US20080288075A1 - Spine distraction implant and method - Google Patents

Abstract

A spine distraction implant alleviates pain associated with spinal stenosis and facet arthropathy by expanding the volume in the spine canal and/or neural foramen. The implant provides a spinal extension stop while allowing freedom of spinal flexion.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a continuation of each of U.S. patent application Ser. Nos. 11/806,529 (Attorney Docket No. KYPH-039/10US 305363-2188) and 11/806,527 (Attorney Docket No. KYPH-039/11US 305363-2189), each entitled “Spine Distraction Implant and Method,” and filed May 31, 2007; each of which is incorporated herein by reference in its entirety.
• Each of U.S. patent application Ser. Nos. 11/806,529 (Attorney Docket No. KYPH-039/10US 305363-2188) and 11/806,527 (Attorney Docket No. KYPH-039/11US 305363-2189) is a continuation-in-part of U.S. patent application Ser. No. 11/092,862, entitled “Supplemental Spine Fixation Device and Method,” filed Mar. 29, 2005, which is a divisional application of U.S. patent application Ser. No. 09/842,819, entitled “Supplemental Spine Fixation Device,” filed Apr. 26, 2001, now U.S. Pat. No. 7,201,751, which claims priority to U.S. Provisional Application Ser. No. 60/219,985, entitled “Supplemental Spine Fixation Device and Method,” filed Jul. 21, 2000 and which is a continuation-in-part of U.S. patent application Ser. No. 09/579,039, entitled “Supplemental Spine Fixation Device and Method,” filed May 26, 2000, now U.S. Pat. No. 6,451,019, which is a continuation-in-part of U.S. patent application Ser. No. 09/473,173, entitled “Spine Distraction Implant,” filed Dec. 28, 1999, now U.S. Pat. No. 6,235,030, which is a continuation of U.S. patent application Ser. No. 09/179,570, entitled “Spine Distraction Implant,” filed Oct. 27, 1998, now U.S. Pat. No. 6,048,342, which is a continuation-in-part of U.S. patent application Ser. No. 08/958,281, entitled “Spine Distraction Implant and Method,” filed Oct. 27, 1997, now U.S. Pat. No. 5,860,977, which is a continuation-in-part of U.S. patent application Ser. No. 08/778,093, entitled “Spine Distraction Implant and Method,” filed Jan. 2, 1997, now U.S. Pat. No. 5,836,948; each of which is incorporated herein by reference in its entirety.
• Each of U.S. patent application Ser. Nos. 11/806,529 (Attorney Docket No. KYPH-039/10US 305363-2188) and 11/806,527 (Attorney Docket No. KYPH-039/11US 305363-2189) is a continuation-in-part of U.S. patent application Ser. No. 10/747,534, entitled “Interspinous Process Distraction System and Method With Positionable Wing and Method,” filed Dec. 29, 2003, which is a continuation of U.S. patent application Ser. No. 10/014,118, entitled “Interspinous Process Distraction System and Method With Positionable Wing and Method,” filed Oct. 26, 2001, now U.S. Pat. No. 6,695,842, which claims priority to U.S. Provisional Application Ser. No. 60/306,263, entitled “Interspinous Process Distraction System and Method With Positionable Wing and Method,” filed Jul. 18, 2001 and which is a continuation-in-part of U.S. patent application Ser. No. 09/799,215, entitled “Spine Distraction Implant,” filed Mar. 5, 2001, now U.S. Pat. No. 7,101,375, which is a continuation-in-part of U.S. patent application Ser. No. 09/473,173, entitled “Spine Distraction Implant,” filed Dec. 28, 1999, now U.S. Pat. No. 6,235,030, which is a continuation of U.S. patent application Ser. No. 09/179,570, entitled “Spine Distraction Implant,” filed Oct. 27, 1998, now U.S. Pat. No. 6,048,342, which is a continuation-in-part of U.S. patent application Ser. No. 08/958,281, entitled “Spine Distraction Implant and Method,” filed Oct. 27, 1997, now U.S. Pat. No. 5,860,977, which is a continuation-in-part of U.S. patent application Ser. No. 08/778,093, entitled “Spine Distraction Implant and Method,” filed Jan. 2, 1997, now U.S. Pat. No. 5,836,948; each of which is incorporated herein by reference in its entirety.
• Each of U.S. patent application Ser. Nos. 11/806,529 (Attorney Docket No. KYPH-039/10US 305363-2188) and 11/806,527 (Attorney Docket No. KYPH-039/11US 305363-2189) is a continuation-in-part of U.S. patent application Ser. No. 10/037,236, entitled “Interspinous Process Implant and Method With Deformable Spacer,” filed Nov. 9, 2001, which claims priority to U.S. Provisional Application Ser. No. 60/323,467, entitled “Interspinous Process Implant and Method With Deformable Spacer,” filed Sep. 18, 2001 and which is a continuation-in-part of U.S. patent application Ser. No. 09/799,215, entitled “Spine Distraction Implant,” filed Mar. 5, 2001, now U.S. Pat. No. 7,101,375, which is a continuation-in-part of U.S. patent application Ser. No. 09/473,173, entitled “Spine Distraction Implant,” filed Dec. 28, 1999, now U.S. Pat. No. 6,235,030, which is a continuation of U.S. patent application Ser. No. 09/179,570, entitled “Spine Distraction Implant,” filed Oct. 27, 1998, now U.S. Pat. No. 6,048,342, which is a continuation-in-part of U.S. patent application Ser. No. 08/958,281, entitled “Spine Distraction Implant and Method,” filed Oct. 27, 1997, now U.S. Pat. No. 5,860,977, which is a continuation-in-part of U.S. patent application Ser. No. 08/778,093, entitled “Spine Distraction Implant and Method,” filed Jan. 2, 1997, now U.S. Pat. No. 5,836,948; each of which is incorporated herein by reference in its entirety.
• Each of U.S. patent application Ser. Nos. 11/806,529 (Attorney Docket No. KYPH-039/10US 305363-2188) and 11/806,527 (Attorney Docket No. KYPH-039/11US 305363-2189) is a continuation-in-part of U.S. patent application Ser. No. 10/770,372, entitled “Mating Insertion Instruments for Spinal Implants and Methods of Use,” filed Feb. 2, 2004, which is a divisional application of U.S. patent application Ser. No. 09/981,859, entitled “Mating Insertion Instruments for Spinal Implants and Methods of Use,” filed Oct. 18, 2001, now U.S. Pat. No. 6,712,819, which claims priority to U.S. Provisional Application Ser. No. 60/306,101, entitled “Mating Insertion Instruments for Spinal Implants and Methods of Use,” filed Jul. 17, 2001 and which is a continuation-in-part of U.S. patent application Ser. No. 09/799,470, entitled “Spinal Implants, Insertion Instruments, and Methods of Use,” filed Mar. 5, 2001, now U.S. Pat. No. 6,902,566, which claims priority to U.S. Provisional Application Ser. No. 60/220,022, entitled “Spinal Implants, Insertion Instruments, and Methods of Use,” filed Jul. 21, 2000 and which is a continuation-in-part of U.S. patent application Ser. No. 09/474,037, entitled “Spine Distraction Implant,” filed Dec. 28, 1999, now U.S. Pat. No. 6,190,387, which is a divisional application of U.S. patent application Ser. No. 09/175,645, entitled “Spine Distraction Implant,” filed Oct. 20, 1998, now U.S. Pat. No. 6,068,630, which is a continuation-in-part of U.S. patent application Ser. No. 08/958,281, entitled “Spine Distraction Implant and Method,” filed Oct. 27, 1997, now U.S. Pat. No. 5,860,977, which is a continuation-in-part of U.S. patent application Ser. No. 08/778,093, entitled “Spine Distraction Implant and Method,” filed Jan. 2, 1997, now U.S. Pat. No. 5,836,948; each of which is incorporated herein by reference in its entirety. U.S. patent application Ser. No. 09/799,470, is also a continuation-in-part of U.S. patent application Ser. No. 09/473,173 entitled “Spine Distraction Implant,” filed Dec. 28, 1999, now U.S. Pat. No. 6,235,030, which is a continuation of U.S. patent application Ser. No. 09/179,570, entitled “Spine Distraction Implant,” filed Oct. 27, 1998, now U.S. Pat. No. 6,048,342, which is a continuation-in-part of U.S. patent application Ser. No. 08/958,281, entitled “Spine Distraction Implant and Method,” filed Oct. 27, 1997, now U.S. Pat. No. 5,860,977, which is a continuation-in-part of U.S. patent application Ser. No. 08/778,093, entitled “Spine Distraction Implant and Method,” filed Jan. 2, 1997, now U.S. Pat. No. 5,836,948; each of which is incorporated herein by reference in its entirety. U.S. patent application Ser. No. 09/799,470, is also a continuation-in-part of U.S. patent application Ser. No. 09/200,266 entitled “Spine Distraction Implant and Method,” filed Nov. 25, 1998, now U.S. Pat. No. 6,183,471, which is a continuation of U.S. patent application Ser. No. 09/139,333, entitled “Spine Distraction Implant and Method,” filed Aug. 25, 1998, now U.S. Pat. No. 5,876,404, which is a continuation of U.S. patent application Ser. No. 08/958,281, entitled “Spine Distraction Implant and Method,” filed Oct. 27, 1997, now U.S. Pat. No. 5,860,977, which is a continuation-in-part of U.S. patent application Ser. No. 08/778,093, entitled “Spine Distraction Implant and Method,” filed Jan. 2, 1997, now U.S. Pat. No. 5,836,948; each of which is incorporated herein by reference in its entirety.
BACKGROUND
• As the present society ages, it is anticipated that there will be an increase in adverse spinal conditions which are characteristic of older people. By way of example, with aging comes increases in spinal stenosis (including but not limited to central canal and lateral stenosis), the thickening of the bones which make up the spinal column and facet arthropathy. Spinal stenosis is characterized by a reduction in the available space for the passage of blood vessels and nerves. Pain associated with such stenosis can be relieved by medication and/or surgery. Of course, it is desirable to eliminate the need for major surgery for all individuals and in particular for the elderly.
• Accordingly, there needs to be developed procedures and implants for alleviating such condition which are minimally invasive, can be tolerated by the elderly and can be performed preferably on an outpatient basis.
SUMMARY
• The present invention is directed to providing a minimally invasive implant and method for alleviating discomfort associated with the spinal column.
• The present invention provides for apparatus and method for relieving pain by relieving the pressure and restrictions on the aforementioned blood vessels and nerves. Such alleviation of pressure is accomplished in the present invention through the use of an implant and method which distract the spinous process of adjacent vertebra in order to alleviate the problems caused by spinal stenosis and facet arthropathy and the like. While the implant and method particularly address the needs of the elderly, the invention can be used with individuals of all ages and sizes where distraction of the spinous process would be beneficial.
• In one aspect of the invention, an implant is provided for relieving pain comprising a device positioned between a first spinous process and a second spinous process. The device includes a spinal column extension stop and a spinal column flexion non-inhibitor.
• In another aspect of the invention, the implant is positioned between the first spinous process and the second spinous process and includes a distraction wedge that can distract the first and second spinous processes as the implant is positioned between the spinous processes.
• In yet another aspect of the present invention, the implant includes a device which is adapted to increasing the volume of the spinal canal and/or the neural foramen as the device is positioned between adjacent spinous processes.
• In yet a further aspect of the present invention, a method is presented for relieving pain due to the development of, by way of example only, spinal stenosis and facet arthropathy. The method is comprised of the steps of accessing adjacent first and second spinal processes of the spinal column and distracting the processes a sufficient amount in order to increase the volume of the spinal canal in order to relieve pain. The method further includes implanting a device in order to maintain the amount of distraction required to relieve such pain.
• In yet a further aspect of the invention, the method includes implanting a device in order to achieve the desired distraction and to maintain that distraction.
• In yet a further aspect of the invention, the implant includes a first portion and a second portion. The portions are urged together in order to achieve the desired distraction.
• In still a further aspect of the invention, the implant includes a distracting unit and a retaining unit. The distracting unit includes a body which can be urged between adjacent spinous processes. The body includes a slot. After the distracting unit is positioned, the retaining unit can fit into the slot of the retaining unit and be secured thereto.
• In yet a further aspect of the invention, the implant includes a first unit with a central body. A sleeve is provided over the central body and is at least partially spaced from the central body in order to allow for deflection toward the central body.
• In a further aspect of the invention, the implant includes a first unit having a central body with a guide and a first wing, with the first wing located at first end of the body. The guide extends from a second end of the body located distally from the first wing. The implant further includes a sleeve provided over said central body. The sleeve is at least partially spaced from the central body in order to allow for deflection of the sleeve toward the central body. The implant further includes a second wing and a device for securing the second wing to the first unit, wherein the sleeve is located between the first and second wings.
• In yet another aspect of the invention, an implant system includes a cylindrical sleeve which is inwardly deflectable. The system further includes an insertion tool which includes an insertion guide, a central body, a stop and a handle. The guide and the stop extend from opposite sides of the central body and the handle extend from the stop. A sleeve fits over the guide and against the stop preparatory to being positioned between the two adjacent vertebrae with the insertion tool.
• In yet a further aspect of the invention, the implant includes central body and first and second wings and a means for selectively positioning one of the first and second wings relative to the other in order to accommodate spinous processes of different sizes.
• Other implants and methods within the spirit and scope of the invention can be used to increase the volume of the spinal canal thereby alleviating restrictions on vessels and nerves associated therewith, and pain.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIGS. 1 and 2 depict an embodiment of an implant of the invention which is adjustable in order to select the amount of distraction required.FIG. 1 depicts the implant in a more extended configuration than doesFIG. 2.
• FIGS. 3aand3bdepict side and end views of a first forked and of the embodiment ofFIG. 1.
• FIGS. 4aand4bdepict side sectioned and end views of an interbody piece of the implant ofFIG. 1.
• FIGS. 5aand5bdepict side and end views of a second forked end of the embodiment ofFIG. 1.
• FIGS. 6,7,8,9 and10 depict apparatus and method for another embodiment of the present invention for creating distraction between adjacent spinous processes.
• FIGS. 11,12 and13 depict yet a further embodiment of the invention for creating distraction between adjacent spinous processes.
• FIGS. 14 and 15 depict a further apparatus and method of an embodiment of the invention for creating distraction.
• FIGS. 16,16a, and17 depict yet another embodiment of the present invention.
• FIGS. 18,19 and20 depict yet a further apparatus and method of the present embodiment.
• FIGS. 21 and 22 depict still a further embodiment of the present invention.
• FIGS. 23,24 and25 depict another embodiment of the present invention.
• FIGS. 26,27 and28 depict another embodiment of the invention.
• FIGS. 29 and 30 depict side elevational views of differently shaped implants of embodiments of the present invention.
• FIGS. 31,32 and33 depict various implant positions of an apparatus of the present invention.
• FIGS. 34 and 35 depict yet another apparatus and method of the present invention.
• FIGS. 36,37 and38 depict three different embodiments of the present invention.
• FIGS. 39 and 40 depict yet another apparatus and method of an embodiment of the present invention.
• FIGS. 41,42 and43 depict yet further embodiments of an apparatus and method of the present invention.
• FIG. 44 is still a further embodiment of an implant of the invention.
• FIG. 45 is yet another depiction of an apparatus and method of the invention.
• FIGS. 46 and 47 depict still a further apparatus and method of an embodiment of the invention.
• FIGS. 48,49,50 and51 depict yet a further apparatus and method of the invention.
• FIGS. 52,53,54,55aand55bdepict another apparatus and method of the invention.
• FIGS. 56,57 and58 depict yet a further apparatus and method of the invention.
• FIGS. 59 and 60 depict still a further embodiment of the invention.
• FIG. 61 depict another embodiment of the invention.
• FIGS. 62 and 63 depict yet another embodiment of the present invention.
• FIGS. 64 and 65 depict still a further embodiment of the present invention.
• FIG. 66 depicts another embodiment of the invention.
• FIGS. 67 and 68 depict yet another embodiment of the present invention.
• FIGS. 69,70,71 and71adepict a further embodiment of the present invention.
• FIGS. 72 and 73 depict still another embodiment of the invention.
• FIGS. 74,75,76,77, and78 depict still other embodiments of the invention.
• FIGS. 79,80,80a,81,82,83,83a,84,85,86 and87 depict still a further embodiment of the present invention.
• FIGS. 88,89,90 and91 depict yet another embodiment of the present invention.
• FIGS. 92,92a,92b,93,93a,93b,93c,93d,94,94a,94b,95,95a, and96, depict still a further embodiment of the present invention wherein a sleeve is provided which is capable of deflecting response to relative motion between the spinous processes.
• FIG. 97 depicts still another embodiment of the present invention.
• FIG. 98 depicts yet a further embodiment of the present invention.
• FIGS. 99 and 100 depict still another embodiment of the present invention including an insertion tool.
• FIGS. 101,102,102a,103,104,105,106, and107 depict still a further embodiment of the present invention.
• FIGS. 108,109, and110 depict still another embodiment of the present invention.
• FIGS. 111,112,113,114,115,116, and117 depict yet another embodiment of the present invention.
• FIG. 118 depicts a graph showing characteristics of a preferred material usable with several of the embodiments of the present invention.
• FIGS. 119aand119bdepict side and plan views of still a further embodiment of the present invention.
• FIGS. 120aand120bdepict side and plan views of the second wing which can be used in conjunction with the embodiment of the invention ofFIGS. 119aand119b.
• FIGS. 121aand121bdepict side and plan views of the first wing and central body of the embodiment of the invention depicted inFIGS. 119aand119b.
• FIGS. 122a,122b, and122cdepict top, side and end views of a guide which is a portion of the embodiment of the invention ofFIGS. 119aand119b.
• FIGS. 123aand123bdepict an end view and a cross-sectioned view respectfully of the sleeve of the embodiment of the invention ofFIGS. 119aand119b.
• FIGS. 124a,124band124cdepict a view of the embodiment of the invention ofFIGS. 119aand119btaken through line124-124 inFIG. 119bshown in with the sleeve in various positions relative to a first wing.
• FIG. 125 depicts an alternative embodiment of the invention as depicted inFIGS. 119aand119b.
• FIG. 126 depicts yet a further alternative embodiment of the invention depicted inFIGS. 119aand119b.
• FIG. 127 depicts yet a further embodiment of the invention as depicted inFIGS. 119aand119b.
• FIG. 128 is still a further embodiment of the invention as depicted inFIG. 93a.
• FIG. 129 depicts still a further embodiment of the invention as depicted inFIGS. 119aand119b.
• FIG. 130 is a perspective view of a first embodiment of the invention.
• FIG. 131 is an exploded view of the embodiment of the invention ofFIG. 130.FIG. 131aand131bare alternative components of the embodiment ofFIG. 131.
• FIG. 132 is a plan view of the embodiment of the invention ofFIG. 130.
• FIGS. 133a,133b,133c, and133dare perspective, first end, second end, and sectional views of a spacer or sleeve of the embodiment of the invention depicted inFIG. 130.
• FIG. 134 is a cross sectional view of an embodiment of the invention taken through line134-134 inFIG. 132.
• FIGS. 135a-135fare various views of an embodiment of the hook mechanism of the embodiment of the invention ofFIG. 130.
• FIG. 136 is a schematical representation of an embodiment of the invention as positioned with respect to adjacent spinous processes.
• FIG. 137 is a perspective view of another embodiment of the invention.
• FIG. 138 is an exploded view of the embodiment of the invention ofFIG. 137.
• FIG. 138ais an alternative component of the embodiment ofFIG. 137.
• FIG. 138bis an upside down perspective view of a component of the embodiment ofFIG. 138.
• FIG. 139 is a plan view of the embodiment of the invention ofFIG. 137.
• FIG. 140 is a partial section view taken through line140-140 ofFIG. 139.
• FIG. 141 is an exploded view of yet another embodiment of the invention.FIG. 141ais an upside down perspective view of a component of the embodiment ofFIG. 141.
• FIG. 142 is a sectional view of a body portion of the embodiment of the invention ofFIG. 141 taken through line142-142.
• FIG. 143 is a top view of the body portion shown inFIG. 142.
• FIG. 144 is a sectional view of yet another embodiment of a body portion of the invention.
• FIG. 145 is a perspective view of yet a further embodiment of the body portion of the invention.
• FIGS. 146a,146b, and146cdepict yet a further embodiment of a body portion of the invention.
• FIGS. 147aand147bare side and top views of yet another embodiment of the invention depicting a mechanism for adjusting the positions of the hook mechanisms of, for example, the embodiment of the invention ofFIGS. 130,137, and141.
• FIGS. 148aand148bare sectional top and side views of yet another embodiment of the invention for adjusting the position of the hook mechanisms.
• FIGS. 149aand149bare perspective and side views of yet a further mechanism of an embodiment of the invention for adjusting the position of hook mechanisms of the invention.
• FIG. 150 is a perspective view of yet a further embodiment of the invention.
• FIG. 151 is a perspective view of an embodiment of the invention which is addressable to multiple levels of spinous processes.
• FIG. 152 is a perspective view of an alternative embodiment of the supplemental spine fixation device of the invention.
• FIG. 153 is an exploded view of the embodiment of the invention ofFIG. 152.
• FIG. 154ais a sectioned view of the spacer and lead-in nose tissue expander of the invention.
• FIG. 154bis an end view of a spacer ofFIG. 154a.
• FIG. 154cis an exploded view of several of the components ofFIG. 154a.
• FIG. 155ais a plan, partially sectioned view of an embodiment of a hook of the invention.
• FIG. 155bis a sectioned view taken throughline155b-155bofFIG. 155a.
• FIG. 155cis a sectioned view taken throughline155c-155cofFIG. 155a.
• FIG. 155dis a bottom view of the embodiment of the hook of the invention of155a.
• FIG. 155eis an end view ofFIG. 155d.
• FIG. 156 is a view of an embodiment of a shaft arrangement of the invention upon which hooks can be mounted.
• FIG. 157 is an alternate view of the top member of the hub showing the locking mechanism.
• FIGS. 158aand158bare sectioned views of an alternate embodiment of the hub mechanism of the invention.
• FIG. 159 is an alternate embodiment of the hook attached to a shaft of the invention.
• FIG. 160 is an alternate embodiment of a sleeve of the invention positioned between adjacent spinous processes.
• FIGS. 161a,161band161care top, side, and side sectioned views respectively of an embodiment of a lead-in nose, guide, or tissue expander of the invention.
• FIG. 161dis a left-end view ofFIG. 161c.
• FIG. 161eis a right-end view ofFIG. 161c.
• FIG. 162 is an alternate embodiment of a second wing of the invention usable with the guide or tissue expander inFIG. 161a-161e.
• FIG. 163ais yet a further embodiment of the spacer of the invention which is substantially egg-shaped and positional between adjacent spinous processes.
• FIG. 163bis an end view of the base of a lead-in nose usable with the spacer ofFIG. 163a.
• FIG. 163cis a side view of an embodiment of an implant of the invention implanted in the spine, the implant having at least a first wing.
• FIG. 164 is a perspective view of an embodiment of the present invention.
• FIG. 165 is a top view of an embodiment of the adjustable wing of the present invention.
• FIG. 166 is a perspective view of an embodiment of the fastener used in the present invention.
• FIG. 167 is cut-away view illustrating the interaction between the fastener and the adjustable wing with the adjustable wing is in a first position.
• FIG. 168 is a cut-away view illustrating the fastener engaging the adjustable wing with the adjustable wing in a second position.
• FIG. 169 is a side view illustrating an embodiment of the present invention as implanted between adjacent spinous processes.
• FIG. 170 is a front view of an embodiment of the present invention as implanted between adjacent spinous processes.
• FIG. 171ais an assembly view of an embodiment of the invention
• FIG. 171bis a side view of the embodiment of the invention ofFIG. 171aincluding a spacer, a main body and a first wing.
• FIG. 171cis a plane view of the embodiment of the invention inFIG. 171b.
• FIG. 171dis a side view illustrating the second wing of the embodiment of the invention inFIG. 171a.
• FIG. 171eis a plane view of the second wing of an embodiment of the invention ofFIG. 171a.
• FIG. 171fis an end view of the spacer of the embodiment of the invention ofFIG. 171a.
• FIG. 171gis a cut-away view illustrating the spacer of the embodiment of the invention ofFIG. 171a.
• FIG. 172 is a perspective view of still another embodiment of the spacer of the invention.
• FIG. 173 is a perspective view of yet another embodiment of the spacer of the invention.
• FIG. 174 is a perspective view of still another embodiment of the spacer of the invention.
• FIG. 175ais a perspective view of yet another embodiment of the spacer of the invention.
• FIG. 175bis an end view of the embodiment of the spacer illustrated inFIG. 175a.
• FIG. 176ais a perspective view of yet another embodiment of the spacer of the invention.
• FIG. 176bis a perspective view of the first outer shell of the spacer illustrated inFIG. 176a.
• FIG. 176cis an end view of the embodiment of the spacer shown inFIG. 176afilled with a deformable or compressible material.
• FIG. 177 is a perspective view of yet another embodiment of the spacer of the invention.
• FIGS. 178a-178bare perspective views of still other embodiments of the spacer of the invention.
• FIG. 179ais a perspective view of another embodiment of the present invention.
• FIG. 179bis a cut-away view of the embodiment of the invention illustrated inFIG. 9a.
• FIG. 180 depicts an exterior view of a main body insertion instrument of one embodiment of this invention for inserting an implant body into the spine of a patient.
• FIG. 181 depicts a schematic, sectional, longitudinal view of a main body insertion instrument as depicted inFIG. 180.
• FIGS. 182a-182cdepict schematic views of an insertion tip of the main body insertion instrument of one embodiment of this invention as shown inFIGS. 180 and 181.
• FIG. 182adepicts a side view of the insertion tip of a main body insertion instrument of one embodiment of this invention with a locking pin and spacer engagement pin spacer in the extended position.
• FIG. 182bdepicts the insertion tip as shown inFIG. 182awith a locking pin and spacer engagement pin spacer in a retracted position.
• FIG. 182cdepicts a top view of the insertion tip of the main body insertion instrument of one embodiment of this invention with the locking pin and engagement pin spacer in a retracted position.
• FIG. 183adepicts an embodiment of a main body assembly of a spinal implant of the invention used with a main body insertion instrument of this invention.
• FIG. 183bdepicts an embodiment of a main body insertion instrument of this invention and an embodiment of a main body assembly of the invention as shown inFIG. 183a, showing the points of engagement between the assembly and the instrument.
• FIG. 183cdepicts an embodiment of a main body assembly of the invention and an embodiment of a main body insertion instrument of the invention, both depicted inFIG. 183b, engaged with one another.
• FIG. 184 depicts an exterior view of an embodiment of a wing insertion instrument of the invention.
• FIG. 185 depicts a schematic, sectioned, longitudinal view of the embodiment of a wing insertion instrument of the invention as shown inFIG. 184
• FIG. 186adepicts an end view of an embodiment of an insertion tip of a wing insertion instrument of the invention are depicted inFIGS. 184 and 185.
• FIG. 186bdepicts a top view of an embodiment of an insertion tip of a wing insertion instrument of the invention as depicted inFIG. 186awith a driver in a distal position.
• FIG. 186cdepicts a top view of the embodiment of the insertion tip of a wing insertion instrument of the invention as depicted inFIGS. 186aand186bwith the driver in a proximal position.
• FIG. 187adepicts a side view of an embodiment of a universal wing of the invention which is implantable with a wing insertion instrument of the invention.
• FIG. 187bdepicts an end view of an embodiment of a universal wing of the invention are depicted inFIG. 187awithout an attachment bolt.
• FIG. 187cdepicts the embodiment of an embodiment of the universal wing of the invention as shown inFIG. 187bwith an attachment bolt.
• FIGS. 188a-188cdepict an embodiment of an insertion tip of a wing insertion instrument of the invention as shown inFIGS. 185 and 186, and an embodiment of a universal wing of the invention. More particularly,FIGS. 188a-188cdepict the following.
• FIG. 188ais a side view showing the relationships of an embodiment a universal wing of the invention and an embodiment of a wing insertion instrument of the invention, showing the points of engagement.
• FIG. 188bis a side view of the embodiment of the universal wing and the wing insertion instrument of the invention depicted inFIG. 188aafter engagement.
• FIG. 188cis a top view of the embodiment of a universal wing and a wing insertion instrument of the invention as depicted inFIG. 188b.
• FIGS. 189a-189ddepict trial implantation and distraction instruments of the invention.
• FIGS. 190aand190bdepict the insertion of a main body assembly of the invention into the spine of a patient. More particularly,FIGS. 190aand190bdepict the following.
• FIG. 190adepicts a lateral view of a spine, and an embodiment of a main body insertion instrument of the invention engaged with an embodiment of a main body assembly of the invention positioned between spinous processes of adjacent vertebrae of a patient.
• FIG. 190bdepicts a dorsal view of a spine of a patient depicting an embodiment of a main body assembly of the invention inserted between spinal processes of adjacent vertebrae.
• FIG. 191 depicts a lateral view of a spine with an embodiment of a main body assembly of the invention inserted between spinous processes of adjacent vertebrae and a wing implant insertion instrument of the invention engaged with an embodiment of a universal wing of the invention, showing the points of attachment between the embodiment of the main body assembly and the universal wing of the invention.
• FIG. 192 depicts a dorsal view of a spine with an embodiment of a main body assembly of the invention inserted between spinous processes of adjacent vertebrae, and showing the insertion of an embodiment of a universal wing of the invention and its attachment to the embodiment of main body assembly of the invention.
• FIG. 193 depicts an alternative embodiment of instruments of the present invention with the handle of the main body insertion instrument nested into an alternate embodiment of the wing insertion instrument of the invention.
• FIG. 194 depicts the wing insertion instrument ofFIG. 193.
• FIG. 195 depicts an alternative embodiment of the main body insertion instrument.
• FIG. 196 depicts the alternative embodiment of the main body insertion instrument ofFIG. 195 nested into the wing insertion instrument ofFIG. 194.
DETAILED DESCRIPTIONEmbodiment of FIGS.1-5a,5b
• A first embodiment of the invention is shown inFIGS. 1-5a,5b.Implant20 includes first and second forked ends22 and24, each defining asaddle26,28 respectively. The forked ends22,24 are mated using aninterbody piece30. As can be seen inFIGS. 3a,3b, the first forkedend22 includes a threadedshaft32 which projects rearwardly from thesaddle26. The threadedshaft32 fits into the threaded bore34 (FIG. 4a) of theinterbody piece30.
• The second forked end24 (FIGS. 5a,5b) includes a smoothcylindrical shaft36 which can fit into thesmooth bore38 of theinterbody piece30.
• FIG. 1 shows theimplant20 in a fully extended position, whileFIG. 2 shows the implant in an unextended position. In the unextended position, it can be seen that the threadedshaft32 of the first forkedend22 fits inside the hollowcylindrical shaft36 of the second forkedend24.
• For purposes of implantation between adjacent first and second spinous processes of the spinal column, theimplant20 is configured as shown inFIG. 2. The first and second spinous processes are exposed using appropriate surgical techniques and thereafter, theimplant20 is positioned so thatsaddle26 engages the first spinous process, and saddle28 engages the second spinous process. At this point, theinterbody piece30 can be rotated by placing an appropriate tool or pin into the cross holes40 and upon rotation, thesaddle26 is moved relative to thesaddle28. Such rotation spreads apart or distracts the spinous processes with the resultant and beneficial effect of enlarging the volume of the spinal canal in order to alleviate any restrictions on blood vessels and nerves.
• It is noted that this implant as well as the several other implants described herein act as an extension stop. That means that as the back is bent backwardly and thereby placed in extension the spacing between adjacent spinous processes cannot be reduced to a distance less than the distance between the lowest point ofsaddle26 and the lowest point ofsaddle28. This implant, however, does not inhibit or in any way limit the flexion of the spinal column, wherein the spinal column is bent forward.
• Preferably, such a device provides for distraction in the range of about 5 mm to about 15 mm. However, devices which can distract up to and above 22 mm may be used depending on the characteristics of the individual patient.
• With all the ligaments (such as the supraspinous ligament) and tissues associated with the spinous processes left intact, theimplant20 can be implanted essentially floating in position in order to gain the benefits of the aforementioned extension stop and flexion non-inhibitor. If desired, one of thesaddles26 can be laterally pinned withpin29 to one of the spinous processes and the other saddle can be loosely associated with the other spinous processes by using atether31 which either pierces or surrounds the other spinous process and then is attached to the saddle in order to position the saddle relative to the spinous process. Alternatively, both saddles can be loosely tethered to the adjacent spinous process in order to allow the saddles to move relative to the spinous processes.
• The shape of the saddles, being concave, gives the advantage of distributing the forces between the saddle and the respective spinous process. This ensures that the bone is not resorbed due to the placement of theimplant20 and that the structural integrity of the bone is maintained.
• Theimplant20 in this embodiment can be made of a number of materials, including but not limited to, stainless steel, titanium, ceramics, plastics, elastics, composite materials or any combination of the above. In addition, the modulus of elasticity of the implant can be matched to that of bone, so that theimplant20 is not too rigid. The flexibility of the implant can further be enhanced by providing additional apertures or perforations throughout the implant in addition to theholes40 which also have the above stated purpose of allowing theinterbody piece30 to be rotated in order to expand the distance between thesaddle26,28.
• In the present embodiment, it is understood that the spinous processes can be accessed and distracted initially using appropriate instrumentation, and that theimplant20 can be inserted and adjusted in order to maintain and achieve the desired distraction. Alternatively, the spinous process can be accessed and theimplant20 appropriately positioned. Once positioned, the length of the implant can be adjusted in order to distract the spinous processes or extend the distraction of already distracted spinous processes. Thus, the implant can be used to create a distraction or to maintain a distraction which has already been created.
• The placement of implants such asimplant20 relative to the spinous process will be discussed herein with other embodiments. However, it is to be noted that ideally, theimplant20 would be placed close to the instantaneous axis of rotation of the spinal column so that the forces placed on theimplant20 and the forces that theimplant20 places on the spinal column are minimized.
• Further, it is noted that during the actual process of installing or implanting theimplant20, that the method uses the approach of extending the length of the implant20 a first amount and then allowing the spine to creep or adjust to this distraction. Thereafter,implant20 would be lengthened another amount, followed by a period where the spine is allowed to creep or adjust to this new level of distraction. This process could be repeated until the desired amount of distraction has been accomplished. This same method can be used with insertion tools prior to the installation of an implant. The tools can be used to obtain the desired distraction using a series of spinal distraction and spine creep periods before an implant is installed.
Embodiment of FIGS.6,7,8,9 and10
• The embodiment of the invention shown in the aboveFIGS. 6,7,8,9 and10 includes distraction orspreader tool50 which has first andsecond arms52,54.Arms52,54 are pivotal aboutpivot point56 and releaseable frompivot point56 in order to effect the implantation ofimplant58. As can be seen inFIG. 6, in cross-section, thearms52,54 are somewhat concave in order to cradle and securely hold the firstspinous process60 relative toarm52 and the secondspinous process62 relative toarm54. Thedistraction tool50 can be inserted through a small incision in the back of the patient in order to address the space between the firstspinous process60 and the secondspinous process62. Once thetool50 is appropriately positioned, thearms52,54 can be spread apart in order to distract the spinous processes. After this has occurred, animplant58 as shown inFIGS. 8 and 9, or of a design shown in other of the embodiments of this invention, can be urged between thearms52,54 and into position between the spinous processes. After this occurs, thearms52,54 can be withdrawn from the spinous processes leaving theimplant58 in place. Theimplant58 is urged into place using atool64 which can be secured to theimplant58 through a threadedbore66 in the back of the implant. As can be seen inFIG. 10, theimplant58 includessaddles68 and70 which cradle the upper and lowerspinous processes60,62 in much the same manner as the above first embodiment and also in much the same manner as the individual arms of thetool50. The saddles as described above tend to distribute the load between the implant and the spinous processes and also assure that the spinous process is stably seated at the lowest point of the respective saddles.
Embodiment of FIGS.11,12 and13
• Another embodiment of the apparatus and method of the invention is shown inFIGS. 11,12 and13. In this embodiment, the spreader ordistraction tool80 includes first andsecond arms82,84 which are permanently pivoted atpivot point86. The arms include L-shaped ends88,90. Through a small incision, the L-shaped ends88,90 can be inserted between the first and second spinous processes92,94. Once positioned, thearms82,84 can be spread apart in order to distract the spinous processes. Theimplant96 can then be urged between the spinous processes in order to maintain the distraction. It is noted thatimplant96 includes wedged surfaces orramps98,100. As theimplant96 is being urged between the spinous processes, the ramps further cause the spinous processes to be distracted. Once theimplant96 is fully implanted, the full distraction is maintained by theplanar surfaces99,101 located rearwardly of the ramps. It is to be understood that the cross-section of theimplant96 can be similar to that shown forimplant58 or similar to other implants in order to gain the advantages of load distribution and stability.
Embodiments of FIGS.14,15,16,16a, and17
• InFIGS. 14 and 15, yet another embodiment of the invention is depicted. In this embodiment, theimplant110 includes first and second conically shapedmembers112,114.Member112 includes amale snap connector116 andmember114 includes afemale snap connector118. Withmale snap connector116 urged intofemale snap connector118, thefirst member112 is locked to thesecond member114. In this embodiment, a distraction orspreader tool80 could be used. Once the spinous process has been spread apart, animplantation tool120 can be used to position and snap together theimplant110. Thefirst member112 ofimplant110 is mounted on one arm andsecond member114 is mounted on the other arm oftool120. Themember112,114 are placed on opposite sides of the space between adjacent spinous processes. Themembers112,114 are urged together so that theimplant110 is locked in place between the spinous processes as shown inFIG. 15. It is to be noted that theimplant110 can also be made more self-distracting by causing thecylindrical surface122 to be more conical, much assurface124 is conical, in order to holdimplant110 in place relative to the spinous processes and also to create additional distraction.
• An alternative embodiment of the implant can be seen inFIGS. 16 and 17. Thisimplant130 includes first andsecond members132,134. In this particular embodiment, the implants are held together using a screw (not shown) which is inserted through countersunkbore136 and engages a threadedbore138 of thesecond member134.Surfaces139 are flattened (FIG. 17) in order to carry and spread the load applied thereto by the spinous processes.
• The embodiment ofimplant130 is not circular in overall outside appearance, as is theembodiment110 ofFIGS. 14 and 15. In particular, with respect to the embodiment ofimplant130 ofFIGS. 16 and 17, this embodiment is truncated so that thelateral side140,142 are flattened with the upper andlower sides144,146 being elongated in order to capture and create a saddle for the upper and lower spinous processes. The upper and lower sides,144,146 are rounded to provide a more anatomical implant which is compatible with the spinous processes.
• If it is desired, and in order to assure that thefirst member132 and thesecond member134 are aligned, key148 andkeyway150 are designed to mate in a particular manner.Key148 includes at least one flattened surface, such as flattenedsurface152, which mates to an appropriately flattenedsurface154 of thekeyway150. In this manner, the first member is appropriately mated to the second member in order to form appropriate upper and lower saddles holding theimplant130 relative to the upper and lower spinous processes.
• FIG. 16adepictssecond member134 in combination with a rounded nose lead-inplug135. Lead-inplug135 includes abore137 which can fit snugly overkey148. In this configuration, the lead-inplug135 can be used to assist in the placement of thesecond member134 between spinous processes. Once thesecond member134 is appropriately positioned, the lead-inplug135 can be removed. It is to be understood that the lead-inplug135 can have other shapes such as pyramids and cones to assist in urging apart the spinous processes and soft tissues in order to position thesecond member134.
Embodiment of FIGS.18,19 and20
• Theimplant330 as shown inFIG. 18 is comprised of first andsecond mating wedges332 and334. In order to implant thesewedges332,334, the spinous processes are accessed from both sides and then a tool is used to push the wedges towards each other. As the wedges are urged towards each other, the wedges move relative to each other so that the combined dimension of theimplant330 located between the upper and lowerspinous processes336,338 (FIG. 20), increases, thereby distracting the spinous processes. It is noted that thewedges332,334 includesaddle340,342, which receiving thespinous processes336,338. These saddles have the advantages as described hereinabove.
• The first orsecond wedges332,334 have a mating arrangement which includes achannel344 and a projection of346 which can be urged into the channel in order to lock thewedges332,334 together. Thechannel334 is undercut in order to keep the projection from separating therefrom. Further, as in other devices described herein, a detent can be located in one of the channel and the projection, with a complimentary recess in the other of the channel and the projection. Once these two snap together, the wedges are prevented from sliding relative to the other in thechannel344.
• While the above embodiment was described with respect to wedges, the wedges could also have been designed substantially as cones with all the same features and advantages.
Embodiments of FIGS.21 and22
• Theimplant370 is comprised of first andsecond distraction cone372,374. These cones are made of a flexible material. The cones are positioned on either side of thespinous processes376,378 as shown inFIG. 21. Using appropriate tool as shown hereinabove, thedistraction cones372,374 are urged together. As they are urged together, the cones distract the spinous processes as shown inFIG. 22. Once this has occurred, an appropriate screw or other type offastening mechanism380 can be used to maintain the position of thedistraction cones372,374. The advantage of this arrangement is that theimplant370 is self-distracting and also that the implant, being flexible, molds about the spinous processes as shown inFIG. 22.
Embodiments of FIGS.23,24 and25
• InFIGS. 23 and 24, another embodiment of theimplant170 is depicted. This implant is guided in place using an L-shapedguide172 which can have a concave cross-section such as thecross-section52 ofretraction tool50 inFIG. 6 in order to cradle and guide theimplant170 in position. Preferably a small incision would be made into the back of the patient and the L-shapedguide tool172 inserted between the adjacent spinous processes. Theimplant170 would be mounted on the end ofinsertion tool174 and urged into position between the spinous processes. The act of urging the implant into position could cause the spinous processes to be further distracted if that is required. Prior to the insertion of the L-shapedguide tool172, a distraction tool such as shown inFIG. 13 could be used to initially distract the spinous processes.
• Implant170 can be made of a deformable material so that it can be urged into place and so that it can somewhat conform to the shape of the upper and lower spinous processes. This deformable material would be preferably an elastic material. The advantage of such a material would be that the load forces between the implant and the spinous processes would be distributed over a much broader surface area. Further, the implant would mold itself to an irregular spinous process shape in order to locate the implant relative to spinous processes.
• With respect toFIG. 25, thisimplant176 can be inserted over a guide wire, guide tool orstylet178. Initially, theguide wire178 is positioned through a small incision to the back of the patient to a position between the adjacent spinous processes. After this has occurred, the implant is threaded over theguide wire178 and urged into position between the spinous processes. This urging can further distract the spinous processes if further distraction is required. Once the implant is in place, theguide tool178 is removed and the incision closed. The insertion tools ofFIGS. 23 and 24 can also be used if desired.
Embodiment of FIGS.26,27 and28
• The embodiment shown inFIGS. 26,27 and28 uses an implant similar to that depicted inFIGS. 8 and 9 with different insertion tools. As can be seen inFIG. 26, an L-shapeddistraction tool190 is similar to L-shaped distraction tool80 (FIG. 12), is used to distract the first and secondspinous processes192,194. After this has occurred, aninsertion tool196 is placed between thespinous processes192,194.Insertion tool196 includes ahandle198 to which is mounted a square-shapedring200.
• Thedistraction tool190 can be inserted through a small incision in the back in order to spread apart the spinous processes. Through the same incision which has been slightly enlarged laterally, anupper end202 ofring200 can be initially inserted followed by the remainder of thering200. Once the ring is inserted, the ring can be rotated slightly by movinghandle198 downwardly in order to further wedge the spinous processes apart. Once this has been accomplished, an implant such asimplant204 can be inserted through the ring and properly positioned usingimplant handle206. Thereafter, theimplant handle206 and theinsertion tool196 can be removed.
Embodiments of FIGS.29,30,31,32 and33
• As can be seen inFIGS. 29 and 30, theimplants210,212, can have different shapes when viewed from the side. These implants are similar to the above-referenced implants58 (FIG. 8) and 204 (FIG. 28). These implants have cross-sections similar to that shown inFIG. 10 which includes saddles in order to receive and hold the adjacent spinous processes.
• As can be seen inFIGS. 31,32 and33, these implants can be placed in different positions with respect to thespinous process214. Preferably as shown inFIG. 33, theimplant210 is placed closest to thelamina216. Being so positioned, theimplant210 is close to the instantaneous axis ofrotation218 of the spinal column, and the implant would experience least forces caused by movement of the spine. Thus, theoretically, this is the optimal location for the implant.
• As can be seen inFIGS. 31 and 32, the implant can be placed midway along the spinous process (FIG. 32) and towards the posterior aspect of the spinous process (FIG. 31). As positioned shown inFIG. 31, the greatest force would be placed on theimplant210 due to a combination of compression and extension of the spinal column.
Embodiment of FIGS.34 and35
• Another embodiment of the invention is shown inFIGS. 34 and 35. In these figures,implant220 is comprised of a plurality ofindividual leaves222 which are substantially V-shaped. The leaves include interlocking indentations ordetents224. That is, each leaf includes an indentation with a corresponding protrusion such that a protrusion of one leaf mates with an indentation of an adjacent leaf. Also associated with this embodiment is aninsertion tool226 which has ablunt end228 which conforms to the shape of anindividual leaf222. For insertion of this implant into the space between the spinous processes as shown inFIG. 29, theinsertion tool226 first insert asingle leaf220. After that has occurred, the insertion tool then inserts a second leaf with theprotrusion224 of the second leaf snapping into corresponding indentation made by theprotrusion224 of the first leaf. This process would reoccur with third and subsequent leaves until the appropriate spacing between the spinous processes was built up. As can be seen inFIG. 29, thelateral edges229 of the individual leaves222 are slightly curved upwardly in order to form a saddle for receiving the upper and lower spinous processes.
Embodiments of FIGS.36,37 and38
• The embodiments ofFIGS. 36,37 and38 which includeimplants230,232, and234 respectively, are designed in such a manner so the implant locks itself into position once it is properly positioned between the spinous processes.Implant220 is essentially a series of truncated cones and includes a plurality of ever expandingsteps236. These steps are formed by the conical bodies starting with thenose body238 followed there behind byconical body240. Essentially, theimplant234 looks like a fir tree placed on its side.
• Theimplant230 is inserted laterally throughout the opening between upper and lower spinous processes. Thefirst body238 causes the initial distraction. Each successive conical body distracts the spinous processes a further incremental amount. When the desired distraction has been reached, the spinous processes are locked into position bysteps236. At this point, if desired, theinitial nose body238 of the implant andother bodies240 can be broken, snapped or sawed off if desired in order to minimize the size of theimplant230. In order for a portion of theimplant230 to be broken or snapped off, the intersection between bodies such asbody238 and240, which isintersection line242, would be somewhat weaken with the appropriate removal of material. It is noted that only the intersection lines of the initial conical bodies need to be so weakened. Thus,intersection line244 between the bodies which remain between the spinous processes would not need to be weaker, as there would be no intention that the implant would be broken off at this point.
• FIG. 37 shows implant232 positioned between upper and lower spinous processes. This implant is wedge-shaped or triangular shaped in cross-sectioned and includes borepluralities245 and246. Through these bores can be placed lockingpins248 and250. The triangular or wedged-shaped implant can be urged laterally between and thus distract the upper and lower spinous processes. Once the appropriate distraction is reached,pins248,250 can be inserted through the appropriate bores of thebore pluralities245 and246 in order to lock the spinous processes in a V-shaped valley formed bypins248,250 on the one hand and the rampedsurface233,235 on the other hand.
• Turning toFIG. 38, theimplant234 has a triangular-shaped or wedge-shaped body similar to that shown inFIG. 32. In this embodiment,tab252,254 are pivotally mounted to the triangularshaped body234. Once theimplant234 is appropriately positioned in order to distract the spinous processes to the desired amount, thetabs252,254 rotate into position in order to hold theimplant234 in the appropriate position.
Embodiment of FIGS.39 and40
• In the embodiment ofFIGS. 39 and 40,cannula258 is inserted through a small incision to a position between upper and lower spinous processes. Once the cannula is properly inserted, animplant260 is pushed through thecannula258 using aninsertion tool262. Theimplant260 includes a plurality of ribs orindentation264 that assist in positioning theimplant260 relative to the upper and lower spinal processes. Once theimplant260 is in position, thecannula258 is withdrawn so that theimplant260 comes in contact with and wedges between the spinous processes. Thecannula258 is somewhat conical in shape with thenose end266 being somewhat smaller than the distal end268 in order to effect the insertion of the cannula into the space between the spinous processes.
• Further, a plurality of cannula can be used instead of one, with each cannula being slightly bigger than one before. In the method of the invention, the first smaller cannula would be inserted followed by successively larger cannula being placed over the previous smaller cannula. The smaller cannula would then be withdrawn from the center of the larger cannula. Once the largest cannula is in place, and the opening of the skin accordingly expanded, the implant, which is accommodated by only the larger cannula, is inserted through the larger cannula and into position.
Embodiments of FIGS.41,42 and43
• Theprecurved implant270 inFIGS. 41 and 42, andprecurved implant272 inFIG. 43 have common introduction techniques which includes a guide wire, guide tool, orstylet274. For both embodiments, theguide wire274 is appropriately positioned through the skin of the patient and into the space between the spinous processes. After this is accomplished, the implant is directed over the guide wire and into position between the spinous processes. The precurved nature of the implant assist in (1) positioning the implant through a first small incision in the patient's skin on one side of the space between two spinous processes and (2) guiding the implant toward a second small incision in the patient's skin on the other side of the space between the two spinous processes. With respect to theimplant270, the implant includes aconical introduction nose276 and adistal portion278. As thenose276 is inserted between the spinous processes, this causes distraction of the spinous processes.Break lines280,282 are established at opposite sides of theimplant270. Once the implant is properly positioned over the guide wire between the spinous processes, thenose portion276 and thedistal portion278 can be broken off along the break lines, through the above two incisions, in order to leave theimplant270 in position.
• Although only twobreak lines280,282 are depicted, multiple break lines can be provided onimplant270 so that the implant can continue to be fed over theguide wire278 until the appropriate width of theimplant270 creates the desired amount of distraction. As described hereinabove, the break lines can be created by perforating or otherwise weakening theimplant270 so that the appropriate portions can be snapped or sawed off.
• With respect to theprecurved implant272, this implant is similar in design to theimplant230 shown inFIG. 36. Thisimplant272 inFIG. 47, however, is precurved and inserted over aguide wire274 to a position between the spinous processes. As withimplant230 inFIG. 43, once the appropriate level of this distraction has been reached and if desired, sections of theimplant272 can be broken, snapped or sawed off as described hereinabove in order to leave a portion of the implant wedged between the upper and lower spinous processes.
Embodiment of FIG.44
• A further embodiment of the invention is shown inFIG. 44. This embodiment includes a combination insertion tool andimplant290. The insertion tool andimplant290 is in the shape of a ring which is hinged atpoint292. The ring is formed by a first elongated and conically shapedmember294 and a second elongated and conically shapedmember296.Members294 and296 terminate in points and through the use ofhinge292 are aligned and meet. Through similar incisions on both sides of the spinous processes, first member and second member are inserted through the skins of the patient and are mated together between the spinous processes. After this has occurred, theimplant290 is rotated, for example clockwise, so that increasingly widening portions of thefirst member292 are used to distract the first and second spinous processes. When the appropriate level of distraction has occurred, the remainder of the ring before and after the section which is located between the spinous processes can be broken off as taught hereinabove in order to maintain the desired distraction. Alternatively, with a small enough ring, the entire ring can be left in place with the spinous processes distracted.
Embodiment of FIG.45
• InFIG. 45, theimplant300 is comprised of a plurality of rods orstylets302 which are inserted between the upper and lower spinous processes. The rods are designed much as described hereinabove so that they may be broken, snapped or cut off. Once these are inserted and the appropriate distraction has been reached, the stylets are broken off and a segment of each stylet remains in order to maintain distraction of the spinous process.
Embodiment of FIGS.46 and47
• Implant310 ofFIGS. 46 and 47 is comprised of a shape memory material which coils upon being released. The material is straightened out in adelivery tool312. The delivery tool is in position between upper and lowerspinous processes314,316. The material is then pushed through the delivery tool. As it is released from thedelivery end318 of the delivery tool, the material coils, distracting the spinous processes to the desired amount. Once this distraction has been achieved, the material is cut and the delivery tool removed.
Embodiments of FIGS.48,49,50 and51
• As can be seen inFIG. 48, theimplant320 is delivered between upper and lowerspinous processes322 and324, bydelivery tool326. Once theimplant320 is in place between the spinous processes, the delivery tool is given a 90° twist so that the implant goes from the orientation as shown inFIG. 49, with longest dimension substantially perpendicular to the spinous processes, to the orientation shown inFIG. 50 where the longest dimension is in line with and parallel to the spinous processes. This rotation causes the desired distraction between the spinous processes.Implant320 includes opposedrecesses321 and323 located at the ends thereof. Rotation of theimplant320 causes the spinous processes to become lodged in these recesses.
• Alternatively, theinsertion tool326 can be used to insertmultiple implants320,321 into the space between thespinous processes322,324 (FIG. 51).Multiple implants320,321 can be inserted until the appropriate amount of distraction is built up. It is to be understood in this situation that one implant would lock to another implant by use of, for example, a channel arrangement wherein a projection from one of the implants would be received into and locked into a channel of the other implant. Such a channel arrangement is depicted with respect to the other embodiment.
Embodiment of FIGS.52,53,54,55aand55b
• The embodiment ofFIGS. 52 through 55bis comprised of a fluid-filleddynamic distraction implant350. This implant includes amembrane352 which is placed overpre-bent insertion rod354 and then inserted through an incision on one side of thespinous process356. The bent insertion rod, with theimplant350 thereover, is guided between appropriate spinous processes. After this occurs, theinsertion rod354 is removed leaving the flexible implant in place. Theimplant350 is then connected to a source of fluid (gas, liquid, gel and the like) and the fluid is forced into the implant causing it to expand as shown inFIG. 54, distracting the spinal processes to the desired amount. Once the desired amount of distraction has occurred, theimplant350 is closed off as is shown inFIG. 55a. Theimplant350 being flexible, can mold to the spinous processes which may be of irregular shape, thus assuring positioning. Further, implant350 acts as a shock absorber, damping forces and stresses between the implant and the spinous processes.
• A variety of materials can be used to make the implant and the fluid which is forced into the implant. By way of example only, viscoelastic substances such as methylcellulose, or hyaluronic acid can be used to fill the implant. Further, materials which are initially a fluid, but later solidify, can be inserted in order to cause the necessary distraction. As the materials solidify, they mold into a custom shape about the spinous processes and accordingly are held in position at least with respect to one of two adjacent spinous processes. Thus, it can be appreciated that using this embodiment and appropriate insertion tools the implant can be formed about one spinous process in such a manner that the implant stays positioned with respect to that spinous process (FIG. 55b). With such an embodiment, a single implant can be used as an extension stop for spinous process located on either side, without restricting flexion of the spinal column.
• It is to be understood that many of the other implants disclosed herein can be modified so that they receive a fluid in order to establish and maintain a desired distraction much in the manner asimplant350 receives a fluid.
Embodiment of FIGS.56,57 and58
• Theimplant360 as shown inFIG. 56 is comprised of a shape memory material such as a plastic or a metal. A curvedintroductory tool362 is positioned between the appropriate spinous processes as described hereinabove. Once this has occurred, bore364 of the implant is received over the tool. This act can cause the implant to straighten out. The implant is then urged into position and thereby distracts the spinous processes. When this has occurred, theinsertion tool362 is removed, allowing the implant to assume its pre-straightened configuration and is thereby secured about one of the spinous processes. Such an arrangement allows for an implant that is an extension stop and does not inhibit flexion of the spinous column. Alternatively, the implant can be temperature sensitive. That is to say that the implant would be more straightened initially, but become more curved when it was warmed by the temperature of the patient's body.
Embodiments of FIGS.59 and60
• In this embodiment, theimplant380 is comprised of a plurality of interlocking leaves382. Initially, a first leaf is positioned between opposedspinous processes384,386. Then subsequently,leafs382 are interposed between the spinous processes until the desired distraction has been built up. The leaves are somewhat spring-like in order to absorb the shock and can somewhat conform to the spinous processes.
Embodiment of FIG.61
• Theimplant390 ofFIG. 61 includes the placement ofshields392,394 over adjacentspinous processes396,398. The shields are used to prevent damage to the spinous processes. These shields include apertures which receives a self-tappingscrew400,402. In practice, the shields are affixed to the spinous processes and the spinous processes are distracted in the appropriate amount. Once this has occurred, arod404 is used to hold the distracted position by being screwed into each of the spinous processes through the aperture in the shields using the screws as depicted inFIG. 61.
Embodiment of FIGS.62 and63
• Implant410 ofFIGS. 62,63 is comprised of first andsecond members412,414 which can be mated together using an appropriate screw and threaded bore arrangement to form theimplant410.Main member412 andmating member414form implant410. Accordingly, theimplant410 would have a plurality ofmembers414 for use with a standardizedfirst member412.FIGS. 62 and 64 show different types ofmating members414. InFIG. 62, themating member414 includesprojections416 and418 which act like shims. These projections are used to project into the space ofsaddles420,422 of thefirst member412. Theseprojections416,418 can be of varying lengths in order to accommodate different sizes of spinous processes. Agroove424 is placed between theprojections416,418 and mates with anextension426 of thefirst member412.
• As shown inFIG. 63, the projections of the embodiment shown inFIG. 62 are removed and recesses428,430 are substituted therefor. These recesses expand the area of thesaddles420,422 in order to accommodate larger spinous processes.
Embodiment of FIGS.64,65 and66
• The embodiments ofFIGS. 64,65 and66 are similar in design and concept to the embodiment ofFIGS. 62 and 63. InFIG. 64, theimplant500 includes the first andsecond members502,504. These members can be secured together with appropriate screws or other fastening means as taught in other embodiments.Implant500 includes first andsecond saddles506,508 which are formed between the ends of first andsecond members502,504. Thesesaddles506,508 are used to receive and cradle the adjacent spinous processes. As can be seen inFIG. 64, eachsaddle506,508 is defined by a single projection orleg510,512, which extends from the appropriate first andsecond members502,504. Unlike the embodiment found inFIGS. 62 and 63, each of the saddles is defined by only a single leg as the ligaments and other tissues associated with the spinous processes can be used to ensure that the implant is held in an appropriate position. With the configuration ofFIG. 64, it is easier to position the implant relative to the spinous processes as each saddle is defined by only a single leg and thus the first and second members can be more easily worked into position between the various tissues.
• In the embodiment ofFIG. 65, theimplant520 is comprised of a singlepiece having saddles522 and524. The saddles are defined by asingle leg526,528 respectively. In order for thisimplant520 to be positioned between the spinous processes, an incision is made between lateral sides of adjacent spinous processes. Thesingle leg526 is directed through the incision to a position adjacent to an opposite lateral side of the spinous process with the spinous process cradled in thesaddle522. The spinous processes are then urged apart untilsaddle524 can be pivoted into position into engagement with the other spinous process in order to maintain the distraction between the two adjacent spinous processes.
• The embodiment ofFIG. 66 is similar to that ofFIG. 65 with animplant530 and first andsecond saddles532 and534. Associated with each saddle is atether536,538 respectively. The tethers are made of flexible materials known in the trade and industry and are positioned through bores in theimplant530. Once appropriately positioned, the tethers can be tied off. It is to be understood that the tethers are not meant to be used to immobilize one spinous process relative to the other, but are used to guide motion of the spinous processes relative to each other so that theimplant530 can be used as an extension stop and a flexion non-inhibitor. In other words, thesaddles532,534 are used to stop spinal column backward bending and extension. However, the tethers do not inhibit forward bending and spinal column flexion.
Embodiments of FIGS.67,68
• Theimplant550 is Z-shaped and includes acentral body552 and first andsecond arms554,556, extending in opposite directions therefrom. Thecentral body552 of theimplant550 includes first andsecond saddles558 and560. The first andsecond saddles558 and560 would receive upper and lowerspinous processes562,568. Thearms554,556 are accordingly located adjacent the distal end566 (FIG. 68) of thecentral body552. The first andsecond arms554,556, act to inhibit forward movement, migration or slippage of theimplant550 toward the spinal canal and keep the implant in place relative to the first and second spinal processes. This prevents the implant from pressing down on the ligamentum flavum and the dura. In a preferred embodiment, the central body would have a height of about 10 mm with each of thearms554,556 have a height of also about 10 mm. Depending on the patient, the height of the body could vary from about less than 10 mm to about greater than 24 mm. As can be seen inFIGS. 67 and 68, the first andsecond arms554,556 are additionally contoured in order to accept the upper and lowerspinous processes556,558. In particular, thearms554,556 as can be seen with respect toarm554 have a slightly outwardly bowed portion568 (FIG. 68) with adistal end570 which is slightly inwardly bowed. This configuration allows the arm to fit about the spinous process with thedistal end570 somewhat urged against the spinous process in order to guide the motion of the spinous process relative to the implant. Thesearms554,556 could if desired to be made more flexible than thecentral body552 by makingarms554,556 thin and/or with perforations, and/or other material different than that of thecentral body550. As with the last embodiment, this embodiment can be urged into position between adjacent spinous processes by directing an arm into a lateral incision so that thecentral body552 can be finally positioned between spinous processes.
Embodiment of FIGS.69,70,71 and71a
• FIGS. 69,70 and71 are perspective front, end, and side views ofimplant580 of the invention. This implant includes acentral body582 which has first andsecond saddles584,586 for receiving adjacent spinous processes. Additionally, theimplant580 includes first andsecond arms588 and590. The arms, as with the past embodiment, prevent forward migration or slippage of the implant toward the spinal canal.First arm588 projects outwardly from thefirst saddle584 andsecond arm590 projects outwardly from thesecond saddle586. In a preferred embodiment, thefirst arm588 is located adjacent to thedistal end600 of thecentral body582 and proceeds only partly along the length of thecentral body582. Thefirst arm588 is substantially perpendicular to the central body as shown inFIG. 70. Further, thefirst arm588, as well as thesecond arm590, is anatomically rounded.
• Thesecond arm590, projecting fromsecond saddle586, is located somewhat rearward of thedistal end600, and extends partially along the length of thecentral body582. Thesecond arm590 projects at a compound angle from thecentral body582. As can be seen inFIGS. 70 and 71, thesecond arm590 is shown to be at about an angle of 45° from the saddle586 (FIG. 70). Additionally, thesecond arm590 is at an angle of about 45° relative to the length of thecentral body580 as shown inFIG. 71. It is to be understood that other compound angles are within the spirit and scope of the invention as claimed.
• In a preferred embodiment, the first andsecond arms588,590 have a length which is about the same as the width of thecentral body582. Preferably, the length of each arm is about 10 mm and the width of the central body is about 10 mm. However, the bodies with the widths of 24 mm and greater are within the spirit and scope of the invention, along with first and second arms ranging from about 10 mm to greater than about 24 mm. Further, it is contemplated that the embodiment could include a central body having a width of about or greater than 24 mm with arms being at about 10 mm.
• It is to be understood that the embodiment ofFIGS. 69,70 and71 as well as the embodiment ofFIGS. 67 and 68 are designed to preferably be positioned between the L4-L5 and the L5-S1 vertebral pairs. The embodiment ofFIGS. 69,70,71 is particularly designed for the L5-S1 position with the arms being designed to conform to the sloping surfaces found therebetween. The first and second arms are thus contoured so that they lie flat against the lamina of the vertebra which has a slight angle.
• The embodiment ofFIGS. 69,70, and71 as with the embodiment ofFIGS. 67 and 68 is Z-shaped in configuration so that it may be inserted from one lateral side to a position between adjacent spinous processes. A first arm, followed by the central body, is guided through the space between the spinous processes. Such an arrangement only requires that a incision on one side of the spinous process be made in order to successfully implant the device between the two spinous processes.
• Theimplant610 ofFIG. 71ais similar to that immediately above with thefirst arm612 located on the same side of the implant as thesecond arm614. The first andsecond saddle616,618 are slightly modified in thatdistal portion620,622 are somewhat flattened from the normal saddle shape in order to allow the implant to be positioned between the spinous processes from one side. Once in position, the ligaments and tissues associated with the spinous processes would hold the implant into position. Tethers also could be used if desired.
Embodiment of FIGS.72,73
• Implant630 is also designed so that it can be inserted from one side of adjacent spinous processes. Thisinsert630 includes acentral body632 with the first andsecond arms634,636 extending on either side thereof. As can be seen inFIG. 72, aplunger638 is positioned to extend from an end of thecentral body632. As shown inFIG. 72, theplunger638 is fully extended and as shown inFIG. 73, theplunger638 is received within thecentral body632 of theimplant630. With the plunger received into theimplant632, the third and fourth arms or hooks640,642 can extend outwardly from thecentral body632. The third and fourth arms or hooks640,642 can be comprised of a variety of materials, such as for example, shape memory metal materials or materials which have a springy quality.
• For purposes of positioning theimplant630 between adjacent spinous processes, theplunger638 is pulled outwardly as shown inFIG. 72. Thecentral body632 is then positioned between adjacent spinous processes and theplunger638 is allowed to move to the position ofFIG. 73 so that the third andfourth arms640,642 can project outwardly from thecentral body632 in order to hold theimplant630 in position between the spinous processes.
• Plunger638 can be spring biased to the position as shown inFIG. 73 or can include detents or other mechanisms which lock it into that position. Further, the third and fourth arms themselves, as deployed, can keep the plunger in the position as shown inFIG. 73.
Embodiments of FIGS.74,75,76,77, and78
• Other embodiments of the invention are shown inFIGS. 74 through 78.FIGS. 74,75 and76disclose implant700.Implant700 is particularly suited for implantation between the L4-L5 and L5-S1 vertebra. As can be seen inFIG. 74, theimplant700 includes acentral body702 which has abore704 provided therein.Bore704 is used in order to adjust the modulus of elasticity of the implant so that it is preferably approximately two times the anatomical load placed on the vertebra in extension. In other words, theimplant700 is approximately two times stiffer than the normal load placed on the implant. Such an arrangement is made in order to ensure that the implant is somewhat flexible in order to reduce potential resorption of the bone adjacent to the implant. Other modulus values can be used and be within the spirit of the invention.
• Implant700 includes first andsecond saddle706,708 which are used to receive and spread the load from the upper and lower spinous processes. Thesaddle706 is defined by first andsecond arms710 and712. Thesecond saddle708 is defined by third andfourth arms714 and716. As can be seen inFIG. 74, thefirst arm710, in a preferred embodiment, is approximately two times the length of thebody702 with the second arm being approximately less than a quarter length of the body.Third arm714 is approximately one times the length of thebody702 with thefourth arm716 being, in this preferred embodiment, approximately one and a half times the length of thebody702. The arms are designed in such a way that the implant (1) can be easily and conveniently inserted between the adjacent spinous processes, (2) will not migrate forwardly toward the spinal canal, and (3) will hold its position through flexion and extension as well as lateral bending of the spinal column.
• First arm710 is in addition designed to accommodate the shape of the vertebra. As can be seen inFIG. 74, thefirst arm710 becomes narrower as it extends away from thebody702. Thefirst arm710 includes a slopingportion718 followed by asmall recess720 ending in arounded portion722 adjacent to theend724. This design is provided to accommodate the anatomical form of for example the L4 vertebra. It is to be understood that these vertebra have a number of surfaces at roughly 30° angles and that the sloping surfaces of this embodiment and the embodiments shown inFIGS. 77 and 78 are designed to accommodate these surfaces. These embodiments can be further modified in order to accommodate other angles and shapes.
• Thesecond arm712 is small so that it is easy to insert between the spinous processes, yet still define thesaddle706. Thefourth arm716 is larger than thethird arm714, both of which are smaller than thefirst arm710. The third and fourth arms are designed so that they define thesaddle706, guide the spinous processes relative to theimplant700 during movement of the spinal column, and yet are of a size which makes the implant easy to position between the spinous processes.
• The procedure, by way of example only, for implanting theimplant700 can be to make an incision laterally between two spinous processes and then initially insertfirst arm710 between the spinous processes. The implant and/or appropriate tools would be used to distract the spinous processes allowing thethird leg714 and thecentral body702 to fit through the space between the spinous processes. Thethird leg714 would then come to rest adjacent the lower spinous processes on the opposite side with the spinous processes resting in the first andsecond saddle706,708. The longerfourth leg716 would then assist in the positioning of theimplant700.
• FIG. 77 includes animplant740 which is similar toimplant700 and thus have similar numbering. Thesaddle706,708 ofimplant740 have been cantered or sloped in order to accommodate the bone structure between, by way of example, the L4-L5 and the L5-S1 vertebra. As indicated above, the vertebra in this area have a number of sloping surfaces in the range of about 30°. Accordingly,saddle706 is sloped at less than 30° and preferably about 20° whilesaddle708 is sloped at about 30° and preferably more than 30°.
• Theimplant760 as shown inFIG. 78 is similar toimplant700 inFIG. 74 and is similarly numbered.Implant760 includes third andfourth legs714,716 which have slopingportions762,764 which slope toward ends766,768 of third andfourth arm714,716 respectively. The sloping portions accommodate the form of the lower vertebra against which they are positioned. In the preferred embodiment, the sloping portions are of about 30°. However, it is to be understood that sloping portions which are substantially greater and substantially less than 30° can be included and be within the spirit and scope of the invention.
Embodiment of FIGS.79,80,80a,81,82,83,83a,84,85,86 and87
• Another embodiment of the invention is shown inFIGS. 79-87 and includes implant800 (FIG. 86).Implant800 includes adistracting unit802 which is shown in left side, plan, and right side views ofFIGS. 79,80 and81. A perspective view of the distraction unit is shown inFIG. 84. The distracting unit as can be seen inFIG. 80 includes adistracting body804, withlongitudinal axis805, whichbody804 has agroove806 and a rounded orbulbous end808 which assist in the placement of the distracting body between adjacent spinous process so that an appropriate amount of distraction can be accomplished. Extending from thedistracting body804 is afirst wing810 which inFIG. 80 is substantially perpendicular to thedistracting body804. Such wings which are not perpendicular to the body are within the spirit and scope of the invention.First wing810 includes aupper portion812 and alower portion814. The upper portion810 (FIG. 79) includes arounded end816 and asmall recess818. Therounded end816 and thesmall recess818 in the preferred embodiment are designed to accommodate the anatomical form or contour of the L4 (for a L4-L5 placement) or L5 (for a L5-S1 placement) superior lamina of the vertebra. It is to be understood that the same shape or variations of this shape can be used to accommodate other lamina of any vertebra. Thelower portion814 is also rounded in order to accommodate in the preferred embodiment in order to accommodate the vertebrae. The distracting unit further includes a threadedbore820 which in this embodiment accepts a set screw822 (FIG. 86) in order to hold a second wing824 (FIGS. 82,83) in position as will be discussed hereinbelow.
• The threaded bore820 in this embodiment slopes at approximately 45° angle and intersects theslot806. With thesecond wing824 in position, theset screw822 when it is positioned in the threadedbore820 can engage and hold thesecond wing824 in position in theslot806.
• Turning toFIGS. 82,83 and85, left side, plan and perspective views of thesecond wing824 are depicted. Thesecond wing824 is similar in design to the first wing. The second wing includes anupper portion826 and alower portion828. The upper portion includes arounded end830 and asmall recess832. In addition, thesecond wing824 includes aslot834 which mates with theslot806 of thedistracting unit802. Thesecond wing824 is the retaining unit of the present embodiment.
• As can be seen inFIGS. 83 and 86, the second wing or retainingunit824 includes theupper portion826 having a first width “a” and thelower portion828 having a second width “b”. In the preferred embodiment, the second width “b” is larger than first width “a” due to the anatomical form or contour of the L4-L5 or L5-S1 laminae. As can be seen inFIG. 83ain second wing or retainingunit824, the widths “a” and “b” would be increased in order to, as described hereinbelow, accommodate spinous processes and other anatomical forms or contours which are of different dimensions. Further, as appropriate, width “a” can be larger than width “b”. Thus, as will be described more fully hereinbelow, the implant can include a universally-shapeddistracting unit802 with a plurality of retainingunits824, with each of the retaining units having different widths “a” and “b”. During surgery, the appropriatelysized retaining unit824, width with the appropriate dimensions “a” and “b” can be selected to match to the anatomical form of the patient.
• FIG. 86 depicts an assembledimplant800 positioned adjacent to upper andlower laminae836,838 (which are shown in dotted lines) of the upper and lower vertebrae. Thevertebrae836,838 are essentially below theimplant800 as shown inFIG. 86. Extending upwardly from thevertebrae836,838, and between the first andsecond wings810,824, are the upper and lowerspinous processes840,842. It is to be understood that in a preferred embodiment, the fit of the implant between the spinous processes can be such that the wings do not touch the spinous processes, as shown inFIG. 86, and be within the spirit and scope of the invention.
• Theimplant800 includes, as assembled, anupper saddle844 and thelower saddle846. Theupper saddle844 has an upper width identified by the dimension “UW”. Thelower saddle846 has a lower width identified by the dimension “LW”. In a preferred embodiment, the upper width is greater than the lower width. In other embodiments, the “UW” can be smaller than the “LW” depending on the anatomical requirements. The height between the upper andlower saddles844,846 is identified by the letter “h”. These dimensions are carried over intoFIG. 87 which is a schematic representation of the substantially trapezoidal shape which is formed between the upper and lower saddles. The table below gives sets of dimensions for the upper width, lower width, and height as shown inFIG. 87. This table includes dimensions for some variations of this embodiment.

• 	Variation	1	2	3
  	Upper Width	8	7	6
  	Lower Width	7	6	5
  	Height	10	9	8

• For the above table, all dimensions are given in millimeters.
• For purposes of surgical implantation of theimplant800 into a patient, the patient is preferably positioned on his side (arrow841 points up from an operating table) and placed in a flexed (tucked) position in order to distract the upper and lower vertebrae.
• In a preferred procedure, a small incision is made on the midline of the spinous processes. The spinous processes are spread apart or distracted with a spreader. The incision is spread downwardly toward the table, and thedistracting unit802 is preferably inserted upwardly between thespinous processes840 and842 in a manner that maintains the distraction of spinous processes. Thedistracting unit802 is urged upwardly until the distracting orbulbous end808 and theslot806 are visible on the other wide of the spinous process. Once this is visible, the incision is spread upwardly away from the table and the retaining unit orsecond wing824 is inserted into theslot806 and thescrew822 is used to secure the second wing in position. After this had occurred, the incisions can be closed.
• An alternative surgical approach requires that small incisions be made on either side of the space located between the spinous processes. The spinous processes are spread apart or distracted using a spreader placed through the upper incision. From the lower incision, thedistracting unit802 is preferably inserted upwardly between thespinous processes840 and842 in a manner that urges the spinous processes apart. Thedistracting unit802 is urged upwardly until the distracting orbulbous end808 and theslot806 are visible through the second small incision in the patient's back. Once this is visible, the retaining unit orsecond wing824 is inserted into theslot806 and thescrew822 is used to secure the second wing in position. After this has occurred, the incisions can be closed.
• The advantage of either of the above present surgical procedures is that a surgeon is able to observe the entire operation, where he can look directly down onto the spinous processes as opposed to having to view the procedure from positions which are to the right and to the left of the spinous processes. Generally, the incision is as small as possible and the surgeon is working in a bloody and slippery environment. Thus, an implant that can be positioned directly in front of a surgeon is easier to insert and assemble than an implant which requires the surgeon to shift from side to side. Accordingly, a top-down approach, as an approach along a position to anterior line is preferred so that all aspects of the implantation procedure are fully visible to the surgeon at all times. This aides in the efficient location of (i) the distracting unit between the spinous processes, (ii) the retaining unit in the distracting unit, and (iii) finally the set screw in the distracting unit.
• FIG. 80ashows an alternative embodiment of thedistracting unit802a. Thisdistracting unit802ais similar todistracting unit802 inFIG. 80 with the exception that the bulbous end808ais removable from the rest of thedistracting body804aas it is screwed into the threadedbore809. The bulbous end808ais removed once thedistracting unit802ais positioned in the patient in accordance with the description associated withFIG. 86. The bulbous end808acan extend past the threadedbore820 by about 1 cm in a preferred embodiment.
Embodiment of FIGS.88,89,90 and91
• Another embodiment of the invention is shown inFIGS. 88,89,90 and91. In this embodiment, the implant is identified by thenumber900. Other elements ofimplant900 which are similar toimplant800 are similarly numbered but in the 900 series. For example, the distracting unit is identified by thenumber902 and this is in parallel with thedistracting unit802 of theimplant800. The distracting body is identified by thenumber904 in parallel with thedistracting body804 of theimplant800. Focusing onFIG. 90, thedistracting unit902 is depicted in a perspective view. The distracting unit includesslot906 which is wider at the top than at the bottom. The reason for this is that the wider upper portion of theslot906, which is wider than the second wing924 (FIG. 89), is used to, allow the surgeon to easily place thesecond wing924 into theslot906 and allow the wedge-shapedslot906 to guide thesecond wing924 to its final resting position. As can be see inFIG. 91, in the final resting position, the largest portion of theslot906 is not completely filled by thesecond wing924.
• Theend908 ofimplant900 is different in that it is more pointed, havingsides909 and911 which are provided at about 45° angles (other angles, such as by way of example only, from about 30° to about 60° are within the spirit of the invention), with a smallflat tip913 so that thebody904 can be more easily urged between the spinous processes.
• Thedistracting unit902 further includes a tongue-shapedrecess919 which extends from theslot906. Located in the tongue-shaped recess is a threadedbore920.
• As can be seen inFIG. 89, asecond wing924 includes atongue948 which extends substantially perpendicular thereto and between the upper andlower portions926,928. Thetab948 includes abore950. With thesecond wing924 positioned in theslot906 of thedistracting unit902 andtab948 positioned inrecess919, a threadedset screw922 can be positioned through thebore950 and engage the threaded bore920 in order to secure the second wing or retainingunit924 to thedistracting unit902. Theembodiment900 is implanted in the same manner asembodiment800 previously described. In addition, as thebore922 is substantially perpendicular to the distracting body904 (and not provided at an acute angle thereto), the surgeon can even more easily secure the screw in place from a position directly behind the spinous processes.
Embodiment of FIGS.92,92a,92b,93,93a,93b,93c,93d,94,94a,94b,95,95a, and96
• Still a further embodiment of the invention is depicted inFIGS. 92, and92a. In this embodiment, theimplant1000 as can be seen inFIG. 92aincludes a centralelongated body1002 which has positioned at one end thereof afirst wing1004.Wing1004 is similar to the first wing previously described with respect to the embodiment ofFIG. 88.Bolt1006 secureswing1004 tobody1002 in this embodiment.Bolt1006 is received in a bore of thebody1002 which is along thelongitudinal axis1008 of body. It is to be understood that in this embodiment, the first unit is defined by thecentral body1002, thefirst wing1004, and theguide1010.
• Alternatively, the first wing can be secured to the central body with a press fit and detent arrangement as seen inFIG. 93c. In this arrangement, the first wing has aprotrusion1040 extending preferably about perpendicularly from the first wing, with aflexible catch1042. The protrusion and flexible catch are press fit into abore1044 of the central body with the catch received in adetent1046.
• In yet another alternative embodiment, the first wing can be designed as shown inFIG. 93dwith the protrusion directed substantially parallel to the first wing from a member that joins the first wing to the protrusion. Thus in this embodiment, the first wing is inserted into the body along the same direction as the second wing is inserted.
• Positioned at the other end of thecentral body1002 is aguide1010. In this particular embodiment,guide1010 is essentially triangularly-shaped so as to be a pointed and arrow-shaped guide. Alternatively,guide1010 could be in the shape of a cone with lateral truncated sides along thelongitudinal axis1008.Guide1010 includes arecess1012 having a threadedbore1014.Recess1012 is for receiving asecond wing1032 as will be described hereinbelow.
• Additionally, it is also to be understood that theguide1010 can be bulbous, cone-shaped, pointed, arrow-shaped, and the like, in order to assist in the insertion of theimplant1000 between adjacent spinous processes. It is advantageous that the insertion technique disturb as little of the bone and surrounding tissue or ligaments as possible in order to (1) reduce trauma to the site and facilitate early healing, and (2) not destabilize the normal anatomy. It is to be noted that with the present embodiment, there is no requirement to remove any of the bone of the spinous processes and depending on the anatomy of the patient, there may be no requirement to remove or sever ligaments and tissues immediately associated with the spinous processes.
• Theimplant1000 further includes asleeve1016 which fits around and is at least partially spaced from thecentral body1002. As will be explained in greater detail below, while the implant may be comprised of a bio-compatible material such as titanium, the sleeve is comprised preferably of a super-elastic material which is by way of example only, a nickel titanium material (NiTi), which has properties which allow it to withstand repeated deflection without fatigue, while returning to its original shape. The sleeve could be made of other materials, such as for example titanium, but these materials do not have the advantages of a super-elastic material.
• FIG. 93ais a cross-section through theimplant1000 depicting thecentral body1002 and thesleeve1016. As can be seen from the cross-section ofFIG. 93ain a preferred embodiment, both thecentral body1002 and thesleeve1016 are substantially cylindrical and oval or elliptically-shaped. An oval or elliptical shape allows more of the spinous process to be supported by the sleeve, thereby distributing the load between the bone and the sleeve more evenly. This reduces the possibility of fracture to the bone or bone resorption. Additionally, an oval or elliptical shape enhances the flexibility of the sleeve as the major axis of the sleeve, as described below, is parallel to the longitudinal direction of the spinous process. However, other shapes such as round cross-sections can come within the spirit and scope of the invention.
• In this particular embodiment, thecentral body1002 includes elongatedgrooves1018, alongaxis1008, which receives elongatedspokes1020 extending from the internal surface of thecylinder1016.
• In a preferred embodiment, both the cross-section of the central body and the sleeve have a major dimension alongaxis1022 and a minor dimensional along axis1024 (FIG. 93a). Thespokes1020 are along the major dimension so that along the minor dimension, thesleeve1016 can have its maximum inflection relative to thecentral body1002. It is to be understood that the central body along theminor dimension1024 can have multiple sizes and can, for example, be reduced in thickness in order to increase the ability of thesleeve1016 to be deflected in the direction of thecentral body1002.
• Alternatively as can be seen inFIG. 93b, thecentral body1002 can include thespokes1020 and thesleeve1016 can be designed to include thegrooves1018 in order to appropriately space thesleeve1016 from thecentral body1002.
• In other embodiments, the sleeve can have minor and major dimensions as follows:

• 	MinorDimension	Major Dimension

  6	mm	10	mm
  8	mm	10.75	mm
  12	mm	14	mm
  6	mm	12.5	mm
  8	mm	12.5	mm
  10	mm	12.5	mm

• In one preferred embodiment, said sleeve has a cross-section with a major dimension and a minor dimension and said major dimension is greater than said minor dimension and less than about two times said minor dimension. In said embodiment, said guide has a cross-section which is adjacent to said sleeve with a guide major dimension about equal to said sleeve major dimension and a guide minor dimension about equal to said sleeve minor dimension. Further in said embodiment, said guide extends from said central body with a cross-section which reduces in size in a direction away from said central body.
• In another preferred embodiment, said guide is cone-shaped with a base located adjacent to said sleeve. Further, said guide has a base cross-section about the same as the oval cross-section of said sleeve.
• Thus, from the above, it is evident that preferably a major dimension of the sleeve correspond with a major dimension of the central body and a minor dimension of the sleeve corresponds with a minor dimension of the central body. Additionally, it is evident that the major dimension of thesleeve1016 is substantially perpendicular to a major dimension of thefirst wing1004 along longitudinal axis1030 (FIG. 92a). This is so that as discussed above, when theimplant1000 is properly positioned between the spinous processes, a major portion of the sleeve comes in contact with both the upper and lower spinous processes in order to distribute the load of the spinous processes on thesleeve1016 during spinal column extension.
• As indicated above, the preferred material for thesleeve1016 is a super-elastic material and more preferably one comprised of an alloy of nickel and titanium. Such materials are available under the trademark Nitinol. Other super-elastic materials can be used as long as they are bio-compatible and have the same general characteristics of super-elastic materials. In this particular embodiment, a preferred super-elastic material is made up of the following composition of nickel, titanium, carbon, and other materials as follows:

• 	Nickel	55.80%	by weight
  	Titanium	44.07%	by weight
  	Carbon	<0.5%	by weight
  	Oxygen	<0.5%	by weight

• In particular, this composition of materials is able to absorb about 8% recoverable strain. Of course, other materials which can absorb greater and less than 8% can come within the spirit and scope of the invention. This material can be repeatably deflected toward the central body and returned to about its original shape without fatigue. Preferably and additionally, this material can withstand the threshold stress with only a small amount of initial deforming strain and above the threshold stress exhibit substantial and about instantaneous deformation strain which is many times the small amount of initial deforming strain. Such a characteristic is demonstrated inFIG. 118 where it is shown that above a certain threshold stress level, deformation strain is substantially instantaneous up to about 8%.FIG. 118 shows a loading and unloading curve between stress and deformation strain for a typical type of super-elastic material as described above.
• Preferably, the above super-elastic material is selected to allow deformation of up to about, by way of example only, 8%, at about 20 lbs. to 50 lbs. force applied between a spinous processes. This would cause a sleeve to deflect toward the central body absorbing a substantial amount of the force of the spinous processes in extension. Ideally, the sleeves are designed to absorb 20 lbs. to 100 lbs. before exhibiting the super-elastic effect (threshold stress level) described above. Further, it is possible, depending on the application of the sleeve and the anatomy of the spinal column and the pairs of spinous processes for a particular individual, that the sleeve can be designed for a preferable range of 20 lbs. to 500 lbs. of force before the threshold stress level is reached. Experimental results indicate that with spinous processes of an older individual, that at about 400 pounds force, the spinous process may fracture. Further, such experimental results also indicate that with at least 100 pounds force, the spinous process may experience some compression. Accordingly, ideally the super-elastic material is designed to deform or flex at less than 100 pounds force.
• In a preferred embodiment, the wall thickness of the sleeve is about 1 mm or 40/1000 of an inch (0.040 in.). Preferably the sleeve is designed to experience a combined 1 mm deflection. The combined 1 mm deflection means that there is ½ mm of deflection at the top of the minor dimension and a ½ mm deflection at the bottom of the minor dimension. Both deflections are toward the central body.
• In a particular embodiment where the sleeve is more circular in cross-section, with an outer dimension of 0.622 in. and a wall thickness of 0.034 in., a 20 lb. load causes a 0.005 in. deflection and a 60 lb. load causes a 0.020 in. deflection (approximately ½ mm). A 100 lb. load would cause a deflection of about 0.04 in. or approximately 1 mm.
• Thus in summary, the above preferred super-elastic material means that the sleeve can be repeatedly deflected and returned to about its original shape without showing fatigue. The sleeve can withstand a threshold stress with a small amount of deforming strain and at about said threshold stress exhibit about substantially instantaneous deformation strain which is many times the small amount of the forming strain. In other words, such super-elastic qualities mean that the material experiences a plateau stress where the material supports a constant force (stress) over very large strain range as exhibited inFIG. 118.
• It is to be understood that for this particular embodiment, bar stock of the super-elastic material is machined into the appropriate form and then heat treated to a final temperature to set the shape of the material by increasing the temperature of the material to 932° Fahrenheit and holding that temperature for five (5) minutes and then quickly quenching the sleeve in water. It is also to be understood that preferably the present nickel titanium super-elastic alloy is selected to have a transition temperature A_fof about 59° Fahrenheit. (15° C.). Generally for such devices the transition temperature can be between 15° C. to 65° C. (59° F. to 149° F.), and more preferably 10° C. to 40° C. (50° F. to 104° F.). Preferably, the material is maintained in the body above the transition temperature in order to exhibit optimal elasticity qualities.
• Alternatively, and preferably, the sleeve can be fabricated by wire Electrical Discharge Machining (EDM) rather than machined. Additionally, the sleeve can be finished using a shot blast technique in order to increase the surface strength and elasticity of the sleeve.
• Top and side views of thesecond wing1032 are shown inFIGS. 94 and 95.Second wing1032 as in several past embodiments includes atab1034 with abore1036 which aligns with thebore1014 of theguide1010. In this particular embodiment, thesecond wing1032 includes a cut-out1038 which is sized to fit over theguide1010, with thetab1034 resting in therecess1012 of theguide1010.
• An alternative configuration of thesecond wing1032 is depicted inFIG. 94a. In this configuration, thesecond wing1032 is held at acute angle with respect to thetab1034. This is different from the situation in the embodiment ofFIGS. 94 and 95 where the second wing is substantially perpendicular to the tab. For the embodiment of the second wing inFIG. 94a, such embodiment will be utilized as appropriate depending on the shape of the spinous processes.
• With respect to the alternativesecond wing1032 depicted inFIGS. 94band95a,elongated tab1034 has a plurality of closely positioned bores1036. The bores, so positioned, appear to form a scallop shape. Each individual scallop portion of thebore1036 can selectively hold the bolt in order to effectively position thesecond wing1032 in three different positions relative to thefirst wing1004. The cut-out1038 (FIG. 95aof this alternative embodiment) is enlarged over that ofFIG. 95 as in a position closest to thefirst wing1004, thesecond wing1032 is immediately adjacent and must conform to the shape of thesleeve1016.
Embodiment of FIG.97
• Implant1050 ofFIG. 97 is similar to theimplant1000 inFIG. 92 with the major difference being that a second wing is not required. Theimplant1050 includes a central body as doesimplant1000. The central body is surrounded by asleeve1016 which extends between afirst wing1004 and aguide1010. Theguide1010 in this embodiment is substantially cone-shaped without any flats and with no bore as there is no need to receive a second wing. The sleeve and the central body as well as the first wing and guide act in a manner similar to those parts of theimplant1000 inFIG. 92. It is to be understood a cross-section of thisimplant1050 throughsleeve1016 can preferably be likeFIG. 93a. This particular embodiment would be utilized in a situation where it was deemed impractical or unnecessary to use a second wing. This embodiment has the significant advantages of the sleeve being comprised of super-elastic alloy materials as well as the guide being utilized to guide the implant between spinous processes while minimizing damage to the ligament and tissue structures found around the spinous processes.
Embodiment of FIG.98
• Implant1060 is depicted inFIG. 98. This implant is similar to theimplants1000 ofFIG. 92 and theimplant1050 ofFIG. 97, except that this implant does not have either first or second wings.Implant1060 includes asleeve1016 which surrounds a central body just ascentral body1002 ofimplant1000 inFIG. 93. It is to be understood that a cross-section of thisimplant1060 throughsleeve1016 can preferably be likeFIG. 93a.Implant1060 includes aguide1010 which in this preferred embodiment is cone-shaped.Guide1010 is located at one end of the central body. At the other end is astop1062.Stop1062 is used to contain the other end of thesleeve1016 relative to the central body. This embodiment is held together with a bolt such asbolt1006 ofFIG. 93 that is used for the immediate above two implants. For theimplant1060 ofFIG. 98, such a device would be appropriate where the anatomy between the spinous processes was such that it would be undesirable to use either a first or second wing. However, this embodiment affords all the advantageous described hereinabove (FIGS. 92 and 97) with respect to the guide and also with respect to the dynamics of the sleeve.
Embodiment of FIGS.99 and100
• FIGS. 99 and 100 depict animplant system1070.Implant system1070 includes asleeve1072 which is similar to and has the advantageous ofsleeve1016 of the embodiment inFIG. 92.Sleeve1072 does not, however, have any spokes. Additionally,implant system1070 includes aninsertion tool1074.Insertion tool1074 includes aguide1076 which in a preferred embodiment is substantially cone-shaped.Guide1076 guides the insertion of thesleeve1072 and theinsertion tool1074 between adjacent spinous processes. Theinsertion tool1074 further includes acentral body1078, astop1080, and ahandle1082. Theguide1076 at its base has dimensions which are slightly less than the internal dimensions of thesleeve1074 so that the sleeve can fit over theguide1076 and rest against thestop1080. Thetool1074 with theguide1076 is used to separate tissues and ligaments and to urge thesleeve1072 in the space between the spinous processes. Once positioned, theguide insertion tool1074 can be removed leaving thesleeve1072 in place. If desired, after the sleeve is positioned, position maintaining mechanisms such asspringy wires1084 made out of appropriate material such as the super-elastic alloys and other materials including titanium, can be inserted using a cannula through the center of thesleeve1072. Once inserted, the ends of the retaining wires1084 (FIG. 99) extend out of both ends of thesleeve1072, and due to this springy nature, bent at an angle with respect to the longitudinal axis of thesleeve1072. These wires help maintain the position of the sleeve relative to the spinous processes.
Embodiment of FIGS.101,102,102a,103,104,105,106, and107
• Another embodiment of the invention can be seen inFIG. 101 which includesimplant1100.Implant1100 has many similar features that are exhibited with respect toimplant1000 inFIG. 92. Accordingly, elements with similar features and functions would be similarly numbered. Additionally, features that are different fromimplant1100 can be, if desired, imported into and become a part of theimplant1000 ofFIG. 92.
• As withimplant1000,implant1100 includes a central body1002 (FIG. 102) with afirst wing1004 and abolt1006 which holds the first wing and the central body together. In this particular embodiment, the central body is made in two portions. Thefirst portion1102 is in the shape of a truncated cone with an oval or elliptical base and asecond portion1104 includes a cylindrical central portion with a distal end in the shape of atruncated cone1103 with an oval or elliptical base. In addition, in this particular embodiment, formed with the central body is theguide1010 which has an oval or elliptical base.Bolt1006 is used to secure the first wing through thesecond portion1104 with thefirst portion1102 held in-between. In this particular embodiment, theguide1010 in addition to includingrecess1012 and bore1014 includes agroove1106 which receives a portion of thesecond wing1032.
• In this particular embodiment, thesleeve1016 is preferably oval or elliptical in shape as can be seen inFIG. 102a. The central body can be oval, elliptical or circular in cross-section, although other shapes are within the spirit and scope of the invention. Thesleeve1016 held in position due to the fact that the truncatedconical portion1102 and the corresponding truncatedconical portion1103 each have a base that is elliptical or oval in shape. Thus, the sleeve is held in position so that preferably the major dimension of the elliptical sleeve is substantially perpendicular to the major dimension of the first wing. It is to be understood that if the first wing is meant to be put beside the vertebrae so that the first wing is set at an angle other than perpendicular with respect to the vertebrae and that the sleeve may be held in a position so that the major dimension of the sleeve is at an angle other than perpendicular to the major dimension of the first wing and be within the spirit and scope of the invention. This could be accomplished by tighteningbolt1006 with thefirst wing1004 andsleeve1016 so positioned. In such a configuration, the major dimension of the sleeve would be preferably positioned so that it is essentially parallel to the length of the adjacent spinous processes. So configured, the elliptical or oval shape sleeve would bear and distribute the load more evenly over more of its surface.
• It is to be understood that the sleeve in this embodiment has all the characteristics and advantages described hereinabove with respect to the above-referenced super-elastic sleeves.
• The second wing as discussed above, can come in a variety of shapes in order to provide for variations in the anatomical form of the spinous processes. Such shapes are depicted inFIGS. 103,104,105,106, and107. In each configuration, thesecond wing1032 has aupper portion1108 and alower portion1110. InFIG. 104, the lower portion is thicker than the upper portion in order to accommodate the spinous process, where the lower spinous process is thinner than the upper spinous process. InFIG. 105, both the upper and lower portions are enlarged over the upper and lower portions ofFIG. 103 to accommodate both the upper and lower spinous processes being smaller. That is to say that the space between the upper and lower portions of the first and second wings are reduced due to the enlarged upper and lower portions of the second wing.
• Alternative embodiments of second wings, as shown inFIGS. 104 and 105, are depicted inFIGS. 106 and 107. In theseFIGS. 106 and 107, thesecond wing1032 accommodates the same anatomical shape and size of the spinous processes as does the second wing inFIGS. 104 and 105 respectively. However, in the embodiments of thesecond wing1032 ofFIGS. 106 and 107, substantial masses have been removed from the wings. The upper andlower portions1108 and1110 are essentially formed or bent in order to extend from thecentral portion1112 of thesecond wing1032.
• It is to be understood that in this embodiment, if desired, the second wing may not have to be used, depending on the anatomy of the spinal column of the body, and this embodiment still has the significant advantages attributable to theguide1010 and the functionality of thesleeve1016.
Embodiment of FIGS.108,109, and110
• Theimplant1120 as shown inFIGS. 108 and 109, is similar toimplant1100 which is in turn similar toimplant1000. Such similar details have already been described above and reference here is made to the unique orientation of the first andsecond wings1122 and1124. These wings havelongitudinal axis1126 and1128 respectfully. As can be seen in these figures, the first andsecond wings1122,1124 have been rotated so that they both slope inwardly and if they were to continue out of the page of the drawing ofFIG. 108, they would meet to form an A-frame structure as is evident from the end view ofFIG. 109. In this particular embodiment, as can be seen inFIGS. 109 and 110, thetab1034 is provided an acute angle to the remainder of thesecond wing1124. Further, thegroove1018 formed in the implant is sloped in order to accept thesecond wing1124. Accordingly, thispresent implant1120 is particularly suited for an application where the spinous process is wider adjacent to the vertebral body and then narrows in size at least some distance distally from the vertebral body. It is to be understood that a cross-section of thisimplant1120 throughsleeve1016 can preferably be likeFIG. 93a.
Embodiment of FIGS.111,112,113,114,115,116, and117
• An additional embodiment of theimplant1150 is shown inFIG. 111.Implant1150 has features similar to those described with respect toFIG. 94b.
• Implant1150 includes acentral body1152 with afirst wing1154, wherecentral body1152 includes elongatedgroove1156 which extends to theguide1158. Ascrew1160 is received in a threaded bore located in theelongated groove1156.
• Thesecond wing1162 includes acentral body1164 which is substantially perpendicular to thesecond wing1162.
• Thecentral body1164 includes a plurality ofbores1166 provided therein. These bores are formed adjacent to each other in order to define a plurality of scallops, each scallop capable of retainingbolt1160 therein. As can be seen inFIG. 114, the second wing includes a cut-out1168 such that with thecentral body1164 of the second wing received in thegroove1156 of the central body associated with the first wing, the remainder of the second wing is received over thecentral body1152 of theimplant1150. With thisimplant1150, the distance between the first and second wings can be adjusted by selectively placing thebolt1160 through one of the five specified bores defined by the scalloped plurality ofbores1166. Accordingly,FIG. 112 depicts the implant where the first and second wings are widest apart in order to accommodate spinous processes of greater thickness.FIG. 111 shows the middle position between the first and second wings in order to accommodate average size spinous processes.
• It is to be understood that preferably during the surgical process, thecentral body1152 is urged between spinous processes. After this has occurred, the second wing is guided by the other sides of the spinous processes from a path which causes the plane of the second wing to move substantially parallel to the plane of the first wing until thecentral body1164 associated with thesecond wing1162 is received in the groove of1156 of thecentral body1152 associated with thefirst wing1154. After this has occurred, thebolt1160 is positioned through aligned bores associated with thesecond wing1162 and thecentral body1152 in order to secure the second wing to the central body.
• Whileembodiment1150 does not depict a sleeve such assleeve1016, such asleeve1016 could be placed overbody1152 and be within the spirit of the invention.
Embodiments of FIGS.119a,119b,120a,120b,121a,121b,122a,122b,122c,123a,123b,124a,124b, and124c
• Implant1200 of the invention is depicted inFIGS. 119aand119b. This implant includes thefirst wing1202 andsleeve1204 and aguide1206. An alternative to this embodiment further includes, as required,second wing1208 as depicted inFIGS. 120aand120b.
• As can be seen inFIGS. 121aand121b, thefirst wing1202 includes a bore which receives acentral body1210. Preferably, the central body is pressed fit through the bore of the first wing although it is to be understood that other securing mechanisms such as through the use of threads and still other mechanisms can be used to accomplish this task. Additionally, in this particular embodiment first andsecond pins1212 extend from thefirst wing1202, each along an axis which is substantially parallel to thelongitudinal axis1214 of thecentral body1210. In this particular embodiment, thedistal end1216 of thecentral body1210 is threaded in order to be coupled to theguide1206.
• As can be seen inFIGS. 122a,122band122c, theguide1206 in this particular embodiment is pointed in order to allow the implant to be inserted between, and if necessary distract, adjacent spinous processes. Theguide206 includes a threaded bore1218 which is designed to accept the threadedend1216 of thecentral body1210 in order to secure the guide to the central body and additionally for purposes of retaining the sleeve between theguide1206 and thefirst wing1202.
• As can be seen inFIG. 123athesleeve1204 is preferably cylindrical, and oval or elliptical in shape in cross-section. It is to be understood thatsleeve1204 can have other shapes as described throughout the specification and be within the spirit and scope of the invention. In this particular embodiment,sleeve1204 has at least one major diameter and one minor diameter in cross-section.Sleeve1204 includes acentral bore1220 which extends the length ofsleeve1204 andcurve grooves1222 which are formed aboutcentral bore1220 and extend only part way into the body of the sleeve. In this particular embodiment, thecurved grooves1222 describe an arc of about 60°. It is to be understood that in other embodiment, this arc can be less than 60° and extend past 120°.
• Thesleeve1204 is received over thecentral body1210 of theimplant1200 and can rotate thereon about thelongitudinal axis1214 of thecentral body1210. When this particular embodiment is assembled, thegrooves1222 have received therein thepins1212 that extend from thefirst wing1202. Accordingly, the pins inserted in thegrooves1222 assist in the positioning of the sleeve relative to the remainder of theimplant1200. With thepins1212 received in thecurved grooves1222, the pins limit the extent of the rotation of the sleeve about the central body and relative to the first wing.
• As can be seen inFIGS. 124a,124b, and124c, the sleeve is free to rotate relative to the longitudinal axis of thecentral body1210 and thus relative to thefirst wing1202 of the embodiment shown inFIGS. 119aand119b. The sleeve can rotate relative to asecond wing1208, when the second wing is utilized in conjunction with the embodiment ofFIGS. 119aand119b. The pins limit the rotation of the sleeve. In an alternative embodiment, the pins are eliminated so that the sleeve can rotate to any position relative to the first wing.
• It is to be understood that the sleeve can be comprised of biologically acceptable material such as titanium. Additionally, it can be comprised of super-elastic material such as an alloy of nickel and titanium, much as described hereinabove with respect to other embodiments.
• The great advantage of the use of thesleeve1204 as depicted in the embodiment ofFIGS. 119aand119bis that the sleeve can be rotated and repositioned with respect to thefirst wing1202, and/or thesecond wing1208 should the second wing be used in the embodiment, in order to more optimally position theimplant1200 between spinous processes. It is to be understood that the cortical bone or the outer shell of the spinous processes is stronger at an anterior position adjacent to the vertebral bodies of the vertebra than at a posterior position distally located from the vertebral bodies. Accordingly, there is some advantage of having theimplant1200 placed as close to the vertebral bodies as is possible. In order to facilitate this and to accommodate the anatomical form of the bone structures, as the implant is inserted between the vertebral bodies and urged toward the vertebral bodies, thesleeve1204 can be rotated relative to the wings, such aswing1202, so that the sleeve is optimally positioned between the spinous processes, and thewing1202 is optimally positioned relative to the spinous processes. Without this capability, depending on the anatomical form of the bones, it is possible for the wings to become some what less than optimally positioned relative to the spinous processes.
Embodiments of FIGS.125,126, and127
• FIGS. 125,126 and127 depict three alternative embodiments of the invention as can be seen through a line parallel to line124-124 ofFIG. 119b.
• InFIG. 125, thesleeve1204 is rotatable aboutcentral body1210. In this embodiment, however, thesleeve1204 design does not include thegrooves1222 as previously depicted in the embodiment shown inFIG. 123a. Thus, without pins, the sleeve is completely free to rotate about thecentral body1210.
• An alternative embodiment is shown inFIG. 126. In this embodiment, thesleeve1204 is essentially a thin wall cylinder which is spaced from thecentral body1210.Sleeve1204 is free to move relative tocentral body1210.Sleeve1204 can rotate relative tocentral body1210. In addition,sleeve1204 can take a somewhat cocked or skewed position relative tocentral body1210.
• A further embodiment, it is shown inFIG. 127. This embodiment is somewhat similar to the embodiment shown inFIG. 126 except that in this case, several pins project from the first wing in order to some what limit and restrict the motion of thesleeve1204. As shown inFIG. 127, four pins are depicted. It is to be understood however that such an embodiment can include one, two, three, four or more pins and be within the spirit and scope of the invention. It is to be understood that if the embodiment is used with a second wing, that similar pins can extend from the second wing. However, in the embodiment using a second wing, the pins would preferably be somewhat flexible so that they could snap into the inside of thesleeve1204 as the second wing is inserted relative to the central body and secured in place. In the embodiment shown inFIG. 127, thesleeve1204 is free to rotate about the longitudinal axis of thecentral body1210 and is somewhat restricted in this motion and its ability to become skewed relative to the longitudinal axis of the central body by the pins.
Embodiments of FIGS.128 and129
• The embodiments ofFIG. 128 is an advantageous alternative to that ofFIG. 93a. In this embodiment, thecentral body1002 is similar to that as shown inFIG. 93a. Thesleeve116 is comprised of twosleeve portions1016aand1016b. The sleeve portions are preferably formed from flat stock material which is substantially easier to form than having the sleeve formed or machined from solid bar stock material. A further advantage of thesleeve1016, if formed of super-elastic material, is that the sleeve can be formed in a manner which optimizes the super-elastic characteristics of such material in order to enhance its ability to repeatedly deflect under load. In this particular embodiment, thesleeve portions1016aand1016bare somewhat C-shaped and then after being formed, are snapped into the grooves of thecentral body1002.
• An alternative embodiment of the invention is shown inFIG. 128. This embodiment is most favorably used with the embodiment ofFIG. 119aand119b. In this particular embodiment, thesleeve1204 is designed to rotate about thecentral body1210.Sleeve1204 includes acentral member1230 which includes a bore that receives thecentral body1210. Thecentral member1230 is rotatable about thecentral body1210 of theimplant1200. Thecentral member1230 includes first andsecond grooves1232 and1234. These grooves can receive C-shapedsleeve members1204aand1204b. These C-shaped sleeve members are similar in construction and design to the C-shaped sleeve members shown above with respect toFIG. 128. These sleeve members can be snapped into position relative to thecentral member1230 of thesleeve1204. It is to be understood that other mechanisms can be used to secure the C-shaped sleeve member relative to the central member of the sleeve and be within the spirit and scope of the invention. Further, it is to be understood that thesleeve members1204aand1204bcan be formed from a single flat stock material such that one of thegrooves1232 and1234 receives continuous piece of flat material which has been appropriately bent and the other grooves receives two ends of the sleeve.
Embodiments of FIGS.130-136
• Embodiment2000 of the supplemental spine fixation device of the invention is depicted inFIG. 130. Thisembodiment2000 includes ahub2002 to which is adjustably secured afirst hook member2004 and asecond hook member2006.First hook member2004 includes ahook2008 which is more fully described hereinbelow, and ashaft2010 extending therefrom. Similarly,second hook member2006 includes ahook2012 and ashaft2014 extending therefrom. As described more fully hereinbelow,hook2008 is swivelly or pivotably mounted toshaft2010. It is to be understood that the description and functionality offirst hook member2004 applies equally well to that ofsecond hook member2006. Theshaft2010 in this embodiment includes arack2016 which can mate selectively withrack2018 ofhook member2006. These tworacks2016 and2018 interlock in a multitude of positions in order to adjust the position of first andsecond hook members2004 and2006, relative to each other and relative to thehub2002. Theshafts2010 and2014 are positioned throughbore2020 in thehub2002, selectively interlocked together and are then lockingly positioned using a locking mechanism such as thescrew2022. As is described more fully below, thehooks2008 and2012 are designed and shaped to fit around spinous processes. Further, thehooks2008 and2012 are swivelly mounted to theshafts2010 and2014 in order to accommodate the various sizes, shapes, and positions of spinous processes of the human population.
• Movably mounted to thehub2002 is a shaft2024 (FIG. 131) and extending from theshaft2024 is aninter-spinous process guide2026. Theshaft2024 at a proximal end includes a crossbar ortab2028 which is slidingly or movingly received in aslot2030 of thehub2002. Once thetab2028 is received in theslot2030, the slot can be pinched off or slightly deformed at its open end using a punch or other mechanism in order to prevent thetab2028, and thus theshaft2024 and theguide2026 from being removed from thehub2002. With thetab2028 located in theslot2030, the shaft and also theguide2026 extending from the distal end of theshaft2024 are free to move relative to the hub and also relative to thefirst hook member2004 and thesecond hook member2006. This movement, as well as the ability of thehooks2008 and2012 to swivel on theshafts2010 and2014, allow theembodiment2000 to conform to the spinous process anatomy.
• Movably mounted on theshaft2024 is a spacer orsleeve2032.Spacer2032 includes acentral bore2034 through which theshaft2024 extends. Thespacer2032 is thus able to rotate about theshaft2034. Thespacer2032 is cylindrical and in this particular embodiment is oval or elliptical in shape. In addition, the base of theguide2026 is also somewhat elliptical in shape in order to make a smooth transition between theguide2026 and thespacer2032 as the guide and spacer are inserted between the spinous processes in order to distract apart the spinous processes during the insertion process. As thespacer2032 is rotatable on theshaft2024, and as thespacer2032 is elliptically shaped, it can be inserted in one position and then as theentire embodiment2000 is positioned to the final securing position, thespacer2032 can rotate about theshaft2024 to accommodate the shape of the space between the spinous processes as the spacer is moved from a posterior position to an anterior position.
• Thespacer2032 can include a second alternative spacer embodiment2036 (FIG. 131a) in substitution for thespacer2032.Spacer2036 includes anelongated slot2038 into which theshaft2024 can be received.Elongated slot2038 not only allows thespacer2036 to rotate about theshaft2024, it also allows it to translate relative toshaft2024. Such translation in this embodiment is substantially perpendicular to the shaft, in any direction to which thespacer2036 is rotated. Thus, in this embodiment the degrees of freedom which accommodate the anatomical shape of the spinous processes and the space therebetween, including the ligaments and tissues associated therewith, include (1) the ability of thehooks2004,2006 to swivel on the shafts, (2) the ability of thehooks2004,2006 to move relative to thehub2002 and be locked to the hub, (3) the ability of theshaft2024 to move in theslot2030 of the hub, and (4) finally the ability of thespacer2036 to both rotate and translate on theshaft2024.
• Before proceeding to more specific details of thisembodiment2000, it is to be understood that the same features of the spacer, the shaft, and the lead-in guide, which are found in other embodiments such as by way of example only, the embodiments ofFIGS. 10,16,20,22,86,88,92, and119b, and other figures, can be incorporated into this embodiment. By way of example only, theimplant2000 can be comprised of stainless steel, titanium or other biologically acceptable materials. The shape of the lead-in plug can be cone shaped, pyramid shaped, and other shapes with a small lead-in cross-section expanding into a larger cross-section which is similar to the cross-section of thespacer2032, in order to gradually distract apart the spinous processes to a sufficient distance so that thespacer2032 or thespacer2036 can conveniently fit between the spinous processes. Further, the spacer, as shown in the other embodiments, can include a spacer made of stainless steel or titanium, or of a super-elastic material or of a silicone. The spacer besides being cylindrical can, from parallelplanar end2040 to parallelplanar end2042, be saddle-shaped alongsurface2041 so that the ends are high and the center portions are low in order to more fully accommodate the shape of the spinous processes and also to spread the load across a broader contact surface between the spinous processes and the spacer. For example, thespacer2032 could have a shape such as the saddle shape defined by the mated together components of the embodiment ofFIG. 16. Further, the dimensions of this embodiment as applied to theguide2006 and thespacer2032 can be acquired from other embodiments presented herein.
• The shape of theguide2026 and thespacer2032 is such that for purposes of insertion between spinous processes, the spinous processes to do not need to be altered or cut away in any manner in order to accommodate this implant. Further, the associated ligaments do not need to be cut away and there would be very little or no damage to the other adjacent and surrounding tissues. Similarly, thehook members2004,2006, are appropriately shaped and also pivotable so that alteration of the spinous process is not required.
• Returning toFIGS. 135a-135fandFIG. 136, the design of thehook members2004 and2006 are more fully depicted and described. As indicated above, the description will be made with respect tofirst hook member2004. This description applies equally tosecond hook member2006. As can be seen inFIG. 135b, thefirst hook member2004 includes ashaft2010 which is received in abore2044 of thehook2008. This bore receives arounded ball end2046 seated against a somewhatcircular seat2048. A screw2050 (FIG. 135f) is received in thebore2044 in order to retain therounded ball end2046. The other end of thebore2044,end2052, as can be seen inFIG. 135fis oval or elliptical in shape. This allows thehook2008 to swivel side to side on theshaft2010 in order to accommodate the spinous process while somewhat restricting the back and forth rocking of thehook2008 relative to theshaft2010. This freedom of motion can be seen inFIG. 136 with respect to the upper spinous processes2054. The hook can swivel side to side in order to accommodate the shape of the upper spinous processes2054. Thelower hook2006 additionally can move in order to accommodate the lower spinous processes2056. As can be seen inFIGS. 135cand135d, thehook2008 can swivel about 15°. on either side of a central longitudinal axis of theshaft2010.
• Additionally with respect to thehook2008, as can be seen inFIGS. 135a,135b, and135e, the hook includes a convexinner surface2058 in order to accommodate the varying surface shape of the spinous processes, and in order to even out the load transferred between the hook and the spinous processes.
• Theembodiment2000 can be implanted in a number of methods, preferably, once a spine fixation device is implanted between the vertebral bodies. In this particular embodiment, through a small incision the hub, spacer, and guide are inserted with the guide and spacer inserted between the spinous processes. Once this is accomplished, a first hook member and then a second hook member is secured about the respective spinous processes. The shafts of the hook members are then inserted through the bore of thehub2002 until the spinous processes are brought tight against the spacer. The hooks are appropriately positioned on the spinous processes as depicted inFIG. 136. After this has been accomplished, thesecuring mechanism2022 is tightened in order to lock the hooks in place and to secure the spinous processes in a rigid manner relative to each other and relative to thedistracting spacer2032. Alternatively, the spinous ligaments can hold the spinous processes tightly against the spacer and the hooks can be moved and locked into tight contact with the spinous processes.
• The above procedure can have variations. By way of example only, the hooks can be inserted first through the incision and then the guide, spacer and hub can be inserted. Once this is accomplished the hooks can be mated to the hub.
• In another embodiment and method not depicted, the physician can insert theshaft2024 on which thespacer2032 is mounted into theslot2030 of thehub2002 and can close off the slot with a securing screw in order to retainshaft2024. This process is in contrast to the shaft being secured in the slot during the manufacturing process. The securing screw would be similar to securingscrew2022 and would be placed in a bore made at the top ofslot2030. The physician could accordingly insert thetab2028 of theshaft2024 in theslot2030, and then secure the tab in place with the securing screw.
• Still an alternative method would be for thedevice2000 to be inserted through a larger incision, withdevice2000 fully assembled. Once inserted thescrew2022 could be loosened so that the hook members could be positioned around spinous processes at about the same time that the guide and spacer are inserted between the spinous processes. Once this is accomplished, the spinous processes could be drawn down tightly around the spacer, with the hooks tightly around the spinous processes and secured firmly into thehub2002 with the securingscrew2022.
• In all of the above procedures, it is advantageous that thedevice2000 can address the adjacent spinous processes from one side of the spinous processes and not require exposure of both sides of the spinous processes and thus the procedure is less traumatic to the surgical site.
• Still an alternate insertion method would be to insert the device fully assembled with the hook rotated at 90° to the final position shown inFIG. 130. Once the hooks are positioned adjacent to the spinous processes, the hooks could be rotated to the position shown inFIG. 130. Then simultaneously the guide and spacer could be inserted between the spinous processes, as the hooks are positioned about the spinous processes. The hooks are then drawn together, causing the spinous processes to be held firmly against the spacer. Once this is accomplished thescrew2022 can be securely fastened to thehub2002.
• With respect to the embodiment ofFIG. 130, this embodiment as fully described above can be used as a supplemental fixation or augmentation device for the lumbar level fusion of the L4/L5 vertebrae and above vertebrae, and also for the L5/S1 and below vertebrae. Thus, thisdevice2000 can be used with respect to fusion of any of the vertebrae up and down the spinous processes.
Embodiments of FIGS.137-140
• Anotherembodiment2100 of the invention can be seen inFIGS. 137-140. Components and features of thisembodiment2100 which are similar to components and features of theembodiment2000 have similarly least significant digits. Thus the hub forembodiment2100 would be2102. The main difference between theembodiment2100 and the previously describedembodiment2000 is directed to thehub2102 and theshafts2110 and2114. In this embodiment, theshafts2110,2114 are substantially rectangular in cross-sections as opposed to semi-circular as in the previous embodiment ofFIG. 130. As can be seen inFIG. 138,shaft2110 is substantially rectangular in cross-section and include rack orteeth2116.Shaft2114 is shaped as a fork with twotines2115 and2117. Further, the two tines have rack orteeth2118. Theshaft2110 of thefirst hook member2104 slides between the twotines2115 and2117. As can be seen inFIG. 139, with theshaft2110 slipped between the twotines2115,2117 and also withshafts2110,2114 located in therectangular bore2120 of thehub2102, the top cap2103 (which is shown both from the top side (FIG. 138) and from the bottom side (FIG. 138b)) can be placed over thehub2102. The teeth orrack2105 on the bottom side of thecap2103, mesh with the teeth orrack2116 and2115,2117 of the first and second hook members. Once this is accomplished, thescrew2122 can be inserted through the indicated bore so that thecap2103 can tighten down on thehub2102, locking theshafts2110 and2114 of the first and second hook members in place.
• All the other features, dimensions, characteristics, materials, methods of insertion, and methods of operation of the embodiment shown inFIG. 138 are similar to or derivations from that shown in the embodiment ofFIG. 130.
Embodiments of FIGS.141-143
• Another embodiment of the invention is depicted inFIGS. 141-143. This embodiment is similar to theother embodiments2000 and2100. This embodiment is numbered2200. Similar elements, features, methods and aspects have similar numerical designations with respect to the lowest two significant digits. Thus the hub ofembodiment2200 is identified ashub2202.
• In this particular embodiment, the hub has rigidly affixed theretoshaft2224. Hereshaft2224 does not slide in a slot as happens with respect to the prior twoembodiments2000 and2100.Shaft2224 can be screwed intohub2202 or integrally formed withhub2202. Additionally, theguide2226 can be integrally formed with theshaft2224 or in other manners fastened to theshaft2224 as with a thread mechanism. In this particular embodiment, as can be seen inFIG. 143, theshaft2224 is integrally formed with thehub2202 and theshaft2224 includes a threadedextension2225 onto which is screwed theguide2226. For this particular embodiment, the sleeve orspacer2236 includes theelongated slot2238 in order to provide for freedom of movement between the sleeve orspacer2236, thehub2202, and the first andsecond hook members2204 and2206.
• In this particular embodiment theshaft2210 and2214 are similar to those depicted with respect to theembodiment2000. In other words each has a rack or teeth which mate with the other.Shafts2210 and2214 are inserted through thesemi-circular bore2220 of thehub2202, and then thecap2203 is mated on top of thehub2202. The cap includes asemi-circular bore2207 which is positioned over theupper shaft2210. Both bores2207 and2220 include ribs, teeth, or threads that run along the length of the bores. These ribs, teeth, or threads are urged against the shafts in order to assist in locking the shafts in place. Alternatively, the ribs, teeth, or threads of the bores can be across the length of the bores. Theshafts2210 and2214 can have teeth, ribs, or threads that are positioned all about the shafts so that the shafts can lock to each other, and so that the teeth, racks or threads on the bores can lock the shafts in place. Once thecap2203 is positioned over thehub2202, thescrew2222 is positioned in the bore of thehub2202 in order to lockingly position the first andsecond hook members2204 and2206 relative to the hub. In particular, with respect toembodiment2200, the degrees of freedom are attributable to (1) theslot2238 in thespacer2236, (2) theshafts2210 and2224 which can be positioned relative to each other to position thehooks2204 and2206 relative to the hub, and accordingly relative to the spacer, and (3) the ability of thehooks2204 and2206 to swivel or pivot.
• As indicated above, all the other features, materials, aspects, dimensions, and so forth, of theembodiment2200 are similar to and can be specified according to theother embodiments2000 and2100.
• A preferred method of insertion of thisembodiment2200 into a patient is as follows. Initially through a small incision the guide, spacer and hub are inserted so that the guide is positioned between and distracts apart adjacent spinous processes, allowing the spacer to come between the spinous processes. The spacer and guide can be moved in a posterior to anterior direction, and the spacer is able to rotate and translate in order to accommodate such movement. After this is accomplished, the first and second hook members are positioned through the incision and around upper and lower spinous processes. Once that is accomplished, the spinous processes are urged towards each other and about the spacer, if this is not already the condition caused by the insertion of the spacer in order to distract the spinous processes. Then the racks of the shafts are meshed together, and the cap is placed upon the hub in order to secure the hooks firmly to the hub and thus to secure the spinous processes rigidly in position about the spinous processes.
Embodiments of FIGS.144-146c
• Afurther embodiment2300 of the invention is depicted inFIG. 144. InFIG. 144, thehub2302 of this embodiment is depicted. This hub could be used, for example, with the embodiment shown inFIG. 141 and similar components are similarly numbered. In this embodiment, thehub2302 includes anintegral shaft2324 with a threadedend2325 which can accept a guide such asguide2226 ofFIG. 141. Unlike the embodiment inFIG. 141, thishub2203 does not have a cap. Insteadhub2302 includes anopen bore2320 which is shaped in order to receiveshafts2310 and2314, which have mating notches or teeth.Bore2320 has aportion2321 which is circular and which receives the matedshaft2310,2324.
• Once this is accomplished, ascrew2322 is received in the threadedbore2323 in order to lockingly position the matedshafts2310,2324. As this embodiment has anopen bore2320 and no cap, mating of theshafts2310,2314 to theopen bore2320 of thehub2302 can be done quickly and efficiently.
• FIG. 145 shows ahub2402 of anembodiment2400. Thishub2402 is similar tohub2302, with theopen bore2420 having a shape which is different from the shape ofbore2320. In this embodiment bore2420 includes a flat2421 and acircular portion2423. Theshafts2410 and2414 when mated together would register in thisopen bore2420. In particular,shaft2414 has a flat which mates to flat2421 and the combinedshafts2410 and2424 have a circular portion which would mate to thecircular portion2423 of thebore2420. Otherwise,hub2202 would function similarly tohub2302.
• FIGS. 146a,146b, and146cdepict ahub arrangement2502 of anembodiment2500 of the invention. In this embodiment,hub2502 has twocomponents2511 and2513.Component2511 includes anopen bore2520 which is specially shaped in order to registershafts2510,2514 of the first and second hook members. In this particular embodiment,shaft2510 is semi-circular in cross-section while shaft2514 is triangular-shaped in cross-section. The triangular shape of shaft2514 mates with thecorner2525 of theopen bore2520. The term open bore refers to2520 and also tobores2320 and2420 inFIGS. 144 and 145, and means that not only are both ends of the bore open, but there is a longitudinal slot along the length of the bore which is open, allowing access to the bore from the side of the bore. Once theshafts2510,2514 are inserted as shownFIG. 146c, ascrew2522 can be tightened through a bore of thehub2502, locking the shafts in place. Once this has occurred, thefirst portion2511 of thehub2502 can be mated into thesecond portion2513 of thehub2502. In this embodiment, the second portion of thehub2513 includes aslot2515 into which can be slid or snapped into thefirst portion2511. Thefirst portion2511 includestangs2517 and2519 which fit underlips2521,2523 respectively as thefirst portion2511 of thehub2502 is slid or alternatively snapped into engagement with thesecond portion2513. Once this occurs, alocking cam2527 is turned in order to cause a cam member to be urged against thisportion2511 of the hub in order to lock2511 to thesecond portion2513. Alternatively, it is to be understood that the act of sliding or snappinghub portion2511 intohub portion2513 can be sufficient to lockportion2511 intoportion2513. This embodiment further includesspacer2536 and cone shapedguide2526.
• Other features, functions, dimensions, and so forth of this embodiment are similar to the other embodiments as, for example, the embodiment ofFIG. 141.
• For purposes of insertion, one insertion methodology can be to insert thesecond hub portion2513 with theguide2526 into the position between the spinous processes. After this is accomplished, the hook members can be positioned about the spinous processes and locked into thefirst hub portion2511. Then thefirst hub portion2511 could be slid or snapped into engagement with thesecond hub portion2513. Following that, thecam2527 can be turned in order to secure thefirst hub portion2511 to thesecond hub portion2513.
Embodiments of FIGS.147a-149b
• FIGS. 147aand147bdepict another embodiment2600 of the invention. This embodiment2600 includes ahub2602 and a rack and pinion arrangement. The rack and pinion arrangement includes first andsecond pinions2660 and2662. These pinions engageshafts2610 and2614 respectively. In these embodiments, theseshafts2610 and2614 have rounded ends to which the hook is secured as depicted in, for example,FIG. 131. For simplicity, these hooks have been left off ofFIGS. 147a,147b. The position of theshafts2610 and2614 can be adjusted relative to the hub. Once theshafts2610,2614 are appropriately positioned the pinions can be locked in position, locking the shafts in position. Pinions can be locked in position by tightening down screws such asscrew2664 against thepinion2660. A similar screw, not shown, would tighten downpinion2662.
• Another embodiment of the invention,embodiment2700 is depicted inFIGS. 148aand148b. In this embodiment abevel gear arrangement2770 is contained in thehub2702.Bevel gear arrangement2770 includes afirst bevel gear2772 and asecond bevel gear2774.Bevel gear2772 has ashaft2776 extending therefrom with aslot2778.Slot2778 can receive a tool for turning thebevel gear2772.Bevel gear2774 is mated to a threadedshaft2710 of thehook member2704. In this particular embodiment, the hook is not shown as is the case for the embodiment ofFIGS. 147aand147b. When thebevel gear2772 is turned, it turnsbevel gear2774. The turning ofbevel gear2774 causes the threadedshaft2714 to retreat into or extend out of the center of theother shaft2710. With the hook members positioned around spinous processes, thebevel gear2772 can be used to turnbevel gear2774 in order to draw thehook member2706 toward thehub2702, tightening the hook members about the spinous processes.
• In thisembodiment2700, ashaft2724 extends therefrom in order to receive a spacer and a guide in the same manner that, for example, the embodiment ofFIG. 144 receives a spacer and a guide.
• FIGS. 149aand149bdepictembodiment2800 of the invention.Embodiment2800 includes ahub2802 which houses aturnbuckle arrangement2880 which is actuated by aworm gear drive2882.Turnbuckle2880 receives the threadedshaft2810 and2814 of thehook members2804,2806 respectively. As with the past embodiments, the actual hooks of these hook members are not depicted in order to simplify the drawing. By turning theturnbuckle2880, the threadedshafts2810,2814 are either drawn into or urged out of the turnbuckle. Thus, by turning theworm gear2882 with a tool placed in theslot2884, the turnbuckle turns, causing the hook members to extend out of or be urged into thehub2802.
• Extending from the hub is ashaft2824 with a threadedend2825. As with the other embodiments, such as the embodiment inFIG. 144, a spacer can be placed on theshaft2824 and a guide can be placed on the threadedend2825.
• The preferred method of inserting this embodiment is to insert the embodiment as a whole, placing the guide and spacer between the spinous processes. The hooks would be initially rotated 90° from their final orientation. Once inserted adjacent to the spinous processes, the hooks would be rotated by 90°. and the spacer and the hooks would be further urged into contact with the spinous processes. Once this has occurred, the turnbuckle would be turned in order to tighten the hooks about the spinous processes.
Embodiment of FIG.150
• Anotherembodiment2900 of the invention is depicted inFIG. 150. This embodiment is similar to several of the other embodiments and, in particular, to the embodiment shown inFIG. 130. Accordingly, similar elements will have similar least significant numbers. By way of example, the hub is designated2902. In this particular embodiment, the hub is comprised of two components, thefirst hub component2911 and thesecond hub component2913. This is somewhat similar to the hub components shown inFIG. 146b.
• The two hook members are secured to thefirst hub component2911 in much the same manner as the hook members ofFIG. 130 are secured to the hub inFIG. 130.
• Thehub2902 is divided intofirst hub component2911 andsecond hub component2913 in order to add flexibility in the positioning of the guide and spacer fitted tosecond hub component2913 with respect to the first andsecond hook members2904 and2906 which are secured to thefirst hub component2911. Thus, should the anatomy of the spine and in particular the spinous process require, thespacer2936 and theguide2926 can be moved relative to the first andsecond hook members2904 and2906 by selectively positioning thesecond hub component2913 relative to thefirst hub component2911. This can be accomplished by aligning thebore2980 over one of the plurality ofbores2982 positioned through thefirst hub component2911. After this is accomplished, a threaded screw2984 can be inserted throughsmooth bore2980 and engage one of the threadedbores2982 in order to secure thesecond hub component2913 to thefirst hub component2911, thus positioning the sleeve orspacer2936 in a desired location relative to the first and second hook members.
Embodiment of FIG.151
• Yet another embodiment of theinvention3000 is depicted inFIG. 151.Embodiment3000 is meant for a double level spinous process fixation. That is to say that three spinous processes are engaged and rigidly fixed together. Such a situation would occur, for example, when there is a double level primary fusion. That is, three adjacent vertebral bodies are all fused together. In such a situation a double level supplementalspine fixation device3000 would be used. Thisembodiment3000 could be designed using any of the other embodiments depicted heretofore.Embodiment3000 is in this particular instance modeled after theembodiment2000 shown inFIG. 141. Accordingly, the elements that are similar toFIG. 141 have similarly least significant digits. By way of example, the hubs ofFIG. 151 are both designated3002 in accordance with the designation ofFIG. 141. Similarly, the hub caps, sleeves, hook members, spacers, and guides are similarly numbered. In this embodiment two hubs, two spacers, and two guides are required as the first guide3026 and thespacer3036 would be inserted between first and second spinous processes, while the second guide3026 andspacer3036 would be inserted between the second and third spinous processes. Thehook members3204 and3206 would hook about the first spinous process and the third spinous process respectively.
• A preferred method of insertion of the device relative to three spinous processes would be to insert the guides and spacer between the first and second, and then the second and third spinous processes in order to distract apart the first and second spinous processes and also to distract apart the second and third spinous processes. After this is accomplished, the first hook member would be placed about the first spinous process and the second hook member would be placed about the third spinous process. The shafts of the hook members would be inserted in therespective hubs3002. In this situation, the shafts are both up-facing racks or teeth as shown inFIG. 151. A linkingshaft3039 has downwardly facing racks or teeth. Thus the upwardly facing rack or teeth of thefirst hook member3204 would be laid in theupper hub3002 with the teeth facing up. The teeth of themember3039 facing down would engage the rack or teeth of thefirst hook3204. Once this is accomplished, the cap will be placed over the hub and the screw inserted in order to rigidly secure the hook member and theshaft3039 relative to theupper hub3002. Then the shaft of thesecond hook3206 would be positioned in thelower hub3002. The rack ofshaft3039 would mesh and lock with the rack of the shaft of thesecond hook member3206. Once this is accomplished, thecap3203 would be placed over the hub and the screw would be inserted through the cap into the hub in order to secure theshaft3039 and thesecond hook member3206 relative to the lower hub.
Embodiments of FIGS.152-160
• Analternate embodiment3100 of the supplemental spine fixation device of the invention is depicted inFIG. 152. Thisembodiment3100 includes ahub3102 to which is adjustably secured afirst hook member3104 andsecond hook member3106.First hook member3104 includes ahook3108 which is more fully described herein below, and ashaft3110 extending therefrom. Similarly,second hook member3106 includes asecond hook3112 andshaft3114 extending therefrom.Shaft3110 and3114 are assembled together in a manner as will be described hereinbelow.
• As described more fully below,hook3108 is swivelly or pivotally mounted toshaft3110. It is to be understood that the description and functionality of thefirst hook member3108 applies equally well to that of thesecond hook member3106. Theshaft3110, onto whichhook3108 is mounted in this embodiment, is received inside of theshaft3114.Shaft3110 can extend fromshaft3114 in a telescoping or sliding manner relative toshaft3114 or alternativelyshaft3110 can be threaded intoshaft3114 and the rotation ofshaft3110 would allow it to extend from or be retracted intoshaft3114.Shafts3110 and3114 are received in abore3120 of thehub3102. In thisparticular embodiment shaft3114 can be press fit or otherwise secured inbore3120.Shaft3110 is thus free to move relative to thehub3102 and theshaft3114, until thehub3102 is assembled, lockingshaft3110 into position in this particular embodiment. This locking arrangement will be discussed more fully below.
• Thehooks3108 and3112 are designed and shaped to fit to spinous processes. Further thehooks3108 and3112 are swivelly mounted to theshafts3110 and3114, respectively, in order to accommodate the various sizes, shapes, and positions of the spinous processes of the human population.
• Swivelly mounted to thehub3102 is ashaft3124, and extending from theshaft3124 is an inner-spinous process guide, or lead-in nose, ortissue expander3126. Theshaft3124 at its proximal end includes aball3125, which is received in socket3127 which is formed by the two portions of thehub3102. At this ball and socket mechanism, theshaft3124 is pivotable with respect to thehub3102. With this arrangement, the tissue expand3126 has some freedom of movement with respect to thehub3102. The other end of the shaft3124 (FIG. 154a) also includes aball3129 which fits into asocket arrangement3131 created in the guide ortissue expander3126. This arrangement allows the guide ortissue expander3126 to pivot with respect to theshaft3124. Accordingly theshaft3124 is free to pivot relative to the hub and the guide ortissue expander3126 is free to pivot relative toshaft3124. This movement, as well as the ability ofhooks3108 and3112 to swivel on theshaft3110 and3114, and the ability of the shaft to be positioned relative to each other allows theembodiment3100 to conform to the spinous process anatomy.
• In this particular embodiment, a sleeve orspacer3132 is pivotally mounted on theshaft3124 along with theguide3126. In other embodiments as described below, thesleeve spacer3132 is free to rotate relative to theguide3126.Spacer3132 includes acentral bore3134 in which theshaft3124 extends. Thespacer3132 as well asguide3136 are thus able to pivot and rotate about theshaft3124. Thespacer3132 in this embodiment is cylindrical and in this particular embodiment is oval or elliptical in shape. For such shapes, the spacer can have minor diameters of 6 mm, 8 mm, 10 mm, and 12 mm. Smaller and larger diameters are within the spirit and scope of the invention. In addition, the spacer can be egg shaped as more fully described below. Further, the base of theguide3126 is somewhat elliptical in shape in order to make a smooth transition between theguide3126 and thespacer3132 as the guide and spacer are inserted between the spinous processes in order to distract apart the spinous processes. As theguide3126 and thespacer3132 are rotatable and pivotable on theshaft3124, and as thespacer3132 is elliptically shaped, it can be inserted into one position and then as theentire embodiment3100 is positioned to the final securing position, thespacer3132 can be rotated about theshaft3124 and pivoted relative thereto in order to accommodate the shape of the space between the spinous processes as the spacer is moved generally from a posturing position to an anterior position closer to the spine.
• As can be seen inFIG. 152 and also inFIGS. 154aand154c, thecentral bore3134 of thespacer3132 has afirst end3133 which is enlarged and in this particular embodiment substantially elliptical in shape. The second end3135 is smaller. The reason for this arrangement is most evident inFIGS. 154aand154bwhere in phantom various positions of theshaft3124 are depicted demonstrating the pivotability of theguide3124 and thesleeve3132 relative to thehub3102. As can be seen inFIGS. 154aand154c, in this particular embodiment, theshaft3124 is inserted into the small end3135 of thesleeve3132. Aretainer3137 is inserted relative to theball3129 of theshaft3124. The lead-in nose ortissue expander3126 is then inserted over the small end3139 of thesleeve3132 andpin3141 is inserted into aligned slots in theguide3126 and thesleeve3132 in order to assemble together guide3126, theretainer3137 and thesleeve3132 about theball3129 of theshaft3124 to create a ball and socket arrangement, whereby theguide3126 andsleeve3132 are pivotable and rotatable about theball3129.
• Thespacer3132 can include analternate embodiment spacer3136 as shown inFIG. 160. Thisspacer3136 can be substituted forspacer3132.Spacer3136 includes an egg-shape cross-section with acentral bore3138 upon which theshaft3124 can be inserted so as to allow thespacer3136 to rotate about theshaft3124. As can be seen inFIG. 160, the egg-shapedspacer3136 has ablunt end3143 and apointed end3145. The center of thebore3138 is off-center and more towards thefront end3134 in this preferred embodiment allowing the pointednose end3145 to be positionable more closely to the spine. This allows theflat sides3147,3149 between theblunt end3143 and pointedend3145 to be positioned closer to the spine and adjacent to portions of spinous processes which are generally comprised of stronger bone. In addition, theseflat sides3147 and3149 can more easily accommodate and carry and thus spread the load placed thereupon by the adjacent spinous processes. Thebore3138 can be shaped like bore3134 (FIG. 154c) to allow for pivoting and rotating motion. Also, in order to accommodatebore3138 of the egg-shapedspacer3136 being off-center, the lead-in guide3126 would also be egg-shaped and have an off-center position whereshaft3124 is attached.
• In another arrangement, the embodiment as shown inFIG. 154ccould be modified to so that the small end3139 of thespacer3132 or of thespacer3136 is severed from the remainder of thespacer3132,3136 and pinned by itself to theguide3126 in order to capture the ball of the shaft. Thus the remainder of thespacer3132,3136 could rotate free ofguide3126.
• Before proceeding to more specific details of thisembodiment3100, it is to be understood that the same features of the spacer, the shaft, and the lead-in guide, which are found on other embodiments such as by way of example only the embodiments ofFIGS. 10,16,20,22,86,88,92 and119b, and other figures can be incorporated into this embodiment. By way of example only, theimplant3100 can be comprised of stainless steel, titanium, or other biologically acceptable materials. The shape of the lead in plug can be cone shaped, pyramid shaped and other shapes with a small lead in cross-section expanding into a larger cross-section which is similar to the cross-section of thespacer3132, in order to gradually distract apart the spinous processes to a sufficient distance so that thespacer3132 or thespacer3136 can conveniently fit between the spinous processes. Further, the spacer, as shown in the other embodiments, can include a spacer made of stainless steel or titanium or of a super-elastic material or of a silicone. The spacer besides being cylindrical, can be saddle-shaped along the surface which engages the spinous processes so that the high edges and the lower central portions can more fully accommodate the shape of the spinous process. This shape also aides in spreading the load across the broader contact area between the spinous processes and the spacer. For example, thespacer3132 or3136 could have a shape such as the saddle shape defined by the mated together components of the embodiment ofFIG. 16. Further, dimensions of this embodiment as applied to theguide3106 and thespacer3132 can be acquired from other embodiments presented herein. By way of example only, the guides and spacers can have multiple shapes with the small diameter of the elliptical shape being on the order of 6 mm, 8 mm, 10 mm, 12 mm and 14 mm.
• The shape of theguide3126 and thespacer3132 or thespacer3136 is such that for purposes of insertion between the spinous processes, the spinous processes do not need to be altered or cut away in any manner in order to accommodate this implant. Further, the associated ligaments do not need to be cut away and there would be very little or no damage to the other adjacent and surrounding tissues. Similarly, thehook members3104 and3106 are appropriately shaped, as described below and are also pivotable so that alterations of the spinous processes is not required.
• Referring toFIG. 155athrough155e, the design and shape of thehook3108 is more fully described and depicted. As indicated above, the description will be made with respect to thefirst hook3108. This description applies equally well tosecond hook3112. As can be seen inFIG. 155a, thefirst hook3108 includes abore3144 into which theshaft3110 is received. The shaft has a rounded end which has a bore provided therethrough. This bore mates with thebore3145 associated with thebore3144 of thehook3108. When the bore of theshaft3110 and thebore3145 of the hook are aligned, a pin or screw can be inserted in order to lock thehook3108 onto theshaft3110. As can be seen inFIG. 155d, thelower end3147 of thebore3144 is oval or ob-round in shape allowing for the shaft to be pivotally received in the bore. Thus thehook3108 is pivotable with respect to the end of theshaft3110. The hook thus can pivot in order to accommodate the shape of the spinous process. Turning toFIG. 155a, the lead in nose or guide ortissue expander3150 of thehook3108 is pointed as can be additionally seen inFIGS. 155dand155e. This allows theguide3150 to be easily inserted between spinous processes and spread the tissue so that theconcave recess3152 can be received over the spinous process. The hook is then locked on the spinous process in order to retain thehook3108 in place adjacent to the spinous process. Therecess3152 has a cross-section which is convex in shape in order to accommodate the various surface shapes of the spinous process and in order to even out the load transfer between the hook and the spinous process.
• Again with respect to the lead innose3150 in a preferred embodiment, this nose is essentially shaped in the form of a pyramid with all of its sides rounded and curved. This allows thenose3150 to easily be inserted over and past the spinous process, until theconcave recess3152 rests over the spinous process with thehook element3154 caught by the spinous process in order to retain thehook3108 in place.
• As can be seen inFIG. 153, thehub3102 is comprised of two portions. Thelower hub portion3103 receives theshaft3110 and3114. Thelower portion3103 also receives theshaft3124 upon which the nose and sleeve are mounted. Theupper portion3105 of thehub3102 mates with alower portion3103 in order to lock theshaft3110 and theshaft3124 in place. Theupper hub portion3105 is secured to thelower portion3103 with a screw through threadedbore3107. As can be seen inFIG. 157,upper hub portion3105 includes alocking projection3109. This locking projection includes a concave surface. The lockingprojection3109, with theupper hub portion3105 is mated to lowerhub portion3107, bears down upon theshaft3110 to lock it in position.Upper hub portion3105 also includes a half spherical capturedenclosure3111. With the hub portions assembled, theenclosure3111 captures the ball end ofshaft3124. It is to be understood that with respect to the embodiment ofFIG. 153, that with the two halves of thehub3102 mated together, a spherically shaped capture enclosure captures the ball end ofshaft3124.
• FIGS. 158aand158bdepict alternative embodiments of a hub arrangement. Thisalternative hub3160 includes lower hub portion3162 andupper hub portion3164. In this embodiment, the ball end of theshaft3124 is captured in the lower half of thehub3160. Theupper half3164 of the hub is mated to the lower half with ascrew3166 which is placed through aleaf spring3168 carried with thescrew3166. The leaf spring bias theupper hub portion3164 towards the lower hub portion3162 in order to trap and capture theshaft3114. Once this is accomplished, thescrew3166 is tightened in order to complete the assembly.
• FIG. 159 depicts yet an alternate embodiment of the hook and shaft arrangement which could be used instead of, by way of example only,hook3108 andshaft3110. In this arrangement thehook3170 includes abore3172 which goes completely through thehook3170. Both ends of the oval are oval or ob-round in order to allow thehook3170 to pivot onshaft3174.Shaft3174 has a plurality ofbores3176 provided therethrough, any one of which can align with thebore3178 which is provided across thebore3172 of thehook3170. When such an alignment is made a pin or screw can be inserted intobore3178 in order to secure theshaft3174 to thehub3170. By selecting one of theseveral bores3176 in theshaft3174, the position of the hook relative to the hub can be adjusted in order to accommodate the shape and spacing of the various spinous processes.
• Embodiment3100 can be implanted in a number of methods in accordance with the teachings for the implantation of theembodiment2000. Preferably this would occur once a spine fixation device is implanted between the vertebral bodies in order to fuse together adjacent vertebral bodies.
• In one preferred embodiment of implantation, in particular with respect to the embodiment ofFIG. 153, the guide and sleeve or spacer can be inserted between adjacent spinous processes. Once this is accomplished, the hooks at the end of shafts could be positioned relative to thehub3102 so that the hooks can grab about adjacent spinous processes. Once this has occurred, theshaft3124 can be received in the lower portion of the hub. The upper portion of thehub3105 can be mated with the lower portion in order (1) to capture and fixshaft3124 in place, allowing for the movement of theshaft3124, and also (2) to capture and fix theshaft3110 in place to rigidly position theshaft3110 relative to thehub3102.
• It is also to be understood that in other situations the fully assembled embodiment can be inserted in place relative to the adjacent spinous processes. Once this accomplished, a screw such as the screw inFIG. 153 can be tightened in order to secure the various shafts relative to thehub3102.
• In all of the above procedures, and also in the procedures with respect toprior embodiment2000, it is advantageous that the embodiments can address the adjacent spinous processes from one side of the spinous processes and do not require exposure to both sides of the spinous processes. Thus, this procedure is less traumatic to the surgical site.
Embodiment of FIGS.161a-163c
• The embodiments depicted inFIGS. 161ato163chave some of the same functionalities, features, design characteristics, and materials as previously described in the embodiments depicted and described inFIGS. 1 to 129.FIGS. 1 to 129 are directed to spine distraction implants and methods used in distracting apart spinous processes in order to relieve pain associated with the spine such as, by way of example only, the pain associated with spinal stenosis. Accordingly, as appropriate, and even if not specifically mentioned in each inventive description ofFIGS. 161ato163c, many of the design characteristics, features, functionalities, materials, measurements, dimensions, purposes, aspects, and objects of the devices inFIGS. 1 to 129 are applicable to the present invention.
• An alternate embodiment of the implant of the invention is depicted inFIGS. 161a-163cand designatedimplant3200. Thisimplant3200 is similar to prior implant with several different features. These additional features are depicted inFIGS. 161a-163c. In particular, inFIG. 161athere is depicted a modified lead-in nose, guide ortissue expander3202. In this particular embodiment, theguide3202 is integrally formed with acentral body3204 and thecentral body3204 is secured by a number of devices including by threads to the main body or first wing units described with respect the prior embodiments. It is to be understood, however, that theguide3202 can be secured to thecentral body3204 by a variety of mechanisms including that of a thread bore. In reviewing all ofFIGS. 161ato161e, is evident that theguide3202 has anelliptical base3206. Theguide3202 progressively and somewhat elliptically is reduced in cross-sectional size from thebase3206 to thetip3208. In this particular embodiment, thetip3208 is somewhat elongated. As can be seen inFIGS. 161a,161c, the guide includes a threadedbore3210 which receives a screw (not shown) which is used to affix a second wing as described in prior embodiments.
• With respect toFIG. 161d, it is evident that thecentral body3204 extends fromelliptical base3206 from a point which is somewhat closer to end3212 than to end3214. The reason for this is to allow more of theflatter sides3216,3218 to be positioned closer to the spine and thus adjacent to the portions of the spinous process which are closer to the spine and thus are stronger than portions of the spinous processes located further from the spine. Additionally, this allows the flat surface to have more contact with the outer portions of the spinous processes in order to spread the force exerted by the implant on the spinous processes.
• Elliptical spacers associated with theguide3202 can come in a plurality of sizes. These include spacers with a minor diameter of 6 mm, 8 mm, 10 mm, and 12 mm. As appropriate, the implant can come in smaller and larger sizes.
• With respect toFIG. 161e, in this particular embodiment, surface portion of theguide3202 adjacent to thetip3208 includesfiat surfaces3220 and3222. These surfaces slant toward theelongated tip3208 and assist in the insertion of theguide3202 between the spinous processes by distracting and expanding the tissue between the spinous processes as the implant is positioned.
• FIG. 162 depicts an alternative embodiment of thesecond wing3224 of the invention. In this embodiment, thesecond wing3224 includes aconcave recess3226 which is designed to fit over the elliptically shapednose3202 and in this particular embodiment adjacent to theelliptical base3206.Second wing3224 includes aprojection3228 which fits in to thegroove3230 located above the threadedbore3210 of theguide3202.
• A spacer or sleeve, not shown, associated with this embodiment can be elliptically shaped and about the same size as theelliptical base3206 of the lead-in guide ortissue expander3202. Alternatively, as shown inFIG. 163a, thespacer3240 can be substantially egg-shaped with ablunt end3242 and apointed end3244. This egg-shapedspacer3240 also includesflat side3246 and3248 located between theblunt end3242 and thepointed end3244. As can be seen toFIG. 163a, thesleeve3240 is positioned betweenspinous processes3250,3252. In this embodiment, thecentral bore3254 upon which thesleeve3240 rotates about the central body (shown in prior embodiments) is offset towards theblunt end3242. This means that thepointed end3244 can be positioned closer to the spine and adjacent to the portions of the spinous processes which are closer to the spine and which portions are stronger than more distally located portions of the spinous processes. In addition, theflat sides3246 and3248 of thespacer3240 more fully conform to the sides of thespinous processes3250,3252 in order to spread the load transferred by thespacer3240 onto the adjacentspinous processes3250,3252.
• With such an arrangement, in order to have a smooth transition between the sleeve and the lead-in guide or tissue expander, the base of the lead-in guide as previously shown inFIG. 161dis somewhat modified tobase3256 of the guide as shown inFIG. 163b. In this embodiment, thebase3256 is also egg-shaped, conforming to the shape of thesleeve3240. Further, thecentral body3258 expending from thenose3255 is off-centered toward theblunt end3260 and away from thepointed end3262, in order again to conform to the functionality of thesleeve3240.
• With such an arrangement, the method of implantation is similar to that of the other prior art described embodiments. However in this situation, due to the fact that thebore3254 of thesleeve3240 is offset, the pointed end of thesleeve3244 can be positioned close to the spine in order to contact stronger portions of the spinous processes with theflat sides3246 and3248 of thespacer3240.
• Referring toFIG. 164, theimplant device3300 has amain body3301. Themain body3301 includes aspacer3302, afirst wing3304, a tapered front end, lead-in guide ortissue expander3320 and analignment track3306. Themain body3301 is inserted between adjacent spinous processes. Preferably, themain body3301 remains safely and permanently in place without attachment to the bone or ligaments. All of the components of theimplant device3300 are made of biologically acceptable material such as, but are not limited to, high strength titanium alloy or stainless steel. Preferably thefirst wing3304 is laser welded to themain body3301.
• The tip of thetissue expander3320 has the smallest diameter, allowing the tip to be inserted into a small initial dilated opening. The diameter and/or cross-sectional areas of thetissue expander3320 then gradually increases until it is substantially similar to the diameter of themain body3301 andspacer3302. The taperedfront end3320 makes it easier for a physician to urge theimplant device3300 between adjacent spinous processes. When urging themain body3301 between adjacent spinous processes, thefront end3320 distracts the adjacent spinous processes to the diameter of thespacer3302. As shown inFIG. 164, thetissue expander3320 is a pyramid shape. In another embodiment the tissue expander preferably has an angle of twenty-five degrees that allows it to clear the facet. This reduces the length of thefront end3320. One will appreciate that the shape of thetissue expander3320 can be other shapes such as, but not limited to, cone shaped, or any other shape with a small lead-in cross-section expanding into a larger cross-section. These types of shapes gradually distract the spinous processes to a sufficient distance so that thespacer3302 can conveniently fit between the spinous processes.
• Thespacer3302 can be made of stainless steel, titanium, a super-elastic material or silicone or other biologically acceptable material. The material can be rigid or resilient as desired. As shown inFIG. 164, thespacer3302 is an elliptically shaped cylinder. One will appreciate that the spacer can consist of other shapes such as, but not limited to, egg-shaped, round-shaped or saddle-shaped. For example, thespacer3302 can be saddle-shaped along the surface which engages the spinous processes so that the high edges and the lower central portions can more fully accommodate the shape of the spinous processes. Preferably, thespacer3302 can swivel, allowing thespacer3302 to self-align relative to the uneven surface of the spinous process. This ensures that compressive loads are distributed equally on the surface of the bone. By way of example only, thespacer3302 can have diameters of six millimeters, eight millimeters, ten millimeters, twelve millimeters and fourteen millimeters. These diameters refer to the height by which the spacer distracts and maintains apart the spinous process. Thus for an elliptical spacer the above selected height would represent the small diameter measurement from the center of the ellipse. The largest diameter would be transverse to the alignment, of the spinous process, one above the other. Smaller and larger diameters are within the scope of the invention.
• The shape of thespacer3302 and for that matter the shape of the entire implant is such that for purposes of insertion between the spinous processes, the spinous processes do not need to be altered or cut away in any manner in order to accommodate theimplant3300. Additionally, the associated ligaments do not need to be cut away and there would be very little or no damage to the other adjacent or surrounding tissues other than piercing through and separating, or dilating an opening in a ligament.
• Thefirst wing3304 has alower portion3316 and anupper portion3318. Theupper portion3318 is designed to preferably accommodate, in this particular embodiment, the anatomical form or contour of the L4 (for an L4-L5 placement) or L5 (for an L5-S1 placement) vertebra. It is to be understood that the same shape or variations of this shape can be used to accommodate other vertebra. Thelower portion3316 is also rounded to accommodate, in a preferred embodiment, the vertebra. Thelower portion3316 andupper portion3318 of thefirst wing3304 will act as a stop mechanism when theimplant device3300 is inserted between adjacent spinous processes. Theimplant device3300 cannot be inserted beyond the surfaces of thefirst wing3304. Additionally, once theimplant device3300 is inserted, thefirst wing3304 can prevent side-to-side, or posterior to anterior movement of theimplant device3300.
• Theimplant device3300 also has anadjustable wing3310. Theadjustable wing3310 has alower portion3308 and anupper portion3314. Similar to thefirst wing3304, theadjustable wing3310 is designed to accommodate the anatomical form or contour of the vertebra.
• Theadjustable wing3310 is secured to themain body3301 with afastener3322 provided through taperedcavity3330. Theadjustable wing3310 also has analignment tab3312. When theadjustable wing310 is initially placed on themain body3301, thealignment tab3312 engages thealignment track3306. Thealignment tab3312 slides within thealignment track3306 and helps to maintain theadjustable wing3310 substantially parallel with thefirst wing3304 in this preferred embodiment. When themain body3301 is inserted into the patient and theadjustable wing3310 has been attached, theadjustable wing3310 also can prevent side-to-side, or posterior to anterior movement.
• Referring now toFIG. 165, theadjustable wing3310 includes the above mentioned taperedcavity3330. The taperedcavity3330 has amiddle portion3332, twoend portions3334 and a tapered wall3331. The diameter of themiddle portion3332 is larger than the diameter of eitherend portion3334. The tapered wall3331 has a larger diameter at the top surface of theadjustable wing3310 than at the bottom surface. Accordingly a cone-like shape is formed. When thefastener322 engages the main body301 and is rotated, thefastener322 travels into the main body301 (seeFIG. 164). As thefastener3322 travels into themain body3301, theadjustable wing3310 will travel along thealignment track3306 towards thefirst wing3304. Thealignment tab3312 engages the alignment track306 and functions as a guide, keeping theadjustable wing3310 and thefirst wing3304 substantially parallel to each other.
• Thefastener3322 has a taperedhead3323, amiddle section3336 and threaded bottom section3338 (seeFIG. 166). The top end of the taperedhead3323 was a diameter substantially similar to the diameter of the top surface of the taperedcavity3330. The diameter of the taperedhead3323 is reduced as the tapered head meets themiddle section3336. The slope of the taperedhead3323 is similar to the slope of the taperedcavity3330 of theadjustable wing3310. Themiddle section3336 has a diameter substantially similar to theend portions3334 of theadjustable wing3310. The threadedbottom section3338 has a slightly larger diameter than themiddle section3336 and is in one embodiment slightly smaller than the diameter of themiddle portion3332 of theadjustable wing3310.
• As the diameter of theend portions3334 are smaller than the diameter of thebottom section3338, thefastener3322 cannot initially be placed through theend portions3334 of theadjustable wing3310. Accordingly, to fasten theadjustable wing3310 to themain body3301, the threadedbottom section3338 of thefastener3322 is placed through themiddle portion3332 of theadjustable wing3310 and into themain body3301. With a turn of thefastener3322, the threaded portion of thebottom section3338 will engage themain body3301.
• In another preferred embodiment the diameter of threadedbottom section3338 is larger than the diameter of the middle portion of theadjustable wing3310. For this embodiment, thefasteners3322 is inserted into thecavity3330 by slicing the cavity3330 (FIG. 165) through the thinnest portion of the wall, spreading the wall open, inserting themiddle section3336 in the cavity with the threadedbottom section3338 projection below thecavity3330, and laser welding the wall closed. The slicing step preferably includes using a carbide slicing device.
• When theadjustable wing3310 is in the position furthest from the position of thefirst wing3304, the taperedhead3323 of thefastener3322 is substantially out of, and not engaging, the taperedcavity3330 of the adjustable wing3310 (SeeFIG. 167). As thefastener3322 is rotated, thefastener3322 will continue to engage, and travel further into, themain body3301. As thefastener3322 travels downwardly into themain body3301, the taperedhead3323 of thefastener3322 contacts the wall3331 of the taperedcavity3330. Theadjustable wing3310 can freely slide back and forth, limited by theend portions3334 of the taperedcavity3330. When the taperedhead3323 contacts the wall3331 of the taperedcavity3330, theadjustable wing3310 moves towards thefirst wing3304 guided by thealignment tab3312 in thealignment track3306. Therefore, theadjustable wing3310 remains substantially parallel to thefirst wing3304 in this preferred embodiment as theadjustable wing3310 moves toward the first wing3304 (seeFIG. 168). It is to be understood that thetab3312 and thetrack3306 can be eliminated in another embodiment of the invention.
• As shown inFIG. 168, the tapered head of3323 of thefastener3322 is mated in the tapered wall3331 of theadjustable wing3310. Accordingly, with this ramp mechanism, theadjustable wing3310 is urged toward the spinous processes and thefirst wing3304 and is locked in position at its closest approach to thefirst wing3304. This arrangement allows the surgeon to loosely assemble the implant in the patient and then urge the adjustable wing closer to the first wing, by rotatingfastener3322 intobody3310 making the implanting method more tolerant to the anatomy of the patient.
• The structure of the spine is of course unique for every patient. Accordingly if the width of the spinous processes is excessive, the adjustable wing can be left in a position that is between that shown inFIG. 167 and that shown inFIG. 168. The separation between thefirst wing3304 and theadjustable wing3310 can be incrementally adjusted by the number of turns of thefastener3322.
• FIGS. 169 and 170 illustrate the position of theimplant device3300 in a patient. As shown byFIG. 169, thelower portion3316 andupper portion3318 of thefirst wing3304 function to prevent side-to-side movement, toward and away from the vertebral body ensuring that theimplant device3300 remains in place. Similarly, theadjustable wing3310 will also prevent excessive side-to-side movement. The wing also prevents motion in the direction of the main body into the space between the spinous processes.
• An embodiment of theimplant4100 is depicted inFIGS. 171a,171band171c. This implant includes thefirst wing4104 andsleeve4116 and a lead-in anddistraction guide4110. This embodiment further includes, as required, asecond wing4132 as depicted inFIGS. 171dand171e. As can be seen inFIG. 171a, acentral body4102 extends from thefirst wing4104. Also, as can be seen inFIGS. 171aand171b, theguide4110 in this particular embodiment is pointed in order to allow the implant to be inserted between, and if necessary distract, adjacent spinous processes.
• Additionally, as can be seen inFIGS. 171a,171fand171g, thesleeve4116 is preferably cylindrical, and oval or elliptical in shape in cross-section. It is to be understood thatsleeve4116 can have other shapes as described throughout the specification and be within the spirit and scope of the invention.Sleeve4116 includes acentral bore4119 which extends the length ofsleeve4116. Thesleeve4116 is received over thecentral body4102 of theimplant4100 and can rotate thereon about the central body102. In these embodiments, thespacer4116 can preferably have minor and major dimensions as follows:

• 	Minor Dimension (4116a)	Major Dimension (4116b)

  6	mm	10	mm
  8	mm	10.75	mm
  12	mm	14	mm
  6	mm	12.5	mm
  8	mm	12.5	mm
  10	mm	12.5	mm

• In another preferred embodiment, thespacer4116 has a cross-section with a major dimension and a minor dimension and the major dimension is greater than the minor dimension and less than about two times the minor dimension.
• It is to be understood that the sleeve can be comprised of biologically acceptable material such as titanium or stainless steel. Additionally, it can be comprised of super-elastic material such as an alloy of nickel and titanium. Other structural and material variations for the sleeve are described below.
• The advantage of the use of thesleeve4116 as depicted in the embodiment ofFIG. 171ais that the sleeve can be rotated and repositioned with respect to thefirst wing4104, in the embodiment, in order to more optimally position theimplant4100 between spinous processes. It is to be understood that the cortical bone or the outer shell of the spinous processes is stronger at an anterior position adjacent to the vertebral bodies of the vertebra than at a posterior position distally located from the vertebral bodies. Accordingly, there is some advantage of having theimplant4100 placed as close to the vertebral bodies as is possible. In order to facilitate this and to accommodate the anatomical form of the bone structures, as the implant is inserted between the vertebral bodies and urged toward the vertebral bodies, thesleeve4116 can be rotated relative to the wings, such aswing4104, so that the sleeve is optimally positioned between the spinous processes, and thewing4104 is optimally positioned relative to the spinous processes. Without this capability, depending on the anatomical form of the bones, it is possible for the wings to become somewhat less than optimally positioned relative to the spinous processes.
• As required, theimplant4100 can also include asecond wing4132 which fits over theguide4110 and is preferably secured by a bolt through apparatus4134 ofsecond wing4132 to the threadedbore4112 located inguide4110. As implanted, thefirst wing4104 is located next to the adjacent first side of the spinous processes and thesecond wing4132 is located adjacent to second side of the same spinous processes.
• Referring now toFIGS. 172-178, various embodiments of spacers adapted for placing between thefirst wing4104 and thesecond wing4132 are shown. The preferred material for the various spacers described below is titanium in combination with a deformable material such as silicone. It is within the scope of the present invention to manufacture the spacers from other biologically acceptable material such as, by way of example only, stainless steel or an alloy of nickel and titanium along with another deformable material such as another deformable polymer.
• Turning now toFIG. 172, thespacer4200 includes anouter shell4202. Theouter shell4202 is integrally formed with thecenter shaft4206 by two support columns4204. The center shaft has abore4208 extending through. Each support column4204 extends substantially perpendicular from thecenter shaft4206. Between theouter shell4202 and thecenter shaft4206, a cavity4205 is created.
• The shape of theouter shell4202 as shown inFIG. 172 is elliptical in shape. It is within the scope of the invention that theouter shell4202 may comprise other shapes such as, but not limited to, a cylindrical or egg shape. Regardless of the shape, theouter shell4202 is not continuous in this preferred embodiment. One half of theouter shell4202 extends from the end of onesupport column4204aand around thecenter shaft206 until theouter shell4202 almost reaches thesecond support column4204b. The second half of theouter shell4202 is the same as the first half, and in this case both halves extend in a clockwise direction. Since each half of theouter shell4202 extends from a different support column4204, twoslots4210aand4210bare created. Bothslots4210a,4210bextend along the length of thespacer4200. The slots4210 function to lower the rigidity of theouter shell4202 so that theouter shell4202 is more flexible and functions as a cantilever spring. The smallest diameter of the space (circular or elliptical) can preferably range from 6 mm. to 11 mm. The thickness of the outer shell can preferably be 2 mm. The spacer can have other dimensions as identified previously.
• Preferably, a compressible substance4207 is placed into thecavities4205a,4205blocated between theouter shell4202 and thecenter shaft4206. The compressible substance4207 provides resistance against theouter shell4202 traveling towards thecenter shaft4206. As previously mentioned, the compressible substance in this embodiment is preferably silicone. It is within the scope of the invention that the compressible substance4207 may comprise another medium such as, but not limited to, urethane-coated silicone and/or co-formed with silicone so that the urethane will not be attacked by the body, or another ultra-high molecular weight polymer. Another preferred material is polycarbonate-urethane, a thermoplastic elastomer formed as the reaction product of a hydroxl terminated polycarbonate, an aromatic diisocyanate, and a low molecular weight glycol used as a chain extender. A preferred polycarbonate glycol intermediate, poly (1,6-hexyl 1,2-ethyl carbonate) diol, PHECD, is the condensation product of 1,6-hexanediol with cyclic ethylene carbonate. The polycarbonate macroglycol is reacted with aromatic isocyanate, 4,4′-methylene bisphenyl diisocyanate (MDI), and chain material is preferable used at a hardness of 55 durometer. This material, as well as the other materials, can be used in the other embodiments of the invention.
• The compressible medium preferably has a graduated stiffness to help gradually distribute the load when a spinous processes places a force upon theouter shell4202. For example, the hardness of the silicone can be the lowest where the silicone contacts theouter shell4202, and the hardness of the silicone can be the highest where the silicone contacts thecenter shaft4206. Alternatively, the silicone can have a higher hardness in the center of the silicone located between theouter shell4202 and thecenter shaft4206.
• The compressible medium4207 fills the cavity between theouter shell4202 and thecenter shaft206 and is flush with theouter shell4202. When thespacer4200 is inserted between adjacent spinous processes, theouter shell4202 protects the compressible substance (e.g., silicone) from directly contacting the spinous processes because the slots4210 are along the side of thespacer4200. Therefore, the deformable material4207 does contact the spinous processes and wear debris is reduced or eliminated.
• It is to be understood that for this and also in the embodiments inFIGS. 173,175aand175b, the embodiment can be constructed without a compressible material, with the outer shell solely providing the flexibility of the spacer. It is also to be understood that the embodiments shown inFIGS. 173-178 can have the dimensions and be made of the materials similar to those ofFIG. 172. It is additionally to be understood that the metal components of any of the embodiments hereof can be comprised of a suitable plastic or composite material including fibers for strength.
• Now referring toFIG. 173, thespacer4300 has anouter shell4302 and acenter shaft4306. Thecenter shaft4306 has abore4308 extending through. Thecenter shaft4306 is connected with theouter shell4302 by twosupport columns4304a,b, with eachsupport column4304a,blocated on opposite sides of the center shaft306. Similar to the embodiment of the present invention as illustrated inFIG. 172, theouter shell4302 is elliptical, yet may comprise other shapes such as, but not limited to, a cylindrical or egg shape.
• Theouter shell4302 has twoslots4310a,b. Theslots4310a,bextend through the wall of theouter shell4302 to form a rectangular-like opening. It is within the scope of the invention for thespacer4300 to have more than two slots4310 and with different shapes. Theslots4310a,bare used to make theouter shell4302 more flexible. It is preferred that theslots4310a,bare located on the sides of thespacer4300 so that none of theslots4310a,bcontact a spinous process.
• Between theouter shell4302 and thecenter shaft4306 are twocavities4305a,b. These cavities are separated by thesupport columns4304a,b. The two cavities created between theouter shell4302 and thecenter shaft4306 preferably have a compressible substance therein. As previously mentioned, the compressible substance is preferably silicone. To improve the load distribution upon theouter shell4302 and ease the load on the spinous processes, the silicone can have a graduated stiffness. For example, the hardness of the silicone can be the lowest where theouter shell4302 contacts the silicone, and the hardness of the silicone can be the highest where thecenter shaft4306 and the support column4304 contacts the silicone. Alternatively, the silicone can have a higher hardness in the center of the silicone riding between theouter shell4302 and thecenter shaft4306.
• The silicone is placed between theouter shell4302 and thecenter shaft4306 so that the silicone extends into the slots4310 and is flush with theouter shell4302. Since the spinous processes do not directly contact the silicone, this embodiment of the present invention also helps prevent wear debris.
• Referring now toFIG. 174, yet another embodiment of the present invention includesspacer4400. Thespacer4400 has anouter shell4402 and acenter shaft4406. Thecenter shaft4406 has abore4408 extending through. Thespacer4400 has twoopenings4410a,bthat are substantially along the top4111 and bottom4113 portions of theouter shell4402. Between theouter shell4402 and thecenter shaft4406,cavities4405a,bare created which connects the twoopenings4410a,b.
• Similar to the previous embodiments, a compressible medium such as silicone is placed into thecavity4405a,bandopenings4410a,buntil the silicone becomes flush with theouter shell4402. Preferably, the silicone also has a graduated stiffness. For example, the hardness of the silicone can be the lowest where it is flush with theouter shell4402, and can be the highest where the silicone contacts thecenter shaft4406. Unlike the previous embodiments, the exposed silicone will directly contact the spinous processes.
• Referring now toFIGS. 175a-175b, another embodiment of the invention isspacer4500. Thespacer4500 has anouter shell4502 and acenter shaft4506. Theouter shell4502 forms a “C”-like shape. Thecenter shaft4506 has abore4508 extending through. Thecenter shaft4506 is attached to theouter shell4502 by asupport4504. Thesupport4504 is substantially horizontal extending from the vertical center of the “C” to the middle of theopen end4509. Theouter shell4502 defines twoslots4510a,balong the length of theopen end4509. Bothslots4510a,bare defined by the space between thesupport4504 and each end portion of theouter shell4502. Since theouter shell4502 is fixed at one end only, theouter shell4502 functions like a cantilever-type spring. Theouter shell4502 is shown as elliptical in shape. It is within the scope of the present invention that thespacer4500 may comprise other shapes such as, but not limited to, a cylindrical or egg shape.
• Thesupport4504 has preferably at least two protrusions such as protrusions selected fromprotrusions4512a,b,c,d. For example, thespacer4500 inFIGS. 175a,bhas fourprotrusions4512a,b,c,d. Eachprotrusion4512a,b,c,dextends substantially and preferably perpendicular in this embodiment from thesupport4504 towards the inner surface of theouter shell4502. While thespacer4500 is in anon-compressed state, there is a gap between eachprotrusion4512a,b,c,dand theouter shell4502. When thespacer4500 is compressed, theprotrusions4512a,b,c,dfunction to restrict the deflection of theouter shell4502. When a spinous process exerts a force upon theouter shell4502, theouter shell4502 will deflect toward thecenter shaft4506 until theouter shell4502 contacts theprotrusion4512a,b,c,d. Essentially, theprotrusions4512a,b,c,d, function as a stop mechanism preventing theouter shell4502 from deflecting too much, and thus limiting the motion of the spinous processes.
• Similar to the previous embodiments,cavities4505a,bare formed between thecenter shaft4506 and theouter shell4502. A compressible substance such as silicone is placed within thecavity4505. It is preferable that the silicone have a graduated stiffness to help distribute the load placed upon theouter shell4502. For example, the hardness of the silicone can be the lowest where the silicone contacts the inner surface of theouter shell4502, and the hardness of the silicone can be the highest where the silicone contacts thecenter support shaft4506, and thesupport4504 and theprotrusions4512a,b,c,d. Alternatively, the silicone can have a higher hardness in the center of the silicone rising between theouter shell4502 and thecenter shaft4506.
• The silicone fills thecavities4505a,buntil the silicone is flush with theouter shell4502. When thespacer4500 is inserted between adjacent spinous processes, the top andbottom portions4514,4516 of thespacer4500 contact the spinous process. Therefore, the silicone will not directly contact the spinous processes which aids in the prevention of wear debris.
• Referring now toFIGS. 176a-176c, another embodiment of the present invention is spacer4600. The spacer4600 has a firstouter shell4602 and a secondouter shell4603. The firstouter shell4602 has at least twosupport elements4604a,b. Eachsupport element4604a,bhas abore4605a,bextending therethrough. Thesupport elements4604a,bare located substantially at either end of the firstouter shell4602 along a single horizontal axis. Thebores4605a,bare oval in a preferred embodiment. This shape allows the spacer4600 to move relative to the central shaft or axis (FIG. 117) upon which the spacer is mounted. The secondouter shell4603 has asingle support element4606, located substantially in the center of the secondouter shell4603 and along the same horizontal axis as the twosupport elements4604a,b. Thesupport element4606 also has a bore extending through which is similar to bore4605.Support element4606 is located betweensupport element4604a,binFIG. 176a. A central shaft4612 (shaft4102 inFIG. 171c) is placed through thesupport elements4604a,b,4606 to form a hinge-type connection between the firstouter shell4602 and the second outer shell4603 (seeFIG. 176a). The hinge-type connection allows the firstouter shell4602 and the secondouter shell4603 to move independently of each other.
• When the firstouter shell4602 and the second outer shell603 are connected byshaft4612,slots4610a,bare created along the side edges of the spacer4600. Twocavities4614a,bare also created, defined by the hinge-type connection between the firstouter shell4602 and the secondouter shell4603. Similar to the previous embodiments, a compressible substance (e.g., silicone) can fill each cavity and extend into theslots4610a,buntil the silicone is flush with the firstouter shell4602 and the secondouter shell4603. Additionally, it is preferred that the silicone have a graduate hardness similar to the previous embodiments. In one embodiment, the hardness of the silicone can be the highest along view line A-A, and can be the lowest where the silicone contacts the first and secondouter shell4602,4603. Alternatively, the silicone can have the highest hardness where it contacts thesupport elements4604a,b,4606, and can have the lowest hardness where the silicone fills theslots4610a,b.
• When the spacer4600 is inserted between adjacent spinous process, only the top andbottom portions4616,4618 of the spacer4600 will directly contact each spinous process. Therefore, the firstouter shell4602 and the secondouter shell4603 prevent direct contact between the silicone and the spinous process. Accordingly, the spacer4600 helps prevent wear debris from being formed.
• Now referring toFIG. 177, still yet another embodiment of the present invention isspacer4700.Spacer4700 includes preferably a component in the shape of an elliptical or oval or cylindrical spool4710. Alternatively, thecomponent4700 can be formed for method or suitable plastic material or composites including, by way of example only, fibers for strength. Thespacer4700 has acenter shaft4702 with abore4708 extending through. As in other embodiments, thebore4708 can be, by way of example only, circular, oval or elliptical. Afirst end4704 and asecond end4706 are integrally formed with thecenter shaft4702 in this preferred embodiment. Both thefirst end4704 and thesecond end4706 extend outward from thecenter shaft4702 and form a circular rim around each end of thecenter shaft4702. It is within the scope of the present invention for thefirst end4704 andsecond end4706 to comprise other shapes such as, but not limited to, elliptical, circular, oval or egg-shaped.
• A compressible medium4712 surrounds thecenter shaft4702. As previously mentioned, the compressible substance is preferably silicone. The silicone extends out from thecenter shaft4702 until it is flush with the outer rim of both thefirst end4704 and thesecond end4706. With the silicone around thecenter shaft4702, thespacer4700 will look like an elliptical cylinder in this embodiment. Thespacer4700 does not have an outer shell surrounding the silicone. When thespacer4700 is inserted between adjacent spinous process, the silicone will directly contact the spinous process. A preferred embodiment of thespacer4700 will have silicone with a graduated stiffness to help distribute the load placed upon thespacer4700. For example, the hardness of the silicone can be the lowest at the outermost surface that contacts the spinous process, and the hardness of the silicone can be the highest where the silicone surrounds and contacts thecenter shaft4702. Alternatively the hardness can be greater where the silicone contacts the spinous process and then less hard adjacent to thecenter shaft4702.
• Now turning toFIG. 178a, another embodiment of the present invention isspacer4800. Thespacer4800 has anouter shell4802 which can be metallic or plastic. Theouter shell4802 is preferably elliptical in shape. It is within the scope of the present invention that theouter shell4802 can be a shape such as, but not limited to, a cylindrical or egg shape. Regardless of the shape, theouter shell4802 is open on bothends4808,4810.
• Acompressible substance4804 is placed within theouter shell4802 and is flush with bothends4808,4810 of theouter shell4802. Abore4806 extends through thecompressible substance4804. If desired the bore can be defined by a metallic or plastic sleeve held on thecompressible substance4804. Similar to the previous embodiments, thecompressible substance4804 is preferably silicone. A preferred embodiment of thespacer4800 has silicone with a graduated stiffness. In an embodiment, the hardness of the silicone can be the highest at thebore4806, and the hardness of the silicone can be the lowest where the silicone contacts the inner surface of theouter shell4802. Alternatively, the hardness of the silicone can be the highest adjacent shell and lowest aboutbore4806.
• When thespacer4800 is inserted between adjacent spinous processes, only the top andbottom portions4812,4814 will directly contact each spinous process. Therefore, theouter shell4802 prevents direct contact between the silicone and the spinous processes. Accordingly, thespacer4800 helps prevent wear debris from being formed.
• By way of example only, the thickness of the outer shell can be about 0.010 inches with the hardness of the compressible medium being about 50 durometer. By way of example only, the outer shell can be about 0.010 inches with the hardness of the compressible medium being about 70 durometer.
• It is also to be understood that thespacer4800 can include any of the compressible medium4804 discussed herein and/or compatible with the body, with a bore hole provided therethrough. That is to say that theouter shell4802 can be eliminated in this embodiment. Preferably the spacer is comprised of silicone, however, other materials are within the spirit and scope of the invention.FIG. 178bdepicts an egg-shapedspacer4800′ with abore4806′. Thespacer4800′ is comprised of a compressible medium.
• Referring now toFIGS. 179a-179b, the interspinous process device onimplant4900 has afirst support4902 and asecond support4904. Thefirst support4902 and thesecond support4904 directly contact the spinous process and can be made of a suitable metal or a suitable plastic. Both thefirst support4902 and thesecond support4904 have acontour4903. Thecontour4903 allows thedevice4900 to be contoured to and to engage each spinous process so, preferably, that thedevice4900 does not move laterally. Eachcontour4903 includes aconcave portion4920 andupstanding ridges4922,4924. It is to be understood that the ridges can be higher than shown inFIG. 179ain order to define a deeper contour. Additionally,ridges4924, especially when higher, ofsupports4903,4904 together can define a first wing andridges4922, especially when higher, ofsupport4903,4904 define a second wing. Such wings can function in much the same way as the wings described in other embodiments of the invention.
• During the method of implantingdevice4900, both spinous processes are exposed using appropriate surgical techniques, and thereafter thedevice4900 is positioned so that thesaddles4903 of both thefirst support4902 and thesecond support4904 engage the respective spinous process. The concave shape of the saddle903 distributes the forces between thesaddle4903 and the respective spinous process. This ensures that the bone is not reabsorbed due to the placement of thedevice4900 and that the structural integrity of the bone is maintained.
• Referring now toFIG. 179b, thefirst support4902 has afemale receiving mechanism4906 and thesecond support4904 has amale engaging mechanism4908. The width of thefemale receiving mechanism906 and themale engaging mechanism4908 are substantially similar. Thefemale receiving mechanism4906 further has analignment column4905 to assist in the movement of thesupports4902,4904 relative to each other.
• Thefirst support4902 and thesecond support4904 are interlocked so that thefirst support4902 and thesecond support4904 cannot be independently separated. Thefirst support4902 has aledge4907 that extends around the inner circumference of thefirst support4902. Similarly, thesecond support4904 has aledge4909 extending around the circumference of themale engaging mechanism4908. If thefirst support4902 and thesecond support4904 travel in opposite directions, theledges4907 and4909 will eventually engage and prevent thefirst support4902 and thesecond support4904 from separating. Preventing the first support9402 and thesecond support4904 from separating also contains the compressible medium4910, as described below, within thedevice4900.
• Placed within thefemale receiving mechanism4906 is acompressible medium4910. As previously mentioned the compressible medium4910 provides resistance, limiting the possible range of motion of the spinous process. By way of example only, the compressible medium4910 can be silicone. It is within the scope of the present invention that the compressible medium can include, by way of example only, a spring mechanism, a synthetic gel or a hydrogel. The compressible or deformable material can also include material which offers, for example, increased resistance to compression the more the material is compressed. For example, as compression and deformation occur, the material can offer a steady resistive force or a resistance force that increases, either linearly or non-linearly, the more the implant is compressed.
• With respect to an embodiment with a graduated stiffness, the hardness of the silicone can be the lowest where thefirst support4902 contacts the silicone, and the hardness of thesilicone4910 can be the highest where thesecond support4904 contacts the silicone. Alternatively, the silicone can have a higher hardness in the center of the silicone riding between thesupports4902,4904.
• In this and with the other embodiments, the medium4910 can also be designed to vary resistance to movement according to the speed or rate of deformation. For example, when an individual leans back slowly, the adjacent spinous processes place a force onto thefirst support4902 and thesecond support4904. With slow backward bending the force is small and gradual until the limit of compression of the material is reached. However, if the individual attempts a rapid activity that can result in a severe first compression of thedevice4900, the medium4910 can offer higher stiffness, preventing the spinous processes from making excessive motion and causing pain.
• Preferably, the height of thedevice4900 is slightly larger than the undistracted distance between the adjacent spinous processes. When thedevice4900 is then inserted between the spinous process, thecontours4903 will press against each spinous process and assist to keep thedevice4900 in place. During a daily routine, an individual will perform functions that will translate into vertical movement of each spinous process. It is important that the individual be able to retain some of his normal range of motion. To retain a normal range of motion, thedevice4900 can preferably be compressed when the spinous processes place a force upon thefirst support4902 and thesecond support4904. Thus, when thedevice4900 is in a normal state the outerperipheral edge4930,4932 of first andsecond support4902,4904 respectively do not contact each other. However,ridges4930,4932 act as a limit to theamount device4900 can be compressed. Such an arrangement reduces potential resorption of the bone adjacent to the implant and to more gradually limit extension or backward bending of the spinal column.
• The embodiment of this implant as well as the several other implants described herein act to limit extension. These implants, however, do not inhibit the flexion of the spinal column when the spinal column is bent forward.
• This invention includes instruments and methods for inserting spinal implants in the vertebral columns of patients and to spinal implants themselves. In one embodiment, instruments are provided for inserting a main body assembly between spinous processes of adjacent vertebrae. These instruments, termed herein “main body insertion instruments” generally comprise an elongated body portion having a handle at one end, an insertion shaft and an insertion tip. The insertion tip engages with the main body assembly and holds the assembly in fixed relation to the instrument. The surgeon prepares the site for implantation, and uses the instrument to urge the assembly between spinous processes of adjacent vertebrae.
• In other embodiments of this invention, different instruments can be used to insert universal wings on to the main body assembly of the spinal implant. These other instruments are termed herein “wing insertion instruments.” A wing insertion instrument generally comprises a handle, an insertion shaft and an insertion tip. The insertion tip of a wing insertion instrument engages with the universal wing and holds it fixed relative to the instrument. The surgeon then grasps the handle portion of the instrument and uses it to urge the wing implant portion into proximity with a main body assembly which has been inserted between spinous processes of the spine.
• I. Main Body Insertion Instrument
• Main body insertion instrument of this invention is illustrated, by way of example only, inFIGS. 180-182.FIG. 180 depicts an exterior view of a mainbody insertion instrument5100 of this invention having ahandle5010, aninsertion shaft5020 and aninsertion tip5030.Handle5010 can be made of any suitable material, such as by way of example only, Gray ULTEM™, a polyetherimide resin.Insertion shaft5020 can be made of any suitable, strong material, such as 304 stainless steel.Insertion shaft5020 has a central bore extending through its length. The proximal end ofinsertion shaft5020 is adapted to fit within the distal end ofhandle5010, and can be held in place with a set screw, made of, by way of example only, 304 or 455 stainless steel. A mainbody insertion tip5030 is attached to the distal end of the insertion shaft.Insertion tip5030 can be made of, by way of example only, 17-4 stainless steel. A bore extends longitudinally through theinsertion tip5030 and is contiguous with the bore through theinsertion shaft5020. Aninsertion rod5040, having a distal end with a spacer engagement pin and a locking pin, extends through the length of the bore ininsertion shaft5020.Insertion rod5040 extends into thehandle5010 of the mainbody insertion instrument5100. On one side ofhandle5010,insertion knob5110, having a raisedportion5112, is for manipulation of a locking pin and spacer engagement pin ininsertion tip5030. Theinsertion knob5110 can be made of, by way of example only, 304 stainless steel. The stainless steel components of the instruments of this invention can desirably meet ASTM Standard F899-95: Standard Specifications for Stainless Steel Billet, Bar, and Wire for Surgical Instruments.
• FIG. 181 depicts a longitudinal cross-sectional view of a mainbody insertion instrument5100 as depicted inFIG. 180, and shows details of this embodiment of the invention.Handle5010 has aninsertion knob groove5105 on a lateral surface, within whichinsertion knob5110 is provided.Insertion knob5110 andgroove5105 are sized so thatinsertion knob5110 can move in a proximal/distal path along thehandle5010.Insertion knob5110 has said raisedportion5112 used for applying force to moveinsertion knob5110 proximally and distally alonghandle5010.Insertion knob5110 is attached torod5111, which is located withincavity5121 of thecavity5121. When placed withincavity5121, therod5111 engagesspring5125, which is located within aninterior space5124 ofhandle5010.Spring5125 is urged againstinsertion rod5040. Thespring5125 provides a force that urgesrod5111 and alsorod5040 toward the distal portion of theinstrument5100.Spring5125 is compressed by manual movement ofinsertion knob5110 in a proximal direction, acting viarod5111. Becauseinsertion rod5040 is engaged withrod5111,insertion rod5040 is drawn proximally by proximal movement ofinsertion knob5110. When manual force oninsertion knob5110 is relaxed, as for example, after alignment of a main body implant in relation toinsertion tip5030,spring5125 urgesrod5111,insertion rod5040 andinsertion knob5110 in a distal direction. Asinsertion rod5040 is urged distally, lockingpin5155 andspacer engagement pin5157 are urged toward the distal end ofinsertion instrument5100 as well, wherepins5155,5157 can engage the main body assembly of the spinal implant.FIG. 181 depictsinsertion shaft5020 having a proximal end that is adapted to fit within the distal portion ofhandle5010. When so placed, setscrew5130 engages withinsertion shaft5020 to keepinsertion shaft5020 engaged inhandle5010.Set screw5130 can be made of any convenient material, such as, by way of example only, stainless steel. It can be especially desirable forset screws5120 and5130 to be completely removable fromhandle5010, to provide open access to the interior ofhandle5010 for cleaning and sterilization
• Insertion tip5030 is adapted to fit onto the distal end ofinsertion shaft5020, by way of example only, with an interference fit.FIG. 181 depicts such an interference fit engagement ofinsertion tip5030 with the distal end ofinsertion shaft5020. However, other ways of attachinginsertion tip5030 toinsertion shaft5020 are contemplated and are considered to be part of this invention.
• FIG. 181 depicts components ofinsertion tip5030, which include aproximal portion5145, which can act as a position stop forspacer engagement pin5157.Spacer engagement pin5157 protrudes laterally from the portion of theinsertion rod5040, and is adapted to engage a spacer engagement hole of a main body assembly. When so engaged,spacer engagement pin5157 can position a spacer relative to the remainder of the main body wing and tissue expander, making insertion of the implant between spinous processes convenient. At the distal end ofinsertion rod5040, lockingpin5155 is positioned to engage a hole in the main body assembly. Thus, when so engaged,locking pin5155 andspacer engagement pin5157 can hold the main body, tissue expander and spacer in position relative to one another for convenient insertion. At the distal end of theinsertion tip5030,portion5147, having a flatmedial surface5165, can support the main body. In some embodiments, one ormore alignment pins5160 can be provided to engage with a main body to provide additional support during surgery.
• In general, the construction of mainbody insertion instrument5100 desirably is sufficiently robust to provide firm support of the main body assembly during surgery. For example, in certain situations, it can be desirable for the surgeon to exert relatively large forces on the main body assembly to urge the tissue expander between spinous processes. Generally, the connective tissue, including ligaments, can be strong and tough, tending to resist stretching. However, during surgery using the spinal implants and insertion instruments of this invention, it may be desirable to deflect, distract and/or stretch the ligaments to permit passage and proper location of spinal implants. In these situations, the instruments are strong and rigid.
• It also can be desirable for the surfaces to be smooth and have relatively simple geometrical shape. Simple shape and relatively open construction can provide for easy access to the interior of the parts of the instrument, and can permit easy and convenient cleaning and sterilization.
• FIG. 182a-182cdepict theinsertion tip5030 of main bodyimplant insertion instrument5100 in additional detail.FIG. 182adepicts a side view ofinsertion tip5030 fitted into the distal end ofinsertion shaft5020.Bore5150 ofinsertion shaft5020 is shown in dashed lines. Lockingpin5155 ofinsertion rod5040 is shown in the distal-most extension, as urged byspring5125 ofFIG. 181.Portion5147 is shown havingalignment pin5160 with an axis aligned substantially perpendicularly to the plane ofportion5147. Spacer engagement pin or catch5157 is shown above lockingpin5155. At its distal-most extension, lockingpin5155 crosses the axis ofalignment pin5160. Whenalignment pin5160 andspacer engagement pin5157 have engaged their respective portions of a main body assembly, the assembly can be firmly held by theinsertion tip5030.
• FIG. 182bdepicts an insertion tip as shown inFIG. 182ain which theinsertion rod5040 has been moved to a proximal position. In the embodiment depicted inFIG. 182b, lockingpin5155 andspacer engagement pin5157 have been retracted sufficiently to be proximal tosurface5156 ofinsertion tip5030. When so positioned, the main body assembly can be disengaged frominsertion tip5030 and the instrument can be withdrawn from the patient's body, leaving the main body assembly in place.
• FIG. 182cdepicts a top view ofinsertion tip5030.Insertion rod5040 is shown in the retracted position, with lockingpin5155 andspacer engagement pin5157 being located proximally to surface5156 ofinsertion tip5030. Twoalignment pins5160 are shown. When engaged with a main body assembly,flat surfaces5156 and5165, alignment pins5160, and lockingpin5155 andspacer engagement pin5157 of theinstrument5100 can hold the main body assembly firmly to the insertion instrument.
• FIGS. 183a-183cdepict the method of engagement of a main body insertion instrument of the invention with a main body assembly of the invention.
• FIG. 183adepicts amain body assembly5400 of the invention for use with theinstrument5100 of this invention.Main body assembly5400 has amain body wing5401 having acephalad wing member5402 and acaudal wing member5402a.Cephalad wing member5402, after insertion, is aligned toward the head of the subject along the right side of a dorsal spinous process.Member5402ais also positioned along the side of a spinous process.Main body wing5401 also can have one ormore holes5403 adapted to receivealignment pins5160 of mainbody insertion instrument5100.Main body wing5401 also has lockingpin hole5404 adapted to receivelocking pin5155 of mainbody insertion instrument5100.Main body wing5401 is attached tospacer5405, which hasspacer engagement hole5406 adapted to receivespacer engagement pin5157 ofinsertion instrument5100. On the other end ofspacer5405,tissue expander5407 is shown, having a threadedhole5408 adapted to receive a bolt of a universal wing implant (described below).Tissue expander5407 has a tapered left end to ease insertion of the main body assembly between spinous processes.
• FIG. 183bdepicts a lateral view showing the points of engagement between a main body assembly and main body insertion instrument.Insertion rod5040 of insertion instrument is shown in a retracted, or proximal position. Lockingpin5155 andspacer engagement pin5157 are shown aligned proximally to plane5156 ofinsertion tip5030.Spacer engagement pin5157 is adapted to engage with spacer engagement hole406, lockingpin5155 is adapted to engage with lockingpin hole5404, andalignment pin5160 is adapted to engage withalignment hole5403.
• FIG. 183cdepicts main body insertion instrument engaged with main body assembly. Whileinsertion rod5040, lockingpin5155 andspacer engagement pin5157 are in the retracted position, a main body assembly has been positioned withalignment pin5160 received intoalignment pin hole5403. Thereafter,insertion rod5040 has been urged distally by thespring5125 ofFIG. 181, thereby engaginglocking pin5155 with lockingpin hole5404 andspacer engagement pin5157 withspacer engagement hole5406. The engagement of spacer engagement pin157 withspacer5405 keeps spacer5405 from rotating about its axis, and thereby keeps thespacer5405 in position relative to thetissue expander5407 and to the main bodyimplant insertion instrument5100.
• II. Wing Insertion Instrument
• A wing insertion instrument of this invention is depicted inFIG. 184-186.FIG. 184 depicts an exterior, lateral view of awing insertion instrument5500, having ahandle5010, andinsertion shaft5020, aninsertion tip5030 and adriver knob5050. As with the mainbody insertion instrument5100 depicted inFIGS. 180 and 181, on a lateral surface,insertion knob5110, having raisedportion5112 is provided to actuate a locking mechanism at the distal end of the instrument.
• FIG. 184 depicts a cross-sectional longitudinal view through thewing insertion instrument5500 of this invention.Handle5010 has aninsertion knob groove5505 on a lateral surface, within whichinsertion knob5110 is provided.Insertion knob5110 andgroove5505 are sized so thatinsertion knob5110 can move in a proximal/distal path along thehandle5010.Insertion knob5110 has a raisedportion5112 used for applying force to moveinsertion knob5110 proximally and distally alonghandle5010.Insertion knob5110 is attached torod5511, which is located withininterior space5521 of thehandle5010.Rod5511 engagesinsertion rod5541 by way ofset screw5520 which is accessible throughhole5515.Hole5515 is desirably of sufficient size to permit complete removal ofset screw5520 from the instrument, permittinginsertion knob5110 to be removed fromhandle5010 and the instrument to be cleaned and sterilized.
• Insertion shaft5540 has a proximal end that fits within the distal portion of the bore ofhandle5010.Set screw5530 is inserted throughhole5535, and engagesinsertion shaft5540 withhandle5010. It is desirable forhole5535 to be of sufficient size forset screw5530 to be completely removed, permitting cleaning and sterilization of the component parts ofinstrument5500.
• Insertion rod5541 extends through the full length of the bore ofinstrument5500, and has a proximal portion sized to accommodatespring5525. When installed inhandle5010,insertion rod5541 compressesspring5525. The distal end ofspring5525 is held in place byhandle end cap5501, which, along withhandle5010 can be made of, by way of example, Gray ULTEM™. Handleend cap5501 is engaged withhandle5010 by means of threads. Thus, for disassembly, handleend cap5501 can be disengaged fromhandle5010, andspring5525 andinsertion rod5541 can be removed from the proximal end ofhandle5010. When assembled,rod5511 andinsertion knob5110 are urged byspring5525 in a distal direction. The distal motion is stopped wheninsertion knob5110 orrod5511 reach the distal wall ofspace5521.Spring5525 is further compressed by manual movement ofinsertion knob5110 in a proximal direction, acting viainsertion rod5511. Becauseinsertion rod5541 is engaged withrod5511,insertion rod5541 is drawn proximally by proximal movement ofinsertion knob5110. When manual force oninsertion knob5110 is relaxed, as for example, after alignment of a universal wing in relation toinsertion tip5030,spring5525 urgesinsertion rod5541 andinsertion knob5110 in a distal direction. Asinsertion rod5541 is urged distally,driver5555 is urged toward the distal end ofinsertion instrument5500 as well.
• Driver knob5502 is provided at the proximal end ofinstrument5500.Driver knob5502 can be made of, by way of example, Gray ULTEM™.Driver knob5502 has a bore into which the proximal most extension ofinsertion rod5541 is placed.Insertion rod5541 is held withindriver knob5502 by means ofset screw5504 withinhole5503. It can be desirable forhole5503 to be sufficiently large so that setscrew5504 can be completely removed fromdriver knob5502 for cleaning and sterilization.Insertion rod5541 desirably is free to rotate about its longitudinal axis, so that whendriver knob5504 is rotated,driver5555 is rotated.
• In summary and referring toFIGS. 181 and 185, setscrews5120,5130 of mainbody insertion instrument5100, and setscrews5520,5530, and5504 of universalwing insertion instrument5500 can be removed using a hex screw driver, having a hexagonal driver head made of, by way of example,5455 stainless steel. Such removal can be used to disassemble theinstruments5100 and500 for cleaning.
• FIGS. 186a-186cdepict details ofinsertion tip5030 ofwing insertion instrument5500 of this invention.FIG. 186ais an end-view of the distal end ofinsertion tip5030, showingdriver5555, alignment pins5560, and surfaces5547 and5565. An edge ofuniversal wing5800 can abut surface5547 to provide support during the insertion ofuniversal wing5800. A surface ofuniversal wing5800 can abut surface5565 to provide additional support ofuniversal wing5800.
• FIG. 186bdepicts a bottom view ofinsertion tip5030 ofwing insertion instrument5500.Insertion rod5541 is depicted in a distal position, withininsertion shaft5540.Driver5555 is shown extending intospace5567 ofinsertion tip5030.FIG. 186cdepicts a bottom view of theinsertion tip5030 as shown inFIG. 186bwith thedriver5555 andinsertion rod5541 in a proximal position, with the distal-most end ofdriver5555 retracted from thespace5567. In this position, mountingring5816 ofFIG. 187 (below) of a universal wing can be received inspace5567.
• FIGS. 187a-187cdepict auniversal wing5800 of the invention for use with thewing insertion instrument5500 of the invention.FIG. 187ais a lateral view ofuniversal wing5800, havingcaudad portion5801 andcephalad portion5802. Alignment holes5806 are adapted to receivealignment pins5560 ofwing insertion instrument5500. Although twoalignment holes5806 are depicted, additional or fewer alignment holes can be provided. Betweencaudad portion5801 andcephalad portion5802, mountingring5816 is provided having an oblong bore therethrough to receiveshaft5814 ofbolt5812.Bolt5812 has a proximal end with arecess5813 adapted to receivedriver5555 ofinstrument5500. The distal end ofbolt5812 is threaded to engage withhole5408 of atissue expander5407 depicted inFIGS. 183a-184c. The oblong bore has partial threads that allow a bolt to be screwed through the bore with the smooth shaft of the bolt then trapped in the bore.
• FIG. 187bis a side view ofuniversal wing5800 withoutbolt5812, depicting mountingring5816 withoblong bore5817 therethrough. Alignment holes5806 are shown as dashed lines.FIG. 187cdepicts a similar view of universal with5800 withbolt5812 provided.Hex recess5813, adapted to receivedriver5555 ofinstrument5500 is shown.Hole5817 is oblong to provide a choice of positions ofbolt5812 withinbore5817. By providing a choice of bolt positions, the surgeon can install universal wing with a desired spacing betweenuniversal wing5800 andmain body wing5401.
• FIGS. 188a-188cdepict the relationships betweenwing insertion instrument5500 of this invention and theuniversal wing5800 of the invention.FIG. 188adepicts a lateral view of theinsertion tip5030, withdriver5555 inspace5567 andalignment pin5560.Insertion rod5541 is shown withininsertion shaft5540. Also depicted isuniversal wing5800, havingbolt5812 withrecess5813, mountingring5816,alignment hole5806, andcaudad wing portion5801. The axes ofdriver5555 andalignment pin5560, which in this embodiment cross each other and can be substantially perpendicular if desired, are shown in relation torecess5813 andalignment hole5806, respectively.
• FIG. 188bdepicts a lateral view ofinsertion tip5030 engaged withuniversal wing5800.Driver5555 is received byrecess5813 inbolt5812 andalignment pin5560 is received byalignment hole5806.Bolt5812 is received withinrecess5567 ofinsertion tip5030, and wheninsertion shaft5541 is rotated,bolt5812 can rotate.
• FIG. 188cdepicts a bottom view ofinsertion tip5030 anduniversal wing5800, engaged as inFIG. 188b.Cephalad portion5802 andcaudad portion5801 of the universal wing are shown engaged byalignment pins5560 received through alignment holes5806.Edge5807 ofwing5800 is shown abutted againstsurface5547 ofinsertion tip5030.
• III. Trial Implant Instruments
• Spinal implant surgery can be carried out by using specially designed instruments to determine the correct size of an implant to be used and to predistract the spinous process. The instruments incorporating trial implants comprise a handle, made of a convenient material, for example, Gray ULTEM™.FIGS. 189a-189ddepict four embodiments of trial implant instruments of the invention.FIG. 189a-189ddepictinstruments6000,6001,6002, and6003 of this invention, each havinghandle6006 andinsertion shaft6007. The instruments differ in the size of the trial implant for each.Trial implant6010 is the smallest,implant6011,6012, and6013 become progressively larger, corresponding toinstruments6000,6001,6002 and6003, respectively. These trial implants in the embodiment are cylindrical in shape with diameters of 6 mm, 8 mm, 10 mm, and 12 mm, respectively. The trial implants have a lead-in nose, guide, or tissue expander that is cone shaped. Other shapes such as elliptical shapes, oval shapes, and egg-shapes are within the scope of the invention. Further, the nose can be of other shapes such as pyramid shaped. In use, these trial implant instruments are used one after the other to size the implant location and to progressively distract the implant location in preparation for insertion of the implant, which is left in the patient.
• IV. Methods of Insertion of Spinal Implants
• To use the instruments of this invention to insert spinal implants of the invention, a patient is placed, desirably in a lateral decubitus position with maximum flexion of the lumbar spine. Lateral decubitus position permits easy orientation of the main body assembly during surgery. Generally, the implant can be inserted between the spinous processes from the bottom or right side of the spinous processes to the top or left side of the spinous processes. Such orientation permits easy visualization of the main body assembly when the universal wing is attached. The wings should be oriented properly, withcephalad portions5402 and5802 oriented in a cephalad direction, andcaudad portions5402aand5801 oriented in a caudal direction. The field is prepared for sterile surgery, and local anesthesia of the area is provided. Once the entry point is determined, local anaesthetic is applied to the skin and the underlying musculature.
• To insert a spinal implant in one affected vertebral area for a single level implant process, a midline incision about 1.5 inches long is made at the entry point, exposing the supraspinous ligament overlying the spinous processes at the symptomatic level. The fascia may be incised on either side of the spinous processes and supraspinous ligament. The paraspinous musculature can be elevated laterally from both sides of the midline. The supraspinous ligament is desirably preserved. The interspinous ligament may be separated to permit insertion ofmain body assembly5400.
• To insert spinal implants in adjacent portions of the spine for a double level implant process, a midline incision about 3 inches long is made at the entry point, exposing the supraspinous ligament overlying the spinous processes at the appropriate segments. The fascia is incised if necessary on either side of the spinous processes and supraspinous ligament. The paraspinous musculature can be elevated laterally from both sides of the midline.
• Thefirst implant5400 can be inserted at the inferior level, and thesecond implant5400 of the same or different size, can be inserted at the superior, adjacent level after the first implant has been completely secured. If the supraspinous ligament is compromised during the procedure, it can be desirable to suture the excision in the ligament closed after insertion of the spinal implant.
• Before installing thespinal implant5400, the intraspinous space is prepared using trial implants. Generally, the surgeon can first select the smallest trial implant, for example,trial implant6000. Thetrial implant6000 is urged between the spinous processes of the patient, and if little resistance is encountered, the surgeon can select a larger sized trial implant, such astrial implant6001. If insufficient resistance is encountered, the surgeon can use progressively larger trial implants to distract the spinous process. When the correct trial implant is found, thespinal implant5400 is then chosen for insertion. Additionally, the surgeon may choose to use a trial implant instrument that is larger than the implant to be used in order to further distract the spinous process to make the insertion of the implant easier.
• To insert the main body assembly, a surgeon or assistant engages such assembly with mainbody insertion instrument5100 of this invention. The leading edge oftissue expander5407 of the main body assembly is advanced through the interspinous ligament. If significant resistance is encountered during the insertion of the implant, the next smallest size main body assembly can be used. Once the correct sized implant has been selected, the main body implant is inserted as shown inFIGS. 190aand190b.
• FIG. 190adepicts a right lateral view of a portion of a spine of a patient. L4 and L5 refer to lumbar vertebrae 4 and 5, respectively. For purposes of illustration only, these lumbar segments are depicted. However, any spinal segments can be the sites of insertion of the implants by use of the instruments of this invention. L4-5D refers to the intravertebral disk. L4D and L5D refer to the dorsal spinous processes of L4 and L5, respectively. Mainbody insertion instrument5100 havinginsertion tip5030 attached tomain body assembly5400 is shown in position.Cephalad portion5402 andcaudad portion5402aof a main body wing are shown. It can be desirable to urgemain body assembly5400 ventrally withinintraspinous space6005.
• FIG. 190bdepicts a dorsal view of an insertedmain body assembly5400.Spacer5405 is shown between dorsal spinous processes L4D and L5D.Main body wing5401 is shown near the right lateral surfaces of spinous processes L4D and L5D.
• FIG. 191 depicts a left lateral view of the L4-L5 area of a patient. Themain body assembly5400 has been inserted, and thetissue expander5407 is shown, urged ventrally inintraspinous space6005. Mainbody wing portions5402 and5402aare shown in dashed lines, being located behind (i.e., the right of) the spinous process L4D and L5D, respectively. Threadedhole5408 intissue expander5407 is shown, and axis (dashed lines) is shown to depict the insertion of threadedportion5815 ofbolt5812 ofuniversal wing800.Insertion tip5030 ofwing insertion instrument5500 is shown, with a universal wing engaged5800, as depicted inFIGS. 188band188c. The engaged wing is shown from the top view, in contrast to the view ofFIG. 188c, which is from the bottom. While grasping mainbody insertion instrument5100, the surgeon inserts the universal wing withwing insertion instrument5500. When the universal wing is brought into the correct position relative to the main body assembly,bolt5812 can be inserted intohole5408 of thetissue expander5407, and by rotation of thedriver knob5050 ofFIG. 184 in a clockwise direction,driver5555 can rotatebolt5812 thereby engaging threads of the threaded end815 with the threads ofhole5408. Alternatively, if the threadedportions5815 ofbolt5812 andhole5408 have left-handed threads, thendriver knob5050 should be rotated in a counter-clockwise direction to engagebolt5812 with threadedhole5408. Before tighteningbolt5812, it can be desirable to urgeuniversal wing5800 medially or closer tomain body wing5401 to provide a desired degree of support of spinous processes L1D and L2D. Once in the proper position,bolt5812 can be tightened, and theinsertion instrument5100 and5500 are removed, the incisions sutured and closed.
• FIG. 192 depicts a dorsal view of the spine of a patient, depicting an installedmain body assembly5400 withuniversal wing5800 attached thereto.Universal wing portion5802 is shown oriented in the cephalad direction, as is mainbody wing portion5402.Caudad wing portions5801 and5402aare shown oriented in the caudal direction.Wing element5400,5402aare shown near the right lateral surface of the spinous process.Universal wing5800 is shown placed near the left lateral surfaces of the spinous process. Adjustment of the spacing betweenuniversal wing5800 and the spinous process is accomplished by urging the wing medially before tighteningbolt5812 inoblong mounting ring5817.
• V. Alternative Insertion Instrument Sets
• FIGS. 193 through 196 depict alternative instrument sets of the invention. The aspects of these instrument sets, that are similar to the above described inventive instrument sets, are similarly numbered. Further, the description of the previously described instrument sets applies equally well to these alternative embodiments of the present invention.
• InFIG. 193 the mainbody insertion instrument5100 is shown nested to thewing insertion instrument5500. Both instruments together hold animplant5400. With respect to the mainbody insertion instrument5100 in this embodiment, thisinsertion instrument5100 is essentially identical to that shown inFIG. 1. Thewing insertion instrument5500 has been modified to include an elongated concave recess5580 (FIG. 194) which extends, in this preferred embodiment, for substantially the length of thehandle5010. This elongatedconcave recess5580 is shaped to conform to the outer surface of thehandle5010 of the mainbody insertion instrument5100. Accordingly thehandle5010 of the mainbody insertion instrument5100 can be nested in thisrecess5580 so that the main body insertion instrument can be mated and nested to thewing insertion instrument5500. (FIGS. 193,194). This nesting affords the ability of the handles to align with each other so that the wing carried by thewing insertion instrument5500 can be slid into place relative to and aligned with the main body carried by the mainbody insertion instrument5100, as theinstrument5500 is slid along the handle ofinstrument5100.
• FIGS. 195 and 196 depict yet a further alternative embodiment of the instrument set including a mainbody insertion instrument5100, and awing insertion instrument5500. The mainbody insertion element5100 in this embodiment includes an offsethandle5010 which is depicted as offset from the shaft by about 45 degrees. It has been understood that greater and lesser offsets can be accomplished and be within the spirit and scope of the invention. The offsets servers two functions. The first function is that it gives the surgeon greater leverage in manipulating and positioning the main body of the implant through the ligaments associated with the spinous processes and eventually the spinous processes themselves. This additional leverage allows the physician to urge the main body of the implant into position.
• Also it can be seen inFIG. 195, the mainbody insertion instrument5100 includes aflange5101. Thisflange5101 is an additional enhancement to theinsertion tool5100. It is then to be understood that the instrument set inFIGS. 195 and 196 can be fabricated without theflange5101 and themating groove5501 of thewing insertion instrument5500 and still be within the spirit scope of the invention. As seen inFIG. 196, themating groove5501 of thewing insertion instrument5050 is located in therecess5580.
• It is to be understood that without theflange5100 and themating groove5501, the embodiment of theinsertion instrument5100 ofFIG. 195 can be received in therecess5580 of thewing insertion instrument5500 ofFIG. 196 as thewing insertion instrument5500 is moved relative to the mainbody insertion element5100 in order to align the wing relative to the main body at the surgical site.
• With theflange5101 and themating groove5501 and with the embodiment of theinsertion element5100 ofFIG. 195 positioned so that the main body is inserted through the spinous processes, thewing insertion instrument5500 can be mated over the mainbody insertion instrument5100 with the flange received in themating groove5501. After this is accomplished, thewing insertion instrument5500 can be slid relative to the mainbody insertion instrument5100 in order to bring the wing into contact with and aligned with the main body. After this has occurred, the wing can be fastened to the main body.
• It is to be understood that thewing insertion instrument5500 can also have an offset handle like the offset handle of mainbody insertion instrument5100 ofFIG. 196.
• It is to be understood that other devices and methods for mating and aligninginsertion instrument5100 with thewing insertion instrument5500 can be envisioned and be within the spirit and scope of the invention.
INDUSTRIAL APPLICABILITY
• From the above, it is evident that the present invention can be used to relieve pain caused by spinal stenosis in the form of, by way of example only, central canal stenosis or foraminal (lateral) stenosis. These implants have the ability to flatten the natural curvature of the spine and open the neural foramen and the spacing between adjacent vertebra to relieve problems associated with the above-mentioned lateral and central stenosis. Additionally, the invention can be used to relieve pain associated with facet arthropathy. The present invention is minimally invasive and can be used on an outpatient basis.
• Additional aspects, objects and advantages of the invention can be obtained through a review of the appendant claims and figures.
• It is to be understood that other embodiments can be fabricated and come within the spirit and scope of the claims.
• The foregoing description of preferred embodiments of the present invention has been provided for the purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise forms disclosed. Obviously, many modifications and variations will be apparent to the practitioner skilled in the art. The embodiments were chosen and described in order to best explain the principles of the invention and its practical application, thereby enabling others skilled in the art to understand the invention for various embodiments and with various modifications that are suited to the particular use contemplated. It is intended that the scope of the invention be defined by the following claims and their equivalence.

Claims (38)

1. An apparatus, comprising:

a first implant member configured to contact a first spinous process; and

a second implant member movably coupled to the first implant member, the second implant member configured to contact a second spinous process, the second implant member configured to move relative to the first implant member to maintain a distraction between the first spinous process and the second spinous process.

2. The apparatus ofclaim 1, wherein:

the first implant member includes a first surface configured to contact an inferior surface of the first spinous process and a second surface configured to contact a side surface of the first spinous process; and

the second implant member includes a first surface configured to contact a superior surface of the second spinous process and a second surface configured to contact a side surface of the second spinous process.

3. The apparatus ofclaim 1, wherein the second implant member is configured to translate relative to the first implant member.

4. The apparatus ofclaim 1, wherein the second implant member is configured to translate relative to the first implant member when the first implant member is in contact with the first spinous process and the second implant member is in contact with the second spinous process.

5. The apparatus ofclaim 1, wherein a portion of the second implant member is slidably disposed within the first implant member.

6. The apparatus ofclaim 1, wherein a portion of the second implant member is configured to rotate relative to the first implant member.

7. The apparatus ofclaim 1, wherein the distraction between the first spinous process and the second spinous process is at least 5 mm.

8. The apparatus ofclaim 1, wherein the distraction between the first spinous process and the second spinous process is at least 22 mm.

9. The apparatus ofclaim 1, wherein the second implant member is further configured to move relative to the first implant member to increase the distraction between the first spinous process and the second spinous process.

10. The apparatus ofclaim 1, wherein the first implant member has an actuation portion defining an opening therethrough, the opening configured to receive an actuator to move the first implant member relative to the second implant member.

11. An apparatus, comprising:

a first implant member configured to contact a first spinous process; and

a second implant member movably coupled to the first implant member, the second implant member configured to contact a second spinous process, the second implant member configured to move relative to the first implant member to distract the first spinous process and the second spinous process.

12. The apparatus ofclaim 11, wherein:

the first implant member includes a curved surface configured to contact an inferior surface of the first spinous process; and

the second implant member includes a curved surface configured to contact a superior surface of the second spinous process.

13. The apparatus ofclaim 11, wherein:

the first implant member includes a retention surface configured to contact a side surface of the first spinous process; and

the second implant member includes a retention surface configured to contact a side surface of the first spinous process,

the retention surface of the first implant member and the retention surface of the second implant member configured to collectively limit lateral movement of the implant relative to the first spinous process and the second spinous process.

14. The apparatus ofclaim 11, wherein the second implant member is configured to translate relative to the first implant member.

15. The apparatus ofclaim 11, wherein a portion of the second implant member is slidably disposed within the first implant member.

16. The apparatus ofclaim 11, wherein the second implant member includes a first portion and a second portion rotatably coupled to the first portion.

17. The apparatus ofclaim 11, wherein the first implant member has an actuation portion defining an opening therethrough, the opening configured to receive an actuator to move the first implant member relative to the second implant member.

18. An apparatus, comprising:

a first implant member having a first portion and a second portion, the first portion of the first implant member configured to contact a first spinous process, the second portion of the first implant member defining an opening; and

a second implant member having a first portion and a second portion, the first portion of the second implant member configured to contact a second spinous process, the second portion of the second implant member being slidably disposed within the opening of the second portion of the first implant member.

19. The apparatus ofclaim 18, wherein the first portion of the second implant member is configured to translate relative to the first portion of the first implant member to increase a space between the first spinous process and the second spinous process.

20. The apparatus ofclaim 18, wherein the first portion of the first implant member and the first portion of the second implant member are collectively configured to limit extension of a spinal column including the first spinous process and the second spinous process, and are collectively configured to allow flexion of the spinal column.

21. The apparatus ofclaim 18, wherein the first portion of the first implant member is configured to rotate relative to the second portion of the first implant member.

22. The apparatus ofclaim 18, wherein:

the first portion of the first implant member includes a curved surface configured to contact an inferior surface of the first spinous process; and

the first portion of the second implant member includes a curved surface configured to contact a superior surface of the second spinous process.

23. The apparatus ofclaim 18, wherein:

the opening defined by the second portion of the first implant member is a first opening; and

the second portion of the first implant member defines a second opening configured to receive an actuator to move the first implant member relative to the second implant member.

24. A method, comprising:

inserting an implant having a first support member and a second support member such that at least a portion of the first support member and at least a portion of the second support member are disposed within a space between a first spinous process and a second spinous process; and

moving the second support member relative to the first support member to maintain a distance between the first spinous process and the second spinous process.

25. The method ofclaim 24, wherein the moving includes translating the second support member relative to the first support member.

26. The method ofclaim 24, wherein:

the inserting includes inserting the implant such that a first surface of the first support member contacts an inferior surface of the first spinous process and a second surface of the first support member contacts a side surface of the first spinous process; and

the inserting includes inserting the implant such that a first surface of the second support member contacts a superior surface of the second spinous process and a second surface of the second support member contacts a side surface of the second spinous process.

27. The method ofclaim 24, wherein the moving includes sliding a portion of the second support member within a portion of the first support member.

28. The method ofclaim 24, wherein the moving includes distracting the first spinous process and the second spinous process such that the distance between the first spinous process and the second spinous process is at least 5 mm.

29. The method ofclaim 24, further comprising:

distracting the first spinous process and the second spinous process before the inserting such that the distance between the first spinous process and the second spinous process is at least 5 mm.

30. The method ofclaim 24, further comprising:

distracting the first spinous process and the second spinous process before the inserting such that the distance between the first spinous process and the second spinous process is at least 22 mm.

31. The method ofclaim 24, wherein the moving includes:

inserting a portion of an actuator into an opening defined by the first support member; and

moving the first support member relative to the second support member via the actuator.

32. A method, comprising:

inserting an implant having a first implant member and a second implant member such that a first portion of the first implant member and a first portion of the second implant member are disposed within a space between a first spinous process and a second spinous process; and

moving a second portion of the first implant member about a second portion of the second implant member such that the space between the first spinous process and the second spinous process is increased.

33. The method ofclaim 32, wherein:

the second portion of the first implant member defines an opening; and

at least a portion of the second portion of the second implant member is slidably disposed within the opening.

34. The method ofclaim 32, wherein:

the inserting includes inserting the implant such that the first portion of the first implant member contacts an inferior surface of the first spinous process and the first portion of the second implant member contacts a superior surface of the second spinous process.

35. The method ofclaim 32, wherein the moving includes translating the first portion of the first implant member relative to the first portion of the second implant member.

36. The method ofclaim 32, wherein

the moving includes inserting a portion of an actuator into an opening defined by the second portion of the first implant member; and

moving the first implant member relative to the second implant member via the actuator.

37. The method ofclaim 32, wherein:

the moving includes distracting the space between the first spinous process and the second spinous process a distance of at least 5 mm.

38. The method ofclaim 32, wherein the moving includes:

moving, at a first time, the second portion of the first implant member about the second portion of the second implant member such that the space between the first spinous process and the second spinous process is distracted by a first distance; and

moving, at a second time, the second portion of the first implant member about the second portion of the second implant member such that the space between the first spinous process and the second spinous process is distracted by a second distance greater than the first distance.

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