couple with the plate holder and plate to provide a fixed dimensional and angular alignment between the alignment drill tube and the bone plate.
- the bone plate has two or more pairs of fixation holes and may have one or more slots along the central longitudinal axis of the plate.
- the fixation holes are preferably conical and preferably threaded.
- the bone screws to be used with the bone plate preferably have threaded or unthreaded conical heads to match the fixation holes in the bone plate.
- the fixation holes in the bone plate may be angled toward the central axis of the bone plate up to about 10°, and may also be angled up to about 15° upward or downward along the direction of the longitudinal axis of the bone plate which is generally aligned in the direction of the length of the spine.
- the slot(s) may be threaded or have a counterbore at its ends to allow coupling of the drill guide assembly or the plate holder.
- the bone plate may have any thickness, and its thickness may vary along its length and width; although 2.2 mm is an exemplary thickness.
- the plate may also have a step feature or flange to facilitate placing the plate on the sacral promontory
- the plate holder may include a rod having a circular cross section along with a short threaded section for coupling with a threaded hole in the plate, a short non-circular section, such as, for example, a hexagonal section on the end opposite from the threaded end, and a radial groove between the ends.
- the plate holder attaches to the plate and allows the user to manipulate the plate from a location remote from and without touching the plate.
- the drill guide assembly includes a handle member, an offset handle stem, an outer stem, a release sleeve on the outer stem, captive ball detents in the wall of the outer stem to engage the radial groove of the plate holder rod, and a release sleeve spring that biases the release sleeve axially away from the end of the outer stem opposite the bone plate.
- the release sleeve is preferably captively attached to the outer stem such that it may rotate about the outer stem and has limited axial movement with respect to the outer stem.
- Pressing the release sleeve against the bias of the spring allows radial movement of the captive ball detents in the wall of the outer stem due to a tapered inner surface of the release sleeve or a section of the release sleeve with an increased inner diameter.
- Coupling of the drill guide assembly to the plate holder is accomplished by sliding the outer stem of the drill guide assembly over the plate holder and aligning the non-circular end of the plate holder with a matching non-circular hole at the end of the outer stem of the drill guide assembly.
- the captive ball detents engage the radial groove of the plate holder and lock the drill guide assembly to the plate holder when the release sleeve is allowed to return to its spring-biased position.
- the release sleeve may have a non-circular hole the perimeter of which engages the perimeter of the matching non-circular end of the plate holder.
- the release sleeve can be rotated in relation to the outer stem to allow screwing and unscrewing of the plate holder from the bone plate while the remainder of the drill guide assembly remains stationary.
- connection between the drill guide assembly and the plate holder has been described as a stem coaxial with and sliding over a rod, other embodiments are possible including, for example, a drill guide assembly with a stem attaching to the side of a plate holder.
- the drill guide assembly may include either one or two guiding barrels to allow passage of fixation pins or bone screws, drills, taps, and awls through it in a predetermined trajectory.
- the guiding barrels may have more than one insertion location with variable or pre-determined trajectories offset from a single exit location.
- the guiding barrels of the single barrel embodiments of the drill guide may be movable by means of a pivoting mechanism to allow drilling holes into bone on both sides of the longitudinal axis of the bone plate.
- the guiding barrels of the double barrel embodiments of the drill guide assembly also preferably have a tab to engage a slot of the bone plate to prevent rotation of the drill guide assembly in relation to the bone plate.
- the single barrel embodiments of the drill guide assembly also preferably have a tab on the outer stem to engage a slot of the bone plate to prevent rotation of the drill guide assembly in relation to the bone plate.
- the handle of the drill guide assembly may have a ratchet gear mechanism that permits incremental swiveling with respect to the axis of a button cam.
- the ratchet is operated by pressing and holding a button cam while turning the handle.
- the handle may lock at predetermined angle intervals.
- a surgical drill guide assembly comprising a stem member releasably engageable with the guide engaging hole of the bone plate; at least one guide barrel associated with the stem member and configured to receive a tool, the guide barrel having a longitudinal axis; and a bone plate having at least one fixation hole configured to receive a fastener to fix the plate to a bone, and at least one guide engaging hole for engaging the drill guide.
- the stem member and guide barrel may be configured so that when the stem member engages the bone plate the guide barrel longitudinal axis is oriented non-coaxial with the fixation hole.
- the tool may be a drill bit, an awl, a probe or a tap.
- the fixation hole may also have a center point, wherein when the stem member engages the bone plate the guide barrel longitudinal axis does not intersect with the center point of the fixation hole.
- the bone plate further may have a longitudinal axis and the tool may be configured for forming a hole in bone.
- the center of the hole may be located a first distance from the center of the corresponding plate fixation hole.
- the first distance may be from about 0.1 millimeters (mm) to about 0.8 mm as measured along a line substantially parallel to the plate longitudinal axis.
- the first distance may be about 0.5 mm as measured along a line substantially parallel to the plate longitudinal axis.
- the guide barrel When the stem member engages the guide engaging hole of the bone plate, the guide barrel may not contact the plate. At least a portion of the stem member and the guide engaging hole of the bone plate may comprise corresponding threads to allow the stem to be threadably engaged with the plate.
- the guide barrel may be connected to the stem member via a hinge, the hinge allowing the guide barrel to be pivoted about the stem with respect to the plate so that when the stem is engaged with the guide engaging hole of the bone plate, the guide barrel is selectively alignable with at least two fixation holes of the bone plate to allow the tool to be inserted through the guide barrel to form a hole in bone through each fixation hole without disengaging the stem from the plate.
- the surgical drill guide assembly may further comprise a second drill guide barrel.
- the drill guide barrel may comprise first and second tool receiving recesses.
- Each tool receiving recess may have a longitudinal axis, and the two axes may be non-parallel.
- the longitudinal axes of the tool receiving recesses may converge at a point located a first distance from the center of the plate hole.
- a method of installing a bone plate on at least two vertebrae may comprise the steps of: (a) providing a bone plate having at least one fastener hole configured to receive a bone fastener for fixing the plate to a vertebra; (b) providing a drill guide having a stem member and a guide barrel, the stem member configured to engage a bone plate and the guide barrel configured to receive a tool for forming a hole in bone; (c) engaging the stem member with the bone plate so that the guide barrel is located adjacent to the at least one fastener hole; (d) placing the bone plate on vertebrae so that the at least one fastener hole lies adjacent a vertebra; and (e)passing the tool through the guide barrel and the fastener hole so that the tool engages the vertebra and cuts a hole in the bone underlying the fastener hole; wherein the hole in the bone is located a first distance from the center of the fastener hole.
- the first distance may be from about 0.1 mm to about 0.8 mm, or it may be about
- the method may further comprise the steps of: (f) inserting a bone screw into the hole in the bone; and (g) tightening the screw in the hole, the screw having a head and an underside surface; wherein the underside surface of the screw head engages an inner side surface of the fastener hole so that the screw and plate are moved longitudinally with respect to each other as the screw is screwed into the bone.
- the stem and guide barrel of the drill guide may be configured so that the screw and plate are moved longitudinally with respect to each other by a second distance as the screw is screwed into the hole in the bone.
- the first and second distances are substantially equal.
- the second distance may be about 0.5 mm.
- the bone plate may further comprise a second fastener hole
- the drill guide may have a second guide barrel configured to receive a tool for forming a hole in bone adjacent the second fastener hole.
- the first and second guide barrels may each have first and second tool receiving recesses, the recesses each having a trajectory, the trajectories of the first and second recesses being substantially non-parallel.
- the bone plate may further comprise a second fastener hole
- the guide barrel may be attached to the stem member via a pivot joint.
- the barrel may be movable about the pivot joint to move from a first position adjacent the first fastener hole of the bone plate to a second position adjacent the second fastener hole of the bone plate.
- the guide barrel may further having an internal shoulder configured to engage a portion of the tool inserted therethrough to limit the depth of penetration of the tool into the underlying bone to a predetermined amount.
- the guide barrel further may have at least one longitudinal slot running along a substantial portion of a length of the guide barrel, the slot configured to allow the user to visualize the position of the tool within the guide barrel.
- a handle may be associated with the stem, the handle being pivotably adjustable with respect to the stem to allow the handle to be rotated to a desired position relative to the guide barrel.
- the handle may have a longitudinal axis that is substantially non-parallel to the longitudinal axis of the guide barrel.
- a drill guide kit may also be provided.
- the kit may comprise a first drill guide assembly comprising a first plate-engaging stem and a first guide barrel configured to receive a tool.
- the first guide barrel may have a longitudinal axis, and the stem may be releasably engageable with a bone plate to position the first guide barrel adjacent a first fastener hole of the bone plate.
- the kit may also comprise a second drill guide assembly having a second plate engaging stem and a second guide barrel configured to receive a tool, the second guide barrel having a longitudinal axis.
- the stem may be releasably engageable with the bone plate to position the second guide barrel adjacent a second fastener hole of the bone plate.
- the first stem and first guide barrel may further be configured so that when the stem member engages the bone plate the guide barrel longitudinal axis intersects the center of the fastener hole, and the second stem and second guide barrel may be configured so that when the second stem member engages the bone plate the second guide barrel is substantially aligned with the fixation hole but the longitudinal axis does not intersect the center of the fixation hole.
- the drill guide kit may further comprise a bone plate having at least one fixation hole and a longitudinal axis.
- the second guide barrel may be configured to receive a tool for forming a hole in bone through the fixation hole, and the center of the bone hole may be located a first distance from the center of the fixation hole as measured along an axis parallel to the longitudinal axis of the plate.
- the first distance may be in the range of from about 0.1 mm to about 0.8 mm, and in a specific embodiment, the first distance may be about 0.5 mm.
- the first guide barrel may be configured to receive a tool for forming a hole in bone through the fixation hole, the center of the bone hole being collinear with the center of the fixation hole as measured along an axis parallel to the longitudinal axis of the bone plate.
- the tool may be a drill bit.
- the tool may be an awl, a probe or a tap.
- the first and second drill guides may be configured so that when the stem of the guide assemblies engages the bone plate, the associated guide barrel may not contact the plate.
- the guide barrel of at least one of the first or second drill guide assemblies may have a viewing recess configured to allow the user to visualize at least a portion of the tool as it is passed through the associated guide barrel.
- the stem of at least one of the first or second drill guide assemblies may have threads configured to engage corresponding threads in the plate.
- the guide barrel of at least one of the first and second drill guide assemblies may be connected to the associated stem member via a hinge, the hinge allowing the guide barrel to be pivoted about the stem with respect to the plate so that when the stem is engaged with the plate, the guide barrel is selectively alignable with at least two fixation holes of the bone plate to allow a drill bit inserted through the guide barrel to be used to drill holes in bone through each fixation hole without disengaging the stem from the plate.
- At least one of the first and second drill guide assemblies may further comprise an additional guide barrel configured to receive a tool for forming a hole in bone.
- the plate may further comprise a second fixation hole, wherein when the stem of the drill guide assembly is engaged with the plate the guide barrels are substantially aligned with at least a portion of the first and second fixation holes.
- a surgical system comprising a bone plate having first and second ends, a longitudinal axis, and at least one fixation hole disposed at each of the first and second ends.
- the fixation holes may be configured to receive a fastener to fix the plate to a bone
- the bone plate may further comprise at least one guide engaging hole for engaging the drill guide.
- the system may further comprise a drill guide having a stem member releasably engageable with the guide engaging hole of the bone plate, and a guide barrel associated with the stem member and configured to receive a tool.
- the guide barrel may have a longitudinal axis and may further be configured so that when the stem member engages the bone plate the guide barrel longitudinal axis does not intersect the center of the fixation hole.
- the tool may be configured to form a hole in bone, wherein when the tool is received within the guide barrel and engages bone to form a hole, the hole is collinear with the longitudinal axis of the guide barrel.
- the tool may be a drill bit.
- the tool may be of an awl, a probe or a tap.
- the system may further comprise a plurality of bone fasteners, each fastener having a head portion with an underside surface configured to engage a portion of a corresponding fixation hole.
- the drill guide may be configured so that when the bone plate is placed over first and second bone segments so that the fixation hole in the first end of the plate overlies the first bone segment and the fixation hole in the second end of the plate overlies the second bone segment, the drill guide is selectively engageable with the plate to drill a hole in the bone through at least one fastener hole.
- the drill guide may further be configured so that when the plate is fixed to the first bone segment using a fastener inserted into the fixation hole at the first end of the plate, the drill guide is engageable with the plate to allow a hole to be formed in the bone underlying the fixation hole at the second end of the plate so that a fastener inserted into the hole will contact a portion of the fixation hole.
- the underside surface of the fastener head portion may engage a side portion of the fixation hole before the fastener is fully seated in the fixation hole.
- fastener head portion engages the side portion of the fastener hole
- further tightening of the fastener may cause the fastener to move longitudinally along a longitudinal axis of the plate. Further tightening of the fastener may also cause the first bone segment to move relative to the second bone segment.
- FIG. 1 is a perspective view of the double barrel drill guide assembly, the plate holder, and the bone plate;
- FIG. 2 is a top view of the bone plate of FIG. 1 ;
- FIG. 3 is a side view of the bone plate of FIG. 1 ;
- FIG. 4 is a cross-sectional view of the bone plate of FIG. 1 taken along line IV-IV in FIG. 2 with bone screws;
- FIG. 5 is a side view of an alternative embodiment of the bone plate
- FIG. 6 is a cross-sectional view of the alternative embodiment of the bone plate of FIG. 5 taken along line VI-VI in FIG. 5 with bone screws;
- FIG. 7 is a perspective view of a bone screw to be used with the bone plates of FIGS. 2 through 6 ;
- FIG. 8 is a perspective exploded view of the double barrel drill guide assembly of FIG. 1 ;
- FIG. 8 a is a detail of the underside of the handle member of the double barrel drill guide assembly shown in FIG. 8 ;
- FIG. 8 b is a detail side view of the guide barrel assembly of the drill guide of FIG. 8 ;
- FIG. 9 is a perspective exploded view of the single barrel drill guide assembly
- FIG. 9 a is a detail of the underside of the handle member of the single barrel drill guide assembly shown in FIG. 9 ;
- FIG. 9 b is a detail of the flex shaft receiving groove of the single barrel drill guide assembly shown in FIG. 9 ;
- FIG. 10 is a perspective view of the single barrel drill guide assembly
- FIG. 11 is a perspective view of an alternative embodiment of the single barrel drill guide assembly
- FIG. 12 is a detail of the hinge connection between the drill guiding barrel and the outer stem of the alternative embodiment of the single barrel drill guide assembly shown in FIG. 11 ;
- FIG. 13 is a side view of an offset guide barrel assembly for use with the drill guide of FIG. 1 ;
- FIG. 14 is a top view of a bone plate for use with the drill guide of FIG. 1 incorporating the offset barrel of FIG. 13 ;
- FIG. 15 is a side view of an exemplary bone screw for use with the drill guide of FIG. 1 ;
- FIG. 16 is a side view of the bone plate of FIG. 14 installed across a pair of vertebra with a bone screw of FIG. 15 .
- Assembly 100 includes a handle member 106 , an offset handle stem 110 , release sleeve 120 , outer stem 126 , and drill guiding barrels 130 a and 130 b.
- Handle member 106 of drill guide assembly 100 can be incrementally swiveled by pressing and holding button cam 108 . Releasing the button cam 108 locks handle 106 in place with relation to offset handle stem 110 .
- cervical spine locking bone plate 160 is roughly dog-bone shaped with two pairs of fixation holes, upper fixation holes 170 a, and lower fixation holes 170 b; and a slot 180 along the longitudinal axis 181 of bone plate 160 .
- Exemplary thicknesses of bone plate 160 range from approximately 1.5 mm to approximately 4 mm, although other thicknesses are possible and bone plate 160 can be fabricated from titanium, alloys of titanium, stainless steel, or other biocompatible materials.
- Each end of slot 180 preferably is threaded, countersunk, or both to allow plate holder 140 to be coupled to bone plate 160 . As shown in FIGS.
- underside 184 of bone plate 160 preferably is contoured along its longitudinal axis 181 and its transverse axis 184 to match the outer surface of the vertebrae to which it will be attached.
- Angles of fixation holes are determined in relation to axes 171 , 173 perpendicular to a plane formed by points 174 a - d (shown in FIGS. 2 and 3 ) centered over fixation holes 170 a, 170 b on the extended top surface of bone plate 160 . In bone plates with more than two pairs of fixation holes, the end pairs of fixation holes are used to form the reference plane.
- the conical inner surfaces 172 of the fixation holes 170 a, 170 b are oriented so that the tips of bone fasteners bone screws 190 are locked at an inward angle ⁇ of about 1° to about 10°, preferably about 4.3°, with respect to axes 171 , 173 .
- FIG. 3 shows the upper pair of fixation holes 170 a oriented so that the tips of bone fasteners 190 extend in an upward direction with respect to the spine at an angle ⁇ with respect to the axis 171 .
- the lower pair of fixation holes 170 b is oriented downward with respect to the spine at an angle ⁇ with respect to axis 173 .
- the upward angle ⁇ of the upper pair of fixation holes 170 a can vary from 0 to 15°, and is preferably about 12°, while the downward angle ⁇ of the lower fixation holes 170 b can vary from 0 to 10°, and preferably is about 6°.
- the bone plate 160 may have additional pairs of fixation holes 170 c, 170 d, etc., in order to bridge additional vertebrae.
- the fixation holes located between the fixation holes 170 a, 170 b located at the ends of the bone plate are preferably oriented perpendicular to the plane formed by the holes 170 a, 170 b, but may vary approximately 50 upward or downward with respect to the spine, and may angle toward the central longitudinal axis 181 as viewed from either end of bone plate 160 with an angle y that matches that of holes 170 a, 170 b.
- bone plate 160 has been illustrated and described with pairs of fixation holes, it may also be provided with a single fixation hole for each vertebra or combinations thereof.
- Fixation holes 170 a, 170 b may be threaded, with conical bone screw head 194 threaded to match, as shown in FIG. 7 .
- Conical threads 195 of bone screw head 194 may have a higher pitch than the bone engaging lower threads 192 . This difference in thread pitch between the conical threads 195 and the lower thread 192 results in compression between the plate and vertebra as the bone screw 190 is inserted.
- FIG. 5 shows a side view of an alternative embodiment of the cervical spine locking bone plate.
- Bone plate 260 has three pairs of fixation holes 270 a, 270 b, 270 c, although more than three pairs of fixation holes are possible.
- FIG. 6 is a cross sectional view of bone plate 260 with bone screws 190 .
- underside 284 of bone plate 260 is contoured to match the outer surface of the vertebrae to which it will be attached.
- Angles ⁇ , ⁇ , and ⁇ of holes 270 a, 270 b may take the same values as angles ⁇ , ⁇ , and ⁇ of holes 170 a, 170 b of bone plate 160 .
- Axes 275 of the additional pair of holes 270 c are preferably perpendicular to the plane formed by the holes 270 a, 270 b, as viewed from the side of bone plate 260 .
- central axes 275 may have an orientation within the same range as angle ⁇ of axes 171 , 173 of bone plate 160 .
- FIGS. 5 and 6 also show an optional step feature 262 , which preferably forms a shoulder or flange to accommodate the shape of the sacral promontory to facilitate placing bone plate 260 on the sacral plate.
- the step feature is also an optional feature of bone plate 160 .
- plate holder 140 includes rod 141 that preferably is cylindrical for most of its length (preferably approximately 200 mm long), preferably with threads 143 at distal end 142 of rod 141 .
- Rod 141 couples to bone plate 160 .
- Bone plate 160 preferably has threads 183 at end 182 of slot 180 to mate with threads 143 at distal end 142 of rod 141 .
- distal end 142 of plate holder 140 may have expandable bushings that mate with a counter-bored end 182 of slot 180 of bone plate 160 .
- Proximal end 144 of plate holder 140 may have a non-circular cross-section, such as a hexagonal shape. Non-circular shapes other than hexagonal may also be used.
- Below proximal end 144 of plate holder 140 is a radial groove 146 .
- Plate holder 140 allows a user to manipulate bone plate 160 , 260 from a remote position without touching the plate.
- drill guide assembly 100 is coupled to plate holder 140 by sliding distal end 127 of outer stem 126 of drill guide assembly 100 over proximal end 144 of rod 141 .
- Release sleeve 120 is connected to proximal end 129 of outer stem 126 in a captive non-releasable manner, such as for example, by swaging. Release sleeve 120 can be moved axially within a limited range and can be rotated with respect to outer stem 126 .
- Spring 122 is held captive inside release sleeve 120 above proximal end 129 of outer stem 126 , biasing release sleeve 120 away from proximal end 129 of outer stem 126 .
- Ball detents 124 normally protrude into the bore of outer stem 126 , preventing sliding outer stem 126 over plate holder 140 .
- Release sleeve 120 is pressed axially toward distal end 127 of outer stem 126 against the bias of release spring sleeve 122 to permit ball detents 124 to move outward into an area of greater inside diameter (not shown) of the release sleeve 120 , allowing drill guide assembly 100 to be pushed farther onto plate holder 140 .
- release sleeve spring 122 Removing pressure from release sleeve 120 results in the bias of release sleeve spring 122 returning release sleeve 120 to its axial position farthest from bone plate 160 , forcing ball detents 124 inward to engage radial groove 146 in plate holder 140 , locking drill guide assembly 100 to plate holder 140 .
- Release sleeve 120 has a non-circular, preferably hexagonal, hole 128 at its upper end, the perimeter of which hole 128 engages non-circular proximal end 144 of plate holder 140 .
- hole 128 and proximal end 144 are shown as hexagonal, it will be appreciated that other mating shapes are possible.
- Release sleeve 120 can be rotated in relation to outer stem 126 to screw and unscrew plate holder 140 to allow engagement of plate holder 140 with, and disengagement of plate holder 140 from, bone plate 160 .
- the connection between the drill guide assembly and the plate holder has been described as a stem coaxial with and sliding over a rod, other embodiments are possible including, for example, a drill guide assembly with a stem attaching to the side of a plate holder.
- Handle member 106 is offset from outer stem 126 by offset handle stem 110 , allowing greater visibility and access to bone plate 160 and vertebrae.
- Handle stem 110 is mechanically attached to outer stem 126 , for example by welding, brazing, or friction fit.
- Handle member 106 can be pivoted about offset handle stem 110 by pressing button cam 108 and rotating handle member 106 , providing still greater visibility and access as the surgeon alternates sides of plate 160 and vertebrae on which he is working.
- Handle member 106 is retained on handle stem 110 by means of a set screw 112 loosely engaging a handle stem radial groove 113 .
- button cam 108 presses button cam 108 against the bias of cam spring 116 moves the detents 109 of the button cam 108 out of engagement with detent grooves 115 (shown in FIG. 8 a ) in handle member 106 while the detents 109 remain engaged with detent grooves 111 of handle stem 110 , allowing handle member 106 to be rotated with respect to offset handle stem 110 , with optional ball bearings 114 facilitating rotation.
- Releasing pressure on button cam 108 allows cam spring 116 to return detents 109 of button cam 108 to engagement with detent grooves 115 of handle member 106 , while maintaining engagement between detents 109 of button cam 108 and detent grooves 111 of handle stem 110 , preventing rotation of handle member 106 in relation to handle stem 110 .
- Drill guiding barrels 130 a, 130 b are mechanically attached to outer stem 126 , for example by brazing, welding, or friction fit. Drill guiding barrels 130 a, 130 b may have multiple insertion locations 133 with predetermined trajectories forming passageways that are aligned through a single exit location 135 .
- FIG. 8 b shows drill guiding barrel 130 a with two insertion locations 133 forming passageways along axes 134 a, 134 b.
- One trajectory may be substantially perpendicular to the bone plate while other trajectories may be offset and/or inclined with respect to the perpendicular trajectory.
- the predetermined trajectories preferably match the various trajectories of fixation holes 170 of bone plate 160 and allow greater precision than is possible with adjustable trajectory drill guides.
- the drill guiding barrels are shown with two insertion locations 133 and two predetermined trajectories. However, there may be additional insertion locations 133 with other predetermined trajectories to allow the drill guide to be used with a variety of bone plates.
- drill guiding barrels 130 a, 130 b may have a single insert location 133 and a single exit location 135 .
- drill guiding barrels 130 a, 130 b may have a single insertion location 133 and more than one exit location 135 , or multiple insertion locations 133 and multiple exit locations 135 .
- Guiding barrels 130 a, 130 b are preferably sized to allow passage of fixation pins or bone screws, drills, taps, and awls. Slotted holes 137 in guiding barrels 130 a, 130 b allow a surgeon to see the fixation components and tools as they are inserted into the guiding barrels 130 a, 130 b. Drill guiding barrels 130 a and 130 b have a tab 132 that engages slot 180 of bone plate 160 to prevent rotation of drill guide assembly 100 in relation to bone plate 160 .
- FIG. 9 shows an exploded view of an exemplary single barrel drill guide assembly 200 and plate holder 140 , which are adapted for use with slotted cervical spine locking bone plate 160 . While the bone plate, and plate holder and drill guide assembly are shown and described as a cervical plate for use in the cervical region of the spine, it will be appreciated that the drill guide assembly and plate holder are also usable with other bone plates.
- Assembly 200 includes a handle member 206 , an offset handle stem 210 , release sleeve 220 , outer stem 226 , and drill guiding barrel 230 .
- Handle member 206 of drill guide assembly 200 can be incrementally swiveled by pressing and holding button cam 208 . Releasing button cam 208 locks the handle in place with relation to the handle stem 210 .
- drill guide assembly 200 is coupled to plate holder 140 by sliding distal end 227 of outer stem 226 of the drill guide assembly 200 over proximal end 144 of plate holder 140 .
- Ball detents 224 normally protrude into the bore of outer stem 226 , preventing sliding outer stem 226 over plate holder 140 .
- Release sleeve 220 is pressed axially toward distal end 227 of outer stem 226 against the bias of release spring sleeve 222 to permit ball detents 224 to move outward into an area of greater inside diameter (not shown) of the release sleeve 220 , allowing drill guide assembly 200 to be pushed farther onto plate holder 140 .
- Removing pressure from release sleeve 220 results in the bias of release sleeve spring 222 returning release sleeve 220 to its axial position farthest from bone plate 160 , forcing ball detents 224 inward to engage plate holder radial groove 146 , locking drill guide assembly 200 to plate holder 140 .
- Outer stem 226 has a locking tab 232 at its distal end that is inserted into slot 180 of locking plate 160 to prevent rotation of, and provide alignment of, the drill guide assembly 200 in relation to the bone plate 160 .
- Release sleeve 220 has a hexagonal hole 228 at its upper end, the perimeter of which hole 228 engages hexagonal proximal end 244 of plate holder 240 . Although hole 228 and proximal end 144 are shown as hexagonal, it will be appreciated that other mating shapes are possible. Release sleeve 220 can be rotated with respect to outer stem 226 to screw plate holder 140 into, and unscrew plate holder 140 from, the bone plate 160 .
- Handle member 206 is offset from outer stem 226 by offset handle stem 210 , allowing greater visibility and access to the bone plate and vertebrae. Handle member 206 can be pivoted about handle stem 210 by pressing button cam 208 and rotating handle member 206 , providing still greater visibility and access as the surgeon alternates sides of the bone plate 160 and vertebrae on which he is working. Handle member 206 is retained on handle stem 210 by means of a set screw 212 loosely engaging handle stem radial groove 213 . Pressing button cam 208 against the bias of cam spring 216 moves detents 209 of button cam 208 out of engagement with detent grooves 215 (shown in FIG.
- button cam 208 allows cam spring 216 to return detents 209 of button cam 208 to engagement with detent grooves 215 of handle member 206 , while maintaining engagement between detents 209 of button cam 208 and detent grooves 211 of handle stem 210 , preventing rotation of handle member 206 in relation to handle stem 210 .
- Drill guiding barrel 230 is attached to outer stem 226 by flex shaft 250 (approximately 90 mm long in its major dimension and approximately 2 mm in diameter) made of stainless steel or other flexible biocompatible material, which passes through stem hinge projections 252 a - d on outer stem 226 and drill guiding barrel hinge projections 234 on drill guiding barrel 230 .
- Flex shaft 250 is bent to provide a finger lever 258 for manipulating the drill guiding barrel 230 .
- Dowel pin 236 is inserted through drill guiding barrel dowel pin hole 238 in drill guiding barrel hinge projection 234 and flex shaft dowel pin hole 254 in flex shaft 250 to lock the drill guiding barrel 230 to flex shaft 250 so that the drill guiding barrel 230 and flex shaft 250 rotate together within stem hinge projections 252 a - d.
- Flex shaft 250 has a reduced diameter section 251 , for example approximately 1 mm for a length of 9 mm.
- Lower stem hinge projections 252 c, 252 d are offset from upper stem hinge projections 252 a, 252 b, causing flex shaft 250 to be slightly bowed at reduced diameter section 251 , creating a spring force biasing flex shaft finger lever 258 in the direction of .
- Upper stem hinge projection 252 a has flex shaft receiving grooves 256 a, 256 b that receive the inner radius 253 at the location where flex shaft 250 bends to form flex shaft finger lever 258 , locking drill guiding barrel 230 on either left or right side, respectively, of drill guide assembly 200 .
- Drill guiding barrel 230 is moved from left to right side by pulling flex shaft 250 upward until the flex shaft finger lever 258 is clear of flex shaft receiving groove 256 a and rotating combined locking drill guide barrel 230 and flex shaft 250 until flex shaft finger lever 258 is positioned above flex shaft receiving groove 256 b.
- flex shaft finger lever 258 to seat in flex shaft receiving groove 256 b due to the spring force of bowed flex shaft lower end 259 , the spring force resulting from the bow in reduced diameter section 251 of flex shaft 250 .
- drill guiding barrel 230 has multiple insertion locations 233 with predetermined trajectories preferably inclined or offset from a single exit location 235 , although a drill guiding barrel 230 with a single insertion location 233 and a single exit location 235 is possible.
- a drill guiding barrel 230 with a single insertion location 233 and more than one exit location 235 is possible.
- Multiple insertion locations 233 provide proper trajectories when drill guiding barrel 230 is moved to alternate sides of the plate and also provide for the various trajectories needed for the upper and lower fixation holes 170 a, 170 b of bone plate 160 .
- the predetermined trajectories allow greater precision than possible with adjustable trajectory drill guides.
- Guiding barrel 230 allows passage of fixation pins or bone screws, drills, taps, and awls. Slotted holes 237 in guiding barrel 230 allow a surgeon to see the fixation components and tools as they are inserted into the guiding barrel 230 .
- FIG. 11 shows an alternate embodiment of a single barrel drill guide.
- Drill guide assembly 300 has a relatively long (representative length: approximately 80 mm) drill guiding barrel 330 with a depth stop (a shoulder, not shown) inside the drill guiding barrel 330 (representative outside diameter: approximately 10-12 mm) that stops the drill bit at a pre-determined depth.
- Handle member 306 , button cam 308 , offset handle stem 310 , outer stem 326 , and release sleeve 320 correspond to handle stem 106 , button cam 108 , offset handle stem 110 , outer stem 126 , and release sleeve 120 of drill guide assembly 100 .
- Tab 335 is attached to outer stem 326 , preferably by welding or brazing, and has a horizontal section 335 a and vertical section 335 b.
- Pin 350 is attached to tab horizontal section 335 a, preferably by welding, brazing, or mechanical connection; and is parallel to outer stem 326 .
- Pin 350 has a slot 337 beginning at its upper end and extending through a portion of the length of pin 350 .
- Slot 337 separates hemispherical retainers 355 a, 355 b, which have a greater diameter than the section of pin 350 below the retainers 355 a, 355 b.
- Retainers 355 a, 355 b secure drill guiding barrel hinge 334 on pin 350 .
- drill guiding barrel hinge 334 clears tab vertical section 335 b, allowing the surgeon to pivot the drill guiding barrel 330 to the opposite side.
- the surgeon's pulling of drill guiding barrel 330 toward himself forces the retainers 355 a, 355 b closer together as upper surface 339 of drill guiding barrel hinge 334 contacts retainers 355 a, 355 b, creating a spring force biasing drill guide barrel hinge 334 away from the surgeon.
- the drill guiding barrel 330 is then released and returned to its lower position by the spring force of the compressed retainers 355 a, 355 b against upper surface 339 of drill guide barrel hinge 334 such that drill guiding barrel hinge 334 is held in angular position by tab 335 .
- FIG. 13 illustrates an alternative embodiment of a guide barrel for use with the inventive drill guide which may allow the surgeon to compress the intervertebral space (i.e. the disc space) between adjacent vertebrae when the fasteners are tightened in their respective plate holes.
- the disclosed barrel arrangement compression of the intervertebral disc space may be achieved simply by tightening the bone screws in the plate and without the need for additional tools.
- Compression of the disc space may be important for a number of reasons. Specifically, where an intervertebral fusion spacer has been installed between the vertebra, compression along the spine axis may serve to provide proper initial seating and loading of the spacer between the end plates. This may eliminate any spaces or gaps between the end plates and the spacer. Also, compression may promote fusion by stressing both the end plates and the spacer. Compression may also be used to return the disc space to its normal height.
- the guiding barrels 1130 a, b of the drill guide of this embodiment may be arranged so that at least one bone hole formed in at least one vertebra is slightly longitudinally offset from the center of the respective plate hole 170 a at one end of the bone plate 160 .
- the drill guide of this embodiment will be used with a plate 160 having at least two plate holes 170 a, 170 b (see FIG. 14 ) that overly at least a pair of adjacent vertebra (see FIG. 16 ).
- the plate may be fixed to a first of the pair of vertebrae using a bone screw 1190 inserted through at least one of the plate holes 170 b.
- the drill guide with offset guiding barrels 1130 a, b may then be engaged with the plate 160 and used to form at least one offset bone hole 1200 in the second of the pair of vertebrae through plate hole 170 a. Thereafter, when bone screws 1190 are inserted in the offset bone holes 1200 in the second vertebra, the heads 1192 of the screws 1190 may overhang the far side of plate holes 170 a since they are non-concentric with the plate holes 170 a. As such, when the bone screws 1190 are driven into the offset bone holes 1200 , the under-surface 1195 of the screw head 1194 will contact the far side of conical inner surface 172 of the plate holes 170 a.
- the interaction between the under-surface 1195 of the screw head 1194 and the conical inner surface 172 of the plate holes 170 a causes the screw 1190 (and the underlying second vertebra) to move longitudinally with respect to the plate 160 until the screw is centered within the plate hole 170 a, thus reducing the distance between the vertebrae.
- the pair of vertebrae may be moved together by an amount equal to the distance by which the offset bone holes 1200 are offset from the plate holes 170 a.
- an awl or probe may be used to break the cortical shell of the bone.
- a probe may also be used to dislodge and/or remove cancellous bone underlying the cortical bone to make way for a bone screw.
- a drill may be used to form the bone hole, and a tap may be used to form threads in the bone hole. Where self-tapping screws are used, the tap may not be required, and where self-drilling screws are used, the drill and tap may not be required.
- this offset guide barrel feature may be used with plates having three or more pairs of plate holes (i.e. those that span multiple disc spaces or “levels”). In such cases, compression of multiple “levels” may be achieved by fixing the plate to at least one vertebra, and then creating offset bone holes in at least one vertebra. For example, where a two-level plate is used (i.e. the plate has three pairs of bone screw holes 270 a, 270 b, 270 c (see FIG.
- At least one pair of plate holes may be fixed to an associated vertebra, while offset holes may then be formed in the vertebrae adjacent this “fixed” vertebra using a drill guide having offset guide barrels 1130 a, b as previously described. By driving bone screws into these offset bone holes, these adjacent vertebrae may be moved in the direction of the “fixed” vertebrae, thus compressing the associated disc space.
- an exemplary offset bone hole 1200 is indicated as “X,” while the center point of the bone screw hole 170 a is indicated as “Y.”
- the longitudinal distance from the bone plate slot end-hole 182 to the center of the bone screw hole 170 a is designated “L 1 ,” while the longitudinal distance from the bone plate slot end-hole 182 to the center “X” of the offset bone hole 1200 is designated “L 2 .”
- An axis “D-D” formed by points “X” and “Y” may be oriented substantially parallel to the longitudinal axis “A-A” of the bone plate 160 .
- a bone screw 1190 FIG.
- the bone plate may be attached to adjacent vertebra 2000 , 2002 of the spine such that the plate axis “A-A” may be substantially aligned with the longitudinal axis of the spine.
- One of a pair of bone screws 1190 is shown engaged with the leftmost plate hole 170 b and vertebra 2002 .
- One of a second pair of bone screws 1190 is shown partially installed in one of a pair of rightmost plate holes 170 a, under which a pair of offset holes 1200 have been formed in vertebra 2000 .
- guiding barrels 130 a, b, outer stem 126 , and plate holder 140 may be configured and arranged so that the center of the guiding barrels 130 a, b and the center of the outer stem and plate holder 126 , 140 are separated by a distance equal to length “L 2 ” so that when the plate holder 140 is engaged with slot end hole 182 and the outer stem 126 is engaged with the plate holder 140 , the guiding barrels 130 a, b will be aligned with offset bone hole insertion point “X.”
- the distance “L 1 ” from the center of the slot end hole 182 to the center of each plate hole 170 a, when measured along axis “D-D” ( FIG. 14 ) is about 5.5 mm
- the distance “BL” ( FIG. 13 ) between the center of the plate holder 126 and the center of each guide barrel 1130 a, b is about 6.0 mm.
- the resulting bone holes will be offset from the center of each plate hole 170 a by about 0.5 mm, which will result in a corresponding compression of the associated intervertebral disc space of about 0.5 mm when the screws 1190 are fully seated in the vertebrae.
- the plate guiding barrels 1130 a, b may be configured so that the distance between points “X” and “Y” along axis “D-D” is in the range of from about 0.0 mm to about 0.8 mm, thus providing longitudinal compression of the vertebral bodies of from about 0.0 mm to about 0.8 mm when the associated “offset” bone screws 190 are fully tightened in their plate holes 170 a.
- the guiding barrels, outer stem and plate holder are configured so that the distance between points “X” and “Y” may be about 0.5 mm, thus allowing longitudinal compression of bone segments of from about 0.5 mm when the fasteners are tightened within the appropriate bone screw holes. It should be noted that larger offset dimensions may be provided, as will be apparent to one of ordinary skill in the art.
- the offset guide barrel feature described herein may be implemented with any of the single barrel or double barrel drill guides disclosed herein.
- the bone plate, drill bit, and drill guide assembly are shown and described for use in fixing adjacent vertebra of the spine, it will be appreciated that the drill guide assembly may be utilized with any suitable bone plate or other structure that may be secured to bone using bone fasteners.
- the drill guide may be used without a bone plate to guide the drilling of fastener holes in bone at any appropriate location in the body.
- a surgeon may inserts a plate holder into a slotted hole in a bone plate.
- the surgeon then releasably locks a drill guide assembly onto the plate holder.
- the bone plate is applied to the appropriate vertebrae by a surgeon holding a handle of the drill guide assembly.
- the surgeon then aligns a drill bit with the appropriate insertion location in the appropriate drill guiding barrel of the drill guide assembly and inserts the drill bit into the drill guiding barrel.
- the surgeon then drills a first hole coaxial with the central axis of a first fastener hole in the plate.
- a first bone screw is then inserted into the drill guiding barrel and threaded into the first hole.
- the surgeon then aligns the drill bit with the appropriate insertion location of the adjacent drill guiding barrel. If a single barrel drill guide assembly is being used, the surgeon pivots the drill guiding barrel until it is aligned above a fastener hole adjacent to the first fastener hole in the plate and aligns the drill bit with the appropriate insertion location of the drill guiding barrel. The surgeon then drills a second hole coaxial with the central axis of a second fastener hole in the plate and installs a second bone screw. The surgeon then rotates counterclockwise a release sleeve on the drill guide assembly, which disengages the plate holder from the plate.
- the surgeon removes the drill guide assembly and attached plate holder from the plate and inserts the plate holder into a second hole in the bone plate by rotating the release sleeve counterclockwise, the process of drilling holes and installing bone screws in adjacent through-holes of the plate and removing the drill guide assembly and plate holder is repeated until all pairs of adjacent holes have been drilled and bone screws inserted.
- the surgeon may first insert a pair of bone screws through a corresponding pair of plate holes 170 b overlying the first of a pair of adjacent vertebrae, thus fixing the plate 160 to the first vertebra.
- the surgeon may then engage a drill guide having at least one offset barrel 1130 a, b with the plate 160 as described above, and may use the barrel to form offset holes 1200 in the bone underlying plate holes 170 a which overly the second of the pair of vertebrae.
- These holes may be formed using an awl, followed by a drill and tap.
- the surgeon may use an awl to form the hole.
- a probe may also be used to remove or dislodge cancellous bone within the hole.
- Bone screws 1190 may then be placed in the holes and tightened until the undersides 1195 of the screw heads 1194 contact a portion of the respective plate holes 170 a. Further tightening of the screws 1190 may cause the screws and the underlying second vertebrae to move toward the first vertebra, thus reducing the distance between the two vertebrae.
- An intervertebral spacer placed between the vertebrae will thus be subjected to the compression force associated with the reduction in distance, and the previously discussed benefits of such compression will be provided.
- FIG. 5 shows a two-level plate 260 having three pairs of plate holes 270 a, 270 b and 270 c, where each pair of holes may be associated with a separate vertebral body.
- holes 270 a may be fixed to the associated vertebra
- offset holes may be drilled through plate holes 270 b and 270 c to facilitate compression of the disc spaces between the associated vertebrae.
- plate holes 270 a and 270 b may be fixed to the associated vertebrae, with offset holes drilled only through holes 270 c to compress only the disc space located between the vertebrae associated with holes 270 b and 270 c. Where multiple disc spaces will be compressed, it may be advantageous to compress them incrementally so that an even compression of the disc spaces may be provided.
- screws should first be driven into the offset holes associated with plate holes 270 b to compress the disc space between vertebrae associated with holes 270 a and 270 b. Screws may then be driven into the offset holes associated with plate holes 270 c to subsequently compress the disc space located between vertebrae associated with holes 270 b and 270 c.
Abstract
Description
- This application is a continuation-in-part of U.S. Non-Provisional patent application Ser. No. 10/619,472, filed Jul. 16, 2003, titled “Anterior Plating System and Drill Guides,” the entire contents of which is incorporated herein by reference.
- The present invention relates to a bone fixation system including a plate and surgical drill guide that are releasably attachable to each other for providing a precise alignment therebetween. More particularly, the present invention relates to a bone plate having fastener holes oriented at predetermined angles with respect to the plate and a plate holder and surgical drill guide assembly with at least one alignment drill guiding barrel that is aligned with the respective fastener holes in a bone plate for drilling the holes at the proper angle.
- The use of surgical fixation plates for a variety of orthopedic applications is widely accepted. The plates are used by surgeons to mend, align, and alter compression of patient's bones, and are typically fastened to the bones with a plurality of fasteners such as screws that are installed through holes in the plate. Proper orientation and alignment of fasteners and secure surgical fixation of the plates is advantageous in avoiding future complications after implantation.
- Bone plates used in spinal applications must be installed with special care, as the plates are used for long term, intervertebral fixation, bone-fragment fixation, and anterior decompression in the cervical region of the spine. The margin for error in spinal surgery is quite small, particularly because of the sensitivity of the spinal cord and the risk inherent with invasive procedures around the spinal cord. In particular, the dimensions of vertebral bone available for setting fasteners are fairly limiting.
- Each fixation fastener should properly align with its associated plate hole so that each screw is seated correctly with the plate and enters the bone at an appropriate angle. Any misalignment of the screw within the plate hole risks tissue damage. In addition, improperly seated screws may result in an unstable or insecure connection of the plate to the bony material, thus potentially defeating the usefulness of the plate. Locking plates, in particular, demand precise fastener alignment.
- The invention relates to a bone plate, a surgical drill guide assembly comprising at least one alignment drill tube configured to receive and guide a surgical drill bit; and a plate holder that couples to the plate and to the drill guide assembly. The drill guide assembly is configured and dimensioned to allow it to couple with the plate holder and plate to provide a fixed dimensional and angular alignment between the alignment drill tube and the bone plate.
- The bone plate has two or more pairs of fixation holes and may have one or more slots along the central longitudinal axis of the plate. The fixation holes are preferably conical and preferably threaded. The bone screws to be used with the bone plate preferably have threaded or unthreaded conical heads to match the fixation holes in the bone plate. The fixation holes in the bone plate may be angled toward the central axis of the bone plate up to about 10°, and may also be angled up to about 15° upward or downward along the direction of the longitudinal axis of the bone plate which is generally aligned in the direction of the length of the spine. The slot(s) may be threaded or have a counterbore at its ends to allow coupling of the drill guide assembly or the plate holder. The bone plate may have any thickness, and its thickness may vary along its length and width; although 2.2 mm is an exemplary thickness. The plate may also have a step feature or flange to facilitate placing the plate on the sacral promontory.
- The plate holder may include a rod having a circular cross section along with a short threaded section for coupling with a threaded hole in the plate, a short non-circular section, such as, for example, a hexagonal section on the end opposite from the threaded end, and a radial groove between the ends. The plate holder attaches to the plate and allows the user to manipulate the plate from a location remote from and without touching the plate.
- Preferably, the drill guide assembly includes a handle member, an offset handle stem, an outer stem, a release sleeve on the outer stem, captive ball detents in the wall of the outer stem to engage the radial groove of the plate holder rod, and a release sleeve spring that biases the release sleeve axially away from the end of the outer stem opposite the bone plate. The release sleeve is preferably captively attached to the outer stem such that it may rotate about the outer stem and has limited axial movement with respect to the outer stem. Pressing the release sleeve against the bias of the spring allows radial movement of the captive ball detents in the wall of the outer stem due to a tapered inner surface of the release sleeve or a section of the release sleeve with an increased inner diameter.
- Coupling of the drill guide assembly to the plate holder is accomplished by sliding the outer stem of the drill guide assembly over the plate holder and aligning the non-circular end of the plate holder with a matching non-circular hole at the end of the outer stem of the drill guide assembly. The captive ball detents engage the radial groove of the plate holder and lock the drill guide assembly to the plate holder when the release sleeve is allowed to return to its spring-biased position. The release sleeve may have a non-circular hole the perimeter of which engages the perimeter of the matching non-circular end of the plate holder. The release sleeve can be rotated in relation to the outer stem to allow screwing and unscrewing of the plate holder from the bone plate while the remainder of the drill guide assembly remains stationary. Although the connection between the drill guide assembly and the plate holder has been described as a stem coaxial with and sliding over a rod, other embodiments are possible including, for example, a drill guide assembly with a stem attaching to the side of a plate holder.
- The drill guide assembly may include either one or two guiding barrels to allow passage of fixation pins or bone screws, drills, taps, and awls through it in a predetermined trajectory. The guiding barrels may have more than one insertion location with variable or pre-determined trajectories offset from a single exit location. The guiding barrels of the single barrel embodiments of the drill guide may be movable by means of a pivoting mechanism to allow drilling holes into bone on both sides of the longitudinal axis of the bone plate. The guiding barrels of the double barrel embodiments of the drill guide assembly also preferably have a tab to engage a slot of the bone plate to prevent rotation of the drill guide assembly in relation to the bone plate. The single barrel embodiments of the drill guide assembly also preferably have a tab on the outer stem to engage a slot of the bone plate to prevent rotation of the drill guide assembly in relation to the bone plate.
- The handle of the drill guide assembly may have a ratchet gear mechanism that permits incremental swiveling with respect to the axis of a button cam. The ratchet is operated by pressing and holding a button cam while turning the handle. The handle may lock at predetermined angle intervals.
- A surgical drill guide assembly may be provided, the assembly comprising a stem member releasably engageable with the guide engaging hole of the bone plate; at least one guide barrel associated with the stem member and configured to receive a tool, the guide barrel having a longitudinal axis; and a bone plate having at least one fixation hole configured to receive a fastener to fix the plate to a bone, and at least one guide engaging hole for engaging the drill guide. The stem member and guide barrel may be configured so that when the stem member engages the bone plate the guide barrel longitudinal axis is oriented non-coaxial with the fixation hole. The tool may be a drill bit, an awl, a probe or a tap.
- The fixation hole may also have a center point, wherein when the stem member engages the bone plate the guide barrel longitudinal axis does not intersect with the center point of the fixation hole. The bone plate further may have a longitudinal axis and the tool may be configured for forming a hole in bone. When the tool is received within the guide barrel and engaged with bone to form a hole, the center of the hole may be located a first distance from the center of the corresponding plate fixation hole. The first distance may be from about 0.1 millimeters (mm) to about 0.8 mm as measured along a line substantially parallel to the plate longitudinal axis. The first distance may be about 0.5 mm as measured along a line substantially parallel to the plate longitudinal axis.
- When the stem member engages the guide engaging hole of the bone plate, the guide barrel may not contact the plate. At least a portion of the stem member and the guide engaging hole of the bone plate may comprise corresponding threads to allow the stem to be threadably engaged with the plate. The guide barrel may be connected to the stem member via a hinge, the hinge allowing the guide barrel to be pivoted about the stem with respect to the plate so that when the stem is engaged with the guide engaging hole of the bone plate, the guide barrel is selectively alignable with at least two fixation holes of the bone plate to allow the tool to be inserted through the guide barrel to form a hole in bone through each fixation hole without disengaging the stem from the plate.
- The surgical drill guide assembly may further comprise a second drill guide barrel. The drill guide barrel may comprise first and second tool receiving recesses. Each tool receiving recess may have a longitudinal axis, and the two axes may be non-parallel. The longitudinal axes of the tool receiving recesses may converge at a point located a first distance from the center of the plate hole.
- A method of installing a bone plate on at least two vertebrae is disclosed. The method may comprise the steps of: (a) providing a bone plate having at least one fastener hole configured to receive a bone fastener for fixing the plate to a vertebra; (b) providing a drill guide having a stem member and a guide barrel, the stem member configured to engage a bone plate and the guide barrel configured to receive a tool for forming a hole in bone; (c) engaging the stem member with the bone plate so that the guide barrel is located adjacent to the at least one fastener hole; (d) placing the bone plate on vertebrae so that the at least one fastener hole lies adjacent a vertebra; and (e)passing the tool through the guide barrel and the fastener hole so that the tool engages the vertebra and cuts a hole in the bone underlying the fastener hole; wherein the hole in the bone is located a first distance from the center of the fastener hole. The first distance may be from about 0.1 mm to about 0.8 mm, or it may be about 0.5 mm. The tool may be a drill bit, an awl, a probe or a tap.
- The method may further comprise the steps of: (f) inserting a bone screw into the hole in the bone; and (g) tightening the screw in the hole, the screw having a head and an underside surface; wherein the underside surface of the screw head engages an inner side surface of the fastener hole so that the screw and plate are moved longitudinally with respect to each other as the screw is screwed into the bone.
- The stem and guide barrel of the drill guide may be configured so that the screw and plate are moved longitudinally with respect to each other by a second distance as the screw is screwed into the hole in the bone. The first and second distances are substantially equal. The second distance may be about 0.5 mm. When the screw and plate are moved longitudinally, the associated vertebra may be moved longitudinally. The longitudinal movement of the screw may apply a force on the associated vertebra tending to compress the disc space located between the vertebra.
- The bone plate may further comprise a second fastener hole, and the drill guide may have a second guide barrel configured to receive a tool for forming a hole in bone adjacent the second fastener hole. The first and second guide barrels may each have first and second tool receiving recesses, the recesses each having a trajectory, the trajectories of the first and second recesses being substantially non-parallel.
- The bone plate may further comprise a second fastener hole, and the guide barrel may be attached to the stem member via a pivot joint. The barrel may be movable about the pivot joint to move from a first position adjacent the first fastener hole of the bone plate to a second position adjacent the second fastener hole of the bone plate.
- The guide barrel may further having an internal shoulder configured to engage a portion of the tool inserted therethrough to limit the depth of penetration of the tool into the underlying bone to a predetermined amount. The guide barrel further may have at least one longitudinal slot running along a substantial portion of a length of the guide barrel, the slot configured to allow the user to visualize the position of the tool within the guide barrel. A handle may be associated with the stem, the handle being pivotably adjustable with respect to the stem to allow the handle to be rotated to a desired position relative to the guide barrel. The handle may have a longitudinal axis that is substantially non-parallel to the longitudinal axis of the guide barrel.
- A drill guide kit may also be provided. The kit may comprise a first drill guide assembly comprising a first plate-engaging stem and a first guide barrel configured to receive a tool. The first guide barrel may have a longitudinal axis, and the stem may be releasably engageable with a bone plate to position the first guide barrel adjacent a first fastener hole of the bone plate. The kit may also comprise a second drill guide assembly having a second plate engaging stem and a second guide barrel configured to receive a tool, the second guide barrel having a longitudinal axis. The stem may be releasably engageable with the bone plate to position the second guide barrel adjacent a second fastener hole of the bone plate. The first stem and first guide barrel may further be configured so that when the stem member engages the bone plate the guide barrel longitudinal axis intersects the center of the fastener hole, and the second stem and second guide barrel may be configured so that when the second stem member engages the bone plate the second guide barrel is substantially aligned with the fixation hole but the longitudinal axis does not intersect the center of the fixation hole.
- The drill guide kit may further comprise a bone plate having at least one fixation hole and a longitudinal axis. The second guide barrel may be configured to receive a tool for forming a hole in bone through the fixation hole, and the center of the bone hole may be located a first distance from the center of the fixation hole as measured along an axis parallel to the longitudinal axis of the plate. The first distance may be in the range of from about 0.1 mm to about 0.8 mm, and in a specific embodiment, the first distance may be about 0.5 mm.
- The first guide barrel may be configured to receive a tool for forming a hole in bone through the fixation hole, the center of the bone hole being collinear with the center of the fixation hole as measured along an axis parallel to the longitudinal axis of the bone plate. The tool may be a drill bit. Alternatively, the tool may be an awl, a probe or a tap.
- The first and second drill guides may be configured so that when the stem of the guide assemblies engages the bone plate, the associated guide barrel may not contact the plate. The guide barrel of at least one of the first or second drill guide assemblies may have a viewing recess configured to allow the user to visualize at least a portion of the tool as it is passed through the associated guide barrel. The stem of at least one of the first or second drill guide assemblies may have threads configured to engage corresponding threads in the plate.
- The guide barrel of at least one of the first and second drill guide assemblies may be connected to the associated stem member via a hinge, the hinge allowing the guide barrel to be pivoted about the stem with respect to the plate so that when the stem is engaged with the plate, the guide barrel is selectively alignable with at least two fixation holes of the bone plate to allow a drill bit inserted through the guide barrel to be used to drill holes in bone through each fixation hole without disengaging the stem from the plate. At least one of the first and second drill guide assemblies may further comprise an additional guide barrel configured to receive a tool for forming a hole in bone.
- The plate may further comprise a second fixation hole, wherein when the stem of the drill guide assembly is engaged with the plate the guide barrels are substantially aligned with at least a portion of the first and second fixation holes.
- A surgical system may be provided comprising a bone plate having first and second ends, a longitudinal axis, and at least one fixation hole disposed at each of the first and second ends. The fixation holes may be configured to receive a fastener to fix the plate to a bone, and the bone plate may further comprise at least one guide engaging hole for engaging the drill guide. The system may further comprise a drill guide having a stem member releasably engageable with the guide engaging hole of the bone plate, and a guide barrel associated with the stem member and configured to receive a tool. The guide barrel may have a longitudinal axis and may further be configured so that when the stem member engages the bone plate the guide barrel longitudinal axis does not intersect the center of the fixation hole.
- The tool may be configured to form a hole in bone, wherein when the tool is received within the guide barrel and engages bone to form a hole, the hole is collinear with the longitudinal axis of the guide barrel. The tool may be a drill bit. Alternatively, the tool may be of an awl, a probe or a tap. The system may further comprise a plurality of bone fasteners, each fastener having a head portion with an underside surface configured to engage a portion of a corresponding fixation hole.
- The drill guide may be configured so that when the bone plate is placed over first and second bone segments so that the fixation hole in the first end of the plate overlies the first bone segment and the fixation hole in the second end of the plate overlies the second bone segment, the drill guide is selectively engageable with the plate to drill a hole in the bone through at least one fastener hole.
- The drill guide may further be configured so that when the plate is fixed to the first bone segment using a fastener inserted into the fixation hole at the first end of the plate, the drill guide is engageable with the plate to allow a hole to be formed in the bone underlying the fixation hole at the second end of the plate so that a fastener inserted into the hole will contact a portion of the fixation hole. Where a fastener is inserted into the bone hole, the underside surface of the fastener head portion may engage a side portion of the fixation hole before the fastener is fully seated in the fixation hole. Where the fastener head portion engages the side portion of the fastener hole, further tightening of the fastener may cause the fastener to move longitudinally along a longitudinal axis of the plate. Further tightening of the fastener may also cause the first bone segment to move relative to the second bone segment.
- Preferred features of the present invention are disclosed in the accompanying drawings, wherein similar reference characters denote similar elements throughout the several views, and wherein:
-
FIG. 1 is a perspective view of the double barrel drill guide assembly, the plate holder, and the bone plate; -
FIG. 2 is a top view of the bone plate ofFIG. 1 ; -
FIG. 3 is a side view of the bone plate ofFIG. 1 ; -
FIG. 4 is a cross-sectional view of the bone plate ofFIG. 1 taken along line IV-IV inFIG. 2 with bone screws; -
FIG. 5 is a side view of an alternative embodiment of the bone plate; -
FIG. 6 is a cross-sectional view of the alternative embodiment of the bone plate ofFIG. 5 taken along line VI-VI inFIG. 5 with bone screws; -
FIG. 7 is a perspective view of a bone screw to be used with the bone plates ofFIGS. 2 through 6 ; -
FIG. 8 is a perspective exploded view of the double barrel drill guide assembly ofFIG. 1 ; -
FIG. 8 a is a detail of the underside of the handle member of the double barrel drill guide assembly shown inFIG. 8 ; -
FIG. 8 b is a detail side view of the guide barrel assembly of the drill guide ofFIG. 8 ; -
FIG. 9 is a perspective exploded view of the single barrel drill guide assembly; -
FIG. 9 a is a detail of the underside of the handle member of the single barrel drill guide assembly shown inFIG. 9 ; -
FIG. 9 b is a detail of the flex shaft receiving groove of the single barrel drill guide assembly shown inFIG. 9 ; -
FIG. 10 is a perspective view of the single barrel drill guide assembly; -
FIG. 11 is a perspective view of an alternative embodiment of the single barrel drill guide assembly; -
FIG. 12 is a detail of the hinge connection between the drill guiding barrel and the outer stem of the alternative embodiment of the single barrel drill guide assembly shown inFIG. 11 ; -
FIG. 13 is a side view of an offset guide barrel assembly for use with the drill guide ofFIG. 1 ; -
FIG. 14 is a top view of a bone plate for use with the drill guide ofFIG. 1 incorporating the offset barrel ofFIG. 13 ; -
FIG. 15 is a side view of an exemplary bone screw for use with the drill guide ofFIG. 1 ; -
FIG. 16 is a side view of the bone plate ofFIG. 14 installed across a pair of vertebra with a bone screw ofFIG. 15 . - Referring to
FIG. 1 , there is shown an exemplary double barreldrill guide assembly 100 andplate holder 140, which are adapted for use with a slotted cervical spine lockingbone plate 160. While the bone plate, and plate holder and drill guide assembly are shown and described as a cervical plate for use in the cervical region of the spine, it will be appreciated that the bone plate features are applicable to other bone plates and that the drill guide assembly and plate holder are also usable with other bone plates.Assembly 100 includes ahandle member 106, an offsethandle stem 110,release sleeve 120,outer stem 126, and drill guidingbarrels Handle member 106 ofdrill guide assembly 100 can be incrementally swiveled by pressing and holdingbutton cam 108. Releasing thebutton cam 108 locks handle 106 in place with relation to offsethandle stem 110. - With reference to
FIG. 2 , cervical spine lockingbone plate 160 is roughly dog-bone shaped with two pairs of fixation holes, upper fixation holes 170 a, andlower fixation holes 170 b; and aslot 180 along thelongitudinal axis 181 ofbone plate 160. Exemplary thicknesses ofbone plate 160 range from approximately 1.5 mm to approximately 4 mm, although other thicknesses are possible andbone plate 160 can be fabricated from titanium, alloys of titanium, stainless steel, or other biocompatible materials. Each end ofslot 180 preferably is threaded, countersunk, or both to allowplate holder 140 to be coupled tobone plate 160. As shown inFIGS. 3 and 4 ,underside 184 ofbone plate 160 preferably is contoured along itslongitudinal axis 181 and itstransverse axis 184 to match the outer surface of the vertebrae to which it will be attached. Angles of fixation holes are determined in relation toaxes FIGS. 2 and 3 ) centered overfixation holes bone plate 160. In bone plates with more than two pairs of fixation holes, the end pairs of fixation holes are used to form the reference plane. The conicalinner surfaces 172 of the fixation holes 170 a, 170 b are oriented so that the tips of bone fasteners bone screws 190 are locked at an inward angle γ of about 1° to about 10°, preferably about 4.3°, with respect toaxes FIG. 3 shows the upper pair offixation holes 170 a oriented so that the tips ofbone fasteners 190 extend in an upward direction with respect to the spine at an angle α with respect to theaxis 171. The lower pair offixation holes 170 b is oriented downward with respect to the spine at an angle β with respect toaxis 173. The upward angle α of the upper pair offixation holes 170 a can vary from 0 to 15°, and is preferably about 12°, while the downward angle β of thelower fixation holes 170 b can vary from 0 to 10°, and preferably is about 6°. - While the
bone plate 160 has been shown as having two pairs offixation holes fixation holes 170 c, 170 d, etc., in order to bridge additional vertebrae. The fixation holes located between the fixation holes 170 a, 170 b located at the ends of the bone plate are preferably oriented perpendicular to the plane formed by theholes longitudinal axis 181 as viewed from either end ofbone plate 160 with an angle y that matches that ofholes bone plate 160 has been illustrated and described with pairs of fixation holes, it may also be provided with a single fixation hole for each vertebra or combinations thereof. - Fixation holes 170 a, 170 b may be threaded, with conical
bone screw head 194 threaded to match, as shown inFIG. 7 .Conical threads 195 ofbone screw head 194 may have a higher pitch than the bone engaginglower threads 192. This difference in thread pitch between theconical threads 195 and thelower thread 192 results in compression between the plate and vertebra as thebone screw 190 is inserted. -
FIG. 5 shows a side view of an alternative embodiment of the cervical spine locking bone plate.Bone plate 260 has three pairs offixation holes FIG. 6 is a cross sectional view ofbone plate 260 with bone screws 190. As shown inFIGS. 5 and 6 ,underside 284 ofbone plate 260 is contoured to match the outer surface of the vertebrae to which it will be attached. Angles α, β, and γ ofholes holes bone plate 160.Axes 275 of the additional pair ofholes 270 c are preferably perpendicular to the plane formed by theholes bone plate 260. As viewed from either end ofbone plate 260,central axes 275 may have an orientation within the same range as angle γ ofaxes bone plate 160. -
FIGS. 5 and 6 also show anoptional step feature 262, which preferably forms a shoulder or flange to accommodate the shape of the sacral promontory to facilitate placingbone plate 260 on the sacral plate. The step feature is also an optional feature ofbone plate 160. - Referring to
FIG. 8 ,plate holder 140 includesrod 141 that preferably is cylindrical for most of its length (preferably approximately 200 mm long), preferably withthreads 143 atdistal end 142 ofrod 141.Rod 141 couples tobone plate 160.Bone plate 160 preferably has threads 183 atend 182 ofslot 180 to mate withthreads 143 atdistal end 142 ofrod 141. Alternatively,distal end 142 ofplate holder 140 may have expandable bushings that mate with acounter-bored end 182 ofslot 180 ofbone plate 160.Proximal end 144 ofplate holder 140 may have a non-circular cross-section, such as a hexagonal shape. Non-circular shapes other than hexagonal may also be used. Belowproximal end 144 ofplate holder 140 is aradial groove 146.Plate holder 140 allows a user to manipulatebone plate - As shown in
FIG. 8 ,drill guide assembly 100 is coupled toplate holder 140 by slidingdistal end 127 ofouter stem 126 ofdrill guide assembly 100 overproximal end 144 ofrod 141.Release sleeve 120 is connected toproximal end 129 ofouter stem 126 in a captive non-releasable manner, such as for example, by swaging.Release sleeve 120 can be moved axially within a limited range and can be rotated with respect toouter stem 126. -
Spring 122 is held captiveinside release sleeve 120 aboveproximal end 129 ofouter stem 126, biasingrelease sleeve 120 away fromproximal end 129 ofouter stem 126.Ball detents 124 normally protrude into the bore ofouter stem 126, preventing slidingouter stem 126 overplate holder 140.Release sleeve 120 is pressed axially towarddistal end 127 ofouter stem 126 against the bias ofrelease spring sleeve 122 to permitball detents 124 to move outward into an area of greater inside diameter (not shown) of therelease sleeve 120, allowingdrill guide assembly 100 to be pushed farther ontoplate holder 140. Removing pressure fromrelease sleeve 120 results in the bias ofrelease sleeve spring 122 returningrelease sleeve 120 to its axial position farthest frombone plate 160, forcingball detents 124 inward to engageradial groove 146 inplate holder 140, lockingdrill guide assembly 100 toplate holder 140. -
Release sleeve 120 has a non-circular, preferably hexagonal,hole 128 at its upper end, the perimeter of whichhole 128 engages non-circularproximal end 144 ofplate holder 140. Althoughhole 128 andproximal end 144 are shown as hexagonal, it will be appreciated that other mating shapes are possible.Release sleeve 120 can be rotated in relation toouter stem 126 to screw and unscrewplate holder 140 to allow engagement ofplate holder 140 with, and disengagement ofplate holder 140 from,bone plate 160. Although the connection between the drill guide assembly and the plate holder has been described as a stem coaxial with and sliding over a rod, other embodiments are possible including, for example, a drill guide assembly with a stem attaching to the side of a plate holder. -
Handle member 106 is offset fromouter stem 126 by offsethandle stem 110, allowing greater visibility and access tobone plate 160 and vertebrae. Handlestem 110 is mechanically attached toouter stem 126, for example by welding, brazing, or friction fit.Handle member 106 can be pivoted about offsethandle stem 110 by pressingbutton cam 108 androtating handle member 106, providing still greater visibility and access as the surgeon alternates sides ofplate 160 and vertebrae on which he is working.Handle member 106 is retained onhandle stem 110 by means of a set screw 112 loosely engaging a handle stemradial groove 113. Pressingbutton cam 108 against the bias ofcam spring 116 moves thedetents 109 of thebutton cam 108 out of engagement with detent grooves 115 (shown inFIG. 8 a) inhandle member 106 while thedetents 109 remain engaged with detent grooves 111 ofhandle stem 110, allowinghandle member 106 to be rotated with respect to offsethandle stem 110, withoptional ball bearings 114 facilitating rotation. Releasing pressure onbutton cam 108 allowscam spring 116 to returndetents 109 ofbutton cam 108 to engagement withdetent grooves 115 ofhandle member 106, while maintaining engagement betweendetents 109 ofbutton cam 108 and detent grooves 111 ofhandle stem 110, preventing rotation ofhandle member 106 in relation to handlestem 110. - Drill guiding
barrels outer stem 126, for example by brazing, welding, or friction fit. Drill guidingbarrels multiple insertion locations 133 with predetermined trajectories forming passageways that are aligned through asingle exit location 135. For example,FIG. 8 b showsdrill guiding barrel 130 a with twoinsertion locations 133 forming passageways alongaxes bone plate 160 and allow greater precision than is possible with adjustable trajectory drill guides. The drill guiding barrels are shown with twoinsertion locations 133 and two predetermined trajectories. However, there may beadditional insertion locations 133 with other predetermined trajectories to allow the drill guide to be used with a variety of bone plates. Optionally,drill guiding barrels single insert location 133 and asingle exit location 135. Finally,drill guiding barrels single insertion location 133 and more than oneexit location 135, ormultiple insertion locations 133 andmultiple exit locations 135. Guidingbarrels holes 137 in guidingbarrels barrels barrels tab 132 that engagesslot 180 ofbone plate 160 to prevent rotation ofdrill guide assembly 100 in relation tobone plate 160. -
FIG. 9 shows an exploded view of an exemplary single barreldrill guide assembly 200 andplate holder 140, which are adapted for use with slotted cervical spine lockingbone plate 160. While the bone plate, and plate holder and drill guide assembly are shown and described as a cervical plate for use in the cervical region of the spine, it will be appreciated that the drill guide assembly and plate holder are also usable with other bone plates.Assembly 200 includes ahandle member 206, an offsethandle stem 210,release sleeve 220,outer stem 226, and drill guidingbarrel 230.Handle member 206 ofdrill guide assembly 200 can be incrementally swiveled by pressing and holdingbutton cam 208. Releasingbutton cam 208 locks the handle in place with relation to thehandle stem 210. - As shown in
FIGS. 9 and 10 ,drill guide assembly 200 is coupled toplate holder 140 by slidingdistal end 227 ofouter stem 226 of thedrill guide assembly 200 overproximal end 144 ofplate holder 140.Ball detents 224 normally protrude into the bore ofouter stem 226, preventing slidingouter stem 226 overplate holder 140.Release sleeve 220 is pressed axially towarddistal end 227 ofouter stem 226 against the bias ofrelease spring sleeve 222 to permitball detents 224 to move outward into an area of greater inside diameter (not shown) of therelease sleeve 220, allowingdrill guide assembly 200 to be pushed farther ontoplate holder 140. Removing pressure fromrelease sleeve 220 results in the bias ofrelease sleeve spring 222 returningrelease sleeve 220 to its axial position farthest frombone plate 160, forcingball detents 224 inward to engage plate holderradial groove 146, lockingdrill guide assembly 200 toplate holder 140.Outer stem 226 has alocking tab 232 at its distal end that is inserted intoslot 180 of lockingplate 160 to prevent rotation of, and provide alignment of, thedrill guide assembly 200 in relation to thebone plate 160. -
Release sleeve 220 has ahexagonal hole 228 at its upper end, the perimeter of whichhole 228 engages hexagonal proximal end 244 of plate holder 240. Althoughhole 228 andproximal end 144 are shown as hexagonal, it will be appreciated that other mating shapes are possible.Release sleeve 220 can be rotated with respect toouter stem 226 to screwplate holder 140 into, and unscrewplate holder 140 from, thebone plate 160. -
Handle member 206 is offset fromouter stem 226 by offsethandle stem 210, allowing greater visibility and access to the bone plate and vertebrae.Handle member 206 can be pivoted abouthandle stem 210 by pressingbutton cam 208 androtating handle member 206, providing still greater visibility and access as the surgeon alternates sides of thebone plate 160 and vertebrae on which he is working.Handle member 206 is retained onhandle stem 210 by means of a set screw 212 loosely engaging handle stemradial groove 213. Pressingbutton cam 208 against the bias ofcam spring 216moves detents 209 ofbutton cam 208 out of engagement with detent grooves 215 (shown inFIG. 9 a) inhandle member 206 whiledetents 209 remain engaged withdetent grooves 211 ofhandle stem 210, allowinghandle member 206 to be rotated in relation to handlestem 210. Releasing pressure onbutton cam 208 allowscam spring 216 to returndetents 209 ofbutton cam 208 to engagement with detent grooves 215 ofhandle member 206, while maintaining engagement betweendetents 209 ofbutton cam 208 anddetent grooves 211 ofhandle stem 210, preventing rotation ofhandle member 206 in relation to handlestem 210. - Single barrel
drill guide assembly 200 offers the advantage of greater visibility for the surgeon because only one side of the plate is obscured bydrill guiding barrel 230 at a time. Drill guidingbarrel 230 is attached toouter stem 226 by flex shaft 250 (approximately 90 mm long in its major dimension and approximately 2 mm in diameter) made of stainless steel or other flexible biocompatible material, which passes through stem hinge projections 252 a-d onouter stem 226 and drill guidingbarrel hinge projections 234 ondrill guiding barrel 230.Flex shaft 250 is bent to provide afinger lever 258 for manipulating thedrill guiding barrel 230.Dowel pin 236 is inserted through drill guiding barreldowel pin hole 238 in drill guidingbarrel hinge projection 234 and flex shaft dowel pin hole 254 inflex shaft 250 to lock thedrill guiding barrel 230 to flexshaft 250 so that thedrill guiding barrel 230 andflex shaft 250 rotate together within stem hinge projections 252 a-d.Flex shaft 250 has a reduceddiameter section 251, for example approximately 1 mm for a length of 9 mm. Lowerstem hinge projections stem hinge projections flex shaft 250 to be slightly bowed atreduced diameter section 251, creating a spring force biasing flexshaft finger lever 258 in the direction of . Upperstem hinge projection 252 a has flex shaft receiving grooves 256 a, 256 b that receive theinner radius 253 at the location whereflex shaft 250 bends to form flexshaft finger lever 258, lockingdrill guiding barrel 230 on either left or right side, respectively, ofdrill guide assembly 200. Drill guidingbarrel 230 is moved from left to right side by pullingflex shaft 250 upward until the flexshaft finger lever 258 is clear of flex shaft receiving groove 256 a and rotating combined lockingdrill guide barrel 230 andflex shaft 250 until flexshaft finger lever 258 is positioned above flex shaft receiving groove 256 b. Releasingflex shaft 250 allows flexshaft finger lever 258 to seat in flex shaft receiving groove 256 b due to the spring force of bowed flex shaft lower end 259, the spring force resulting from the bow in reduceddiameter section 251 offlex shaft 250. - Preferably,
drill guiding barrel 230 has multiple insertion locations 233 with predetermined trajectories preferably inclined or offset from asingle exit location 235, although adrill guiding barrel 230 with a single insertion location 233 and asingle exit location 235 is possible. In addition, adrill guiding barrel 230 with a single insertion location 233 and more than oneexit location 235 is possible. Multiple insertion locations 233 provide proper trajectories whendrill guiding barrel 230 is moved to alternate sides of the plate and also provide for the various trajectories needed for the upper and lower fixation holes 170 a, 170 b ofbone plate 160. The predetermined trajectories allow greater precision than possible with adjustable trajectory drill guides. Guidingbarrel 230 allows passage of fixation pins or bone screws, drills, taps, and awls. Slottedholes 237 in guidingbarrel 230 allow a surgeon to see the fixation components and tools as they are inserted into the guidingbarrel 230. -
FIG. 11 shows an alternate embodiment of a single barrel drill guide.Drill guide assembly 300 has a relatively long (representative length: approximately 80 mm)drill guiding barrel 330 with a depth stop (a shoulder, not shown) inside the drill guiding barrel 330 (representative outside diameter: approximately 10-12 mm) that stops the drill bit at a pre-determined depth.Handle member 306,button cam 308, offsethandle stem 310,outer stem 326, andrelease sleeve 320 correspond to handlestem 106,button cam 108, offsethandle stem 110,outer stem 126, andrelease sleeve 120 ofdrill guide assembly 100.Tab 335 is attached toouter stem 326, preferably by welding or brazing, and has ahorizontal section 335 a andvertical section 335 b.Pin 350 is attached to tabhorizontal section 335 a, preferably by welding, brazing, or mechanical connection; and is parallel toouter stem 326.Pin 350 has aslot 337 beginning at its upper end and extending through a portion of the length ofpin 350.Slot 337 separateshemispherical retainers pin 350 below theretainers Retainers barrel hinge 334 onpin 350. To switchdrill guiding barrel 330 to the opposite side ofbone plate 160, the surgeon pullsdrill guiding barrel 330 towards himself so that drill guidingbarrel hinge 334 clears tabvertical section 335 b, allowing the surgeon to pivot thedrill guiding barrel 330 to the opposite side. The surgeon's pulling ofdrill guiding barrel 330 toward himself forces theretainers upper surface 339 of drill guidingbarrel hinge 334contacts retainers guide barrel hinge 334 away from the surgeon. Thedrill guiding barrel 330 is then released and returned to its lower position by the spring force of thecompressed retainers upper surface 339 of drillguide barrel hinge 334 such that drill guidingbarrel hinge 334 is held in angular position bytab 335. -
FIG. 13 illustrates an alternative embodiment of a guide barrel for use with the inventive drill guide which may allow the surgeon to compress the intervertebral space (i.e. the disc space) between adjacent vertebrae when the fasteners are tightened in their respective plate holes. Using the disclosed barrel arrangement, compression of the intervertebral disc space may be achieved simply by tightening the bone screws in the plate and without the need for additional tools. - Compression of the disc space may be important for a number of reasons. Specifically, where an intervertebral fusion spacer has been installed between the vertebra, compression along the spine axis may serve to provide proper initial seating and loading of the spacer between the end plates. This may eliminate any spaces or gaps between the end plates and the spacer. Also, compression may promote fusion by stressing both the end plates and the spacer. Compression may also be used to return the disc space to its normal height.
- Thus, the guiding barrels 1130 a, b of the drill guide of this embodiment may be arranged so that at least one bone hole formed in at least one vertebra is slightly longitudinally offset from the center of the
respective plate hole 170 a at one end of thebone plate 160. In general, the drill guide of this embodiment will be used with aplate 160 having at least twoplate holes FIG. 14 ) that overly at least a pair of adjacent vertebra (seeFIG. 16 ). The plate may be fixed to a first of the pair of vertebrae using abone screw 1190 inserted through at least one of the plate holes 170 b. The drill guide with offset guiding barrels 1130 a, b, may then be engaged with theplate 160 and used to form at least one offsetbone hole 1200 in the second of the pair of vertebrae throughplate hole 170 a. Thereafter, when bone screws 1190 are inserted in the offsetbone holes 1200 in the second vertebra, the heads 1192 of thescrews 1190 may overhang the far side of plate holes 170 a since they are non-concentric with the plate holes 170 a. As such, when the bone screws 1190 are driven into the offsetbone holes 1200, the under-surface 1195 of thescrew head 1194 will contact the far side of conicalinner surface 172 of the plate holes 170 a. As thebone screw 1190 is driven farther into the bone, the interaction between the under-surface 1195 of thescrew head 1194 and the conicalinner surface 172 of the plate holes 170 a causes the screw 1190 (and the underlying second vertebra) to move longitudinally with respect to theplate 160 until the screw is centered within theplate hole 170 a, thus reducing the distance between the vertebrae. In this manner, the pair of vertebrae may be moved together by an amount equal to the distance by which the offsetbone holes 1200 are offset from the plate holes 170 a. - It is noted that various tools may be placed through the guide barrels of the disclosed drill guide to form holes in the underlying bone. For example, an awl or probe may be used to break the cortical shell of the bone. A probe may also be used to dislodge and/or remove cancellous bone underlying the cortical bone to make way for a bone screw. A drill may be used to form the bone hole, and a tap may be used to form threads in the bone hole. Where self-tapping screws are used, the tap may not be required, and where self-drilling screws are used, the drill and tap may not be required.
- Furthermore, while this procedure is described in relation to a bone plate having only two pairs of plate holes 170 a, b, it will be appreciated by one of skill in the art that this offset guide barrel feature may be used with plates having three or more pairs of plate holes (i.e. those that span multiple disc spaces or “levels”). In such cases, compression of multiple “levels” may be achieved by fixing the plate to at least one vertebra, and then creating offset bone holes in at least one vertebra. For example, where a two-level plate is used (i.e. the plate has three pairs of bone screw holes 270 a, 270 b, 270 c (see
FIG. 5 )) , at least one pair of plate holes may be fixed to an associated vertebra, while offset holes may then be formed in the vertebrae adjacent this “fixed” vertebra using a drill guide having offset guide barrels 1130 a, b as previously described. By driving bone screws into these offset bone holes, these adjacent vertebrae may be moved in the direction of the “fixed” vertebrae, thus compressing the associated disc space. - As shown in
FIG. 14 , an exemplary offsetbone hole 1200 is indicated as “X,” while the center point of thebone screw hole 170 a is indicated as “Y.” The longitudinal distance from the bone plate slot end-hole 182 to the center of thebone screw hole 170 a is designated “L1,” while the longitudinal distance from the bone plate slot end-hole 182 to the center “X” of the offsetbone hole 1200 is designated “L2.” An axis “D-D” formed by points “X” and “Y” may be oriented substantially parallel to the longitudinal axis “A-A” of thebone plate 160. A bone screw 1190 (FIG. 15 ) inserted into a hole formed at point “X” will, when tightened into the vertebra, move toward point “Y” due to the previously described interaction of thebone screw head 1194 with the side of the conicalinner surface 172 of thefastener hole 170 a. This movement of thebone screw 1190 along axis “D-D” will also move the attachedvertebra 2000 along axis “D-D” toward theadjacent vertebra 2002 to whichplate 160 has already been firmly affixed. Thus, the two vertebra are drawn closer together along axis “D-D.” - In the embodiment illustrated in
FIG. 16 , the bone plate may be attached toadjacent vertebra bone screws 1190 is shown engaged with theleftmost plate hole 170 b andvertebra 2002. One of a second pair ofbone screws 1190 is shown partially installed in one of a pair of rightmost plate holes 170 a, under which a pair of offsetholes 1200 have been formed invertebra 2000. A portion of theunderside 1195 of thescrew head 1194 can be seen overlying one side of the conicalinner surface 172 of theplate hole 170 a. Compression of thedisc space 2004 between thevertebrae bone screws 1190 invertebra 2000. - To form bone holes having the desired offset, guiding
barrels 130 a, b,outer stem 126, andplate holder 140 may be configured and arranged so that the center of the guidingbarrels 130 a, b and the center of the outer stem andplate holder plate holder 140 is engaged withslot end hole 182 and theouter stem 126 is engaged with theplate holder 140, the guidingbarrels 130 a, b will be aligned with offset bone hole insertion point “X.” - In one embodiment, the distance “L1” from the center of the
slot end hole 182 to the center of eachplate hole 170 a, when measured along axis “D-D” (FIG. 14 ) is about 5.5 mm, and the distance “BL” (FIG. 13 ) between the center of theplate holder 126 and the center of each guide barrel 1130 a, b is about 6.0 mm. Thus, when the drill guide is fit to the plate and holes drilled through guide barrels 1130 a, b, the resulting bone holes will be offset from the center of eachplate hole 170 a by about 0.5 mm, which will result in a corresponding compression of the associated intervertebral disc space of about 0.5 mm when thescrews 1190 are fully seated in the vertebrae. - The plate guiding barrels 1130 a, b, may be configured so that the distance between points “X” and “Y” along axis “D-D” is in the range of from about 0.0 mm to about 0.8 mm, thus providing longitudinal compression of the vertebral bodies of from about 0.0 mm to about 0.8 mm when the associated “offset” bone screws 190 are fully tightened in their plate holes 170 a. In a preferred embodiment, the guiding barrels, outer stem and plate holder are configured so that the distance between points “X” and “Y” may be about 0.5 mm, thus allowing longitudinal compression of bone segments of from about 0.5 mm when the fasteners are tightened within the appropriate bone screw holes. It should be noted that larger offset dimensions may be provided, as will be apparent to one of ordinary skill in the art.
- It will also be appreciated that the offset guide barrel feature described herein may be implemented with any of the single barrel or double barrel drill guides disclosed herein. Moreover, while the bone plate, drill bit, and drill guide assembly are shown and described for use in fixing adjacent vertebra of the spine, it will be appreciated that the drill guide assembly may be utilized with any suitable bone plate or other structure that may be secured to bone using bone fasteners. Alternatively, the drill guide may be used without a bone plate to guide the drilling of fastener holes in bone at any appropriate location in the body.
- The method of drilling holes in vertebrae with the system disclosed above will now be described. A surgeon may inserts a plate holder into a slotted hole in a bone plate. The surgeon then releasably locks a drill guide assembly onto the plate holder. The bone plate is applied to the appropriate vertebrae by a surgeon holding a handle of the drill guide assembly. The surgeon then aligns a drill bit with the appropriate insertion location in the appropriate drill guiding barrel of the drill guide assembly and inserts the drill bit into the drill guiding barrel. The surgeon then drills a first hole coaxial with the central axis of a first fastener hole in the plate. A first bone screw is then inserted into the drill guiding barrel and threaded into the first hole. If a double barrel drill guide assembly is being used, the surgeon then aligns the drill bit with the appropriate insertion location of the adjacent drill guiding barrel. If a single barrel drill guide assembly is being used, the surgeon pivots the drill guiding barrel until it is aligned above a fastener hole adjacent to the first fastener hole in the plate and aligns the drill bit with the appropriate insertion location of the drill guiding barrel. The surgeon then drills a second hole coaxial with the central axis of a second fastener hole in the plate and installs a second bone screw. The surgeon then rotates counterclockwise a release sleeve on the drill guide assembly, which disengages the plate holder from the plate. The surgeon removes the drill guide assembly and attached plate holder from the plate and inserts the plate holder into a second hole in the bone plate by rotating the release sleeve counterclockwise, the process of drilling holes and installing bone screws in adjacent through-holes of the plate and removing the drill guide assembly and plate holder is repeated until all pairs of adjacent holes have been drilled and bone screws inserted.
- When using the drill guide having an offset barrel 1130 a, b to provide a compression of adjacent vertebrae, the surgeon may first insert a pair of bone screws through a corresponding pair of plate holes 170 b overlying the first of a pair of adjacent vertebrae, thus fixing the
plate 160 to the first vertebra. The surgeon may then engage a drill guide having at least one offset barrel 1130 a, b with theplate 160 as described above, and may use the barrel to form offsetholes 1200 in the bone underlying plate holes 170 a which overly the second of the pair of vertebrae. These holes may be formed using an awl, followed by a drill and tap. Alternatively, when using self tapping or self drilling bone screws, the surgeon may use an awl to form the hole. A probe may also be used to remove or dislodge cancellous bone within the hole. Bone screws 1190 may then be placed in the holes and tightened until theundersides 1195 of the screw heads 1194 contact a portion of the respective plate holes 170 a. Further tightening of thescrews 1190 may cause the screws and the underlying second vertebrae to move toward the first vertebra, thus reducing the distance between the two vertebrae. An intervertebral spacer placed between the vertebrae will thus be subjected to the compression force associated with the reduction in distance, and the previously discussed benefits of such compression will be provided. - While the method has been described in relation to a
plate 160 having two pairs of plate holes (i.e. the plate is sized to span a single intervertebral disc space), plates configured for multiple-level fixation may also be used. Thus,FIG. 5 shows a two-level plate 260 having three pairs of plate holes 270 a, 270 b and 270 c, where each pair of holes may be associated with a separate vertebral body. With a two-level plate, either one or two levels may be compressed by fixing various combinations of hole pairs. Thus, holes 270 a may be fixed to the associated vertebra, and offset holes may be drilled through plate holes 270 b and 270 c to facilitate compression of the disc spaces between the associated vertebrae. Likewise, plate holes 270 a and 270 b may be fixed to the associated vertebrae, with offset holes drilled only throughholes 270 c to compress only the disc space located between the vertebrae associated withholes holes 270 a are fixed and offset holes are drilled through plate holes 270 b and 270 c, screws should first be driven into the offset holes associated withplate holes 270 b to compress the disc space between vertebrae associated withholes plate holes 270 c to subsequently compress the disc space located between vertebrae associated withholes - While the invention has been shown and described herein with reference to particular embodiments, it is to be understood that the various additions, substitutions, or modifications of form, structure, arrangement, proportions, materials, and components and otherwise, used in the practice and which are particularly adapted to specific environments and operative requirements, may be made to the described embodiments without departing from the spirit and scope of the present invention. For example, various means may be used to attach the plate holder to the bone plate or to the drill guide assembly. In addition, the plate may be of various thicknesses, shapes, and contours; and have various fixation hole configurations.
Claims (55)
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Cited By (41)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20050085798A1 (en) * | 2003-09-15 | 2005-04-21 | Hofmann Ronald L. | Adjustable surgical cutting instrument and cam system for use in same |
US20060167456A1 (en) * | 2004-12-21 | 2006-07-27 | Packaging Service Corporation Of Kentucky | Cervical plate system |
US20060189997A1 (en) * | 2005-02-10 | 2006-08-24 | Zimmer Spine, Inc. | All through one drill guide for cervical plating |
US20070167953A1 (en) * | 2006-01-17 | 2007-07-19 | Stryker Trauma Gmbh | Targeting device for orthopedic implants |
US20070173836A1 (en) * | 2006-01-17 | 2007-07-26 | Stryker Trauma Gmbh | Targeting device for bone implant |
US20080183172A1 (en) * | 2007-01-26 | 2008-07-31 | Zimmer Technology, Inc. | Retention feature for plate guides |
US20100106196A1 (en) * | 2008-10-24 | 2010-04-29 | Paul Lawrence Erickson | Method and system for attaching a plate to a bone |
US7887595B1 (en) | 2005-12-05 | 2011-02-15 | Nuvasive, Inc. | Methods and apparatus for spinal fusion |
US20110118742A1 (en) * | 2009-05-12 | 2011-05-19 | Urs Hulliger | Readjustable Locking Plate Hole |
US7963980B1 (en) | 2006-04-18 | 2011-06-21 | University Of South Florida | Cervical plate system |
US8114162B1 (en) | 2006-08-09 | 2012-02-14 | Nuvasive, Inc. | Spinal fusion implant and related methods |
US20120053586A1 (en) * | 2010-08-30 | 2012-03-01 | Biomet Manufacturing Corp. | Method and Apparatus for Osteosynthesis |
US8668723B2 (en) | 2011-07-19 | 2014-03-11 | Neurostructures, Inc. | Anterior cervical plate |
USD708747S1 (en) | 2006-09-25 | 2014-07-08 | Nuvasive, Inc. | Spinal fusion implant |
US8986354B2 (en) | 2012-02-14 | 2015-03-24 | Zavation Llc | Surgical kit for spinal surgery |
US9050151B2 (en) | 2012-03-06 | 2015-06-09 | Stryker Trauma Sa | Bone plate and aiming block |
USD734853S1 (en) | 2009-10-14 | 2015-07-21 | Nuvasive, Inc. | Bone plate |
WO2016003477A1 (en) * | 2014-07-02 | 2016-01-07 | Paragon 28, Inc. | Moveable bone plate implantation system and method of use |
US9486250B2 (en) | 2014-02-20 | 2016-11-08 | Mastros Innovations, LLC. | Lateral plate |
USD779065S1 (en) | 2014-10-08 | 2017-02-14 | Nuvasive, Inc. | Anterior cervical bone plate |
US20170042558A1 (en) * | 2006-10-11 | 2017-02-16 | Ignace Ghijselings | Device and method for installing femoral prosthetic knee joint |
US9615866B1 (en) | 2004-10-18 | 2017-04-11 | Nuvasive, Inc. | Surgical fixation system and related methods |
US9629664B2 (en) | 2014-01-20 | 2017-04-25 | Neurostructures, Inc. | Anterior cervical plate |
US9750512B2 (en) | 2013-10-21 | 2017-09-05 | Zimmer Spine, Inc. | Drill guide for installing a bone plate |
US20170348112A1 (en) * | 2013-03-11 | 2017-12-07 | Catalyst Orthoscience Inc. | Stabilized drill guide |
US20180310965A1 (en) * | 2017-03-22 | 2018-11-01 | Zavation Medical Products Llc | Methods of implanting bone plate assemblies |
WO2019120528A1 (en) * | 2017-12-20 | 2019-06-27 | Swemac Innovation Ab | A targeting device for fixation of bone fragments at a bone fracture |
US10512547B2 (en) | 2017-05-04 | 2019-12-24 | Neurostructures, Inc. | Interbody spacer |
US10631884B2 (en) | 2017-06-05 | 2020-04-28 | Conmed Corporation | Multi-barrel drill guide |
US10980641B2 (en) | 2017-05-04 | 2021-04-20 | Neurostructures, Inc. | Interbody spacer |
US11007064B2 (en) | 2015-08-10 | 2021-05-18 | Catalyst Orthoscience Inc. | Arthroplasty prostheses with multi-axis fixation |
US11007063B2 (en) | 2013-03-11 | 2021-05-18 | Catalyst Orthoscience Inc. | Offset reamers |
US11071629B2 (en) | 2018-10-13 | 2021-07-27 | Neurostructures Inc. | Interbody spacer |
US11076892B2 (en) | 2018-08-03 | 2021-08-03 | Neurostructures, Inc. | Anterior cervical plate |
US11123117B1 (en) | 2011-11-01 | 2021-09-21 | Nuvasive, Inc. | Surgical fixation system and related methods |
US11147596B2 (en) * | 2010-07-22 | 2021-10-19 | Globus Medical, Inc. | Sacral-iliac stabilization system |
US20220079629A1 (en) * | 2016-08-15 | 2022-03-17 | Triqueue Holdings, Llc | Bone fusion device, system and methods |
US11304817B2 (en) | 2020-06-05 | 2022-04-19 | Neurostructures, Inc. | Expandable interbody spacer |
US11382761B2 (en) | 2020-04-11 | 2022-07-12 | Neurostructures, Inc. | Expandable interbody spacer |
US11471173B2 (en) * | 2017-06-05 | 2022-10-18 | Conmed Corporation | Multi-barrel drill guide and anchor deployment assembly |
US11717419B2 (en) | 2020-12-10 | 2023-08-08 | Neurostructures, Inc. | Expandable interbody spacer |
Families Citing this family (76)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7527629B2 (en) * | 2002-03-12 | 2009-05-05 | Cervitech, Inc. | Instrument set for fitting an intervertebral joint prosthesis |
DE50213818D1 (en) * | 2002-03-12 | 2009-10-15 | Cervitech Inc | Intrumentarium for the insertion of an intervertebral prosthesis |
US20090182341A1 (en) * | 2002-03-12 | 2009-07-16 | Cervitech, Inc. | Instrument set for fitting an intervertebral jont prosthesis |
US8388624B2 (en) * | 2003-02-24 | 2013-03-05 | Arthrosurface Incorporated | Trochlear resurfacing system and method |
US7909860B2 (en) | 2003-09-03 | 2011-03-22 | Synthes Usa, Llc | Bone plate with captive clips |
US20050049595A1 (en) * | 2003-09-03 | 2005-03-03 | Suh Sean S. | Track-plate carriage system |
JP2008504107A (en) | 2004-06-28 | 2008-02-14 | アースロサーフィス・インコーポレーテッド | Joint surface replacement system |
US7931678B2 (en) * | 2004-12-08 | 2011-04-26 | Depuy Spine, Inc. | Hybrid spinal plates |
US20060264959A1 (en) * | 2005-05-23 | 2006-11-23 | Custom Spine, Inc. | Rod pusher |
CN1900608B (en) * | 2005-07-19 | 2010-05-12 | 乐金电子(天津)电器有限公司 | Indoor unit of air conditioner |
US8177820B2 (en) * | 2005-09-01 | 2012-05-15 | Merete Medical Gmbh | Bone plate comprising at least one screw to be fixed at a stable angle |
US9192398B2 (en) * | 2005-09-19 | 2015-11-24 | DePuy Synthes Products, Inc. | Orthopedic implant insertion handle and aiming guide |
US7772406B2 (en) * | 2005-10-31 | 2010-08-10 | Toray Fine Chemicals Co., Ltd. | Process for production of benzyloxypyrrolidine derivative, and process for production of hydrochloride salt powder of optically active benzyloxypyrrolidine derivative |
DE602007008535D1 (en) * | 2006-03-28 | 2010-09-30 | Synthes Gmbh | FIXING BONE PLATES WITH CONTROLLED FIXING SCREW MISC |
US8771282B2 (en) * | 2006-03-30 | 2014-07-08 | Spinal Elements, Inc. | Drill guide with rotating handle |
KR100705998B1 (en) * | 2006-05-20 | 2007-04-13 | 학교법인 포항공과대학교 | End-effector for bone fusion surgery operation system |
AU2007273986B2 (en) * | 2006-07-07 | 2013-01-31 | Swiss Pro Orthodpedic Sa | Bone plate with complex, adjacent holes joined by a relief-space |
US8282642B2 (en) * | 2006-09-26 | 2012-10-09 | K2M, Inc. | Cervical drill guide apparatus |
EP2136717B1 (en) | 2006-12-11 | 2013-10-16 | Arthrosurface Incorporated | Retrograde resection apparatus |
US8821511B2 (en) * | 2007-03-15 | 2014-09-02 | General Electric Company | Instrument guide for use with a surgical navigation system |
US8172854B2 (en) * | 2007-07-19 | 2012-05-08 | Spinal Elements, Inc. | Attachable instrument guide with detachable handle |
US8628530B2 (en) * | 2007-08-16 | 2014-01-14 | Nutek Orthopedics, Inc. | External fixation apparatus with angularly adjustable drill guiding and pin clamping means |
JP5330392B2 (en) * | 2007-09-18 | 2013-10-30 | ストライカー トラウマ ゲーエムベーハー | Stable fixation system by implant angle |
US8491590B2 (en) * | 2007-12-05 | 2013-07-23 | Depuy Spine, Inc. | System and method of manipulating spinal constructs |
US8328806B2 (en) * | 2008-06-24 | 2012-12-11 | Extremity Medical, Llc | Fixation system, an intramedullary fixation assembly and method of use |
US9044282B2 (en) * | 2008-06-24 | 2015-06-02 | Extremity Medical Llc | Intraosseous intramedullary fixation assembly and method of use |
US8313487B2 (en) | 2008-06-24 | 2012-11-20 | Extremity Medical Llc | Fixation system, an intramedullary fixation assembly and method of use |
US8343199B2 (en) * | 2008-06-24 | 2013-01-01 | Extremity Medical, Llc | Intramedullary fixation screw, a fixation system, and method of fixation of the subtalar joint |
US9289220B2 (en) | 2008-06-24 | 2016-03-22 | Extremity Medical Llc | Intramedullary fixation assembly and method of use |
US8303589B2 (en) * | 2008-06-24 | 2012-11-06 | Extremity Medical Llc | Fixation system, an intramedullary fixation assembly and method of use |
US9017329B2 (en) | 2008-06-24 | 2015-04-28 | Extremity Medical, Llc | Intramedullary fixation assembly and method of use |
US8273111B2 (en) | 2008-07-02 | 2012-09-25 | Ebi, Llc | Growth control device |
US20100076500A1 (en) * | 2008-09-22 | 2010-03-25 | Bray Robert S | Insertion tool and guide system |
US20100256687A1 (en) | 2009-04-01 | 2010-10-07 | Merete Medical Gmbh | Fixation Device and Method of Use for a Ludloff Osteotomy Procedure |
DE102009016394B4 (en) | 2009-04-07 | 2016-02-11 | Merete Medical Gmbh | Device for stable-angle fixation and compression of a fracture site or osteotomy on a bone |
US9662126B2 (en) | 2009-04-17 | 2017-05-30 | Arthrosurface Incorporated | Glenoid resurfacing system and method |
WO2016154393A1 (en) | 2009-04-17 | 2016-09-29 | Arthrosurface Incorporated | Glenoid repair system and methods of use thereof |
US9597095B2 (en) * | 2009-05-15 | 2017-03-21 | Globus Medical, Inc | Screw guide and tissue retractor instrument |
WO2011050140A1 (en) | 2009-10-22 | 2011-04-28 | Blue Fury Consulting, L.L.C. | Posterior cervical fusion system and techniques |
US10098674B2 (en) | 2009-10-22 | 2018-10-16 | Nuvasive, Inc. | System and method for posterior cervical fusion |
US9161795B2 (en) | 2009-12-22 | 2015-10-20 | Merete Medical Gmbh | Bone plate system for osteosynthesis |
US9138246B2 (en) * | 2010-02-19 | 2015-09-22 | Arthrex, Inc. | Elbow reconstruction instruments and techniques |
CA2792048A1 (en) | 2010-03-05 | 2011-09-09 | Arthrosurface Incorporated | Tibial resurfacing system and method |
US8945135B2 (en) * | 2011-02-14 | 2015-02-03 | Michael D. Ries | Patellar prostheses and instrumentation |
US9675399B2 (en) | 2011-02-14 | 2017-06-13 | Michael D. Ries | Patient specific implants and instrumentation for patellar prostheses |
US9707069B2 (en) | 2011-02-25 | 2017-07-18 | Avinash Kumar | Suture mesh and method of use |
DE202011051165U1 (en) | 2011-08-31 | 2011-11-14 | Merete Medical Gmbh | Anatomically adapted, plantar bone plate and bone plate system |
US9918723B2 (en) * | 2011-09-23 | 2018-03-20 | Depuy Mitek, Llc | Glenoid anchor guide |
WO2013096746A1 (en) | 2011-12-22 | 2013-06-27 | Arthrosurface Incorporated | System and method for bone fixation |
DE102012103894B4 (en) | 2012-05-03 | 2016-10-27 | Merete Medical Gmbh | Bone plate system for osteosynthesis |
WO2014008126A1 (en) | 2012-07-03 | 2014-01-09 | Arthrosurface Incorporated | System and method for joint resurfacing and repair |
US9277926B2 (en) | 2012-10-24 | 2016-03-08 | Wisconsin Alumni Research Foundation | Drill sleeve |
US9119732B2 (en) | 2013-03-15 | 2015-09-01 | Orthocision, Inc. | Method and implant system for sacroiliac joint fixation and fusion |
US9545276B2 (en) | 2013-03-15 | 2017-01-17 | Aristotech Industries Gmbh | Fixation device and method of use for a lapidus-type plantar hallux valgus procedure |
US9492200B2 (en) | 2013-04-16 | 2016-11-15 | Arthrosurface Incorporated | Suture system and method |
USD745162S1 (en) | 2014-01-27 | 2015-12-08 | Merete Medical Gmbh | Bone plate |
US9408647B2 (en) * | 2014-02-27 | 2016-08-09 | Biomedical Enterprises, Inc. | Method and apparatus for use of a compressing plate |
US9931219B2 (en) | 2014-03-07 | 2018-04-03 | Arthrosurface Incorporated | Implant and anchor assembly |
US11607319B2 (en) | 2014-03-07 | 2023-03-21 | Arthrosurface Incorporated | System and method for repairing articular surfaces |
US10624748B2 (en) | 2014-03-07 | 2020-04-21 | Arthrosurface Incorporated | System and method for repairing articular surfaces |
CN105326560A (en) * | 2014-08-11 | 2016-02-17 | 天津康立尔生物科技有限公司 | Drill bush |
US10531958B2 (en) * | 2014-10-31 | 2020-01-14 | RIOS Medical AG | Implant assembly for the sacroiliac joint |
KR101658117B1 (en) * | 2014-12-05 | 2016-09-22 | (주)시지바이오 | Instrumentation for Anterior Cervical Discectomy Fusion |
CN104706414B (en) * | 2015-03-30 | 2016-09-28 | 蔡鸿敏 | The entry point of a kind of sacroiliac screw guide pin maintains and direction adjusts instrument |
US10238439B2 (en) * | 2015-04-24 | 2019-03-26 | Meditech Spine, Llc | Anterior spinal bone plate holding system and method |
US10327787B2 (en) | 2015-12-28 | 2019-06-25 | Nuvasive, Inc | Adjustable depth drill guide |
CN108697472B (en) * | 2016-02-19 | 2021-06-25 | 桑尼布鲁克研究所 | Positioning and alignment instrument for introducing a surgical device into a bone |
TWI637721B (en) * | 2016-09-12 | 2018-10-11 | 台灣微創醫療器材股份有限公司 | Spinal surgical tool |
WO2018167381A1 (en) * | 2017-03-15 | 2018-09-20 | Onecox | Intraosseous guide pin, trocar for installing and trocar for withdrawing said pin |
CN107299949B (en) * | 2017-07-31 | 2023-03-31 | 海盐猛凌汽车配件有限公司 | Dog bone piece structure, jig mechanism for drilling dog bone and jig method thereof |
US11160663B2 (en) | 2017-08-04 | 2021-11-02 | Arthrosurface Incorporated | Multicomponent articular surface implant |
USD921898S1 (en) | 2017-12-22 | 2021-06-08 | Orthocision Inc. | Helical implant |
CN109549685A (en) * | 2018-12-26 | 2019-04-02 | 江苏嘉斯康医疗科技有限公司 | The brill guider of integrated angle adjustable |
GB2616360B (en) | 2019-03-12 | 2023-11-29 | Arthrosurface Inc | Humeral and glenoid articular surface implant systems and methods |
US11793558B2 (en) * | 2019-08-30 | 2023-10-24 | K2M, Inc. | All in one plate holder and spring loaded awl |
WO2021183210A1 (en) * | 2020-03-10 | 2021-09-16 | Cartiva, Inc. | Polyaxial drill guide |
Citations (81)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US2200120A (en) * | 1938-04-30 | 1940-05-07 | Walter W Nauth | Fracture nail guide |
US2424485A (en) * | 1944-07-03 | 1947-07-22 | Thomas W Maskell | Adjustable jig bushing |
US2494229A (en) * | 1946-07-08 | 1950-01-10 | John G Collison | Bone surgery |
US2607339A (en) * | 1950-04-07 | 1952-08-19 | James W Price | Adjustable fracture nail guide |
US2670637A (en) * | 1951-07-18 | 1954-03-02 | Frank M Hardy | Drill guide |
US2674906A (en) * | 1950-08-31 | 1954-04-13 | Robert F Krainz | Hole spacing attachment for drill presses |
US3071030A (en) * | 1961-06-06 | 1963-01-01 | Star Cutter Company | Hole forming or enlarging assembly |
US3727611A (en) * | 1971-07-01 | 1973-04-17 | R Schultz | Alignment means for inserting guide wire prior to inserting hip nail for a fractured hip |
US4388921A (en) * | 1980-05-28 | 1983-06-21 | Institut Straumann Ag | Device comprising a plate and screws for fastening a plate to a bone |
US4450835A (en) * | 1981-02-20 | 1984-05-29 | Howmedica, Inc. | Method and system for inserting a surgical wire |
US4493317A (en) * | 1980-11-20 | 1985-01-15 | Synthes Ltd. (U.S.A.) | Surgical compression plate and drill guide |
US4646413A (en) * | 1985-06-18 | 1987-03-03 | Tri Tool Inc. | Tube extractor drill jig |
US4668134A (en) * | 1986-01-13 | 1987-05-26 | P. V. Tool, Inc. | Apparatus for orientation of tool on workpiece |
US4744353A (en) * | 1986-04-18 | 1988-05-17 | Mcfarland Joseph R | Method for attaching soft tissue to bone tissue |
US4803976A (en) * | 1985-10-03 | 1989-02-14 | Synthes | Sighting instrument |
US4898502A (en) * | 1988-09-29 | 1990-02-06 | Reinhard Becher | Mechanical drilling aid |
US4911153A (en) * | 1988-02-04 | 1990-03-27 | Biomet, Inc. | Orthopedic surgical instrument |
US5026376A (en) * | 1990-07-13 | 1991-06-25 | Greenberg Alex M | Surgical drill guide and retractor |
US5030219A (en) * | 1990-01-22 | 1991-07-09 | Boehringer Mannheim Corporation | Glenoid component installation tools |
US5112336A (en) * | 1991-05-14 | 1992-05-12 | Intermedics Orthopedics, Inc. | Drill guide and template for prosthetic devices |
US5133720A (en) * | 1990-07-13 | 1992-07-28 | Greenberg Alex M | Surgical drill guide and retractor |
US5207753A (en) * | 1991-02-18 | 1993-05-04 | Kannivelu Badrinath | Bone fracture repair apparatus and method |
US5281056A (en) * | 1991-07-15 | 1994-01-25 | Cooper Industries, Inc. | Indexing nose couple |
US5306278A (en) * | 1992-09-11 | 1994-04-26 | Ace Medical Company | Corticotomy drill guide |
US5312412A (en) * | 1993-02-03 | 1994-05-17 | Whipple Terry L | Fixation alignment guide for surgical use |
US5324295A (en) * | 1992-04-24 | 1994-06-28 | Shapiro Michael R | Drill guide for surgical pins |
US5423826A (en) * | 1993-02-05 | 1995-06-13 | Danek Medical, Inc. | Anterior cervical plate holder/drill guide and method of use |
US5429641A (en) * | 1993-03-28 | 1995-07-04 | Gotfried; Yechiel | Surgical device for connection of fractured bones |
US5437677A (en) * | 1992-10-09 | 1995-08-01 | Minnesota Mining And Manufacturing Company | Glenoid alignment guide |
US5484446A (en) * | 1994-06-27 | 1996-01-16 | Zimmer, Inc. | Alignment guide for use in orthopaedic surgery |
US5507801A (en) * | 1990-06-06 | 1996-04-16 | Synthes (U.S.A.) | Compression drill guide |
US5595193A (en) * | 1993-02-12 | 1997-01-21 | Walus; Richard L. | Tool for implanting a fiducial marker |
US5601553A (en) * | 1994-10-03 | 1997-02-11 | Synthes (U.S.A.) | Locking plate and bone screw |
US5601550A (en) * | 1994-10-25 | 1997-02-11 | Esser; Rene D. | Pelvic pin guide system for insertion of pins into iliac bone |
US5624447A (en) * | 1995-03-20 | 1997-04-29 | Othy, Inc. | Surgical tool guide and entry hole positioner |
US5634927A (en) * | 1995-07-06 | 1997-06-03 | Zimmer, Inc. | Sizing plate and drill guide assembly for orthopaedic knee instrumentation |
US5637112A (en) * | 1992-06-08 | 1997-06-10 | Orthopedic Systems, Inc. | Apparatus for attaching suture to bone |
US5722978A (en) * | 1996-03-13 | 1998-03-03 | Jenkins, Jr.; Joseph Robert | Osteotomy system |
US5725532A (en) * | 1996-09-10 | 1998-03-10 | Shoemaker; Steven | Integrated surgical reduction clamp and drill guide |
US5741266A (en) * | 1996-09-19 | 1998-04-21 | Biomet, Inc. | Pin placement guide and method of making a bone entry hole for implantation of an intramedullary nail |
US5743916A (en) * | 1990-07-13 | 1998-04-28 | Human Factors Industrial Design, Inc. | Drill guide with removable ferrules |
US5746763A (en) * | 1991-12-03 | 1998-05-05 | Boston Scientific Technology, Inc. | Device for supporting and positioning medical equipment |
US5746743A (en) * | 1990-07-13 | 1998-05-05 | Greenberg Surgical Technologies, Llc | Single-handed surgical drill depth guide with mandibular retractor |
US5755721A (en) * | 1996-03-13 | 1998-05-26 | Synthes | Plate holding drill guide and trocar and method of holding a plate |
US5766221A (en) * | 1991-12-03 | 1998-06-16 | Boston Scientific Technology, Inc. | Bone anchor implantation device |
US5769856A (en) * | 1996-06-24 | 1998-06-23 | Osteonics Corp. | Drill guide and implant method |
US5910143A (en) * | 1994-12-16 | 1999-06-08 | Exactech, Inc. | Intramedullary alignment guide tool |
US5913860A (en) * | 1998-02-27 | 1999-06-22 | Synthes (Usa) | Surgical nail inserter |
US6013083A (en) * | 1997-05-02 | 2000-01-11 | Bennett; William F. | Arthroscopic rotator cuff repair apparatus and method |
US6019767A (en) * | 1990-07-16 | 2000-02-01 | Arthrotek | Tibial guide |
US6036696A (en) * | 1997-12-19 | 2000-03-14 | Stryker Technologies Corporation | Guide-pin placement device and method of use |
US6059789A (en) * | 1998-06-22 | 2000-05-09 | Xomed Surgical Products, Inc. | Drill guide for creating a tunnel in bone for fixating soft tissue to the bone and kit and method for fixating soft tissue to bone |
US6066142A (en) * | 1998-10-22 | 2000-05-23 | Depuy Orthopaedics, Inc. | Variable position bone drilling alignment guide |
US6193721B1 (en) * | 1997-02-11 | 2001-02-27 | Gary K. Michelson | Multi-lock anterior cervical plating system |
US6210415B1 (en) * | 2000-02-18 | 2001-04-03 | Lab Engineering & Manufacturing, Inc. | Surgical drill guide |
US6235034B1 (en) * | 1997-10-24 | 2001-05-22 | Robert S. Bray | Bone plate and bone screw guide mechanism |
US6238400B1 (en) * | 1998-05-01 | 2001-05-29 | Medtronic Xomed, Inc. | Method and apparatus for trephination and irrigation of the frontal sinus cavity |
US6241729B1 (en) * | 1998-04-09 | 2001-06-05 | Sdgi Holdings, Inc. | Method and instrumentation for posterior interbody fusion |
US6258091B1 (en) * | 1996-02-14 | 2001-07-10 | Walter Lorenz Surgical Inc. | Bone fastener and instrument for insertion thereof |
US6342056B1 (en) * | 2000-02-04 | 2002-01-29 | Jean-Marc Mac-Thiong | Surgical drill guide and method for using the same |
US6342057B1 (en) * | 2000-04-28 | 2002-01-29 | Synthes (Usa) | Remotely aligned surgical drill guide |
US20020022847A1 (en) * | 1998-04-09 | 2002-02-21 | Ray Eddie F. | Methods and instrumentation for vertebral interbody fusion |
US6361537B1 (en) * | 2001-05-18 | 2002-03-26 | Cinci M. Anderson | Surgical plate with pawl and process for repair of a broken bone |
US6371959B1 (en) * | 2000-04-05 | 2002-04-16 | Michael E. Trice | Radiolucent position locating device and drill guide |
US6379364B1 (en) * | 2000-04-28 | 2002-04-30 | Synthes (Usa) | Dual drill guide for a locking bone plate |
US6383186B1 (en) * | 1997-02-11 | 2002-05-07 | Gary K. Michelson | Single-lock skeletal plating system |
US20020082606A1 (en) * | 2000-12-21 | 2002-06-27 | Loubert Suddaby | Drill guide |
US6417678B2 (en) * | 1998-09-10 | 2002-07-09 | Shimadzu Corporation | Bridge circuit for detector |
US6416518B1 (en) * | 2001-07-09 | 2002-07-09 | Imp Inc. | Combined surgical drill and surgical screw guide |
US20020120273A1 (en) * | 1999-10-13 | 2002-08-29 | Needham Dusty Anna | Anterior cervical plating system and method |
US6524312B2 (en) * | 2000-01-06 | 2003-02-25 | Spinal Concepts, Inc. | Instrument and method for implanting an interbody fusion device |
US6524238B2 (en) * | 2000-12-20 | 2003-02-25 | Synthes Usa | Universal handle and method for use |
US20030040753A1 (en) * | 1997-06-19 | 2003-02-27 | Wolfgang Daum | Cranial guide device and methods |
US20030040748A1 (en) * | 2001-08-24 | 2003-02-27 | Aikins Jerry L. | Blade plate and instruments |
US20030040752A1 (en) * | 2001-08-21 | 2003-02-27 | Kitchens David Gregory | Method and apparatus for percutaneously securing a bone screw and a bone plate to a bone of a patient |
US20030055430A1 (en) * | 2001-09-14 | 2003-03-20 | Kim Kee D. | System and method for fusing spinal vertebrae |
US20030083661A1 (en) * | 2000-02-01 | 2003-05-01 | Hand Innovations, Inc. | Intramedullary fixation device for metaphyseal long bone fractures and methods of using the same |
US20030083667A1 (en) * | 2001-10-31 | 2003-05-01 | Ralph James D. | Polyaxial drill guide |
US6558089B2 (en) * | 2001-09-14 | 2003-05-06 | Deblasio Michael J. | Extender assembly for core drill |
US6562046B2 (en) * | 1999-11-23 | 2003-05-13 | Sdgi Holdings, Inc. | Screw delivery system and method |
US6565571B1 (en) * | 1998-10-19 | 2003-05-20 | Scient'x | Anterior osteosynthesis plate for lumbar vertebrae or sacral lumbar vertebra and instrument for positioning same |
Family Cites Families (78)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US1831813A (en) | 1928-07-02 | 1931-11-17 | Independent Pneumatic Tool Co | Attachment for drills |
US2181746A (en) | 1939-02-04 | 1939-11-28 | John R Siebrandt | Combination bone clamp and adjustable drill guide |
US3540322A (en) | 1968-08-09 | 1970-11-17 | Carl E Swanson | Drill fixtures |
US3867932A (en) * | 1974-01-18 | 1975-02-25 | Donald R Huene | Assembly for inserting rigid shafts into fractured bones |
GB1571713A (en) | 1976-04-21 | 1980-07-16 | Gil J L | Apparatus for use in the treatment of bone fractures |
DE3222037A1 (en) | 1982-06-11 | 1984-04-12 | Messerschmitt-Bölkow-Blohm GmbH, 8012 Ottobrunn | Device for drilling and/or countersinking workpieces |
US4465065A (en) * | 1983-01-07 | 1984-08-14 | Yechiel Gotfried | Surgical device for connection of fractured bones |
USD291246S (en) | 1985-03-05 | 1987-08-04 | Zimmer, Inc. | Drill guide instrument for surgical use or the like |
CH655646A5 (en) | 1985-04-18 | 1986-05-15 | Hans Ulrich | Surgical forceps for osteosynthesis |
DE3534747A1 (en) | 1985-09-28 | 1987-04-09 | Hasselbach Christoph Von | THIGH NECK IMPLANT |
DD258359A5 (en) | 1986-04-01 | 1988-07-20 | Stabilizer for adjusting the drilling when drilling holes in the bone | |
FR2598311B1 (en) | 1986-05-07 | 1988-09-09 | Laboureau Jacques | SURGICAL INSTRUMENT FOR FOCUSING AND PLACING THE PLASTY (OR PROSTHETIC REPLACEMENT) OF THE LIGAMENT CROSS POSTERIOR KNEE |
US4872451A (en) | 1987-02-02 | 1989-10-10 | Moore Robert R | Glenohumeral ligament repair |
JPH02236331A (en) | 1989-03-09 | 1990-09-19 | Mirai Ind Co Ltd | Insert for steel deck and fixing method thereof |
US4969781A (en) | 1989-04-07 | 1990-11-13 | The B. F. Goodrich Company | Blind fastener hand tool |
US5071293A (en) | 1989-10-30 | 1991-12-10 | Mcdonnell Douglas Corporation | Feed rate regulator for a hand-held drill |
DD293261A5 (en) | 1990-04-06 | 1991-08-29 | Veb Komb. Medizin- U. Labortechnik,De | DRILLING FOR PLATE FIXATEUR |
US5054968A (en) | 1990-10-18 | 1991-10-08 | Dresser Industries, Inc. | Mechanical positive feed drill with supported spindle |
IE920024A1 (en) | 1991-01-15 | 1992-07-15 | Pfizer Hospital Prod | Surgical drill guide |
US5147367A (en) | 1991-02-22 | 1992-09-15 | Ellis Alfred B | Drill pin guide and method for orthopedic surgery |
JP3192147B2 (en) | 1991-12-03 | 2001-07-23 | ボストン サイエンティフィック アイルランド リミテッド,バーバドス ヘッド オフィス | Bone anchor insertion device |
US5154720A (en) | 1992-02-19 | 1992-10-13 | Linvatec Corporation | Surgical drill guide |
US5250055A (en) | 1992-06-08 | 1993-10-05 | Orthopedic Systems Inc. | Method and apparatus for tying suture to bone |
DE4238582A1 (en) | 1992-11-16 | 1994-05-19 | Erwin Prof Dr Med Brug | Guide for boring holes in bones - has block with two guide holes mounted on system of arms with spherical joints |
US5342363A (en) * | 1992-11-30 | 1994-08-30 | Wright Medical Technology, Inc. | Medical instrument and procedure |
US5364399A (en) | 1993-02-05 | 1994-11-15 | Danek Medical, Inc. | Anterior cervical plating system |
DE9308276U1 (en) * | 1993-06-02 | 1993-08-05 | Weber, Gerhard, 78727 Oberndorf, De | |
FR2713473A1 (en) | 1993-12-13 | 1995-06-16 | Caffiniere De Jean Yves | Posterior vertebral osteosynthesis system |
USD357534S (en) * | 1993-12-15 | 1995-04-18 | Zimmer, Inc. | Surgical parallel drill guide instrument |
US5458602A (en) | 1994-01-11 | 1995-10-17 | Mitek Surgical Products, Inc. | Surgical drill guide |
USD359557S (en) * | 1994-02-09 | 1995-06-20 | Zimmer, Inc. | Orthopaedic drill guide |
DE4419894A1 (en) * | 1994-06-07 | 1995-12-14 | Gip Medizin Technik Gmbh | Endoscopic puncture needle with elastic catheter |
WO1996005778A1 (en) | 1994-08-23 | 1996-02-29 | Spinetech, Inc. | Cervical spine stabilization system |
US5681311A (en) | 1994-09-15 | 1997-10-28 | Smith & Nephew, Inc. | Osteosynthesis apparatus |
SE506404C2 (en) | 1994-11-22 | 1997-12-15 | Lars Johan Henrik Hansson | Control instruments intended for fixing bone fragments in case of bone fracture |
US5584839A (en) | 1994-12-12 | 1996-12-17 | Gieringer; Robert E. | Intraarticular drill guide and arthroscopic methods |
WO1996020650A1 (en) | 1995-01-06 | 1996-07-11 | Synthes Ag, Chur | Cooled drill bushing |
US5873289A (en) * | 1995-03-06 | 1999-02-23 | Jarvis; Jack D. | Releasable locking connector for tool |
DE29504857U1 (en) | 1995-03-22 | 1995-05-18 | Aesculap Ag | Drilling jig for surgical drilling tools |
FR2735008A1 (en) | 1995-06-07 | 1996-12-13 | Jbs Sa | Surgical instrument for inter vertebral arthrodesis |
DE59509247D1 (en) * | 1995-09-06 | 2001-06-13 | Synthes Ag | BONE PLATE |
US6007535A (en) | 1996-01-03 | 1999-12-28 | John M. Rayhack | Multi-plane bone distraction system |
USD397220S (en) | 1996-03-28 | 1998-08-18 | Zimmer, Inc. | Orthopaedic alignment tool |
US6491714B1 (en) | 1996-05-03 | 2002-12-10 | William F. Bennett | Surgical tissue repair and attachment apparatus and method |
USD382056S (en) | 1996-05-15 | 1997-08-05 | Ethicon, Inc. | Arthoscopic drill guide |
US5700267A (en) | 1996-08-15 | 1997-12-23 | Kinetikos Medical Incorporated | Method for repairing bone fractures using bone-lock system |
USD398996S (en) | 1997-02-27 | 1998-09-29 | Smith & Nephew, Inc. | Threaded screw cannula |
IT1290011B1 (en) | 1997-03-03 | 1998-10-19 | Cembre Spa | DRILL FOR BORING CROSSBARS, PARTICULARLY FOR USE IN THE RAILWAY SECTOR |
DE19719052C1 (en) | 1997-05-06 | 1998-08-06 | Thomas Dr Gausepohl | Marrow-chamber-preparation awl for hip-pinning |
ZA983955B (en) | 1997-05-15 | 2001-08-13 | Sdgi Holdings Inc | Anterior cervical plating system. |
US5851207A (en) | 1997-07-01 | 1998-12-22 | Synthes (U.S.A.) | Freely separable surgical drill guide and plate |
FR2766353B1 (en) | 1997-07-28 | 1999-11-26 | Dimso Sa | IMPLANT, ESPECIALLY ANTERIOR CERVICAL PLATE |
US5954722A (en) | 1997-07-29 | 1999-09-21 | Depuy Acromed, Inc. | Polyaxial locking plate |
USD404126S (en) * | 1997-12-01 | 1999-01-12 | Asfora Wilson T | Surgical drill guide |
US5957927A (en) | 1998-02-24 | 1999-09-28 | Synthes (Usa) | Bone fixation device introducer |
US6494913B1 (en) * | 1998-03-17 | 2002-12-17 | Acumed, Inc. | Shoulder prosthesis |
EP1069864B1 (en) | 1998-04-09 | 2004-09-01 | SDGI Holdings, Inc. | Vertebral body distraction device |
US5947654A (en) | 1998-04-14 | 1999-09-07 | Mcdonnell Douglas Corporation | Drill/countersink nosepiece assembly |
US5976145A (en) * | 1998-06-01 | 1999-11-02 | Johnson & Johnson Professional, Inc. | Calcar milling guide and system |
US5951561A (en) | 1998-06-30 | 1999-09-14 | Smith & Nephew, Inc. | Minimally invasive intramedullary nail insertion instruments and method |
FR2784570B1 (en) | 1998-10-19 | 2001-02-16 | Scient X | INTERVERTEBRAL CONNECTION DEVICE HAVING ANTI-EXTRACTION MEANS FOR ANCHORAGE SCREWS |
US6113637A (en) | 1998-10-22 | 2000-09-05 | Sofamor Danek Holdings, Inc. | Artificial intervertebral joint permitting translational and rotational motion |
DE19851370C2 (en) | 1998-11-07 | 2000-09-21 | Aesculap Ag & Co Kg | Endoscopic insertion instruments |
DE19858889B4 (en) | 1998-12-19 | 2008-08-07 | Wolter, Dietmar, Prof. Dr.Med. | Fixation system for bones |
USD433506S (en) | 1999-06-04 | 2000-11-07 | Asfora Wilson T | Double drill guide |
FR2795621B1 (en) | 1999-07-01 | 2001-11-30 | Vanacker Gerard | VERTEBRAL OSTEOSYNTHESIS PLATE, OSTEOSYNTHESIS SYSTEM, AND METHOD USING SUCH A PLATE |
DK1211992T3 (en) * | 1999-09-13 | 2004-05-10 | Synthes Ag | Bone Plate System |
US6692503B2 (en) | 1999-10-13 | 2004-02-17 | Sdgi Holdings, Inc | System and method for securing a plate to the spinal column |
JP2001245894A (en) | 2000-03-03 | 2001-09-11 | Masashi Sakamoto | Operation instrument for fracture of olecranon |
US6283969B1 (en) | 2000-03-10 | 2001-09-04 | Wright Medical Technology, Inc. | Bone plating system |
US6330845B1 (en) | 2000-05-17 | 2001-12-18 | Bristol-Myers Squibb | Wrench for an implant |
EP1299679B1 (en) | 2000-07-03 | 2007-02-07 | Rick C. Hunter | Enclosure thermal shield |
US6419678B1 (en) | 2000-11-28 | 2002-07-16 | Wilson T. Asfora | Curved drill guide system |
US6475190B2 (en) | 2001-01-23 | 2002-11-05 | Ispg, Inc. | Needle assembly including a retractable sheath |
CA2442967A1 (en) | 2001-04-06 | 2002-10-17 | Sdgi Holdings, Inc. | Anterior plating system and method |
FR2823096B1 (en) | 2001-04-06 | 2004-03-19 | Materiel Orthopedique En Abreg | PLATE FOR LTE AND LTE VERTEBRATE OSTEOSYNTHESIS DEVICE, OSTEOSYNTHESIS DEVICE INCLUDING SUCH A PLATE, AND INSTRUMENT FOR LAYING SUCH A PLATE |
WO2002098277A2 (en) | 2001-06-04 | 2002-12-12 | Michelson Gary K | Anterior cervical plate system having vertebral body engaging anchors, connecting plate, and method for installation thereof |
US6960216B2 (en) * | 2003-03-21 | 2005-11-01 | Depuy Acromed, Inc. | Modular drill guide |
-
2003
- 2003-07-16 US US10/619,472 patent/US7731721B2/en active Active
-
2004
- 2004-04-30 US US10/837,085 patent/US20050015093A1/en not_active Abandoned
- 2004-07-16 BR BRPI0412677-7A patent/BRPI0412677A/en not_active IP Right Cessation
- 2004-07-16 WO PCT/US2004/023193 patent/WO2005009487A2/en active Application Filing
- 2004-07-16 AT AT04757129T patent/ATE498368T1/en active
- 2004-07-16 ES ES04757129T patent/ES2363270T3/en active Active
- 2004-07-16 AU AU2004258937A patent/AU2004258937A1/en not_active Abandoned
- 2004-07-16 ZA ZA200600858A patent/ZA200600858B/en unknown
- 2004-07-16 DE DE602004031429T patent/DE602004031429D1/en active Active
- 2004-07-16 EP EP04757129A patent/EP1651122B1/en active Active
- 2004-07-16 KR KR1020067001039A patent/KR20060035762A/en not_active Application Discontinuation
- 2004-07-16 PL PL04757129T patent/PL1651122T3/en unknown
- 2004-07-16 CN CNA2004800266847A patent/CN1909849A/en active Pending
- 2004-07-16 CA CA002532747A patent/CA2532747A1/en not_active Abandoned
- 2004-07-16 JP JP2006520409A patent/JP2007523693A/en active Pending
Patent Citations (99)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US2200120A (en) * | 1938-04-30 | 1940-05-07 | Walter W Nauth | Fracture nail guide |
US2424485A (en) * | 1944-07-03 | 1947-07-22 | Thomas W Maskell | Adjustable jig bushing |
US2494229A (en) * | 1946-07-08 | 1950-01-10 | John G Collison | Bone surgery |
US2607339A (en) * | 1950-04-07 | 1952-08-19 | James W Price | Adjustable fracture nail guide |
US2674906A (en) * | 1950-08-31 | 1954-04-13 | Robert F Krainz | Hole spacing attachment for drill presses |
US2670637A (en) * | 1951-07-18 | 1954-03-02 | Frank M Hardy | Drill guide |
US3071030A (en) * | 1961-06-06 | 1963-01-01 | Star Cutter Company | Hole forming or enlarging assembly |
US3727611A (en) * | 1971-07-01 | 1973-04-17 | R Schultz | Alignment means for inserting guide wire prior to inserting hip nail for a fractured hip |
US4388921A (en) * | 1980-05-28 | 1983-06-21 | Institut Straumann Ag | Device comprising a plate and screws for fastening a plate to a bone |
US4493317A (en) * | 1980-11-20 | 1985-01-15 | Synthes Ltd. (U.S.A.) | Surgical compression plate and drill guide |
US4450835A (en) * | 1981-02-20 | 1984-05-29 | Howmedica, Inc. | Method and system for inserting a surgical wire |
US4646413A (en) * | 1985-06-18 | 1987-03-03 | Tri Tool Inc. | Tube extractor drill jig |
US4803976A (en) * | 1985-10-03 | 1989-02-14 | Synthes | Sighting instrument |
US4668134A (en) * | 1986-01-13 | 1987-05-26 | P. V. Tool, Inc. | Apparatus for orientation of tool on workpiece |
US4744353A (en) * | 1986-04-18 | 1988-05-17 | Mcfarland Joseph R | Method for attaching soft tissue to bone tissue |
US4911153A (en) * | 1988-02-04 | 1990-03-27 | Biomet, Inc. | Orthopedic surgical instrument |
US4898502A (en) * | 1988-09-29 | 1990-02-06 | Reinhard Becher | Mechanical drilling aid |
US4941781A (en) * | 1988-09-29 | 1990-07-17 | Reinhard Becher | Mechanical drilling aid |
US5030219A (en) * | 1990-01-22 | 1991-07-09 | Boehringer Mannheim Corporation | Glenoid component installation tools |
US5507801A (en) * | 1990-06-06 | 1996-04-16 | Synthes (U.S.A.) | Compression drill guide |
US5026376A (en) * | 1990-07-13 | 1991-06-25 | Greenberg Alex M | Surgical drill guide and retractor |
US5888034A (en) * | 1990-07-13 | 1999-03-30 | Greenberg; Alex M. | Drill mountable drill guide |
US5743916A (en) * | 1990-07-13 | 1998-04-28 | Human Factors Industrial Design, Inc. | Drill guide with removable ferrules |
US5133720A (en) * | 1990-07-13 | 1992-07-28 | Greenberg Alex M | Surgical drill guide and retractor |
US5746743A (en) * | 1990-07-13 | 1998-05-05 | Greenberg Surgical Technologies, Llc | Single-handed surgical drill depth guide with mandibular retractor |
US5409493A (en) * | 1990-07-13 | 1995-04-25 | Greenberg; Alex M. | Single-handed surgical drill depth guide |
US6019767A (en) * | 1990-07-16 | 2000-02-01 | Arthrotek | Tibial guide |
US5207753A (en) * | 1991-02-18 | 1993-05-04 | Kannivelu Badrinath | Bone fracture repair apparatus and method |
US5112336A (en) * | 1991-05-14 | 1992-05-12 | Intermedics Orthopedics, Inc. | Drill guide and template for prosthetic devices |
US5281056A (en) * | 1991-07-15 | 1994-01-25 | Cooper Industries, Inc. | Indexing nose couple |
US5938686A (en) * | 1991-12-03 | 1999-08-17 | Boston Scientific Technology, Inc. | Method of installing bone anchor |
US5766221A (en) * | 1991-12-03 | 1998-06-16 | Boston Scientific Technology, Inc. | Bone anchor implantation device |
US5749884A (en) * | 1991-12-03 | 1998-05-12 | Boston Scientific Technology, Inc. | Bone anchor implantation device and method |
US5746763A (en) * | 1991-12-03 | 1998-05-05 | Boston Scientific Technology, Inc. | Device for supporting and positioning medical equipment |
US5324295A (en) * | 1992-04-24 | 1994-06-28 | Shapiro Michael R | Drill guide for surgical pins |
US5637112A (en) * | 1992-06-08 | 1997-06-10 | Orthopedic Systems, Inc. | Apparatus for attaching suture to bone |
US5306278A (en) * | 1992-09-11 | 1994-04-26 | Ace Medical Company | Corticotomy drill guide |
US5437677A (en) * | 1992-10-09 | 1995-08-01 | Minnesota Mining And Manufacturing Company | Glenoid alignment guide |
US5312412A (en) * | 1993-02-03 | 1994-05-17 | Whipple Terry L | Fixation alignment guide for surgical use |
US5423826A (en) * | 1993-02-05 | 1995-06-13 | Danek Medical, Inc. | Anterior cervical plate holder/drill guide and method of use |
US5595193A (en) * | 1993-02-12 | 1997-01-21 | Walus; Richard L. | Tool for implanting a fiducial marker |
US5429641A (en) * | 1993-03-28 | 1995-07-04 | Gotfried; Yechiel | Surgical device for connection of fractured bones |
US5484446A (en) * | 1994-06-27 | 1996-01-16 | Zimmer, Inc. | Alignment guide for use in orthopaedic surgery |
US5601553A (en) * | 1994-10-03 | 1997-02-11 | Synthes (U.S.A.) | Locking plate and bone screw |
US5601550A (en) * | 1994-10-25 | 1997-02-11 | Esser; Rene D. | Pelvic pin guide system for insertion of pins into iliac bone |
US6193723B1 (en) * | 1994-12-16 | 2001-02-27 | Exactech, Inc. | Intramedullary alignment guide tool |
US5910143A (en) * | 1994-12-16 | 1999-06-08 | Exactech, Inc. | Intramedullary alignment guide tool |
US5624447A (en) * | 1995-03-20 | 1997-04-29 | Othy, Inc. | Surgical tool guide and entry hole positioner |
US5634927A (en) * | 1995-07-06 | 1997-06-03 | Zimmer, Inc. | Sizing plate and drill guide assembly for orthopaedic knee instrumentation |
US20020004661A1 (en) * | 1996-02-14 | 2002-01-10 | Sevrain Lionel C. | Bone fastener and instrument for insertion thereof |
US6258091B1 (en) * | 1996-02-14 | 2001-07-10 | Walter Lorenz Surgical Inc. | Bone fastener and instrument for insertion thereof |
US5722978A (en) * | 1996-03-13 | 1998-03-03 | Jenkins, Jr.; Joseph Robert | Osteotomy system |
US5755721A (en) * | 1996-03-13 | 1998-05-26 | Synthes | Plate holding drill guide and trocar and method of holding a plate |
US6206886B1 (en) * | 1996-05-03 | 2001-03-27 | William F. Bennett | Arthroscopic rotator cuff repair apparatus and method |
US5769856A (en) * | 1996-06-24 | 1998-06-23 | Osteonics Corp. | Drill guide and implant method |
US5725532A (en) * | 1996-09-10 | 1998-03-10 | Shoemaker; Steven | Integrated surgical reduction clamp and drill guide |
US5895390A (en) * | 1996-09-19 | 1999-04-20 | Biomet, Inc. | Pin placement guide used in making a bone entry hole for implantation of an intramedullary nail |
US5741266A (en) * | 1996-09-19 | 1998-04-21 | Biomet, Inc. | Pin placement guide and method of making a bone entry hole for implantation of an intramedullary nail |
US20030018335A1 (en) * | 1997-02-11 | 2003-01-23 | Michelson Gary K. | Anterior cervical plate system |
US20030045880A1 (en) * | 1997-02-11 | 2003-03-06 | Michelson Gary K. | Anterior cervical plate system |
US6193721B1 (en) * | 1997-02-11 | 2001-02-27 | Gary K. Michelson | Multi-lock anterior cervical plating system |
US6428542B1 (en) * | 1997-02-11 | 2002-08-06 | Gary K. Michelson | Single-lock anterior cervical plate |
US6527776B1 (en) * | 1997-02-11 | 2003-03-04 | Gary K. Michelson | Locking element for locking at least two bone screws to an orthopedic device |
US6416528B1 (en) * | 1997-02-11 | 2002-07-09 | Gary K. Michelson | Anterior cervical plating system, instrumentation, and method of installation |
US6398783B1 (en) * | 1997-02-11 | 2002-06-04 | Sulzer Spine-Tech Inc. | Multi-lock anterior cervical plate |
US6383186B1 (en) * | 1997-02-11 | 2002-05-07 | Gary K. Michelson | Single-lock skeletal plating system |
US20020045896A1 (en) * | 1997-02-11 | 2002-04-18 | Michelson Gary K. | Anterior cervical plating system, instrumentation, and method of installation |
US6013083A (en) * | 1997-05-02 | 2000-01-11 | Bennett; William F. | Arthroscopic rotator cuff repair apparatus and method |
US20030040753A1 (en) * | 1997-06-19 | 2003-02-27 | Wolfgang Daum | Cranial guide device and methods |
US6235034B1 (en) * | 1997-10-24 | 2001-05-22 | Robert S. Bray | Bone plate and bone screw guide mechanism |
US6036696A (en) * | 1997-12-19 | 2000-03-14 | Stryker Technologies Corporation | Guide-pin placement device and method of use |
US5913860A (en) * | 1998-02-27 | 1999-06-22 | Synthes (Usa) | Surgical nail inserter |
US20020022847A1 (en) * | 1998-04-09 | 2002-02-21 | Ray Eddie F. | Methods and instrumentation for vertebral interbody fusion |
US6241729B1 (en) * | 1998-04-09 | 2001-06-05 | Sdgi Holdings, Inc. | Method and instrumentation for posterior interbody fusion |
US6238400B1 (en) * | 1998-05-01 | 2001-05-29 | Medtronic Xomed, Inc. | Method and apparatus for trephination and irrigation of the frontal sinus cavity |
US6059789A (en) * | 1998-06-22 | 2000-05-09 | Xomed Surgical Products, Inc. | Drill guide for creating a tunnel in bone for fixating soft tissue to the bone and kit and method for fixating soft tissue to bone |
US6417678B2 (en) * | 1998-09-10 | 2002-07-09 | Shimadzu Corporation | Bridge circuit for detector |
US6565571B1 (en) * | 1998-10-19 | 2003-05-20 | Scient'x | Anterior osteosynthesis plate for lumbar vertebrae or sacral lumbar vertebra and instrument for positioning same |
US6066142A (en) * | 1998-10-22 | 2000-05-23 | Depuy Orthopaedics, Inc. | Variable position bone drilling alignment guide |
US6533786B1 (en) * | 1999-10-13 | 2003-03-18 | Sdgi Holdings, Inc. | Anterior cervical plating system |
US20020120273A1 (en) * | 1999-10-13 | 2002-08-29 | Needham Dusty Anna | Anterior cervical plating system and method |
US6562046B2 (en) * | 1999-11-23 | 2003-05-13 | Sdgi Holdings, Inc. | Screw delivery system and method |
US6524312B2 (en) * | 2000-01-06 | 2003-02-25 | Spinal Concepts, Inc. | Instrument and method for implanting an interbody fusion device |
US20030083661A1 (en) * | 2000-02-01 | 2003-05-01 | Hand Innovations, Inc. | Intramedullary fixation device for metaphyseal long bone fractures and methods of using the same |
US6342056B1 (en) * | 2000-02-04 | 2002-01-29 | Jean-Marc Mac-Thiong | Surgical drill guide and method for using the same |
US6210415B1 (en) * | 2000-02-18 | 2001-04-03 | Lab Engineering & Manufacturing, Inc. | Surgical drill guide |
US6371959B1 (en) * | 2000-04-05 | 2002-04-16 | Michael E. Trice | Radiolucent position locating device and drill guide |
US6379364B1 (en) * | 2000-04-28 | 2002-04-30 | Synthes (Usa) | Dual drill guide for a locking bone plate |
US6342057B1 (en) * | 2000-04-28 | 2002-01-29 | Synthes (Usa) | Remotely aligned surgical drill guide |
US6524238B2 (en) * | 2000-12-20 | 2003-02-25 | Synthes Usa | Universal handle and method for use |
US6436103B1 (en) * | 2000-12-21 | 2002-08-20 | Loubert Suddaby | Drill guide and plate attachment mechanism for orthopedic plating |
US20020082606A1 (en) * | 2000-12-21 | 2002-06-27 | Loubert Suddaby | Drill guide |
US6361537B1 (en) * | 2001-05-18 | 2002-03-26 | Cinci M. Anderson | Surgical plate with pawl and process for repair of a broken bone |
US6416518B1 (en) * | 2001-07-09 | 2002-07-09 | Imp Inc. | Combined surgical drill and surgical screw guide |
US20030040752A1 (en) * | 2001-08-21 | 2003-02-27 | Kitchens David Gregory | Method and apparatus for percutaneously securing a bone screw and a bone plate to a bone of a patient |
US20030040748A1 (en) * | 2001-08-24 | 2003-02-27 | Aikins Jerry L. | Blade plate and instruments |
US20030055430A1 (en) * | 2001-09-14 | 2003-03-20 | Kim Kee D. | System and method for fusing spinal vertebrae |
US6558089B2 (en) * | 2001-09-14 | 2003-05-06 | Deblasio Michael J. | Extender assembly for core drill |
US20030083667A1 (en) * | 2001-10-31 | 2003-05-01 | Ralph James D. | Polyaxial drill guide |
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US10631884B2 (en) | 2017-06-05 | 2020-04-28 | Conmed Corporation | Multi-barrel drill guide |
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Also Published As
Publication number | Publication date |
---|---|
DE602004031429D1 (en) | 2011-03-31 |
PL1651122T3 (en) | 2011-11-30 |
AU2004258937A1 (en) | 2005-02-03 |
WO2005009487A2 (en) | 2005-02-03 |
BRPI0412677A (en) | 2006-10-03 |
ES2363270T3 (en) | 2011-07-28 |
EP1651122A2 (en) | 2006-05-03 |
WO2005009487A3 (en) | 2005-10-20 |
US7731721B2 (en) | 2010-06-08 |
EP1651122A4 (en) | 2008-08-13 |
KR20060035762A (en) | 2006-04-26 |
ZA200600858B (en) | 2007-07-25 |
JP2007523693A (en) | 2007-08-23 |
CN1909849A (en) | 2007-02-07 |
ATE498368T1 (en) | 2011-03-15 |
EP1651122B1 (en) | 2011-02-16 |
CA2532747A1 (en) | 2005-02-03 |
US20050015092A1 (en) | 2005-01-20 |
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