US20050137596A1 - Spinal-column buttress plate assembly and method for attachment - Google Patents
Spinal-column buttress plate assembly and method for attachment Download PDFInfo
- Publication number
- US20050137596A1 US20050137596A1 US10/918,678 US91867804A US2005137596A1 US 20050137596 A1 US20050137596 A1 US 20050137596A1 US 91867804 A US91867804 A US 91867804A US 2005137596 A1 US2005137596 A1 US 2005137596A1
- Authority
- US
- United States
- Prior art keywords
- buttress plate
- bone screw
- screw
- bone
- vertebral body
- Prior art date
- 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
Links
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7059—Cortical plates
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
- A61B17/8038—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers the additional component being inserted in the screw head
Definitions
- the present invention relates generally to medical apparatus and procedures, and more particularly to apparatus and a method which attaches a spinal-column buttress plate to two vertebral bodies of a spinal column of a medical patient.
- Conventional medical procedures include attaching together (sometimes called fusing) first and second vertebral bodies of a spinal column (such as adjacent first and second cervical vertebral bodies of the cervical column portion of the spinal column) of a medical patient.
- a spinal-vertebral buttress plate (such as a cervical-vertebral buttress plate) of appropriate length is obtained.
- the buttress plate is positioned on the anterior side of the first and second vertebral bodies.
- the buttress plate comes with pre-drilled holes.
- first and second holes, of the positioned buttress plate which are aligned over the first vertebral body, first and second starter holes are marked and drilled on the anterior cortex of the first vertebral body.
- third and fourth starter holes are marked and drilled on the anterior cortex of the second vertebral body.
- a first bone screw is inserted in the first hole and a second bone screw is inserted in the second hole of the buttress plate and threaded into the corresponding starter hole in the anterior cortex of the first vertebral body, and a third bone screw is inserted in the third hole and a fourth bone screw is inserted in the fourth hole of the buttress plate and threaded into the corresponding starter hole in the anterior cortex of the second vertebral body.
- the first and second vertebral bodies With the four bone screws securing the spinal-column buttress plate to the first and second vertebral bodies, the first and second vertebral bodies are thereby attached together (or fused) preventing their relative movement. Attachment problems arise when the pre-drilled holes of the spinal-column buttress plate are only alignable over a non-optimum area of the first and/or second vertebral body.
- a spinal-column buttress plate assembly such as a cervical-column buttress plate assembly
- a method for attachment which provides better attachment of the spinal-column (e.g., cervical-column) buttress plate to the first and second vertebral bodies (e.g., the first and second cervical vertebral bodies.
- a first expression of a preferred embodiment of the invention is for a cervical-column buttress plate assembly for fusing together first and second cervical vertebral bodies of a cervical column of a medical patient.
- the buttress plate assembly includes a first cervical-vertebral buttress plate, a first screw assembly, and a second screw assembly.
- the cervical-vertebral buttress plate has an elongated slot with opposing and serrated edges.
- the first screw assembly includes a first bone screw and a first inner screw.
- the first bone screw has an internally-threaded hole, has an externally-threaded shaft which is threadably insertable into the first cervical vertebral body of the cervical column of the medical patient and which has an expandable tip, and has an expandable head which is attached to the shaft and which has external teeth.
- the second screw assembly has a second bone screw and a second inner screw.
- the second bone screw has an internally-threaded hole, has an externally-threaded shaft which is threadably insertable into the second cervical vertebral body of the cervical column of the medical patient and which has an expandable tip, and has an expandable head which is attached to the shaft and which has external teeth.
- the first and second inner screws are engageable, respectively, in the internally-threaded holes of the first and second bone screws to expand the tips of the first and second bone screws against the first and second cervical vertebral bodies and to expand the heads of the first and second bone screws to engage the external teeth of the heads of the first and second bone screws against the opposing and serrated edges of the elongated slot of the buttress plate after the elongated slot of the buttress plate has been disposed to enclose the heads of the first and second bone screws after the first and second bone screws have been threadably inserted into the first and second vertebral bodies.
- a second expression of a preferred embodiment of the invention is for a spinal-column buttress plate assembly for attaching together first and second vertebral bodies of a spinal column of a medical patient.
- the buttress plate assembly includes a spinal-vertebral buttress plate, a first screw assembly, and a second screw assembly.
- the buttress plate has an elongated slot with opposing edges.
- the first screw assembly includes a first bone screw and a first inner screw.
- the first bone screw has an internally-threaded hole, has a shaft which is insertable into the first vertebral body of the spinal column of the medical patient, and has an expandable head which is attached to the shaft and which has a first unexpanded state and a first expanded state.
- the head of the first bone screw is small enough to pass through the elongated slot in the first unexpanded state but not in the first expanded state.
- the second screw assembly includes a second bone screw and a second inner screw.
- the second bone screw has an internally-threaded hole, has a shaft which is insertable into the second vertebral body of the spinal column of the medical patient, and has an expandable head which is attached to the shaft and which has a second unexpanded state and a second expanded state.
- the head of the second bone screw is small enough to pass through the elongated slot in the second unexpanded state but not in the second expanded state.
- the first and second inner screws are engageable, respectively, in the internally-threaded holes of the first and second bone screws to expand the heads of the first and second bone screws to engage the heads of the first and second bone screws against the opposing edges of the elongated slot of the buttress plate after the elongated slot of the buttress plate has been disposed to enclose the heads of the first and second bone screws after the first and second bone screws have been inserted into the first and second vertebral bodies.
- An alternate preferred embodiment is identical to the previously-described second expression of the preferred embodiment except that the buttress plate has first and second elongated slots with the first bone screw associated with the first elongated slot and with the second bone screw associated with the second elongated slot.
- a first expression of a method of the invention is for fusing together first and second vertebral bodies of a spinal column of a medical patient and includes steps a) through h).
- Step a) includes obtaining first and second bone screws each having an internally-threaded hole, each having a shaft with an expandable tip, and each having an expandable head attached to the shaft and having external teeth.
- Step b) includes obtaining first and second inner screws engageable, respectively, with the internally-threaded holes of the first and second bone screws to expand the tips and the heads of the first and second bone screws.
- Step c) includes obtaining a buttress plate having an elongated slot with opposing and serrated edges.
- Step d) includes inserting the first bone screw into the first vertebral body of the spinal column of the medical patient with the head of the first bone screw protruding above the first vertebral body.
- Step e) includes inserting the second bone screw into the second vertebral body of the spinal column of the medical patient with the head of the second bone screw protruding above the second vertebral body.
- Step f) includes placing the buttress plate on the first and second vertebral bodies with the heads of the first and second bone screws disposed in the elongated slot of the buttress plate.
- Step g) includes threading the first inner screw into the internally-threaded hole of the first bone screw expanding the tip of the first bone screw against the first vertebral body and expanding the head of the first bone screw to engage the external teeth of the head of the first bone screw against the opposing and serrated edges of the elongated slot of the buttress plate.
- Step h) includes threading the second inner screw into the internally-threaded hole of the second bone screw expanding the tip of the second bone screw against the second vertebral body and expanding the head of the second bone screw to engage the external teeth of the head of the second bone screw against the opposing and serrated edges of the elongated slot of the buttress plate.
- a second expression of a method of the invention is for attaching together first and second vertebral bodies of a spinal column of a medical patient and includes steps a) through h).
- Step a) includes obtaining first and second bone screws each having an internally-threaded hole, each having a shaft, and each having an expandable head attached to the shaft.
- Step b) includes obtaining first and second inner screws engageable, respectively, with the internally-threaded holes of the first and second bone screws to expand the heads of the first and second bone screws.
- Step c) includes obtaining a buttress plate having an elongated slot with opposing edges.
- Step d) includes inserting the first bone screw into the first vertebral body of the spinal column of the medical patient with the head of the first bone screw protruding above the first vertebral body.
- Step e) includes inserting the second bone screw into the second vertebral body of the spinal column of the medical patient with the head of the second bone screw protruding above the second vertebral body.
- Step f) includes placing the buttress plate on the first and second vertebral bodies with the heads of the first and second bone screws disposed in the elongated slot of the buttress plate.
- Step g) includes threading the first inner screw into the internally-threaded hole of the first bone screw expanding the head of the first bone screw to engage the head of the first bone screw against the opposing edges of the elongated slot of the buttress plate.
- Step h) includes threading the second inner screw into the internally-threaded hole of the second bone screw expanding the head of the second bone screw to engage the head of the second bone screw against the opposing edges of the elongated slot of the buttress plate.
- An alternate second expression of a method of the invention is identical to the previously-described second expression of a method of the invention except that the buttress plate has first and second elongated slots with the first bone screw associated with the first elongated slot and with the second bone screw associated with the second elongated slot.
- a third expression of a method of the invention is for attaching together first and second vertebral bodies of a spinal column of a medical patient and includes steps a) through e).
- Step a) includes obtaining first and second bone screws.
- Step b) includes obtaining a buttress plate.
- Step c) includes inserting the first bone screw into the first vertebral body of the spinal column of the medical patient.
- Step d) includes inserting the second bone screw into the second vertebral body of the spinal column of the medical patient.
- Step e) includes attaching the buttress plate to the first and second bone screws after performing steps a) through d).
- the apparatus and method of the invention allows a physician to choose an optimum location for the first bone screw on the first vertebral body (e.g., on the first cervical vertebral body) and to choose an optimum location for the second bone screw on the second vertebral body (e.g., on the second cervical vertebral body) for maximum attachment strength and mechanical stability. This is accomplished by first installing the bone screws on the vertebral bodies and then securing the buttress plate to the installed bone screws. In comparison, the prior art forces the physician to use pre-drilled holes in the buttress plate which often provide less than optimum attachment locations (providing less attachment strength and less mechanical stability) for the bone screws to be installed in the vertebral bodies.
- FIG. 1 is a schematic, top planar view a preferred embodiment of the buttress plate assembly of the invention (showing a buttress plate and three screw assemblies) attached to three vertebral bodies of a spinal column of a medical patient;
- FIG. 2 is a cross-sectional view of the buttress plate assembly and one of the vertebral bodies of FIG. 1 taken along lines 2 - 2 in FIG. 1 ;
- FIG. 3 is a schematic, top planar view of the buttress plate portion of the buttress plate assembly of FIGS. 1 and 2 ;
- FIG. 4 is a cross-sectional view of the buttress plate of FIG. 3 taken along lines 4 - 4 in FIG. 3 ;
- FIG. 5 is a front elevational view of a bone screw portion of a first screw assembly of FIGS. 1 and 2 ;
- FIG. 6 is a top planar view of the bone screw of FIG. 5 ;
- FIG. 7 is a side elevational view of the bone screw of FIG. 5 ;
- FIG. 8 is a front elevational view of an inner screw portion of the first screw assembly of FIGS. 1 and;
- FIG. 9 is a schematic, top planar view of an alternate preferred embodiment of a buttress plate showing multiple elongated slots having various orientations.
- a preferred embodiment of the invention is for a spinal-column buttress plate assembly 10 for attaching together first and second vertebral bodies 12 and 14 of a spinal column 16 of a medical patient 18 (only a portion of the spinal column of whom is shown in FIG. 1 ).
- the spinal column 16 is a cervical column
- the first and second vertebral bodies 12 and 14 are first and second cervical vertebral bodies
- the spinal-column buttress plate assembly 10 is a cervical-column buttress plate assembly
- the spinal-column buttress plate assembly 10 is for fusing together the first and second cervical vertebral bodies of the cervical column of the medical patient.
- the cervical-column buttress plate assembly is an anterior cervical-column buttress plate assembly.
- the first and second vertebral bodies 12 and 14 are vertebral bodies of an upper back portion and/or a lower back portion of the spinal column.
- the medical patient is a person, although the buttress plate assembly 10 of the invention is applicable to animals having spinal columns with vertebral bodies.
- first (or second) vertebral body means a vertebral body (also known as a vertebral level) and is not limited to a specific vertebral body medically known as the first (or second) vertebral body or level.
- the spinal-column buttress plate assembly 10 of FIGS. 1-8 includes a spinal-vertebral buttress plate 20 , a first screw assembly 22 , and a second screw assembly 24 .
- the spinal-vertebral buttress plate 20 is a cervical-vertebral buttress plate.
- the buttress plate 20 has an elongated (and preferably longitudinal) slot 26 with opposing edges 28 and 30 , and preferably the opposing edges 28 and 30 are opposing and serrated edges.
- the buttress plate 20 comprises (and preferably consists essentially of, and more preferably consists of) titanium or a titanium alloy.
- the first screw assembly 22 includes a first bone screw 32 and a first inner screw 34 having threads which are preferably tapered.
- the first bone screw 32 has an internally-threaded hole 36 which preferably is a through hole coaxially aligned with the longitudinal axis of the first bone screw 32 (not to be confused with the longitudinal axis of the buttress plate).
- the first bone screw 32 also has a shaft 38 which is insertable into the first vertebral body 12 of the spinal column 16 of the medical patient 18 .
- the shaft 38 is an externally-threaded shaft which is threadably insertable into the first vertebral body 12 .
- bone screw includes any elongated member, threaded or non-threaded, which is securable within a bone.
- a starter hole is made by an awl, and the first bone screw 32 is inserted into the starter hole.
- the first bone screw 32 additional has an expandable head 40 attached to the shaft 38 .
- the expandable head 40 has a first unexpanded state and a first expanded state.
- the head 40 of the first bone screw 32 is small enough to pass through the elongated slot 26 in the first unexpanded state but not in the first expanded state.
- the head 40 has a longitudinal slit 42 which allows head expansion.
- the shaft 38 has an expandable tip 44 .
- the tip 44 has a longitudinal slit 46 which allows tip expansion.
- the expandable head 40 has external teeth 48 .
- the second screw assembly 24 shown in FIG. 1 , is substantially identical to the first screw assembly 22 shown in detail in FIGS. 2 and 5 - 8 , and therefore details of the second screw assembly 24 are not separately shown.
- the second screw assembly 24 includes a second bone screw substantially identical to the first bone screw 32 and a second inner screw substantially identical to the first inner screw 34 .
- the second bone screw has an internally-threaded hole which preferably is a through hole coaxially aligned with the longitudinal axis of the second bone screw (not to be confused with the longitudinal axis of the buttress plate).
- the second bone screw also has a shaft which is insertable into the second vertebral body 14 of the spinal column 16 of the medical patient 18 .
- the shaft is an externally-threaded shaft which is threadably insertable into the second vertebral body 14 .
- bone screw includes any elongated member, threaded or non-threaded, which is securable within a bone.
- a starter hole is made by an awl, and the second bone screw is inserted into the starter hole.
- the second bone screw additional has an expandable head attached to the shaft.
- the expandable head has a second unexpanded state and a second expanded state.
- the head of the second bone screw is small enough to pass through the elongated slot in the second unexpanded state but not in the second expanded state.
- the head has a longitudinal slit which allows head expansion.
- the shaft has an expandable tip.
- the tip has a longitudinal slit which allows tip expansion.
- the expandable head has external teeth.
- the first and second inner screws 34 are engageable, respectively, in the internally-threaded holes 36 of the first and second bone screws 32 to expand the heads 40 of the first and second bone screws 32 to engage the heads 40 of the first and second bone screws 32 against the opposing edges 28 and 30 of the buttress plate 20 after the elongated slot 26 of the buttress plate has been disposed to enclose the heads 40 of the first and second bone screws 32 after the first and second bone screws 32 have been inserted into the first and second vertebral bodies 12 and 14 .
- the first and second inner screws 34 are engageable, respectively, in the internally-threaded holes 36 of the first and second bone screws 32 to expand the tips 44 of the first and second bone screws against the first and second cervical vertebral bodies and to expand the heads 40 of the first and second bone screws to engage the external teeth 48 of the heads of the first and second bone screws against the opposing and serrated edges of the buttress plate 20 after the elongated slot of the buttress plate has been disposed to enclose the heads of the first and second bone screws after the first and second bone screws have been threadably inserted into the first and second vertebral bodies.
- the heads 40 have different textured outer surfaces (instead of the preferred longitudinally-extending external teeth) and the opposing edges 28 and 30 have different textured surfaces (instead of the preferred serrations) to have the heads better grip the opposing edges.
- the buttress plate 20 includes claws (i.e., bone claws) 50 engageable with the first and second vertebral bodies 12 and 14 .
- the claws 50 provide the buttress plate 20 with a better grip on the first and second vertebral bodies 12 and 14 .
- the bone claws are located along the prominent edges of the inferior side of the buttress plate 20 .
- the first bone screw 32 includes first means 52 for trapping the first inner screw 34 when the first inner screw 34 is fully engaged in the internally-threaded hole 36 of the first bone screw 32
- the second bone screw includes second means for trapping the second inner screw when the second inner screw is fully engaged in the internally-threaded hole of the second bone screw.
- the second means is substantially identical to the first means 52 , and the first means includes a lip 54 which is attached to, or a monolithic portion of, the shaft 38 .
- Other means include conventional anti-rotation features employed with, or on, conventional bolts and screws, as is known to those skilled in the art.
- a screw cap (which either is separate from or attached to the first inner screw) further secures the first inner screw to the first bone screw preventing screw back out.
- the head 40 of the first bone screw 32 has a substantially rectangular shape
- the head of the second bone screw has a substantially rectangular shape. This will provide a better grip for the expansion of the head 40 against the opposing edges 28 and 30 .
- the spinal-column buttress plate assembly 10 of FIG. 1 includes a third screw assembly 56 , substantially identical to the first screw assembly 22 , whereby the spinal-vertebral buttress plate 20 is also attached to a third vertebral body 58 of the spinal column 16 .
- Different buttress plates may span two or more vertebral bodies depending on the needs of a particular medical application.
- the buttress plate 20 is narrow-waisted over soft tissue regions 60 between the vertebral bodies 12 , 14 , and 58 , as seen in FIG. 1 .
- Each narrow-waisted region of the buttress plate 20 provides a bend zone for inter-operative modification, as can be appreciated by the artisan.
- FIG. 9 An alternate embodiment of the buttress plate 62 is shown in FIG. 9 as including a first elongated slot 64 , a second elongated slot 66 , and additional elongated slots 68 and 70 .
- the head 40 of the first bone screw 32 is small enough to pass through the first elongated slot 64 in the first unexpanded state but not in the first expanded state
- the head of the second bone screw is small enough to pass through the second elongated slot 66 in the second unexpanded state but not in the second expanded state.
- the first elongated slot 64 is disposed to enclose the head 40 of the first bone screw 32
- the second elongated slot 66 is disposed to enclose the head of the second bone screw after the first bone screw 32 has been inserted into the first vertebral body 12 and the second bone screw has been inserted into the second vertebral body 14 .
- the first and second elongated slots 64 and 66 are horizontal slots, but that other applications require that the bone screws be engaged in longitudinal or oblique elongated slots 68 and 70 or in any combination of arbitrarily-aligned elongated slots and/or arbitrarily-located holes.
- a buttress plate 20 for cervical use is a buttress plate having rounded edges, having a length sufficient to span the required number of vertebral bodies to be fused, having a thickness of substantially 3 mm, having a width of substantially 18 mm over a vertebral body, having a width of substantially 10 mm over a soft tissue region, having a slot substantially 25 mm long and 4 mm wide with a substantially 1 mm wide and 1 mm deep chamfered perimeter extension.
- the chamfered perimeter extension allows the first inner screw 34 to sit flush with the surface of the buttress plate 20 , as seen in FIG. 2 .
- first bone screw 32 is a bone screw having a length of between substantially 12 and 16 mm, having a diameter of substantially 5 mm which will be positioned perpendicular to the anterior cortex and along the cephalo-caudal midline of each involved vertebral body.
- a typical use is to install the buttress plate after a graft to a soft tissue region so that the installed buttress plate provides intervertebral graft stabilization and fixation of the anterior cervical column.
- a conventional-design adjustable-depth driver is used to insert the first bone screw 32 which prevents the first bone screw 32 from being driven beyond the proper depth into the first vertebral body 12 .
- the buttress plate 20 has an overall lordotic curve in the widthwise direction to match the curve of a vertebral body.
- a first preferred method of the invention is for fusing together first and second vertebral bodies 12 and 14 of a spinal column 16 of a medical patient 18 , and the method includes steps a) through h).
- Step a) includes obtaining first and second bone screws 32 each having an internally-threaded hole 36 , each having a shaft 38 with an expandable tip 44 , and each having an expandable head 40 attached to the shaft 38 and having external teeth 48 .
- Step b) includes obtaining first and second inner screws 34 engageable, respectively, with the internally-threaded holes 36 of the first and second bone screws 32 to expand the tips 44 and the heads 40 of the first and second bone screws 32 .
- Step c) includes obtaining a buttress plate 20 having an elongated slot 26 with opposing and serrated edges.
- Step d) includes inserting the first bone screw 32 into the first vertebral body 12 of the spinal column 16 of the medical patient 18 with the head 40 of the first bone screw 32 protruding above the first vertebral body 12 .
- Step e) includes inserting the second bone screw into the second vertebral body 14 of the spinal column of the medical patient with the head of the second bone screw protruding above the second vertebral body.
- Step f) includes placing the buttress plate 20 on the first and second vertebral bodies 12 and 14 (with or without an intervening layer of something else) with the heads 40 of the first and second bone screws 32 disposed in the elongated slot 26 of the buttress plate 20 .
- Step g) includes threading the first inner screw 34 into the internally-threaded hole 36 of the first bone screw 32 expanding the tip 44 of the first bone screw 32 against the first vertebral body 12 and expanding the head 40 of the first bone screw 32 to engage the external teeth 48 of the head 40 of the first bone screw 32 against the opposing and serrated edges of the elongated slot 26 of the buttress plate 20 .
- Step h) includes threading the second inner screw into the internally-threaded hole of the second bone screw expanding the tip of the second bone screw against the second vertebral body 14 and expanding the head of the second bone screw to engage the external teeth of the head of the second bone screw against the opposing and serrated edges of the buttress plate.
- a second preferred method of the invention is for attaching together first and second vertebral bodies 12 and 14 of a spinal column 16 of a medical patient 18 , and the method includes steps a) through h)
- Step a) includes obtaining first and second bone screws 32 each having an internally-threaded hole 36 , each having a shaft 38 , and each having an expandable head 40 attached to the shaft 38 .
- Step b) includes obtaining first and second inner screws 34 engageable, respectively, with the internally-threaded holes 36 of the first and second bone screws 32 to expand the heads 40 of the first and second bone screws.
- Step c) includes obtaining a buttress plate 20 having an elongated slot 26 with opposing edges 28 and 30 .
- Step d) includes inserting the first bone screw 32 into the first vertebral body 12 of the spinal column 16 of the medical patient 18 with the head 40 of the first bone screw 32 protruding above the first vertebral body 12 .
- Step e) includes inserting the second bone screw into the second vertebral body 14 of the spinal column of the medical patient with the head of the second bone screw protruding above the second vertebral body.
- Step f) includes placing the buttress plate 20 on the first and second vertebral bodies 12 and 14 (with or without an intervening layer of something else) with the heads 40 of the first and second bone screws 32 disposed in the elongated slot 26 of the buttress plate 20 .
- Step g) includes threading the first inner screw 34 into the internally-threaded hole 36 of the first bone screw 32 expanding the head 40 of the first bone screw 32 to engage the head 40 of the first bone screw 32 against the opposing edges 28 and 30 of the elongated slot 26 of the buttress plate 20 .
- Step h) includes threading the second inner screw into the internally-threaded hole of the second bone screw expanding the head of the second bone screw to engage the head of the second bone screw against the opposing edges of the elongated slot of the buttress plate.
- the buttress plate 62 has first and second elongated slots 64 and 66 , and step f) places the buttress plate 62 so that the first bone screw 32 is disposed in the first elongated slot 64 and the second bone screw is disposed in the second elongated slot 66 .
- the first and second vertebral bodies 12 and 14 are adjacent first and second vertebral bodies of the spinal column such as adjacent first and second cervical vertebral bodies of the spinal column.
- step d) inserts the first bone screw 32 into the anterior cortex of the first (e.g., cervical) vertebral body 12
- step e) inserts the second bone screw into the anterior cortex of the second (e.g., cervical) vertebral body.
- step d) inserts the first bone screw 32 into the first (e.g., cervical) vertebral body 12 along the midline of the first (e.g., cervical) vertebral body 12
- step e) inserts the second bone screw into the second (e.g., cervical) vertebral body 14 along the midline of the second (e.g., cervical) vertebral body.
- the buttress plate 20 has claws 50
- step f) includes tamping down the buttress plate 20 to engage the claws 50 into the anterior cortex of the first and second (e.g., cervical) vertebral bodies 12 and 14 .
- a third preferred method of the invention is for attaching together first and second vertebral bodies 12 and 14 of a spinal column 16 of a medical patient 18 , and the method includes steps a) through e).
- Step a) includes obtaining first and second bone screws each having a shaft.
- Step b) includes obtaining a buttress plate.
- Step c) includes inserting the first bone screw into the first vertebral body of the spinal column of the medical patient.
- Step d) includes inserting the second bone screw into the second vertebral body of the spinal column of the medical patient.
- Step e) includes attaching the buttress plate to the first and second bone screws after performing steps a) through d).
- the anterior cervical-column buttress plate is installed following a graft placement to a soft tissue region.
- the anterior aspect of a vertebral body is prepared by removing soft tissue and prominent osteophytes.
- the midline portion of the vertebral body is identified, and an optimum site for screw placement is determined.
- An awl is used to breach the anterior cortex with an awl guide used to ensure that the awl is driven perpendicular to the anterior cortex.
- a bone screw of appropriate length is selected and then is driven into the starter hole to the proper depth using the adjustable-depth driver giving care to place the bone screw perpendicular to the anterior cortex in both the lateral and transverse planes.
- a malleable template is used to determine the appropriate plate length and curvature.
- a buttress plate is selected which is the smallest plate which allows the elongated slot to engage the heads of the bone screws and allows the claws to engage the anterior cortex. Following plate selection, the buttress plate is positioned with the elongated slot(s) over the heads of the bone screws and lightly tamped down onto the anterior cortex. This allows the claws to engage the bone.
- An inner screw of corresponding length is then placed into an installed bone screw. As the tip of the inner screw advances towards the tip of the bone screw, the tip of the bone screw expands, thus increasing the purchase of the screw against the vertebral body.
- the apparatus and method of the invention allows a physician to choose an optimum location for the first bone screw on the first vertebral body (e.g., on the first cervical vertebral body) and to choose an optimum location for the second bone screw on the second vertebral body (e.g., on the second cervical vertebral body) for maximum attachment strength and mechanical stability. This is accomplished by first installing the bone screws on the vertebral bodies and then securing the buttress plate to the installed bone screws. In comparison, the prior art forces the physician to use pre-drilled holes in the buttress plate which often provide less than optimum attachment locations (providing less attachment strength and less mechanical stability) for the bone screws to be installed in the vertebral bodies.
Landscapes
- Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Neurology (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Prostheses (AREA)
- Surgical Instruments (AREA)
Abstract
A spinal-column (e.g., cervical-column) buttress plate assembly and method for attaching together first and second vertebral bodies of a spinal column (e.g., cervical column) of a medical patient. Bone screws are inserted into the vertebral bodies at optimum locations on the vertebral bodies. A buttress plate having an elongated slot is placed on the vertebral bodies so that the heads of the bone screws are positioned in the elongated slot. Inner screws are threaded into the bone screws to expand their heads against the opposing edges of the elongated slot thereby attaching the buttress plate to the vertebral bodies.
Description
- The present invention relates generally to medical apparatus and procedures, and more particularly to apparatus and a method which attaches a spinal-column buttress plate to two vertebral bodies of a spinal column of a medical patient.
- Conventional medical procedures include attaching together (sometimes called fusing) first and second vertebral bodies of a spinal column (such as adjacent first and second cervical vertebral bodies of the cervical column portion of the spinal column) of a medical patient. A spinal-vertebral buttress plate (such as a cervical-vertebral buttress plate) of appropriate length is obtained. The buttress plate is positioned on the anterior side of the first and second vertebral bodies. The buttress plate comes with pre-drilled holes. Using first and second holes, of the positioned buttress plate, which are aligned over the first vertebral body, first and second starter holes are marked and drilled on the anterior cortex of the first vertebral body. Using third and fourth holes, of the positioned buttress plate, which is aligned over the second vertebral body, third and fourth starter holes are marked and drilled on the anterior cortex of the second vertebral body. A first bone screw is inserted in the first hole and a second bone screw is inserted in the second hole of the buttress plate and threaded into the corresponding starter hole in the anterior cortex of the first vertebral body, and a third bone screw is inserted in the third hole and a fourth bone screw is inserted in the fourth hole of the buttress plate and threaded into the corresponding starter hole in the anterior cortex of the second vertebral body. With the four bone screws securing the spinal-column buttress plate to the first and second vertebral bodies, the first and second vertebral bodies are thereby attached together (or fused) preventing their relative movement. Attachment problems arise when the pre-drilled holes of the spinal-column buttress plate are only alignable over a non-optimum area of the first and/or second vertebral body.
- What is needed is a spinal-column buttress plate assembly (such as a cervical-column buttress plate assembly) and a method for attachment which provides better attachment of the spinal-column (e.g., cervical-column) buttress plate to the first and second vertebral bodies (e.g., the first and second cervical vertebral bodies.
- A first expression of a preferred embodiment of the invention is for a cervical-column buttress plate assembly for fusing together first and second cervical vertebral bodies of a cervical column of a medical patient. The buttress plate assembly includes a first cervical-vertebral buttress plate, a first screw assembly, and a second screw assembly. The cervical-vertebral buttress plate has an elongated slot with opposing and serrated edges. The first screw assembly includes a first bone screw and a first inner screw. The first bone screw has an internally-threaded hole, has an externally-threaded shaft which is threadably insertable into the first cervical vertebral body of the cervical column of the medical patient and which has an expandable tip, and has an expandable head which is attached to the shaft and which has external teeth. The second screw assembly has a second bone screw and a second inner screw. The second bone screw has an internally-threaded hole, has an externally-threaded shaft which is threadably insertable into the second cervical vertebral body of the cervical column of the medical patient and which has an expandable tip, and has an expandable head which is attached to the shaft and which has external teeth. The first and second inner screws are engageable, respectively, in the internally-threaded holes of the first and second bone screws to expand the tips of the first and second bone screws against the first and second cervical vertebral bodies and to expand the heads of the first and second bone screws to engage the external teeth of the heads of the first and second bone screws against the opposing and serrated edges of the elongated slot of the buttress plate after the elongated slot of the buttress plate has been disposed to enclose the heads of the first and second bone screws after the first and second bone screws have been threadably inserted into the first and second vertebral bodies.
- A second expression of a preferred embodiment of the invention is for a spinal-column buttress plate assembly for attaching together first and second vertebral bodies of a spinal column of a medical patient. The buttress plate assembly includes a spinal-vertebral buttress plate, a first screw assembly, and a second screw assembly. The buttress plate has an elongated slot with opposing edges. The first screw assembly includes a first bone screw and a first inner screw. The first bone screw has an internally-threaded hole, has a shaft which is insertable into the first vertebral body of the spinal column of the medical patient, and has an expandable head which is attached to the shaft and which has a first unexpanded state and a first expanded state. The head of the first bone screw is small enough to pass through the elongated slot in the first unexpanded state but not in the first expanded state. The second screw assembly includes a second bone screw and a second inner screw. The second bone screw has an internally-threaded hole, has a shaft which is insertable into the second vertebral body of the spinal column of the medical patient, and has an expandable head which is attached to the shaft and which has a second unexpanded state and a second expanded state. The head of the second bone screw is small enough to pass through the elongated slot in the second unexpanded state but not in the second expanded state. The first and second inner screws are engageable, respectively, in the internally-threaded holes of the first and second bone screws to expand the heads of the first and second bone screws to engage the heads of the first and second bone screws against the opposing edges of the elongated slot of the buttress plate after the elongated slot of the buttress plate has been disposed to enclose the heads of the first and second bone screws after the first and second bone screws have been inserted into the first and second vertebral bodies.
- An alternate preferred embodiment is identical to the previously-described second expression of the preferred embodiment except that the buttress plate has first and second elongated slots with the first bone screw associated with the first elongated slot and with the second bone screw associated with the second elongated slot.
- A first expression of a method of the invention is for fusing together first and second vertebral bodies of a spinal column of a medical patient and includes steps a) through h). Step a) includes obtaining first and second bone screws each having an internally-threaded hole, each having a shaft with an expandable tip, and each having an expandable head attached to the shaft and having external teeth. Step b) includes obtaining first and second inner screws engageable, respectively, with the internally-threaded holes of the first and second bone screws to expand the tips and the heads of the first and second bone screws. Step c) includes obtaining a buttress plate having an elongated slot with opposing and serrated edges. Step d) includes inserting the first bone screw into the first vertebral body of the spinal column of the medical patient with the head of the first bone screw protruding above the first vertebral body. Step e) includes inserting the second bone screw into the second vertebral body of the spinal column of the medical patient with the head of the second bone screw protruding above the second vertebral body. Step f) includes placing the buttress plate on the first and second vertebral bodies with the heads of the first and second bone screws disposed in the elongated slot of the buttress plate. Step g) includes threading the first inner screw into the internally-threaded hole of the first bone screw expanding the tip of the first bone screw against the first vertebral body and expanding the head of the first bone screw to engage the external teeth of the head of the first bone screw against the opposing and serrated edges of the elongated slot of the buttress plate. Step h) includes threading the second inner screw into the internally-threaded hole of the second bone screw expanding the tip of the second bone screw against the second vertebral body and expanding the head of the second bone screw to engage the external teeth of the head of the second bone screw against the opposing and serrated edges of the elongated slot of the buttress plate.
- A second expression of a method of the invention is for attaching together first and second vertebral bodies of a spinal column of a medical patient and includes steps a) through h). Step a) includes obtaining first and second bone screws each having an internally-threaded hole, each having a shaft, and each having an expandable head attached to the shaft. Step b) includes obtaining first and second inner screws engageable, respectively, with the internally-threaded holes of the first and second bone screws to expand the heads of the first and second bone screws. Step c) includes obtaining a buttress plate having an elongated slot with opposing edges. Step d) includes inserting the first bone screw into the first vertebral body of the spinal column of the medical patient with the head of the first bone screw protruding above the first vertebral body. Step e) includes inserting the second bone screw into the second vertebral body of the spinal column of the medical patient with the head of the second bone screw protruding above the second vertebral body. Step f) includes placing the buttress plate on the first and second vertebral bodies with the heads of the first and second bone screws disposed in the elongated slot of the buttress plate. Step g) includes threading the first inner screw into the internally-threaded hole of the first bone screw expanding the head of the first bone screw to engage the head of the first bone screw against the opposing edges of the elongated slot of the buttress plate. Step h) includes threading the second inner screw into the internally-threaded hole of the second bone screw expanding the head of the second bone screw to engage the head of the second bone screw against the opposing edges of the elongated slot of the buttress plate.
- An alternate second expression of a method of the invention is identical to the previously-described second expression of a method of the invention except that the buttress plate has first and second elongated slots with the first bone screw associated with the first elongated slot and with the second bone screw associated with the second elongated slot.
- A third expression of a method of the invention is for attaching together first and second vertebral bodies of a spinal column of a medical patient and includes steps a) through e). Step a) includes obtaining first and second bone screws. Step b) includes obtaining a buttress plate. Step c) includes inserting the first bone screw into the first vertebral body of the spinal column of the medical patient. Step d) includes inserting the second bone screw into the second vertebral body of the spinal column of the medical patient. Step e) includes attaching the buttress plate to the first and second bone screws after performing steps a) through d).
- Several benefits and advantages are derived from the invention. The apparatus and method of the invention allows a physician to choose an optimum location for the first bone screw on the first vertebral body (e.g., on the first cervical vertebral body) and to choose an optimum location for the second bone screw on the second vertebral body (e.g., on the second cervical vertebral body) for maximum attachment strength and mechanical stability. This is accomplished by first installing the bone screws on the vertebral bodies and then securing the buttress plate to the installed bone screws. In comparison, the prior art forces the physician to use pre-drilled holes in the buttress plate which often provide less than optimum attachment locations (providing less attachment strength and less mechanical stability) for the bone screws to be installed in the vertebral bodies.
-
FIG. 1 is a schematic, top planar view a preferred embodiment of the buttress plate assembly of the invention (showing a buttress plate and three screw assemblies) attached to three vertebral bodies of a spinal column of a medical patient; -
FIG. 2 is a cross-sectional view of the buttress plate assembly and one of the vertebral bodies ofFIG. 1 taken along lines 2-2 inFIG. 1 ; -
FIG. 3 is a schematic, top planar view of the buttress plate portion of the buttress plate assembly ofFIGS. 1 and 2 ; -
FIG. 4 is a cross-sectional view of the buttress plate ofFIG. 3 taken along lines 4-4 inFIG. 3 ; -
FIG. 5 is a front elevational view of a bone screw portion of a first screw assembly ofFIGS. 1 and 2 ; -
FIG. 6 is a top planar view of the bone screw ofFIG. 5 ; -
FIG. 7 is a side elevational view of the bone screw ofFIG. 5 ; -
FIG. 8 is a front elevational view of an inner screw portion of the first screw assembly of FIGS. 1 and; -
FIG. 9 is a schematic, top planar view of an alternate preferred embodiment of a buttress plate showing multiple elongated slots having various orientations. - A preferred embodiment of the invention, shown in
FIGS. 1-8 , is for a spinal-column buttressplate assembly 10 for attaching together first and secondvertebral bodies spinal column 16 of a medical patient 18 (only a portion of the spinal column of whom is shown inFIG. 1 ). Preferably, thespinal column 16 is a cervical column, the first and secondvertebral bodies plate assembly 10 is a cervical-column buttress plate assembly, and the spinal-column buttressplate assembly 10 is for fusing together the first and second cervical vertebral bodies of the cervical column of the medical patient. Preferably, the cervical-column buttress plate assembly is an anterior cervical-column buttress plate assembly. In other medical procedures, the first and secondvertebral bodies plate assembly 10 of the invention is applicable to animals having spinal columns with vertebral bodies. It is noted that the terminology “first (or second) vertebral body” means a vertebral body (also known as a vertebral level) and is not limited to a specific vertebral body medically known as the first (or second) vertebral body or level. - The spinal-column buttress
plate assembly 10 ofFIGS. 1-8 includes a spinal-vertebral buttressplate 20, afirst screw assembly 22, and asecond screw assembly 24. Preferably, the spinal-vertebral buttressplate 20 is a cervical-vertebral buttress plate. The buttressplate 20 has an elongated (and preferably longitudinal)slot 26 with opposingedges edges plate 20 comprises (and preferably consists essentially of, and more preferably consists of) titanium or a titanium alloy. - The
first screw assembly 22 includes afirst bone screw 32 and a firstinner screw 34 having threads which are preferably tapered. Thefirst bone screw 32 has an internally-threadedhole 36 which preferably is a through hole coaxially aligned with the longitudinal axis of the first bone screw 32 (not to be confused with the longitudinal axis of the buttress plate). Thefirst bone screw 32 also has ashaft 38 which is insertable into the firstvertebral body 12 of thespinal column 16 of themedical patient 18. Preferably, theshaft 38 is an externally-threaded shaft which is threadably insertable into the firstvertebral body 12. It is noted that the terminology “bone screw” includes any elongated member, threaded or non-threaded, which is securable within a bone. Typically, a starter hole is made by an awl, and thefirst bone screw 32 is inserted into the starter hole. Thefirst bone screw 32 additional has anexpandable head 40 attached to theshaft 38. Theexpandable head 40 has a first unexpanded state and a first expanded state. Thehead 40 of thefirst bone screw 32 is small enough to pass through theelongated slot 26 in the first unexpanded state but not in the first expanded state. In one design, thehead 40 has alongitudinal slit 42 which allows head expansion. Preferably, theshaft 38 has anexpandable tip 44. In one design, thetip 44 has a longitudinal slit 46 which allows tip expansion. Preferably, theexpandable head 40 hasexternal teeth 48. - The
second screw assembly 24, shown inFIG. 1 , is substantially identical to thefirst screw assembly 22 shown in detail inFIGS. 2 and 5 -8, and therefore details of thesecond screw assembly 24 are not separately shown. Thesecond screw assembly 24 includes a second bone screw substantially identical to thefirst bone screw 32 and a second inner screw substantially identical to the firstinner screw 34. The second bone screw has an internally-threaded hole which preferably is a through hole coaxially aligned with the longitudinal axis of the second bone screw (not to be confused with the longitudinal axis of the buttress plate). The second bone screw also has a shaft which is insertable into the secondvertebral body 14 of thespinal column 16 of themedical patient 18. Preferably, the shaft is an externally-threaded shaft which is threadably insertable into the secondvertebral body 14. It is noted that the terminology “bone screw” includes any elongated member, threaded or non-threaded, which is securable within a bone. Typically, a starter hole is made by an awl, and the second bone screw is inserted into the starter hole. The second bone screw additional has an expandable head attached to the shaft. The expandable head has a second unexpanded state and a second expanded state. The head of the second bone screw is small enough to pass through the elongated slot in the second unexpanded state but not in the second expanded state. In one design, the head has a longitudinal slit which allows head expansion. Preferably, the shaft has an expandable tip. In one design, the tip has a longitudinal slit which allows tip expansion. Preferably, the expandable head has external teeth. - The first and second
inner screws 34 are engageable, respectively, in the internally-threadedholes 36 of the first and second bone screws 32 to expand theheads 40 of the first and second bone screws 32 to engage theheads 40 of the first and second bone screws 32 against the opposingedges plate 20 after theelongated slot 26 of the buttress plate has been disposed to enclose theheads 40 of the first and second bone screws 32 after the first and second bone screws 32 have been inserted into the first and secondvertebral bodies inner screws 34 are engageable, respectively, in the internally-threadedholes 36 of the first and second bone screws 32 to expand thetips 44 of the first and second bone screws against the first and second cervical vertebral bodies and to expand theheads 40 of the first and second bone screws to engage theexternal teeth 48 of the heads of the first and second bone screws against the opposing and serrated edges of the buttressplate 20 after the elongated slot of the buttress plate has been disposed to enclose the heads of the first and second bone screws after the first and second bone screws have been threadably inserted into the first and second vertebral bodies. In one example, theheads 40 have different textured outer surfaces (instead of the preferred longitudinally-extending external teeth) and the opposingedges - In a preferred construction, the buttress
plate 20 includes claws (i.e., bone claws) 50 engageable with the first and secondvertebral bodies claws 50 provide the buttressplate 20 with a better grip on the first and secondvertebral bodies plate 20. In an example, thefirst bone screw 32 includes first means 52 for trapping the firstinner screw 34 when the firstinner screw 34 is fully engaged in the internally-threadedhole 36 of thefirst bone screw 32, and wherein the second bone screw includes second means for trapping the second inner screw when the second inner screw is fully engaged in the internally-threaded hole of the second bone screw. This will prevent the firstinner screw 34 from backing out of thefirst bone screw 32. Preferably, the second means is substantially identical to the first means 52, and the first means includes alip 54 which is attached to, or a monolithic portion of, theshaft 38. Other means include conventional anti-rotation features employed with, or on, conventional bolts and screws, as is known to those skilled in the art. For example, in one variation (not shown), a screw cap (which either is separate from or attached to the first inner screw) further secures the first inner screw to the first bone screw preventing screw back out. In a preferred design, thehead 40 of thefirst bone screw 32 has a substantially rectangular shape, and the head of the second bone screw has a substantially rectangular shape. This will provide a better grip for the expansion of thehead 40 against the opposingedges - The spinal-column buttress
plate assembly 10 ofFIG. 1 includes athird screw assembly 56, substantially identical to thefirst screw assembly 22, whereby the spinal-vertebral buttressplate 20 is also attached to a thirdvertebral body 58 of thespinal column 16. Different buttress plates may span two or more vertebral bodies depending on the needs of a particular medical application. Preferably, the buttressplate 20 is narrow-waisted oversoft tissue regions 60 between thevertebral bodies FIG. 1 . Each narrow-waisted region of the buttressplate 20 provides a bend zone for inter-operative modification, as can be appreciated by the artisan. Preferably, there is one bone screw for each involved vertebral level (i.e., body). - An alternate embodiment of the buttress
plate 62 is shown inFIG. 9 as including a firstelongated slot 64, a secondelongated slot 66, and additionalelongated slots head 40 of thefirst bone screw 32 is small enough to pass through the firstelongated slot 64 in the first unexpanded state but not in the first expanded state, and the head of the second bone screw is small enough to pass through the secondelongated slot 66 in the second unexpanded state but not in the second expanded state. The firstelongated slot 64 is disposed to enclose thehead 40 of thefirst bone screw 32, and the secondelongated slot 66 is disposed to enclose the head of the second bone screw after thefirst bone screw 32 has been inserted into the firstvertebral body 12 and the second bone screw has been inserted into the secondvertebral body 14. It is noted that the first and secondelongated slots elongated slots - An example of a buttress
plate 20 for cervical use is a buttress plate having rounded edges, having a length sufficient to span the required number of vertebral bodies to be fused, having a thickness of substantially 3 mm, having a width of substantially 18 mm over a vertebral body, having a width of substantially 10 mm over a soft tissue region, having a slot substantially 25 mm long and 4 mm wide with a substantially 1 mm wide and 1 mm deep chamfered perimeter extension. The chamfered perimeter extension allows the firstinner screw 34 to sit flush with the surface of the buttressplate 20, as seen inFIG. 2 . An example of afirst bone screw 32 is a bone screw having a length of between substantially 12 and 16 mm, having a diameter of substantially 5 mm which will be positioned perpendicular to the anterior cortex and along the cephalo-caudal midline of each involved vertebral body. A typical use is to install the buttress plate after a graft to a soft tissue region so that the installed buttress plate provides intervertebral graft stabilization and fixation of the anterior cervical column. Preferably, a conventional-design adjustable-depth driver is used to insert thefirst bone screw 32 which prevents thefirst bone screw 32 from being driven beyond the proper depth into the firstvertebral body 12. Preferably, the buttressplate 20 has an overall lordotic curve in the widthwise direction to match the curve of a vertebral body. - A first preferred method of the invention is for fusing together first and second
vertebral bodies spinal column 16 of amedical patient 18, and the method includes steps a) through h). Step a) includes obtaining first and second bone screws 32 each having an internally-threadedhole 36, each having ashaft 38 with anexpandable tip 44, and each having anexpandable head 40 attached to theshaft 38 and havingexternal teeth 48. Step b) includes obtaining first and secondinner screws 34 engageable, respectively, with the internally-threadedholes 36 of the first and second bone screws 32 to expand thetips 44 and theheads 40 of the first and second bone screws 32. Step c) includes obtaining a buttressplate 20 having anelongated slot 26 with opposing and serrated edges. Step d) includes inserting thefirst bone screw 32 into the firstvertebral body 12 of thespinal column 16 of themedical patient 18 with thehead 40 of thefirst bone screw 32 protruding above the firstvertebral body 12. Step e) includes inserting the second bone screw into the secondvertebral body 14 of the spinal column of the medical patient with the head of the second bone screw protruding above the second vertebral body. Step f) includes placing the buttressplate 20 on the first and secondvertebral bodies 12 and 14 (with or without an intervening layer of something else) with theheads 40 of the first and second bone screws 32 disposed in theelongated slot 26 of the buttressplate 20. Step g) includes threading the firstinner screw 34 into the internally-threadedhole 36 of thefirst bone screw 32 expanding thetip 44 of thefirst bone screw 32 against the firstvertebral body 12 and expanding thehead 40 of thefirst bone screw 32 to engage theexternal teeth 48 of thehead 40 of thefirst bone screw 32 against the opposing and serrated edges of theelongated slot 26 of the buttressplate 20. Step h) includes threading the second inner screw into the internally-threaded hole of the second bone screw expanding the tip of the second bone screw against the secondvertebral body 14 and expanding the head of the second bone screw to engage the external teeth of the head of the second bone screw against the opposing and serrated edges of the buttress plate. - A second preferred method of the invention is for attaching together first and second
vertebral bodies spinal column 16 of amedical patient 18, and the method includes steps a) through h) Step a) includes obtaining first and second bone screws 32 each having an internally-threadedhole 36, each having ashaft 38, and each having anexpandable head 40 attached to theshaft 38. Step b) includes obtaining first and secondinner screws 34 engageable, respectively, with the internally-threadedholes 36 of the first and second bone screws 32 to expand theheads 40 of the first and second bone screws. Step c) includes obtaining a buttressplate 20 having anelongated slot 26 with opposingedges first bone screw 32 into the firstvertebral body 12 of thespinal column 16 of themedical patient 18 with thehead 40 of thefirst bone screw 32 protruding above the firstvertebral body 12. Step e) includes inserting the second bone screw into the secondvertebral body 14 of the spinal column of the medical patient with the head of the second bone screw protruding above the second vertebral body. Step f) includes placing the buttressplate 20 on the first and secondvertebral bodies 12 and 14 (with or without an intervening layer of something else) with theheads 40 of the first and second bone screws 32 disposed in theelongated slot 26 of the buttressplate 20. Step g) includes threading the firstinner screw 34 into the internally-threadedhole 36 of thefirst bone screw 32 expanding thehead 40 of thefirst bone screw 32 to engage thehead 40 of thefirst bone screw 32 against the opposingedges elongated slot 26 of the buttressplate 20. Step h) includes threading the second inner screw into the internally-threaded hole of the second bone screw expanding the head of the second bone screw to engage the head of the second bone screw against the opposing edges of the elongated slot of the buttress plate. - In an alternate method, the buttress
plate 62 has first and secondelongated slots plate 62 so that thefirst bone screw 32 is disposed in the firstelongated slot 64 and the second bone screw is disposed in the secondelongated slot 66. - In the first and second preferred methods of the invention, preferably, the first and second
vertebral bodies first bone screw 32 into the anterior cortex of the first (e.g., cervical)vertebral body 12, and step e) inserts the second bone screw into the anterior cortex of the second (e.g., cervical) vertebral body. Also in these two methods, preferably step d) inserts thefirst bone screw 32 into the first (e.g., cervical)vertebral body 12 along the midline of the first (e.g., cervical)vertebral body 12, and wherein step e) inserts the second bone screw into the second (e.g., cervical)vertebral body 14 along the midline of the second (e.g., cervical) vertebral body. It is preferred in these two methods that the buttressplate 20 hasclaws 50, and that step f) includes tamping down the buttressplate 20 to engage theclaws 50 into the anterior cortex of the first and second (e.g., cervical)vertebral bodies - A third preferred method of the invention is for attaching together first and second
vertebral bodies spinal column 16 of amedical patient 18, and the method includes steps a) through e). Step a) includes obtaining first and second bone screws each having a shaft. Step b) includes obtaining a buttress plate. Step c) includes inserting the first bone screw into the first vertebral body of the spinal column of the medical patient. Step d) includes inserting the second bone screw into the second vertebral body of the spinal column of the medical patient. Step e) includes attaching the buttress plate to the first and second bone screws after performing steps a) through d). - In an example of a medical procedure utilizing a preferred method of the invention, the anterior cervical-column buttress plate is installed following a graft placement to a soft tissue region. The anterior aspect of a vertebral body is prepared by removing soft tissue and prominent osteophytes. The midline portion of the vertebral body is identified, and an optimum site for screw placement is determined. An awl is used to breach the anterior cortex with an awl guide used to ensure that the awl is driven perpendicular to the anterior cortex. A bone screw of appropriate length is selected and then is driven into the starter hole to the proper depth using the adjustable-depth driver giving care to place the bone screw perpendicular to the anterior cortex in both the lateral and transverse planes. These steps are repeated for all vertebral bodies to be plated. A malleable template is used to determine the appropriate plate length and curvature. A buttress plate is selected which is the smallest plate which allows the elongated slot to engage the heads of the bone screws and allows the claws to engage the anterior cortex. Following plate selection, the buttress plate is positioned with the elongated slot(s) over the heads of the bone screws and lightly tamped down onto the anterior cortex. This allows the claws to engage the bone. An inner screw of corresponding length is then placed into an installed bone screw. As the tip of the inner screw advances towards the tip of the bone screw, the tip of the bone screw expands, thus increasing the purchase of the screw against the vertebral body. As the tapered threads of the inner screw advance down the shaft of the bone screw, the head of the bone screw expands. This causes the external teeth of the head of the bone screw to engage the serrations of the opposing edges of the elongated slot of the buttress plate. The final turn of the inner screw will seat the screw flush with the buttress plate and will recess the top thread of the inner screw below a lip in the shaft of the bone screw. These steps are repeated until the last inner screw is in place.
- Several benefits and advantages are derived from the invention. The apparatus and method of the invention allows a physician to choose an optimum location for the first bone screw on the first vertebral body (e.g., on the first cervical vertebral body) and to choose an optimum location for the second bone screw on the second vertebral body (e.g., on the second cervical vertebral body) for maximum attachment strength and mechanical stability. This is accomplished by first installing the bone screws on the vertebral bodies and then securing the buttress plate to the installed bone screws. In comparison, the prior art forces the physician to use pre-drilled holes in the buttress plate which often provide less than optimum attachment locations (providing less attachment strength and less mechanical stability) for the bone screws to be installed in the vertebral bodies.
- The foregoing description of several expressions of a preferred embodiment of the invention and several methods of the invention has been presented for purposes of illustration. It is not intended to be exhaustive or to limit the invention to the precise forms and processes disclosed, and obviously many modifications and variations are possible in light of the above teaching. It is intended that the scope of the invention be defined by the claims appended hereto.
Claims (2)
1. A method for attaching together first and second vertebral bodies of a spinal column of a medical patient, wherein the method comprises the steps of:
a) obtaining first and second bone screws;
b) obtaining a buttress plate;
c) inserting the first bone screw into the first vertebral body of the spinal column of the medical patient;
d) inserting the second bone screw into the second vertebral body of the spinal column of the medical patient; and
e) attaching the buttress plate to the first and second bone screws after performing steps a) through d).
2-23. (canceled)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US10/918,678 US20050137596A1 (en) | 2000-09-28 | 2004-08-14 | Spinal-column buttress plate assembly and method for attachment |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/672,552 US6776781B1 (en) | 2000-09-28 | 2000-09-28 | Spinal-column buttress plate assembly and method for attachment |
US10/918,678 US20050137596A1 (en) | 2000-09-28 | 2004-08-14 | Spinal-column buttress plate assembly and method for attachment |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US09/672,552 Continuation US6776781B1 (en) | 2000-09-28 | 2000-09-28 | Spinal-column buttress plate assembly and method for attachment |
Publications (1)
Publication Number | Publication Date |
---|---|
US20050137596A1 true US20050137596A1 (en) | 2005-06-23 |
Family
ID=32851279
Family Applications (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US09/672,552 Expired - Fee Related US6776781B1 (en) | 2000-09-28 | 2000-09-28 | Spinal-column buttress plate assembly and method for attachment |
US10/918,678 Abandoned US20050137596A1 (en) | 2000-09-28 | 2004-08-14 | Spinal-column buttress plate assembly and method for attachment |
Family Applications Before (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US09/672,552 Expired - Fee Related US6776781B1 (en) | 2000-09-28 | 2000-09-28 | Spinal-column buttress plate assembly and method for attachment |
Country Status (1)
Country | Link |
---|---|
US (2) | US6776781B1 (en) |
Cited By (7)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20060217717A1 (en) * | 2005-03-24 | 2006-09-28 | Dale Whipple | Methods and devices for stabilizing a bone anchor |
US20070233114A1 (en) * | 2005-10-14 | 2007-10-04 | Stryker Leibinger Gmbh & Co. Kg | Bone plate with at least two elongate holes and bone plate system |
US8034081B2 (en) | 2007-02-06 | 2011-10-11 | CollabComl, LLC | Interspinous dynamic stabilization implant and method of implanting |
US20140052189A1 (en) * | 2012-08-15 | 2014-02-20 | Blackstone Medical, Inc. | Pivoting spinal fixation devices |
US9155580B2 (en) | 2011-08-25 | 2015-10-13 | Medos International Sarl | Multi-threaded cannulated bone anchors |
US9161794B2 (en) | 2011-04-14 | 2015-10-20 | Globus Medical, Inc. | Expanding spinal anchor |
US9265548B2 (en) | 2008-10-30 | 2016-02-23 | DePuy Synthes Products, Inc. | Systems and methods for delivering bone cement to a bone anchor |
Families Citing this family (42)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US8062367B2 (en) | 2003-09-30 | 2011-11-22 | X-Spine Systems, Inc. | Screw locking mechanism and method |
US8821553B2 (en) | 2003-09-30 | 2014-09-02 | X-Spine Systems, Inc. | Spinal fusion system utilizing an implant plate having at least one integral lock |
US7641701B2 (en) | 2003-09-30 | 2010-01-05 | X-Spine Systems, Inc. | Spinal fusion system and method for fusing spinal bones |
US9078706B2 (en) | 2003-09-30 | 2015-07-14 | X-Spine Systems, Inc. | Intervertebral fusion device utilizing multiple mobile uniaxial and bidirectional screw interface plates |
US8372152B2 (en) * | 2003-09-30 | 2013-02-12 | X-Spine Systems, Inc. | Spinal fusion system utilizing an implant plate having at least one integral lock and ratchet lock |
US20060106387A1 (en) * | 2004-11-16 | 2006-05-18 | Depuy Spine, Inc. | Spinal plate system and method of use |
US7674296B2 (en) | 2005-04-21 | 2010-03-09 | Globus Medical, Inc. | Expandable vertebral prosthesis |
US20070118129A1 (en) * | 2005-11-22 | 2007-05-24 | Depuy Spine, Inc. | Implant fixation methods and apparatus |
US20070118127A1 (en) * | 2005-11-22 | 2007-05-24 | Depuy Spine, Inc. | Implant fixation methods and apparatus |
US20070118130A1 (en) * | 2005-11-22 | 2007-05-24 | Depuy Spine, Inc. | Implant fixation methods and apparatus |
US20070118128A1 (en) * | 2005-11-22 | 2007-05-24 | Depuy Spine, Inc. | Implant fixation methods and apparatus |
US9039768B2 (en) | 2006-12-22 | 2015-05-26 | Medos International Sarl | Composite vertebral spacers and instrument |
EP2252224A4 (en) * | 2008-03-10 | 2012-06-06 | Gonzalez Hernandez Eduardo | Bone fixation system |
US20090248092A1 (en) | 2008-03-26 | 2009-10-01 | Jonathan Bellas | Posterior Intervertebral Disc Inserter and Expansion Techniques |
US20090264936A1 (en) | 2008-04-17 | 2009-10-22 | Eduardo Gonzalez-Hernandez | Soft tissue attachment system and clip |
US8721723B2 (en) | 2009-01-12 | 2014-05-13 | Globus Medical, Inc. | Expandable vertebral prosthesis |
US9526620B2 (en) | 2009-03-30 | 2016-12-27 | DePuy Synthes Products, Inc. | Zero profile spinal fusion cage |
US9393129B2 (en) | 2009-12-10 | 2016-07-19 | DePuy Synthes Products, Inc. | Bellows-like expandable interbody fusion cage |
US8870880B2 (en) | 2010-04-12 | 2014-10-28 | Globus Medical, Inc. | Angling inserter tool for expandable vertebral implant |
US8591585B2 (en) | 2010-04-12 | 2013-11-26 | Globus Medical, Inc. | Expandable vertebral implant |
US9301850B2 (en) | 2010-04-12 | 2016-04-05 | Globus Medical, Inc. | Expandable vertebral implant |
US8282683B2 (en) | 2010-04-12 | 2012-10-09 | Globus Medical, Inc. | Expandable vertebral implant |
US20120078373A1 (en) | 2010-09-23 | 2012-03-29 | Thomas Gamache | Stand alone intervertebral fusion device |
US11529241B2 (en) | 2010-09-23 | 2022-12-20 | DePuy Synthes Products, Inc. | Fusion cage with in-line single piece fixation |
US20120078372A1 (en) | 2010-09-23 | 2012-03-29 | Thomas Gamache | Novel implant inserter having a laterally-extending dovetail engagement feature |
US8961573B2 (en) | 2010-10-05 | 2015-02-24 | Toby Orthopaedics, Inc. | System and method for facilitating repair and reattachment of comminuted bone portions |
US8870963B2 (en) | 2010-10-27 | 2014-10-28 | Toby Orthopaedics, Inc. | System and method for fracture replacement of comminuted bone fractures or portions thereof adjacent bone joints |
EA028861B1 (en) * | 2011-02-02 | 2018-01-31 | Мид Корп | Dental implant |
WO2012119146A2 (en) | 2011-03-03 | 2012-09-07 | Toby Orthopaedics, Llc | Anterior lesser tuberosity fixed angle fixation device and method of use associated therewith |
US9248028B2 (en) | 2011-09-16 | 2016-02-02 | DePuy Synthes Products, Inc. | Removable, bone-securing cover plate for intervertebral fusion cage |
US9271772B2 (en) | 2011-10-27 | 2016-03-01 | Toby Orthopaedics, Inc. | System and method for fracture replacement of comminuted bone fractures or portions thereof adjacent bone joints |
US9730797B2 (en) | 2011-10-27 | 2017-08-15 | Toby Orthopaedics, Inc. | Bone joint replacement and repair assembly and method of repairing and replacing a bone joint |
US9402667B2 (en) | 2011-11-09 | 2016-08-02 | Eduardo Gonzalez-Hernandez | Apparatus and method for use of the apparatus for fracture fixation of the distal humerus |
US9271836B2 (en) | 2012-03-06 | 2016-03-01 | DePuy Synthes Products, Inc. | Nubbed plate |
US10182921B2 (en) * | 2012-11-09 | 2019-01-22 | DePuy Synthes Products, Inc. | Interbody device with opening to allow packing graft and other biologics |
US9283008B2 (en) | 2012-12-17 | 2016-03-15 | Toby Orthopaedics, Inc. | Bone plate for plate osteosynthesis and method for use thereof |
US9333014B2 (en) | 2013-03-15 | 2016-05-10 | Eduardo Gonzalez-Hernandez | Bone fixation and reduction apparatus and method for fixation and reduction of a distal bone fracture and malunion |
US10052394B2 (en) | 2014-11-21 | 2018-08-21 | General Electric Company | Microbubble tether for diagnostic and therapeutic applications |
US9987052B2 (en) | 2015-02-24 | 2018-06-05 | X-Spine Systems, Inc. | Modular interspinous fixation system with threaded component |
CN106994038B (en) * | 2017-05-23 | 2024-03-26 | 温州医科大学附属第二医院、温州医科大学附属育英儿童医院 | Be used for broken wall of backbone pedicle of vertebral arch to remedy fixing device |
US10940016B2 (en) | 2017-07-05 | 2021-03-09 | Medos International Sarl | Expandable intervertebral fusion cage |
USD829911S1 (en) * | 2017-09-12 | 2018-10-02 | NuTech Spine, Inc. | Cervical buttress plate implant |
Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4743260A (en) * | 1985-06-10 | 1988-05-10 | Burton Charles V | Method for a flexible stabilization system for a vertebral column |
US4790297A (en) * | 1987-07-24 | 1988-12-13 | Biotechnology, Inc. | Spinal fixation method and system |
US5085660A (en) * | 1990-11-19 | 1992-02-04 | Lin Kwan C | Innovative locking plate system |
US5129899A (en) * | 1991-03-27 | 1992-07-14 | Smith & Nephew Richards Inc. | Bone fixation apparatus |
US6287309B1 (en) * | 1997-09-23 | 2001-09-11 | Dimso (Distribution Medicale Du Sudouest) | Screw and plate system for backbone osteosynthesis |
US6488683B2 (en) * | 2000-11-08 | 2002-12-03 | Cleveland Clinic Foundation | Method and apparatus for correcting spinal deformity |
Family Cites Families (16)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JPH02500490A (en) * | 1986-11-25 | 1990-02-22 | シンセス アクチエン ゲゼルシャフト | osteosynthesis device |
US5209751A (en) * | 1992-02-19 | 1993-05-11 | Danek Medical, Inc. | Spinal fixation system |
US5397363A (en) | 1992-08-11 | 1995-03-14 | Gelbard; Steven D. | Spinal stabilization implant system |
US5324290A (en) * | 1992-09-24 | 1994-06-28 | Danek Medical, Inc. | Anterior thoracolumbar plate |
US5364399A (en) | 1993-02-05 | 1994-11-15 | Danek Medical, Inc. | Anterior cervical plating system |
US5344421A (en) * | 1993-07-16 | 1994-09-06 | Amei Technologies Inc. | Apparatus and method for adjusting a bone plate |
US5395372A (en) * | 1993-09-07 | 1995-03-07 | Danek Medical, Inc. | Spinal strut graft holding staple |
AU3207895A (en) * | 1994-08-23 | 1996-03-14 | Spine-Tech, Inc. | Cervical spine stabilization system |
US5681311A (en) | 1994-09-15 | 1997-10-28 | Smith & Nephew, Inc. | Osteosynthesis apparatus |
US5578034A (en) | 1995-06-07 | 1996-11-26 | Danek Medical, Inc. | Apparatus for preventing screw backout in a bone plate fixation system |
US5843082A (en) | 1996-05-31 | 1998-12-01 | Acromed Corporation | Cervical spine stabilization method and system |
US5961519A (en) * | 1997-04-11 | 1999-10-05 | Kinamed, Inc. | Burr hole cover for cranial surgery |
US6017345A (en) | 1997-05-09 | 2000-01-25 | Spinal Innovations, L.L.C. | Spinal fixation plate |
US6030389A (en) | 1997-08-04 | 2000-02-29 | Spinal Concepts, Inc. | System and method for stabilizing the human spine with a bone plate |
US5904683A (en) | 1998-07-10 | 1999-05-18 | Sulzer Spine-Tech Inc. | Anterior cervical vertebral stabilizing device |
US5899904A (en) * | 1998-10-19 | 1999-05-04 | Third Milennium Engineering, Llc | Compression locking vertebral body screw, staple, and rod assembly |
-
2000
- 2000-09-28 US US09/672,552 patent/US6776781B1/en not_active Expired - Fee Related
-
2004
- 2004-08-14 US US10/918,678 patent/US20050137596A1/en not_active Abandoned
Patent Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4743260A (en) * | 1985-06-10 | 1988-05-10 | Burton Charles V | Method for a flexible stabilization system for a vertebral column |
US4790297A (en) * | 1987-07-24 | 1988-12-13 | Biotechnology, Inc. | Spinal fixation method and system |
US5085660A (en) * | 1990-11-19 | 1992-02-04 | Lin Kwan C | Innovative locking plate system |
US5129899A (en) * | 1991-03-27 | 1992-07-14 | Smith & Nephew Richards Inc. | Bone fixation apparatus |
US6287309B1 (en) * | 1997-09-23 | 2001-09-11 | Dimso (Distribution Medicale Du Sudouest) | Screw and plate system for backbone osteosynthesis |
US6488683B2 (en) * | 2000-11-08 | 2002-12-03 | Cleveland Clinic Foundation | Method and apparatus for correcting spinal deformity |
Cited By (15)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20060217717A1 (en) * | 2005-03-24 | 2006-09-28 | Dale Whipple | Methods and devices for stabilizing a bone anchor |
US20070233114A1 (en) * | 2005-10-14 | 2007-10-04 | Stryker Leibinger Gmbh & Co. Kg | Bone plate with at least two elongate holes and bone plate system |
US8172884B2 (en) * | 2005-10-14 | 2012-05-08 | Stryker Leibinger Gmbh & Co. Kg | Bone plate with at least two elongate holes and bone plate system |
US8034081B2 (en) | 2007-02-06 | 2011-10-11 | CollabComl, LLC | Interspinous dynamic stabilization implant and method of implanting |
US9265548B2 (en) | 2008-10-30 | 2016-02-23 | DePuy Synthes Products, Inc. | Systems and methods for delivering bone cement to a bone anchor |
USRE48870E1 (en) | 2008-10-30 | 2022-01-04 | DePuy Synthes Products, Inc. | Systems and methods for delivering bone cement to a bone anchor |
USRE47871E1 (en) | 2008-10-30 | 2020-02-25 | DePuy Synthes Products, Inc. | Systems and methods for delivering bone cement to a bone anchor |
US9161794B2 (en) | 2011-04-14 | 2015-10-20 | Globus Medical, Inc. | Expanding spinal anchor |
US10064669B2 (en) | 2011-04-14 | 2018-09-04 | Globus Medical, Inc. | Expanding spinal anchor |
US10736683B2 (en) | 2011-04-14 | 2020-08-11 | Globus Medical, Inc. | Expanding spinal anchor |
US10321937B2 (en) | 2011-08-25 | 2019-06-18 | Medos International Sarl | Bone anchors |
US9155580B2 (en) | 2011-08-25 | 2015-10-13 | Medos International Sarl | Multi-threaded cannulated bone anchors |
US11202659B2 (en) | 2011-08-25 | 2021-12-21 | Medos International Sarl | Bone anchors |
US9510866B2 (en) * | 2012-08-15 | 2016-12-06 | Blackstone Medical, Inc. | Pivoting spinal fixation devices |
US20140052189A1 (en) * | 2012-08-15 | 2014-02-20 | Blackstone Medical, Inc. | Pivoting spinal fixation devices |
Also Published As
Publication number | Publication date |
---|---|
US6776781B1 (en) | 2004-08-17 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US6776781B1 (en) | Spinal-column buttress plate assembly and method for attachment | |
CA2767403C (en) | Expandable fixation assemblies | |
US6146384A (en) | Orthopedic fixation device and method of implantation | |
US6969390B2 (en) | Anterior cervical plating system and bone screw | |
US8007523B2 (en) | System and method for stabilizing the human spine with a bone plate | |
US7468069B2 (en) | Static anterior cervical plate | |
US6030389A (en) | System and method for stabilizing the human spine with a bone plate | |
US5713904A (en) | Selectively expandable sacral fixation screw-sleeve device | |
CA2444232C (en) | Anterior cervical plating system and bone screw | |
JP5830301B2 (en) | System and method for bone fixation or fusion | |
US20090198291A1 (en) | Bone screw | |
US20040210222A1 (en) | Laminoplasty plates and methods of use | |
US20090080997A1 (en) | Retaining Device and Apparatus | |
KR20070111498A (en) | Orthopedic plate system and method for using the same | |
US20100211109A1 (en) | Tack for spine fixation | |
WO2008100239A2 (en) | Improved static anterior cervical plate |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
STCB | Information on status: application discontinuation |
Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION |