CN101166478A - Multi-axial anchor assemblies for spinal implants and methods - Google Patents

Abstract

Systems and methods are provided that include a plate member (120, 140, 160, 180, 600) engageable to the spinal column with an anchor assembly (20, 320, 420, 520, 620, 720). The anchor assembly (20, 320, 420, 520, 620, 720) includes a coupling member (30, 130, 330, 430, 530, 630) having a post (32, 332, 432, 532, 632, 732) extending through at least one opening of the plate member (120, 140, 160, 180, 600) and an anchor member (70) pivotally captured in a receiver portion (34, 334, 434, 534, 634) of the coupling member (30, 130, 330, 430, 530, 630) below a lower surface of the plate member (120, 140, 160, 180, 600). A locking member (90, 590) secures the plate member (120, 140, 160, 180, 600) to the coupling member (30, 130, 330, 430, 530, 630). A crown (50, 150, 250, 350, 550, 650) in the receiver portion (34, 334, 434, 534, 634) of the coupling member (30, 130, 330, 430, 530, 630) is engaged by the plate member (120, 140, 160, 180, 600) to secure the anchor member (70) in position relative to the coupling member (30, 130, 330, 430, 530, 630).

Description

The multi-axial anchor assemblies and the method that are used for spinal implant

Background

In art of orthopedic surgery,, need for a long time an elongated elements such as plate or bar are attached to bone, so that they are kept and be supported in the given position especially in field of spinal surgery.For example, in the operation of or compromised spine unusual at fuse damaged, ill, distortion or other, the surgeon is positioned at spinal column in the correct position.The contiguous one or more vertebral bodys of one long shaped plate are placed, and adopt bone anchor such as screw or bolt that plate is fixed in vertebral body.Anchor and plate are interfixed, relatively move to reduce as far as possible or to prevent.Like this, vertebral body will be held and/or be supported in the tram that helps healing.

Still need to be convenient to implant is located and is attached to system, the apparatus and method of the one or more vertebras of spinal column, the multiple attachment means of one or more vertebral bodys of implant and spinal column is provided, and provides and implant is attached to the anchor assemblies that adopts in one or more vertebras of spinal column has multiaxis to ability.

Summary of the invention

The present invention relates in correct bone dislocation disease, be used for the bone element is stabilized in the rectificating surgery implant system and method for requisite space relation, providing fixing, or be used for spinal column or other bone merges along one or more vertebral.Multi-axial anchor assemblies is engageable to implant, and for example panel element or rod element or other connector or implant are to be fixed in bone structure with implant element.

According on the one hand, a kind of anchor assemblies is provided, this assembly comprises anchoring element, it has head and is used for the bottom of extending from the head of engage bone element.Anchor assemblies also comprises the connection element that is pivotally connected to the anchor head.Connection element comprises the below receiving portion and extends the bar portion of leaving head from the receiving portion below that the below receiving portion is formed for admitting the internal admission space of head.The engageable locking member of the configuration of bar portion.At least one sidewall opening of the external communications of below receiving portion formation and connection element.Anchor assemblies also comprises the head localized hat spare in the admittance space of connection element around anchoring element.The hat part comprises the base part that is communicated with at least one sidewall opening, is used to contact the location around the localized implant element of connection element bar portion, so that implant element is fixed between locking member and the base part.

According on the other hand, a kind of spinal plate system is provided, this system comprises: elongate plate member, it is included in upper surface and extends through wherein at least one opening between the spinal column opposing lower surface.Described system also comprises engageable anchor assemblies to panel element.Anchor assemblies comprises connection element, and it has the spatial receiving portion of the localized admittance of lower surface that can pass at least one opening localized bar portion and comprise the adjoining plate element.Anchor assemblies comprises anchoring element, and its head is received in the admittance space of receiving portion pivotly, and the bottom is extended from the head and is used for engagement ridge spinous process of the seventh cervical vertebra structure.The hat part is contiguous head location in admitting the space, comprises the base part that extends through connection element along the lower surface of panel element.But the engageable upper surface location of locking member, so that the base part of the fixing contact hat of the lower surface of panel element part to bar portion and contact plate element.

According on the other hand, a kind of spinal plate system is provided, this system comprises: along the elongate plate member of vertical axis extension, it is included in upper surface and at least one opening that extends through wherein between the spinal column opposing lower surface.This system also comprises engageable anchor assemblies to panel element.Anchor assemblies comprises connection element, and described at least one opening location and engageable to described panel element can be passed by its bar portion, makes connection element can not pivot with respect to panel element.Connection element comprises can be along the localized receiving portion of the lower surface of panel element, and it admits the space opening to deviate from panel element.Anchor assemblies also comprises anchoring element, and it comprises the head in the admittance space that is received in receiving portion pivotly.Anchoring element comprises the bottom of extending from the head, is used for engagement ridge spinous process of the seventh cervical vertebra structure.When bar portion was engaged to panel element in described at least one opening, anchoring element can pivot with respect to panel element and receiving portion.

According on the one hand, a kind of anchor assemblies is provided, this assembly comprises: anchoring element, it has head and is used for the bottom of extending from the head of engage bone element.Anchor assemblies also comprises the connection element that is pivotally connected to the anchor head.Connection element comprises the below receiving portion and leaves the bar portion that head extends from described receiving portion that the below receiving portion is formed for accepting the internal admission space of head.Bar portion is configured to mesh locking member.A plurality of openings of the external communications of receiving portion formation and connection element.The hat part is located in the admittance space of connection element around the head of anchoring element.The hat part comprises a plurality of axially extended base part that extends through a plurality of openings respectively.Base part contacts at least one implant components or locatees around the localized locking member of the bar portion of connection element.

According on the other hand, a kind of spinal plate system is provided, this system comprises implant, it is included in upper surface and at least one opening that extends through between the localized opposing lower surface along spinal column wherein.System also comprises engageable anchor assemblies to implant.Anchor assemblies comprises connection element, and it has can pass described at least one opening localized bar portion and towards the localized receiving portion of the lower surface of implant.Receiving portion comprises admits the space, and bar portion forms from its near-end to the passage of admitting the space to extend.Anchor assemblies also comprises anchoring element, and it comprises the head in the admittance space that is pivotally captured in receiving portion and is used for the bottom of extending from the head of engagement ridge spinous process of the seventh cervical vertebra structure.Locking member can contact the mounting portion that one of upper surface of implant or receiving portion is engaged to bar portion, so that implant is fixed in spinal column.

According on the other hand, a kind of spinal plate system is provided, this system comprises panel element, it has at least one opening that extends through wherein between upper surface and the localized opposing lower surface of Ke Chao spinal column.This system also comprises engageable anchor assemblies to panel element.Anchor assemblies comprises connection element, and it has the localized bar of described at least one opening portion and can be along the localized receiving portion of the lower surface of panel element can passed.Bar portion is in the proximal openings place and the receiving portion screw-threaded engagement of receiving portion.Receiving portion comprises admittance space and anchoring element, and anchoring element comprises the head in the admittance space that is received in receiving portion that pivots.Extend from the head the bottom of anchoring element, is used for engagement ridge spinous process of the seventh cervical vertebra structure.But the upper surface of locking member contact plate element is engaged to bar portion, so that panel element is fixed in connection element between locking member and receiving portion.

According on the other hand, a kind of spinal surgery method is provided, this method comprises: at least one vertebra that arrives spinal column; Make the anchoring element of anchor assemblies be engaged to described at least one vertebra, described anchor assemblies comprises connection element, its receiving portion can pivot around the head of anchoring element and install, and to proximal extension, available receiving portion pivots with respect to anchoring element from described receiving portion in bar portion; Make bar portion and receiving portion be switched to desired location with respect to the anchoring element of engagement; Elongate plate member is located near bar portion near-end; Panel element is advanced into the position of contiguous receiving portion along bar portion; And against pass the hat spare engaging plate element that connection element extends from the anchoring element head.

According on the other hand, a kind of spinal surgery method is provided, this method comprises: at least one vertebra that arrives spinal column by otch; Make the anchoring element of anchor assemblies be engaged to described at least one vertebra by otch, described anchor assemblies comprises pivoting and is installed on the connection element of anchoring element, its bar portion from anchoring element to proximal extension; With respect to the anchoring element pivot connection element of engagement, so that bar portion is orientated in desired location; Elongate plate member is located near bar portion near-end; Make panel element be advanced into the position of contiguous anchoring element along bar portion; Against hat part engaging plate element, the anchor of described hat spare from connection element extends and comprises a plurality of base parts that are positioned at the connection element outside, and panel element is against hat part location, so that anchoring element is fixed in the connection element.

Hereinafter will further describe these and other aspect.

Brief Description Of Drawings

Fig. 1 is the exploded perspective view of multi-axial anchor assemblies.

Fig. 2 is the decomposition side view of Fig. 1 anchor assemblies.

Fig. 3 is the side view through assembling of Fig. 1 anchor assemblies.

Fig. 4 is that Fig. 1 anchor assemblies revolves the side view through assembling that turn 90 degrees from Fig. 3 orientation around its longitudinal axis.

Fig. 5 is the vertical view of Fig. 4 anchor assemblies.

Fig. 6 is the cutaway view of connection element of the part of pie graph 1 anchor assemblies.

Fig. 7 is the cutaway view of hat spare of the part of pie graph 1 anchor assemblies.

Fig. 8 is the axonometric chart of the hat spare of another embodiment.

Fig. 9 is the cutaway view of the hat spare of another embodiment.

Figure 10 is the cutaway view of the locking member of engageable connection element in Fig. 1 anchor assemblies.

Figure 11 is the cutaway view of anchoring element of Fig. 1 anchor assemblies of first embodiment.

Figure 12 is the cutaway view of anchoring element of Fig. 1 anchor assemblies of another embodiment.

Figure 13 is that the locking member with Fig. 8 is fixed in the side view of single shaft to anchor with multi-axial anchor assemblies and the panel element that panel element is fixed in Fig. 1.

Figure 14 is the cutaway view along the line 14-14 of Figure 13.

Figure 15 is the plane graph of the panel element of an embodiment.

Figure 16 is the side view of Figure 15 panel element.

Figure 17 is the cutaway view along the line 17-17 of Figure 16.

Figure 18 has the crooked vertically side view of Figure 15 panel element of profile.

Figure 19 is the plane graph of the panel element of another embodiment.

Figure 20 is the plane graph of the panel element of another embodiment.

Figure 21 is the axonometric chart of the panel element with bar receiving portion of another embodiment.

Figure 22 A is the side view that is used to grasp the apparatus of panel element.

Figure 22 B is the vertical view of Figure 22 A apparatus.

Figure 22 C is the zoomed-in view of the far-end grip portion of Figure 22 A apparatus in first orientation.

Figure 22 D is the side view of Figure 22 A apparatus of grip portion in second orientation.

Figure 22 E is the vertical view of Figure 22 A apparatus of grip portion in second orientation.

Figure 23 is the decomposition side view of the multi-axial anchor assemblies of another embodiment.

Figure 24 is the side view of Figure 23 anchor assemblies.

Figure 25 is that Figure 24 anchor assemblies revolves the side view that turn 90 degrees around its longitudinal axis.

Figure 26 is the cutaway view that constitutes the connection element of Figure 23 anchor assemblies.

Figure 27 is the decomposition side view of the multi-axial anchor assemblies of another embodiment.

Figure 28 is the side view of Figure 27 anchor assemblies.

Figure 29 is that Figure 28 anchor assemblies revolves the side view that turn 90 degrees around its longitudinal axis.

Figure 30 is the axonometric chart of the multi-axial anchor assemblies that is engaged in panel element of another embodiment.

Figure 31 is the panel element of Figure 30 and the decomposition view of anchor assemblies.

Figure 32 is the profile of Figure 31 panel element and anchor assemblies.

Figure 33 is the decomposition view of the multi-axial anchor assemblies that is engaged in panel element of another embodiment.

Figure 34 is the axonometric chart of Figure 33 grappling combination and panel element.

Figure 35 is the decomposition view of the multi-axial anchor assemblies that is engaged in panel element of another embodiment.

Figure 36 is the axonometric chart of Figure 35 anchor assemblies and panel element.

The description of illustrated embodiment

In order to promote understanding, also these embodiments are described with concrete language referring now to this paper illustrated embodiment to the principle of the invention.It should be understood that this does not limit the scope of the present invention.Can consider any change of described mthods, systems and devices and further improve, and the further application of the principle of the invention described herein, as one of ordinary skill in the art of the present invention are common understand.

Provide multi-axial anchor assemblies, so that implant such as panel element or connector are fixed in one or more spinal vertebraes.Anchor assemblies comprises the anchoring element in the receiving portion that is connected in connection element that pivots.Connection element comprises from the bar portion of anchoring element to proximal extension, is used for admitting implant around it.Anchoring element can be around the multi-direction pivot of longitudinal axis of assembly.In one embodiment, engageable connection element, it is restricted to make that connection element pivots on respect at least one direction of implant, and anchoring element can pivot in connection element.

In one form, connection element is included in the hat spare in the receiving portion, and it can extend at anchor with around between the localized element of bar portion.In one embodiment, when locking member against implant or hat one of part fixedly the time, being preced with part can be with the anchoring element rigid engagement in the appropriate location with respect to connection element.In another form, connection element comprises at least one window, and the hat part comprises the base part that extends through described at least one window, with lower surface or the locking member of contact around the localized implant of bar portion.When locking member finally is engaged in anchor assemblies, locking member can be in hat base part secure engagement base part of part or the implant one.

In another form, provide multi-axial anchor assemblies, this assembly comprises and being used for around the connection element of its admittance implant with from the anchoring element of connection element to remote extension.In an application of panel element, before with locking member secure engagement connection element, connection element is received within the elongated slot of panel element, make it not pivotly transverse to the longitudinal axis of elongated slot, and anchor can be along pivoting in all directions with respect to connection element.In case fixedly locked element is to be engaged in connection element securely with panel element, connection element and anchoring element interfix and fix with respect to panel element.

In another form, provide multi-axial anchor assemblies, this assembly comprises connection element and the anchoring element that is pivoted in the connection element receiving portion.Bar portion from receiving portion to proximal extension and admit locking member.Bar portion comprises the mounting portion of contiguous receiving portion, and locking member can be installed to the mounting portion implant is fixed in connection element or the hat part is engaged in the connection element.The extension from the mounting portion to proximal extension, so that implant is around the placement of bar portion.The extension can be removed from the mounting portion, to reduce the invasive of postoperative anchor assemblies to adjacent tissue as far as possible.

With reference now to Fig. 1-5,, shownmulti-axial anchor assemblies 20, it has along first orientation oflongitudinal axis 21alignment.Anchor assemblies 20 comprises thatconnection element 30 andavailable clip 60 pivots are engaged in theanchoring element 70 of connection element 30.Anchoringelement 70 can be around being switched to its required orientation with respect to longitudinal axis 21.Hat part 50contiguous anchoring elements 70 are received within theconnection element 30, which comprises at least fromconnection element 30 andpass window 48 outward extending baseparts.Hat part 50 can be against around the lower surface ofconnection element 30 localized panel elements location, locking member 90 (Figure 10) engageable toconnection element 30 with againsthat part 50 fixing head elements, as shown in figure 14.What the engagement oflocking member 90 provided also can makehat part 50 be seated on theanchoring element 70 downwards or to the bed knife of far-end orientation, with anchoringelement 70 with respect toconnection element 30 rigid engagement in the desired position.

The further feature ofconnection element 30 is described referring now to Fig. 1-6.It is the lowerend receiving portion 34 at center thatconnection element 30 comprises to thebar portion 32 of proximal extension with longitudinal axis 21.Bar portion 32 reduces with respect to receivingportion 34 sizes, make bar portion can pass the opening of panel element, and the size of at least aportion receiving portion 34 can prevent to pass the opening of panel element.As shown in Figure 6,connection element 30 comprises and extends through the upperend channel part 42 that theadmittance space 44 that forms inbar portion 32 and thereceiving portion 34 is communicated with.Receivingportion 34 comprises near the Internal locking groove of admitting thespace 44 46, is used for admitting and keepsclip 60 in wherein.

Receivingportion 34 also comprises at least one opening, the external communications offeasible hat part 50 and connection element 30.In illustrated embodiment,connection element 30 forms and thewindow 48 of admittingspace 44 to be communicated with at its opposite side.As further described herein, it is outstanding that at least aportion hat part 50passes window 48, and contact is aroundbar portion 32 localized panel elements.The size ofhat part 50 makes it can be protruding frombar portion 32, makes that being preced withpart 50 around its localized panel element supports.And as shown in Figure 3,bar portion 32 comprisesrelative plane 38 and the relative arc threadedportion 40 that extends between them.As described below with shown in Figure 14, the both sides of elongated slot or other opening in the 38 engageable panel elements of plane.In one embodiment,bar portion 32 can prevent that by the both sides of engaging plate element elongated slot panel element from centering on the distortion or the rotation of bar portion 32.But threadedportion 40 screw-threaded engagement are aroundbar portion 32localized locking members 90.

Thetool engagement passage 36 that the upperend channel part 42 ofbar portion 32 forms to proximal openings, its inner surface form the engageable instrument of configuration so that rotate the noncircular cross section ofconnection elements 30 around longitudinal axis 21.In addition, the size ofchannel part 42 allows driving instruments by being received in the anchoring element in the receivingportion 34 with engagement and driving force being applied directly on the anchoring element byconnection element 30.

With reference now to Fig. 7,, shown the profile of hat part50.Hat part 50 comprisesbase part 52, and it has thearm 53 that extends from lower cup portion 54.As shown in Figure 1,base part 52 forms the ellipse that has in thelinear wall part 57 of 53 extensions of twoarms.Cup portion 54 comprises the semi-spherical shape of stretching out frombase part 52, in its lower end or far-end 55 places formopening.Cup portion 54 limits and admitsspaces 58, and it has the crooked inner surface of depression, and suitable admittance is arranged in the shape of head of the anchoringelement 70 of connection element 30.Throughhole 56 extends throughbase part 52 and is communicated withadmittance space 58 in thecup portion 54, allows driving instruments to place by it, is used for meshing the tool recess of the head that is arranged in theanchor member 70 of admittingspace 58.

Fig. 8 has shown the hat spare 250 of another embodiment, and it has upper end or near-end base part 252 and lower end or distal cup portion254.Cup portion 254 forms and admits spaces, admits the space to extend and in a side direction distal openings relative withbase part 252 from base part 252.The head of anchoringelement 70 is received within the admittance space ofglass portion 254 qualifications.At least aportion base part 252 is formed by a pair of outwardly directedarm 253, andedge cup portion 254 is to near-end with to remote extension.Throughhole 256 extends throughbase part 252 and is communicated with admittance space thatcup portion 254 limits.

Fig. 9 has shown the hat spare 350 of another embodiment, is similar to hat part 50.Hat part 350 comprises upper end or near-end base part 352, lower end or distal cup portion 354 and through hole 356.Arm 353 stretches out from cup portion 354, comprises respectively locating from its flange component 358 to remote extension in the outer end of two arms 353.The far-end of each flange component 358 comprises towards interior lip 359.During use, lip 359 is supported on the window edge 49 of connection element 30, and anchoring element 70 pivots and is received in the receiving portion 34.Flange component 358 and lip 359 can be kept the gap between the head of adjacent crown member 350 localized anchoring elements 70, make when panel element against base part 352 fixedly the time, flange component 358 and lip 359 can be kept the head of anchoring element 70 and be preced with the gap of 350 of parts, make anchoring element 70 to pivot in connection element 30.Under the situation that needs the one or more vertebras of dynamic stability, can adopt hat part 350.In can be by the following method any or combination provide dynamic stability: remove spiral shell ridge 82, elasticity hat part is provided or keeps gap between hat part and anchoring element head from the head of anchoring element 70 (Figure 11).

Figure 10 has shown the lockingmember 90 of an embodiment, and it is engageable in thebar portion 32 of connection element 30.Lockingmember 90 comprisesmain body 92, andmain body 92 has thesidewall 96 that extends around tapped through hole 94.Throughhole 94 extends along the longitudinal axis 95 of thelongitudinal axis 21 that can aim at anchor assemblies 20.Slit 98 extends throughsidewall 96 and is communicated with throughhole 94, and lockingmember 90 is divided into proximal part anddistal portions 91,93.Around lockingmember 90 is engaged onbar portion 32 and during distal portionscontact plate element 120, as shown in figure 14, furtherlocks locking member 90 against panel element and can makeproximal part 91 towardsdistal portions 93 deflections.This provides interference fit or screw thread between the screw thread of the screw thread ofbar portion 32 and lockingmember 90 staggered, prevents in position loosening of locking member 90.Other embodiment has been taked other form of lockingmember 90, comprise: the locking member that does not have slit 98, locking member with breaking portion applies suitable moment of torsion with during guaranteeing to mesh, or locking member with other meshing relation ofbar portion 32 is provided, for example bayonet locking, interference fit or merge connects.

Figure 11 has shown the anchoringelement 70 of anembodiment.Anchoring element 70 is included in theenlarged head 72 and the distal portions of its near-end, and distal portions comprises that from thehead 72 extend distally to the threadedrod 74 of tapered distal end tip 78.Bar 74 comprises thethread contour 76 along its extension, and it is configured to can engagebony tissue.Bar 74 andthread contour 76 can comprise any suitable shape, comprising: along the fluting of all or a part ofbar 74, and evenly or the flight pitch that changes, thread depth, the width of thread and along the shape of bar74.Thread contour 76 can be configured in the hole that insertion gets out or tapping forms, and can be configured to self-tapping screw, perhaps can be configured to from boring and self-tapping screw.Screw thread has non-threadedcervical region 80 betweenhead 72 and thebar portion 74, though also can and/or exceedcervical region 80 alongcervical region 80extensions.Head 72 also is included in thetool engagement depression 84 of its proximal openings, and it can have any suitable configuration with the admittance driven tool, thereby anchoringelement 70 is applied rotary driving force and makes its screw-threaded engagement in osseous tissue.

Head 72 comprises a plurality ofspiral shell ridges 82 that contiguous its near-end extends along periphery, though also considered not have thehead 72 ofspiral shell ridge 82, as indicated above.For example, can adopt the anchoring element with smooth head that the dynamic stability of spinal column segment is provided, when with lockingmember 90 anchor assemblies being engaged to panel element, described smooth head can rotation in hat part 50.As further described herein,spiral shell ridge 82 engageable or bite intocrown member 50, thus when being engaged to panel element, anchoringelement 70 can be locked in the appropriate location with respect toconnection element 30 with locking member 90.Spiral shell ridge 82 can be formed by a series of flat surfaces that machining in thehead 72 forms.Other embodiment is considered to form the spiral shell ridge by pin, annular knurl, tooth or other surface character.Theanchor assemblies 20 that comprises the anchoring element withspiral shell ridge 82 provides rigidity or static connection the between panel element and spinal column segment.

For any implant,, implant is engaged in spinal column fully statically withanchor assemblies 20 by being fixed in implant with the anchoring element of each connection element rigid engagement.Be fixed in implant by the anchoring element that can pivot in each connection element,available anchor assemblies 20 fully dynamically is engaged in spinal column with any implant.Also can adopt the combination of rigidity anddynamic anchor assemblies 20 that implant is engaged to spinal column.

With reference to Figure 12, shown the anchoringelement 70 of another embodiment, wherein, bar 74 has theinner chamber 86 along its longitudinal extension, atdistal tip 78 place's openings and enter tool engagement depression 84.Inner chamber 86 can be configured to accept seal wire or other induction element, thereby guidinganchor 70 is with respect to the placement of bone structure in desired location.Also can utilizeinner chamber 86 that bone graft or other osteogenesis are promoted and/or therapeutant is sent in the bone structure of anchoringelement 70 engagements.Other embodiment considers thatbar 74 comprises one or more perforation or openings that are communicated withinner chamber 86 betweencervical region 80 anddistal tip 78.

Other embodiment considers that anchoringelement 70 comprises that the distal portions with other configuration is with engage bony tissue.For example, distal portions can comprise cable, hook, clamp, have the wing or sphere smooth shaft, expandable anchor, be used for other structure of being positioned at the main body of vertebra disc space or being used for the engage bone structure.

With reference now to Figure 13,, shown withmulti-axial anchor assemblies 20 and single shaft on the opposite side indish gap 28,elongate plate member 120 to be engaged tovertebra 24,26 to anchor 100.Should be understood that available multiaxis to and/or single shaft to the combination in any of anchorassemblies panel element 120 is engaged to vertebra.Single shaft comprises threadedrod element 102 and theproximal head member 104 from its extension integrally formed with threadedrod element 102 to anchor assemblies 100.Proximal head member 104 extends throughpanel element 120, compriseslower support 108, and the lower surface ofpanel element 120 is located against it.Lockingmember 106 is engaged inhead elements 104, and clamps or panel element inplace 120 againstlower support 108.

Figure 14 is a profile, also shown being connected ofpanel element 120 and multi-axial anchor assemblies 20.Panel element 120 is set, makes its lower surface contact the base part 152 ofhat part 150 at least in part.Thebar portion 32 of connection element 130 extends throughpanel element 120, and lockingmember 90 is aroundbar portion 32 location.When locking member when 120 upper surface advances alongbar portion 32 towards panel element, lockingmember 90 applies against the power ofpanel element 120 and with it and fixedly secures between thebase part 52 and lockingmember 90 of hat part 50.In illustrated embodiment, bed knife will be preced withpart 50 against thehead 72 of anchoringelement 70 and push away downwards.In considering the embodiment that rigidly fixes, anchoringelement 70 comprises thespiral shell ridge 82 that snaps intohat part 50, so that anchoringelement 70 is locked in the appropriate location with respect toconnection element 30 andpanel element 120.

With reference now to Figure 15-17,, shown the further details of thepanel element 120 of anembodiment.Panel element 120 comprises theelongate body 122 of extending along longitudinal axis 121.Main body 122 comprises at least one opening ofelongated slot 124 forms, and it is center and along its extension with longitudinal axis 121.Elongated slot 124 is at upper surface and lower surface 125,127 openings.Limit rail 126 is along the opposite side longitudinal extension ofelongated slot 124, and end rail 128 extends between limit rail 126 at the two ends ofmain body 122.

Limit rail 126 comprises inner surface 129 and the outer surface 131 that extends along elongated slot 124.As shown in figure 17,main body 122 comprises the cannelure in inner surface 129 130 that extends along elongated slot 124.Between the upper and lower surface and the plate surface of transition between the inside and outside track surface and rail 126, but 128 edge rounding or chamfering, to eliminate the rapid transition between any sharp edges or plate surface.

In Figure 18, shown to have thepanel element 120 that has crooked outline along its longitudinal axis 121.Upper surface 125 is a spill, and lower surface 127 is a convex.This curved configuration can be provided by the plate that prebends, or by the surgeon at the intra-operative twisted plate to provide patient's anatomical structure required coupling.

In Figure 19, shown thepanel element 140 of anotherembodiment.Panel element 140 is similar topanel element 120, compriseselongate body 142, and it hasrelative limit rail 146 and relative end rail 148.Panel element 140 comprises the opening of a pair of elongated slot 144,145 forms that form alongmain body 142, andintermediate rail 150 is positioned between the elongated slot 144,145 and in 146 extensions of limit rail.In illustrated embodiment,elongated slot 144 is shorter than elongated slot 145.Other embodiment is considered isometric elongated slot, and panel element has plural groove.For any plate member embodiment, groove can comprise pit, depression or further feature, so that anchor is placed or is engaged with.Consider that also panel element can comprise two or more located adjacent one another and along the groove that extends each other.Other embodiment considers that panel element has a plurality of openings between upper and lower surface of circular hole form.

In Figure 20, shown thepanel element 160 of anotherembodiment.Panel element 160 comprisesbody element 162, andbody element 162 haslimit rail 166 and end rail 168.Have a pair ofend slot 165 near theend rail 168, have medial launder 164 between theend slot 165,intermediate rail 170 is between medial launder 164 and each end slot 165.In illustrated embodiment, medial launder 164 is longer thanend slot 165.

In Figure 21, shown thepanel element 180 of anotherembodiment.Panel element 180 comprisesmain body 182, and it has anchor assemblies mate 184 and bar receiving portion 188.Anchor assemblies mate 184 comprises wherein the opening of passing ofelongated slot 186 forms, is used to admit anchor assemblies such as anchor assemblies20.By anchor assemblies 20 is fixed in theelongated slot 186,elongated slot 186 allows the location of adjustable plate element 180.Bar receiving portion 188forms passages 190, is used to admit elongatespinal rod 196 inwherein.Passage 190 extends transverse to elongated slot 186.In illustrated embodiment,bar receiving portion 188 is the cylindrical elements that centers onpassage 190 fully.But, other embodiment is considered, along the passage of its all or part lateral opening,bar receiving portion 188 comprises a plurality of a plurality of members that are used for bar cramp is held or is grasped inpassage 190, and is used to admit and/or other suitable arrangement of mesh rod or other microscler implant element.

Figure 22 A-22E has shown for example engageableplate grasping piece 200 in slit 130 of an embodiment, grasps panel element to be delivered to operative site.Grasp the U.S. Patent Application Serial Number 10/202,918 of the example of apparatus referring to submission on July 25th, 2002, the reference in content of this application is included in this.Plate grasping piece 200 compriseshandle component 202 and can be pivotally connected to thelever element 204 of handle component 202.Rod element 206 connects 208 with first and is connected in lever element 204.Mountingrod 212 extends throughrod element 206 fromhandle component 202, comprises lockingmember 210 with proximal knob portion and the bar that extends through mountingrod 212, shown in Figure 22 C.

The far-end of mountingrod 212 comprises theinstallation elements 214 that pivots and be mountedthereon.Installation elements 214 comprisesmate 218, and its size is fit to coupling in theelongated slot 124 of for example panel element 120.The size ofmate 218 also can be mated in the opening or groove of any plate member embodiment described herein.In illustrated embodiment,mate 218 comprises engagedelement 220, with the slit 130 of engaging plate element 120.Engaged element 220 can be the form of spheroid element or bar stem, can be absorbed inmate 218 to be positioned in theelongated slot 124, can outwards move with engagement slot 130 withpanel element 120 then and be installed to installation elements 214.Then, lockingmember 210 at mountingrod 212 internal rotation, makes that the distal portions in themate 218 can be fixed on engagedelement 220 and the panel element position engaged by its near-end knob.

Bylever 204 is moved between the make position shown in the open position shown in Figure 22 A and Figure 22 D, can makerod element 206 with respect to handlecomponent 202 and mountingrod 212motions.Spring mechanism 222 is biased in open position withlever element 204 and handlecomponent 202 usually.In open position, the orientation ofinstallation elements 214 can make panel element extend along axis 203 (Figure 22 C), andaxis 203 is orientated along thelongitudinal axis 201 ofapparatus 200 more.In make position, when makingrod element 206 when near-end moves withlever 204, can be in theconnection 216 ofrod element 206 and 214 extensions of installation elements around the far-endpivot installation elements 214 of mounting rod 212.In make position,axis 203 so that be fixed ininstallation elements 214 panel element will perpendicular to or substantially extend transverse to thelongitudinal axis 201 of apparatus 200.Therefore, by in first orientation, promptly be orientated and grasp plate along leading to the spinal column path, make then that plate is long-range to be pivoted into along spinal alignment,apparatus 200 helps the placement of plate by narrow otch or pipeline.

Apparatus 200 just grasps panel element and be delivered to spinal column, be used to mesh an example of the suitable instrument of anchor assemblies described herein.Other example that grasps apparatus comprises that tweezers or other grasp apparatus, have securing member with the apparatus of engaging plate and apparatus with the plate interference fit can be provided.For example, apparatus is engageable in board slot or hole, clamp between the outer surface of plate, or between the outer surface of groove or hole surface and plate, grasp plate.Also have other examples to consider, manually grasp plate and it is delivered to surgical site.

With reference now to Figure 23-26,, shown themulti-axial anchor assemblies 320 of anotherembodiment.Anchor assemblies 320 comprisesconnection element 330, and it has thebar portion 332 of extending along thelongitudinal axis 321 of anchor assemblies 320.Bar portion 332 alonglongitudinal axis 321 from receivingportion 334 to the enough length of proximal extension, so that implant is around the location ofconnection element 330 be convenient to assemble in the art.Multi-axial anchor assemblies 320 also can comprise thebar portion 332 with removable proximal extension part, so that the thin profile when implanting to be provided.

In illustrated embodiment,anchor assemblies 320 comprises anchoringelement 70, andavailable clip 60 is received in its pivot in the connection element 330.Hat part 50 can be located inconnection element 330 around thehead 72 of anchoring element 70.Thebase part 52 ofhat part 50passes connection element 330 and exposes, and makes the lockingmember 90 described in the available aboveanchor assemblies 20 will be received in thebar portion 332 and is fixed to anchorassemblies 320 against the lower surface of its localized implant such as panel element.

Connection element 330 is included in the lower end ofbar portion 332 or the receivingportion 334 of far-end.Receiving portion 334 comprises that thehead 72 that is used to accept anchoringelement 70 is in whereinadmittance space 344 be used to admit theInternal locking groove 346 of C clamp button 60.Clip 60 pivots and supports the head of admitting in thespace 344 72, and thecup portion 54 ofhat part 50 around head 372 location, makes at least aportion base part 52 extend throughrelative window 348, as shown in figure 24 in admittingspace 344.

Bar portion 332 comprises lockingmember mounting portion 333 and 333extensions 352 to proximal extension from the mountingportion.Extension 352 provides the proximal extension ofbar portion 332 alonglongitudinal axis 321, be convenient to implant components thereon placement and implant is guided to the position of contiguous receivingportion 334 andbizet 50 at intra-operative.And when operating implant and vertebra,extension 352 can prevent that implant is from 332 slippages of bar portion before intra-operative and lockingmember 90 are engaged to bar portion 332.In addition, lockingmember 90 can temporarily be engaged tobar portion 332 aroundextension 352, enough spaces betweenhat part 50 and the lockingmember 90 are provided, and before with lockingmember 90 implant being fixed inanchor assemblies 320 at intra-operative, operating implant is with respect to anchor assemblies 230 in-positions.

The region offracture 350 is between mountingportion 333 and extension 352.As shown in figure 26, the region offracture 350 can be formed by the wall part that inwardly attenuates in thebar portion 332, has interrupted also having interrupted shaping surface plane 356 (Figure 25) simultaneously along the thread contour of bar portion 332.Tool engagement passage 336 extends throughextension 352 and mountingportion 333, comprises the tool engagement surface that forms noncircular cross section.Hasgauge part 356 inbar portion 332 inner wall surface of adjacent break-off region 350.Gauge part 356 has reduced near the wall thickness ofbar portions 332 region offracture 350, makes that in thetool engagement passage 336 of the region offracture 350 near-endsextension 352 is applied the moment of torsion of predeterminated level will be from the mountingportion 333 cuts off extensions 352.By changing the wall thickness of the region offracture 350place bar portions 332, can change the amount of required torque.

Extension 352 comprises tapered near-end 358, to further facilitate panel element around its placement.The threadedarcuate part 354 thatextension 352 comprisesrelative plane 356 and extends between two planes 356.Similarly, the threadedarcuate part 340 that mountingportion 333 comprisesrelative plane 338 and extends between them is alignd with theplane 356 and thearch section 354 ofextension 352 respectively.Threaded arcuate part 340,354 is with lockingmember 90 receive threaded and be engaged to bar portion 332.The size on plane 338,356 makes it prop up sidewall along elongated slot or other opening of localized panel element on it, to eliminate the sidesway or the pivot of panel element.When along the extension during 352 pushing plate elements,connection element 330 is further with respect to the register of panel element.In another embodiment, consider thatbar portion 332 has screw thread along its whole length.In another embodiment, all orpart bar portion 332 does not have relative plane, but has circular cross-section.In another embodiment,bar portion 332 352 does not have screw thread along the extension.

With reference now to Figure 27-29,, shown themulti-axial anchor assemblies 420 of anotherembodiment.Anchor assemblies 420 comprisesconnection element 430, and itsbar portion 432 extends along thelongitudinal axis 421 of anchor assemblies 420.Anchor assemblies 420 can comprise any suitable configuration described in the anchor assemblies of other embodiment above.Thebar portion 432 of extending is similar to theextension rod portion 332 ofmulti-axial anchor assemblies 320, but its length alonglongitudinal axis 421 can make its near-end contiguous or extend through otch or opening location towards spinal column.Thebar portion 432 of extending helps implant aroundconnection element 430 location, and the guiding implant arrives the contiguous position that is engaged with the vertebral body of anchoringelement 70 by otch.Can save the surgical instruments that grasps implant, crowding in the working place that the minimizing otch forms.

In illustrated embodiment,anchor assemblies 420 comprises anchoringelement 70, andavailable clip 60 is received in its pivot in the connection element 430.Hat part 50 can be located inconnection element 430 around thehead 72 of anchoring element 70.Thebase part 52 ofhat part 50 exposes byconnection element 430 or extends, and makes the lower surface of implant to fix against it, as mentioned described in theanchor assemblies 20.

Connection element 430 is included in the receivingportion 434 ofbar portion 432 lower ends or far-end.Receiving portion 434 can be configured to above about described in receivingportion 34 and 334.Bar portion 432 comprises lockingmember mounting portion 433 and 433extensions 452 to proximal extension from the mounting portion.The region offracture 450 is between mountingportion 433 and extension 452.Extension 452 provides the proximal extension ofbar portion 432, is convenient to implant placement and near the position intra-operative guides to implanthat part 50 thereon.And when operation panel and vertebra,extension 452 can prevent that implant is from 432 slippages of bar portion before intra-operative and lockingmember 90 are engaged to bar portion 432.In addition, lockingmember 90 can temporarily be engaged tobar portion 432 aroundextension 452, before with lockingmember 90 implant being fixed in anchor assemblies at intra-operative, additional space is provided, be used betweenhat part 50 and lockingmember 90 operating implant to position with respect to anchor assemblies.

Be similar to anchorassemblies 320,bar portion 432 can have the in-house tool depression (not shown) that extends throughextension 452 and mountingportion 433, with the adjacent break-offregion 450 gauge part in the wall surface within it, make that at the near-end of the region offracture 450extension 452 being applied the moment of torsion of predeterminated level will be from the mountingportion 433 cut offextensions 452.

Extension 452 comprises tapered near-end 458, to further facilitate the placement of implant around it.The threadedarcuate part 454 thatextension 452 comprisesrelative plane 456 and extends between plane 456.Similarly, the mountingportion 433 threadedarcuate part 440 that comprisesrelative plane 438 and between them, extend.Threaded arcuate part 440,454 receive threaded and engagement locking member 90.The size on plane 438,456 can prop up sidewall along elongated slot or other opening of localized implant on it, with the sidesway or the pivot of elimination implant, andconnection element 430 is alignd with respect to implant.

Extension 452 helps the rotation ofconnection element 430, makes the receivingportion 434 correct implants of aiming at.The rotation ofconnection element 430 can be 452 during to distal movement, to admit the taperedproximal end part 458 of implant and the result that autoregistration receivingportion 434 causes along the extension when implant.Also available instrument or manual engageproximal part 458 rotate to desired location with respect to implant with receivingportion 434.

For the anchor assemblies of any embodiment as herein described, specifically with reference to anchor assemblies 320,420, available reduction instrument mesh rod portion 332,432 is to provide the mechanical advantage ofadjacent crown member 50 location implants such as panel element.Described reduction instrument can reduce the intervertebral displacement of dislocation, or only forces panel element to enter the position ofadjacent crown member 50 before with lockingmember 90 final fixing.Other embodiments are considered to screw in lockingmember 90 to force panel element nearhat part 50 by the upper surface against panel element, realize the deflation of panel element and/or vertebra.

For example, panel element can be around bar portion 332,432 location, and locking member can temporarily be engaged in bar portion 332,432, makes a part of threaded arcuate part 354,454 be exposed to the near-end of locking member.Reduction instrument can comprise second element of screw-threaded engagement relative first element motion with available actuator of 352,452 first element in the extension.First element but second element contact plate element location and available actuator lever are moved is so that panel element moves towardshat part 50 along bar portion 332,432.Then, lockingmember 90 can be along the mounting portion 333,433 advances, and with against hat part engaging plate element securely, reduction instrument remains on desired location with respect to anchor assemblies with panel element simultaneously.

Figure 30-32 has shown themulti-axial anchor assemblies 520 of another embodiment, implant can be fixed in one or more spinalvertebraes.Anchor assemblies 520 comprises in the receiving portion be connected inconnection element 530 that pivots 534 anchoring element 70.Connection element 530 comprises from thebar portion 532 of receivingportion 534 to proximal extension, be used for admitting implant around it, for example shown in panel element 120.Whenbar portion 532 located by theopening 124 ofplate 120, anchoringelement 70 can pivot with respect to panel element 120.In one form,connection element 530 comprises the hat spare 550 in the receivingportion 534 that centers onbar portion 532 location, extends between anchoringelement 70 and panel element 120.In one embodiment, in case againstpanel element 120 fixedly lockedelements 590,hat part 550 can be with anchoringelement 70 rigid engagement in the appropriate location with respect toconnection element 530 andpanel element 120.

Connection element 530 can comprise one or more windows, and the path ofhat part 550 withconnection element 530 external communications is provided.In one embodiment,connection element 530 comprises at least onewindow 548,hat part 550 comprisesbase part 552, and when aroundbar portion 532 location,base part 552 can pass described at least onewindow 548 and at least one ofcontact plate element 120 extendsaxially arm 553 and form by stretching out.When lockingmember 590 during againstpanel element 120 location, lockingmember 590 is against one ormore arms 553 secureengagement panel elements 120 of hat part 550.In illustrated embodiment,connection element 530 comprises that around its fourwindows 548 thatseparate hat part 550 comprises fourarms 553 that limitbase part 552, and they extend axially respectively passes described four windows 548.Other embodiment is considered two arms and window, three arms and windows or is surpassed the setting of four arms and window.Window and arm can be evenly spaced from each other, perhaps non-uniform spacing.Consider that also the particular anchor assembly can have the arm and the window of varying number.

Multi-axial anchor assemblies 520 comprises first orientation, and wherein, anchoringelement 70 andbar portion 532 are alonglongitudinal axis 521alignment.Anchor assemblies 520 comprises that also using receivingportion 534 to pivot towards themaintenance clip 560 in the opening of far-end is engaged in the anchoringelement 70 of connection element 530.Anchoringelement 70 is multiaxis position with respect to its unlimited amount in the circular cone that also can extremely center onlongitudinal axis 521 extensions aroundlongitudinal axis 521 pivoting actions.In one embodiment, the angular range A of 70longitudinal axis 71 fromaxis 521 to anchoring element that limits of circular cone can be up to 90 degree.In another embodiment, angular range A reaches 45 degree.In another embodiment, angular range A is up to about 30 degree.

Thecontiguous anchoring elements 70 ofhat part 550 are received in theconnection element 530, and it comprises stretching out fromconnection element 530 passes one at least onebase part 552 that aligns the window 548.Lockingmember 590 is engageable toconnection element 530, with againsthat part 550 fixinghead elements 120, shown in figure 32.Lockingmember 590 engagement providedhat part 550 is seated on the near-end of anchoringelement 70 downwards or to the bed knife of distal orientation, with anchoringelement 70 with respect toconnection element 530 rigid engagement in desired location.

It is the lowerend receiving portion 534 at center thatconnection element 530 comprises to thebar portion 532 of proximal extension with longitudinal axis521.Bar portion 532 has relative size less than receivingportion 534, makesbar portion 532 can pass the opening of implant, and the size of at least aportion receiving portion 534 can prevent to pass the opening of implantsimultaneously.Connection element 530 comprises and extends through the upperend channel part 542 that theadmittance space 544 that forms inbar portion 532 and the receivingportion 534 is communicatedwith.Receiving portion 534 comprises near the female thread profile of admitting thespace 544 546, is used for receive threaded and engagement and keepsclip 560 in wherein.

Keepclip 560 to comprise externalscrew thread mate 564 and far-end retaining part 562.Inner chamber 566 extends throughmate 564 and retainingpart 562, admits the threaded rod of anchoringelement 70 to pass through wherein.Shown in figure 32,inner chamber 566 comprises that size is fit to admit thecup portion 554 that is preced withpart 550 in proximal part wherein, and the near-end of anchoringelement 70 is arranged in glass portion 554.Far-end retaining part 562 comprises theflange 568 that inwardly radially extends, around and the head ofcontact anchoring element 70 surpass its maximum outside dimension so that anchoringelement 70 is remained in theconnection element 530 to remote extension.Keep the screw-threaded engagement ofclip 560 andconnection element 530 to provide anchoringelement 70 infra terminations to receive settings that be fixedly connected in thepart 534, be convenient to the assembly and disassembly of anchoringelement 70 andconnection element 530 simultaneously, need not distortion orcrooked maintenance clip 560.

Bar portion 532 can comprise rounded outer surface, and it has external threaded profiles with screw-threaded engagement locking member590.Bar portion 532 also can be configured to have the relative plane along its outer surface, as mentioned above.Thetool engagement passage 536 that the upperend channel part 542 ofbar portion 532 forms to proximal openings, its inner surface has noncircular cross section, is fit to engagement tool so that aroundlongitudinal axis 521 rotation connection elements 530.In addition, the size ofchannel part 542 allows driving instruments by being received in the anchoringelement 70 in the receivingportion 534 with engagement, and directly anchoringelement 70 is applied driving force byconnection element 530.

Hat part 550 is included in thebase part 552 oflower cup portion 554 proximally-located.Base part 552 comprises from its axially extended a plurality ofarms 553, forms groove between the alternate arm 553.Base part 552 comprises axially extendedarm 553, and its size can be passed through its extension and protruding fromwindow 548 with respect towindow 548, makes to be supported byhat part 550 at least in part around its localized implant.As shown in figure 31,base part 552 forms the cup-shaped of proximal openings, has thepaddy 558 betweenconcavity zone 557 and the arm 553.Cup portion 554 comprises the hemispherical main body of stretching out to far-end frombase part 552, at the opening of its far-end formation towards far-end.Cup portion 554 forms and admitsspace 559, and it has concave inside surface, is fit to admit the near-end shape of localized anchoringelement 70 in the connection element 530.Throughhole 556 extends throughbase part 552 and is communicated with admittingspace 559, allows driving instruments to place to mesh the tool recess of localized anchoringelement 70 near-ends in the cup portion 551 by it.

Figure 30-32 has shown the locking member 590 of an embodiment, its engageable bar portion 532 to connection element 530.Locking member 590 comprises main body 592, and it has the sidewall 596 that extends around tapped through hole 594.Through hole 594 can be along longitudinal axis 521 alignment of anchor assemblies 520.When locking member 590 during, shown in Figure 30 and 32, further screw locking member 590 against panel element 120 and can make panel element 120 be seated in any one or combination on the end of base part 552 arms 553 around 532 engagements of bar portion and contact plate element 120.This can force hat part 550 to be positioned on the head of anchoring element 70 again.For the anchoring element 70 with lock ridge, anchoring element 70 can be rigidly connected to connection element 530.Considered that also multiaxis is to the arrangement that connects, as mentioned above.And the configuration of locking member 590 can prevent that it is loosening or deviate from along bar portion 532, as mentioned about described in the locking member 590.Other embodiment has been considered other form of locking member 590, comprise that the locking member with breaking portion is to guarantee applying suitable moment of torsion during the engagement, or have the locking member of other meshing relation with bar portion 532, for example bayonet joint, interference fit or merge connects.

Figure 33-34 has shown the multi-axial anchor assemblies 620 of another embodiment, so that implant such as panel element 600 are fixed in one or more spinal vertebraes.In illustrated embodiment, panel element 600 comprises the fluting coupling part 602 with groove 604.The coupling part 602 that other embodiment consideration does not have channel opening to pass.Panel element 600 also comprises the receiving portion 606 that departs from coupling part 602, forms to admit passage 608.Admit passage 608 transverse to groove 604 orientations, when coupling part 602 being engaged to vertebra with the anchor in the groove 604, admittance passage 608 can aligned acceptance along the localized bar of spinal column or other microscler Connection Element.Passing receiving portion 606 has and the horizontal inner chamber 610 of admitting passage 608 to be communicated with.Holding screw or other engaged element can be positioned in the inner chamber 610, with the microscler connector of engagement in the passage 608, connector are fixed in the position with respect to anchor assemblies 620.Should be understood that anchor assemblies 620 can be used for the panel element of any embodiment described herein, and panel element 600 can be used for the anchor assemblies of any embodiment described herein.Consider that also anchor assemblies 620 can be used for the implant of any kind is fixed in the spinal bone structure.

Anchor assemblies 620 comprises anchoringelement 70 and lockingmember 590, as mentioned described in theanchor assemblies 520, though also consider to use the anchor and the locking member of other embodiment in anchor assemblies 602.Anchor 70 be the top pack into and the receiving portion 634 that is received inconnection element 630 that pivots in.Hat part 650 can be in the proximally-located ofanchor 70 heads in receiving portion 634.Connection element 630 also comprises the bar portion 632 that removably is engaged in receiving portion 634 near-ends.In one embodiment, the hat spare 650 in the receiving portion 634 is at anchoringelement 70 with around extending between the bar portion 632 localized panel elements 600.When lockingmember 590 against panel element 600 fixedly the time, hat part 650 can be with anchoringelement 70 rigid engagement in the appropriate location with respect toconnection element 630 and panel element 600.Other embodiment is considered, even after lockingmember 590 is fixed in panel element 600, is limited the angular movement of anchoringelement 70.

When opening 604 location of panel element 600 were passed by bar portion 632, anchoringelement 70 can pivot with respect to panel element 600.Considered that anchoringelement 70 arranges with respect to the various angles of bar portion 632, as this paper about described in the anchor assemblies of otherembodiment.Anchoring element 70 with respect to the angular movement of bar portion 632 help with anchoringelement 70 with required orientation positions in vertebra, allow alignment rods portion 632 to admit panel element simultaneously around it.

In one form, bar portion 632 comprises the far-end mate 660 that extends around the far-end outward radial of proximal stem part 636.Mate 660 can have external screw thread, with the female thread at screw-threaded engagement receiving portion 634 proximal openings places.In another form, mate 660 has female thread, with the external screw thread on the engagement receiving portion 634.Also considered other linkage arrangement, comprised that friction or interference fit, fusion, binding agent, securing member, bayonet socket connect and girdle is buckled cooperation etc.Mate 660 comprises at least one window 648, hat part 650 comprises base part 652, when around bar portion 632 location, base part 652 can pass described at least one window 648 and at least one of contact plate element 600 extends axially arm 653 and form by stretching out.When lockingmember 590 during against panel element 600 location, lockingmember 590 is against the arm 653 secure engagement panel elements 600 of one or more hat spares 650.

In illustrated embodiment, mate 660 comprises around four windows 648 of its circle spacing and along circumference and is thin-and-long.Hat part 650 comprises four arms 653 that limit base part 652, and they extend axially respectively passes described four windows 648.Other embodiment is considered two arms and window, three arms and windows or is surpassed four arms and The Window Design.Consider that also the particular anchor assembly can have the arm and the window of varying number.Hat part 650 can mesh with anchoringelement 70, and above makes up about the variety of way described in thehat part 550 with any.

Hat part 650 can be close to anchoringelement 70 and be received in theconnection element 630, and it comprises at least one base part 652 that stretches out and pass one of window 648 from mate 660respectively.Locking member 590 is engageable to bar portion 632, with against hat part 650 fixing head elements 600, as shown in figure 34.Lockingmember 590 engageable to bar portion 632 with against hat part 650 fixing head elements 600, as shown in figure 34.Lockingmember 590 engagement provided hat part 650 is seated on the near-end of anchoringelement 70 downwards or to the bed knife of distal orientation, with anchoringelement 70 with respect toconnection element 630 and bar portion 632 rigid engagement in desired location.In one embodiment, hat part 650 comprises lower cup portion 654, its outer surface profile meets the inner surface profile of receiving portion 634, at least head pivoting action in receiving portion 634 ofpermission anchoring element 70 before lockingmember 590 meshes against implant.

Connection element 630 comprises with longitudinal axis 621 being the lower end receiving portion 634 at center, mate 660 engageable near-ends at receiving portion 634, bar part 636 along axis 621 from it to proximal extension.Bar part 636 reduces with respect to receiving portion 634 sizes, make bar part 636 can pass the opening of panel element, and the size of at least a portion mate 660 and receiving portion 634 can prevent to pass the opening 604 of panel element 600.Bar portion 632 comprises rounded outer surface, but its external threaded profiles screw-threaded engagement locking member 590.Bar portion 632 also can be configured to have relative plane along its outer surface, as mentioned above.

Bar portion 632 also can form proximal openings tool engagement passage, and its inner surface is formed for the noncircular cross section configuration of engagement tool, so that around longitudinal axis 621 swingle parts 636 and mate 660.The size of passage allows driving instruments by being received in the anchoringelement 70 in the receiving portion 634 with engagement, and directly applies driving force by 632 pairs of anchoringelements 70 of bar portion.

With reference now to Figure 35 and 36,, shown theanchor assemblies 720 of another embodiment, be similar to anchor assemblies mentioned above 620.Anchor assemblies 720 comprises that pivot is received in anchoringelement 70 and the localized hat spare 650 ofcontiguous anchoring element 70 heads in theconnection element 630, and hat part 650 extends axially and passesmate 760 axially extendedwindows.Bar portion 732 is similar to bar portion 632, but comprisesbar part 736, and it has the smooth non-threaded outer surface that extends along its most of length.In one form, the length ofsmooth part 736 is enough to admit the connector of another spinal implant of engagement such as bar or tether.The far-end ofbar portion 732 comprisesthread contour 733, with screw-threadedengagement locking member 590.

Lockingmember 590 can so that the arm that extends axially of the far-end ofmain body 592 contact hat part 650 is located, be fixed on the appropriate location with anchoringelement 70, as mentioned about described in the anchor assemblies 620 alongthread contour 733 engagements.Connector or other implant can be engaged tobar portion 732 at the near-end of locking member 590.By with holding screw, jaw arrangement, frictional fit or other suitable draw bailmesh rod portion 732, connector can be fixed on the appropriate location.Other embodiment is considered, second locking member can be engaged tobar portion 732 at the near-end of connector, with the connector clamp between locking member.

In a kind of technology that adopts anchor assemblies described herein, the size of panel element is fit to two adjacent vertebras of contact, the opening that comprises at least one contiguous this vertebra, make that when the anchoring element of anchor assemblies was engaged to the below bone structure, the connection element of anchor assemblies can be placed by described at least one opening.In another embodiment, available locking member temporarily is received in anchor assemblies on the panel element before meshing with bone structure.The size of panel element and configuration are also extensible to stride across plural vertebra to realize multilevel stabilization procedure, the perhaps engageable vertebra of its configuration, and admitting element to admit can be along the localized microscler connector of two or more vertebras such as bar or plate.

Panel element can prebend or in the intra-operative bending to have curved shape, for example, to rebuild or to meet nature or required rachiocamposis shape.Should be understood that and to comprise any curved shape that is fit to one or more spinal column segment (no matter being cervical vertebra, thoracic vertebra, lumbar vertebra or sacral) in the panel element.These curved shapes can comprise complete convex, spill, straight line (being basic plane) and their combination fully fully.Also consider plate engageable front side, inclined-plane, side or posterior bony part to one or more vertebras.

The panel element of this paper illustrated embodiment is not shown on panel element or engageable holding element to panel element, to prevent or to resist deviating from of locking member.But panel element can have one or more holding elements, with any part the deviating from respect to panel element that prevents anchor assemblies.Holding element can be attached to panel element, be received on the panel element or with panel element integrally formed holding screw, holding screw and packing ring, spring-load element, sliding gasket or other similar structures in any or combination.

For the ease of using, can provide the tool set of any or combination of one or more parts of comprising implant assembly.For example, tool set can comprise the panel element of different length, size, groove configuration and/or the curved shape of some embodiments.Can comprise length and size that suitable cervical vertebra, thoracic vertebra, lumbar vertebra and/or sacral are implanted.One or more groups multiaxis be to can having various anchoring element sizes with single shaft to anchor assemblies, and also can have the connection element that is fit to be attached to one or more spinal column cervical regions, chest, waist, sacrum portion zone in the tool set.Tool set also can comprise a plurality of multi-axial anchor assemblies, comprises the anchor assemblies that is configured to can provide spinal column stiff stability and dynamic stability when being engaged in panel element.

The method of using one or more multi-axial anchor assemblies described herein will be described below.Anchor assemblies can be used for bouncing back in the open surgical procedures of skin and tissue, be used for the minimally-invasive surgical operation, in this operation, the one or more minimally-invasive admission passages that form by Wicresoft's mouth, retractor, sleeve pipe and expansion sleeve are positioned at anchor assemblies and/or panel element in patient's body.

In a kind of operation, the surgeon need connect the vertebra of implant or a kerf is made to the patient in the position of other bone in relative proximity.Obtain to lead to after the suitable path of surgical site, handle the part (for example pedicle of vertebral arch) of the inferior vertebra that will install apparatus additional with standard mode.For example, can use awl or bore to punch, whether investigation depth and tapping are fit to anchoring element then.Then, an anchoring element is inserted in the hole of inferior vertebra, use connection element to be engaged in this vertebra.Obtain to lead to the passage that a part will install the superior vertebra (for example pedicle of vertebral arch) of apparatus additional then, or by existing otch or by otch independently.Identify on the superior vertebra will attached implant point, and prepare vertebra as mentioned above.Another anchor assemblies is engaged to superior vertebra, and at least one anchor assemblies is a multi-axial anchor assemblies.Described at least one multi-axial anchor assemblies can be configured to can provide rigidity or dynamic stability when being engaged to panel element, as mentioned above.Can repeat said process to above and below intervertebral any one or a plurality of vertebra when needing.

Then, panel element directly is inserted into anchor assemblies by otch or by entering pipe or retractor.The bar portion of described at least one multi-axial anchor assemblies connection element locatees by this opening by the opening or the bottom-loaded of panel element respectively.The scalable connection element is with respect to the orientation and the axial location of anchoring element and panel element.When panel element and anchor assemblies are in desired location each other and with respect to spinal column, can advance locking member so that each anchor assemblies and panel element are interfixed in desired location.Panel element finally is fixed in before the anchor assemblies available fixed panel element compression or separate vertebra and also maintain this position.Consider that also one or more intervertebral dish gaps or posterior elements can merge with any or combination in bone graft, bone material and the implant.Have the anchor assemblies of the connection element of extension rod portion for employing, can after plate is fixed in anchor assemblies, remove the extension of bar portion.

Should also be understood that above-mentioned embodiment should be made of suitable implant into body or other intravital material, can comprise inert metal such as titanium or rustless steel.Also can consider other sturdy material such as some pottery or plastics.Biological absorbing material again such as polylactic acid chemical compound can be with above-mentioned parts couplings or as the part of above-mentioned parts.In one embodiment, anchor assemblies adopts non-metal board.The engagement of anchor assemblies and non-rigid plate comprises partially flexible at least to realize flexible spinal stabilization, and the vertebral that allows to install apparatus additional can be moved at least limitedly.Can make panel element dynamic engagement to the anchor assemblies of spinal column can improve spinal motion by providing, as mentioned above.

Though in accompanying drawing and described explanation, show in detail and described the present invention, think that these contents are exemplary and nonrestrictive, should understand and only show and described preferred embodiment, need protection and drop on all changes and improvements in the scope of the invention.

Claims (75)

1. anchor assemblies, described assembly comprises:

Anchoring element, it comprises head and is used for the bottom from described head extension of engage bone element;

Be pivotally connected to the connection element of described anchoring element head, described connection element comprises the below receiving portion and leaves the bar portion of described head from the extension of described below receiving portion, described below receiving portion is formed for admitting the internal admission space of described head, described bar portion is configured to mesh locking member, and described below receiving portion forms the sidewall opening of at least one and described connection element external communications; With

Be positioned at the hat spare in the described admittance space of described connection element around the described head of described anchoring element, described hat spare comprises the base part that is communicated with described at least one sidewall opening, be used to contact around the described localized implant element of bar portion of described connection element and locate, implant element is fixed between described locking member and the described base part.

2. assembly as claimed in claim 1 is characterized in that, the described bottom of described anchoring element comprises threaded rod.

3. assembly as claimed in claim 2 is characterized in that, described anchoring element is included in the non-threaded cervical region between described head and the described threaded rod.

4. assembly as claimed in claim 3, it is characterized in that, described assembly also comprises around described cervical region location and the clip that extends between described connection element and described head, the size of described clip is made and can be prevented that described head is by wherein, so that described anchoring element is remained in the described connection element.

5. assembly as claimed in claim 1 is characterized in that, described head comprises a plurality of spiral shell ridges that center on its extension and be orientated towards described hat spare.

6. assembly as claimed in claim 5, it is characterized in that, when making implant element fix against described base part with described locking member, described a plurality of spiral shell ridges mesh described hat spare, and the described engagement between described spiral shell ridge and described hat spare prevents that described anchoring element from pivoting with respect to described connection element.

7. assembly as claimed in claim 1 is characterized in that, the described base part of described hat spare comprises the arm from its extension, and described at least one sidewall opening of described connection element comprises relative window, and described arm is respectively by described relative window position.

8. assembly as claimed in claim 7 is characterized in that, described hat spare comprises the cup portion of extending from described base part, and described cup portion comprises and is used to admit the described head of described anchoring element in admittance space wherein.

9. assembly as claimed in claim 8 is characterized in that, described hat spare comprises and extends through the spatial through hole of described admittance that described base part enters described cup portion.

10. assembly as claimed in claim 1 is characterized in that, described bar portion comprises external screw thread, is used for around the described locking member of its receive threaded.

11. assembly as claimed in claim 10, it is characterized in that, described locking member comprises the main body that has around the wall of central lumen extension, described central lumen is admitted described bar portion when described locking member is engaged with, described wall comprise be communicated with described inner chamber extend through wherein groove transverse to described inner chamber.

12. assembly as claimed in claim 1 is characterized in that, described bar portion comprise by relative arc thread surface interconnection along relative plane that its certain-length extends.

13. assembly as claimed in claim 1 is characterized in that, described bar portion forms the axial passage that is communicated with described admittance space.

14. a spinal plate system, described system comprises:

Elongate plate member, it is included at least one opening that extends through between upper surface and the relative lower surface wherein, and described lower surface can be located along spinal column;

Can be engaged to the anchor assemblies of described panel element, described anchor assemblies comprises:

Connection element, it has the localized bar of described at least one opening portion and can be in abutting connection with the localized receiving portion of the lower surface of described panel element can passed, and described receiving portion comprises admits the space;

Anchoring element, it comprises the head in the described admittance space that is received in described receiving portion that pivots and is used for the bottom from described head extension of engagement ridge spinous process of the seventh cervical vertebra structure;

The localized hat spare of contiguous described head in described admittance space, described hat spare comprises the base part that extends through described connection element along the described lower surface of described panel element; With

Can be engaged to described bar portion and can contact the localized locking member of described upper surface of described panel element, fix so that the described lower surface of described panel element contacts the described base part of described hat spare.

15. system as claimed in claim 14 is characterized in that, described connection element comprises at least one window, and described base part stretches out by described at least one window.

16. system as claimed in claim 14 is characterized in that, described connection element comprises relative window, and described base part comprises the relative arm that stretches out by described relative window respectively.

17. system as claimed in claim 14 is characterized in that, the described bottom of described anchoring element comprises threaded rod.

18. system as claimed in claim 17 is characterized in that, described anchoring element is included in the non-threaded cervical region between described head and the described threaded rod.

19. system as claimed in claim 18, it is characterized in that, described system also comprises around described cervical region location and the clip that extends between described connection element and described head, the size of described clip is made and can be prevented that described head is by wherein, in the described admittance space that described anchoring element is remained on described connection element.

20. system as claimed in claim 14 is characterized in that, described head comprises a plurality of spiral shell ridges in abutting connection with described hat spare around its extension.

21. system as claimed in claim 20, it is characterized in that, when make panel element against described base part fixedly the time with described locking member, described a plurality of spiral shell ridges mesh described hat spare, and the described engagement between described spiral shell ridge and described hat spare prevents that described anchoring element from pivoting with respect to described connection element.

22. system as claimed in claim 21 is characterized in that, described hat spare comprises the cup portion of extending from described base part, and described cup portion comprises and is used to admit the described head of described anchoring element in admittance space wherein.

23. the system as claimed in claim 22 is characterized in that, described hat spare comprises and extends through the spatial through hole of described admittance that described base part enters described cup portion.

24. system as claimed in claim 14 is characterized in that, described bar portion comprises the external screw thread along its extension, is used for around the described locking member of its receive threaded.

25. system as claimed in claim 24 is characterized in that, described locking member comprises a main body, it has the wall that extends around central lumen, is used to admit described bar portion, and described wall comprises groove, this groove horizontal expansion, is communicated with described inner chamber to described inner chamber by it.

26., it is characterized in that described at least one opening of described panel element comprises elongated slot as claim 14 described systems.

27. system as claimed in claim 26 is characterized in that, described panel element comprises the bar receiving portion, and it forms the passage that extends transverse to described elongated slot, and described passage is used to admit bar to pass through wherein.

28. system as claimed in claim 14 is characterized in that, described panel element comprises the curved profile along described upper and lower surface.

29. system as claimed in claim 14 is characterized in that, described panel element comprises a plurality of grooves along its extension.

30. a spinal plate system, described system comprises:

Along the elongate plate member of vertical axis extension, it is included at least one opening that extends through between upper surface and the relative lower surface wherein, and described lower surface can be located towards spinal column;

Can be engaged to the anchor assemblies of described panel element, described anchor assemblies comprises:

Connection element, it comprises the bar portion that can pass described at least one opening location and can mesh described panel element, make described connection element can not pivot with respect to described panel element, described connection element comprises can be along the localized receiving portion of described lower surface of described panel element, and described receiving portion comprises the admittance space away from described panel element opening; With

Anchoring element, it comprises the head in the admittance space that is received in described receiving portion that pivots, described anchoring element comprises the bottom of extending from described head, be used for engagement ridge spinous process of the seventh cervical vertebra structure, when described bar portion was engaged to described panel element in described at least one opening, described anchoring element can pivot with respect to described panel element and described receiving portion.

31. system as claimed in claim 30 is characterized in that, described anchor assemblies comprises:

The described head of contiguous described anchoring element is positioned at the hat spare in the described admittance space of described connection element, and described hat spare comprises the base part that extends through described connection element along the described lower surface of described panel element; With

Locking member, it can be engaged to described bar portion and can contact the described upper surface location of described panel element, fixes so that the described lower surface of described panel element contacts the described base part of described hat spare.

32. system as claimed in claim 31 is characterized in that, described connection element comprises that opening enters the spatial relative window of described admittance, and the described base part of described hat spare extends through described window.

33. system as claimed in claim 31, it is characterized in that, when described locking member contacts the described upper surface location of described panel element, described anchoring element is not engaged in the described receiving portion pivotly, with described lower surface, thereby mesh described hat spare against the described head of described anchoring element against the described panel element of described base part secure engagement.

34. system as claimed in claim 33, it is characterized in that, described hat spare comprises the cup portion of extending from described base part, described cup portion forms and admits the space, be used to admit the described head of described anchoring element, the described head of described anchoring element comprises a plurality of spiral shell ridges, is used to mesh described cup portion, so that described anchoring element is not fixed in the described connection element pivotly.

35. system as claimed in claim 31, it is characterized in that, described locking member contacts the described upper surface location of described panel element, and with the described lower surface against the described panel element of described base part secure engagement of described hat spare, described anchoring element can pivot in described connection element.

36. system as claimed in claim 30 is characterized in that, the described opening of described panel element comprises at least one elongated slot along the described longitudinal axis of described panel element.

37. system as claimed in claim 30 is characterized in that, described panel element is along described longitudinal axis bending, so that described upper surface is a spill, described lower surface is a convex.

38. system as claimed in claim 30 is characterized in that, described panel element comprises the bar receiving portion, and it is formed for admitting the passage of elongate bars.

39. system as claimed in claim 38 is characterized in that, described at least one opening is the elongated slot that extends transverse to described passage.

40. system as claimed in claim 30 is characterized in that, the described bottom of described anchoring element comprises threaded rod.

41. system as claimed in claim 40 is characterized in that, described anchoring element comprises from the tract of described head by the distal tip extension of described threaded rod.

42. system as claimed in claim 41 is characterized in that, described head comprises the tool engagement depression that is communicated with described tract.

43. system as claimed in claim 30 is characterized in that, described connection element comprises extending axially of being communicated with the described admittance space inner passage by described bar portion.

44. system as claimed in claim 43 is characterized in that, at least a portion of described passage is configured to mesh driven tool.

45. system as claimed in claim 43 is characterized in that, the described head of described anchoring element comprises the tool engagement depression that is communicated with described admittance space.

46. system as claimed in claim 45, it is characterized in that, described anchor assemblies comprises the described head localized hat spare in described admittance space around described anchoring element, and described hat spare comprises the through hole that can align with the described tool engagement depression of the described passage of described connection element and described anchoring element.

47. a spinal surgery method, described method comprises:

Arrive at least one spinal vertebrae;

Make the anchoring element of anchor assemblies be engaged to described at least one vertebra, described anchor assemblies comprises connection element, and it has around the receiving portion of anchoring element head pivot installation with from the bar portion of described receiving portion to proximal extension;

The head that makes receiving portion center on anchoring element is switched to desired location, thus carriage release lever portion;

Make elongate plate member center on bar portion proximally-located;

Make panel element be advanced into the position of contiguous receiving portion along bar portion; And

Against hat part engaging plate element, described hat spare extends through connection element from the head of anchoring element, to mesh described panel element in the connection element outside.

48. method as claimed in claim 47 is characterized in that, described engaging plate element can be against the head engagement hat part of anchoring element.

49. method as claimed in claim 48 is characterized in that, describedly can make connection element be rigidly connected to anchoring element against hat part engaging plate element.

50. method as claimed in claim 47 is characterized in that, when panel element against hat part when engagement, described connection element can pivot with respect to anchoring element.

51. an anchor assemblies, described assembly comprises:

Anchoring element, it comprises near-end and is used for the distal portions from described proximal extension of engage bone element;

Be pivotally connected to the connection element of the described near-end of described anchor, described connection element is along vertical axis extension, it comprises the below receiving portion and leaves the bar portion of described proximal extension along described axis from described receiving portion, the below receiving portion forms the internal admission space of extending around described axis, be used to admit described near-end, described connection element forms at least one the axially extended window with described connection element external communications;

Can be engaged to the element of described bar portion; With

The hat spare of described proximally-located in the described admittance space of described connection element of contiguous described anchoring element, described hat spare comprises the axially extended base part that is communicated with described at least one window, is used to contact the described element of the described bar portion that is engaged to described connection element and locatees.

52. assembly as claimed in claim 51 is characterized in that, described bar portion comprises the inner passage along described vertical axis extension that is communicated with the described admittance space of described receiving portion.

53. assembly as claimed in claim 51 is characterized in that, described anchoring element comprises along the threaded rod of described distal portions with in the enlarged head of described near-end.

54. assembly as claimed in claim 53, it is characterized in that, described assembly also comprises around described cervical region location and the maintenance clip that extends between described connection element and described head, described maintenance clip comprises threaded portion, it meshes described connection element around the spatial open-top screw thread to the far-end orientation of described admittance, described maintenance clip comprises the flange that extends radially inwardly that extends around the described head of described anchoring element, its size is made and can be prevented that described head is by wherein, so that described anchoring element is remained in the described connection element.

55. assembly as claimed in claim 53 is characterized in that, described head comprises a plurality of spiral shell ridges towards described hat spare orientation around its extension.

56. assembly as claimed in claim 55, it is characterized in that, when against the fixing described element of described base part, described a plurality of spiral shell ridges mesh described hat spare, and the described engagement between described spiral shell ridge and described hat spare prevents that described anchoring element from pivoting with respect to described connection element.

57. assembly as claimed in claim 51 is characterized in that, described bar portion is slick along its most of length.

58. assembly as claimed in claim 57 is characterized in that, described bar portion comprises the thread contour of contiguous its far-end, and described element is the locking piece that can contact the described thread contour of described base part screw-threaded engagement.

59. assembly as claimed in claim 51, it is characterized in that, the described base part of described hat spare comprises a plurality of axially extended arms, and described at least one window of described connection element comprises a plurality of axially extended windows, and described a plurality of arms pass described a plurality of window position respectively.

60. assembly as claimed in claim 59 is characterized in that, described hat spare comprises the distal openings cup portion of extending from described base part, and described cup portion comprises the admittance space, and the described near-end that is used to admit described anchoring element is in wherein.

61. assembly as claimed in claim 59 is characterized in that, described a plurality of arms comprise at least three arms around described hat spare peripheral distribution, and described a plurality of windows comprise at least three windows around described connection element peripheral distribution.

62. assembly as claimed in claim 51 is characterized in that, described bar portion comprises circular cross-section and around its external screw thread, is used for the described element of screw-threaded engagement.

63. assembly as claimed in claim 51 is characterized in that, described bar portion comprises the far-end mate that radially extends around the far-end of threaded shank portion, the proximal openings that described mate can the described below of screw-threaded engagement receiving portion.

64., it is characterized in that described at least one window extends through the described mate of described bar portion as the described assembly of claim 63.

65. a spinal implant system, described system comprises:

Implant, it is included at least one opening that extends through between upper surface and the opposing lower surface wherein, and described lower surface is located towards spinal column;

Can be engaged to the anchor assemblies of described implant, described anchor assemblies comprises:

Connection element, it has the localized bar of described at least one opening portion and can be along the localized receiving portion of described lower surface of described plate can passed, and described receiving portion comprises admits space and at least one window to proximal openings that is communicated with described admittance space,

Anchoring element, it comprises the head in the described admittance space that is received in described receiving portion that pivots and is used for the distal portions from described head extension of engagement ridge spinous process of the seventh cervical vertebra structure;

Keep clip, it can be engaged to described connection element in the spatial far-end orientation of described admittance opening, to be subjected to described head in the switching of described admittance space maincenter;

Around the localized hat spare of described head of described anchor, described hat spare comprises and extends through described at least one base part to the proximal openings window, is used to contact described implant location in described admittance space; With

Locking member, it can contact described implant and be engaged to described bar portion, so that described implant contacts described base part and is fixed in described connection element.

66., it is characterized in that described bar portion comprises the inner passage along described vertical axis extension that is communicated with the described admittance space of described receiving portion as the described system of claim 65.

67. as the described system of claim 65, it is characterized in that, described maintenance clip comprises threaded portion, can mesh described connection element around the spatial described open-top screw thread of described admittance to the far-end orientation, described maintenance clip comprises the flange that inwardly radially extends that extends around the described head of described anchoring element, its size is made and can be prevented that described head is by wherein, so that described anchoring element is remained in the described connection element.

68. as the described system of claim 65, it is characterized in that, the described base part of described hat spare comprises a plurality of axially extended arms, and described at least one window of described connection element comprises a plurality of axially extended windows, and described a plurality of arms pass one of described a plurality of windows location respectively.

69., it is characterized in that described a plurality of arms comprise at least three arms around described hat spare peripheral distribution as the described system of claim 68, described a plurality of windows comprise at least three windows around described connection element peripheral distribution.

70. a spinal surgery method, described method comprises:

The anchoring element of anchor assemblies is engaged at least one vertebra, and described anchor assemblies comprises: connection element, its receiving portion are formed for accepting the admittance space of anchoring element, bar portion from described receiving portion to proximal extension; With the hat spare of near-end in admitting the space of contiguous described anchoring element, described hat spare comprises at least one base part to proximal extension that extends to the position of admitting the outside, space from described admittance space;

With respect to the anchoring element of the described engagement described connection element that pivots, so that described bar portion is orientated in desired location;

One element is advanced into the position of contiguous described anchoring element along described bar portion; And

Described at least one base part against described hat spare meshes described element, so that described hat spare is engaged to the described near-end of described anchor in described admittance space.

71. as the described method of claim 70, it is characterized in that, described base part to proximal extension comprises the proximal extension arm of a plurality of hat spares, and described connection element comprises the window to the near-end orientation that is communicated with described admittance space of respective amount, is used to accept described each arm and passes through wherein.

72., it is characterized in that described a plurality of arms comprise at least three arms as the described method of claim 71, described a plurality of windows comprise at least three windows.

73. as the described method of claim 70, it is characterized in that, mesh described panel element and comprise anchoring element is rigidly fixed in the described connection element.

74. as the described method of claim 70, it is characterized in that, but described bar portion screw-threaded engagement is to described receiving portion.

75., it is characterized in that described bar portion comprises the far-end mate that extends from proximal stem part outward radial as the described method of claim 74, described far-end mate comprises a plurality of windows, is used to accept from a plurality of arms of described hat spare to proximal extension.

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