US20090270873A1 - Spine surgery method and inserter - Google Patents

Abstract

A surgical inserter for use in inserting an implant into a vertebral space may include: (a) a handle; (b) a gripper having one end attached to the handle and a second end having a pair of arms; and (c) a grip activator having an opening that threadingly receives the gripper. The grip activator can be rotated in a first direction with respect to the gripper to cause the arms to move toward each other to grip the inserter and in a second direction with respect to the gripper to cause the arms to move away from each other to release the inserter. In one embodiment a compression force activator is used to deploy the implant and in another embodiment a tension force activator is used to deploy the implant.

Description

I. BACKGROUND OF THE INVENTION
• A. Field of Invention
• This invention pertains to the art of methods and apparatuses regarding spine surgery and more specifically relates to surgical procedures and an inserter used to position an implant, and perhaps to deploy the implant, within a vertebral space.
• B. Description of the Related Art
• The volume of spinal surgeries to treat degenerative disc and facet disease has steadily increased over the past decade, fueled by population demographics and advancements in diagnostic and instrumentation adjuncts. Improvements in intraoperative radiological imaging and surgical technique have generated a great deal of interest in applying minimally invasive surgical (MIS) techniques to spinal applications. As in other surgical subspecialties, it is hoped such minimally invasive techniques applied to spinal surgery will result in less soft tissue trauma, less operative blood loss, reduced operative time, faster recovery periods and lower costs.
• Known spinal surgical techniques, though generally working well for their intended purposes, have been adopted from traditional open surgical (non-MIS) techniques. As a result, known spinal surgical methods, instrumentation and interbody implants have limitations. One limitation is that the physical components are relatively large and bulky. This reduces surgeon visualization of the surgical site. Another limitation of known spinal surgical methods is that known surgical tools and implants are cumbersome and difficult to maneuver within the limited surgical space available. The limitations of current instrumentation in MIS spine surgery are noted particularly with regards to interbody fusion surgery.
• The present invention provides methods and apparatuses for overcoming these limitations by providing a surgical inserter that allows for minimally invasive spinal surgery and that provides for precise movement, placement and deployment of an implant into the vertebral space.
II. SUMMARY OF THE INVENTION
• According to one embodiment of this invention, a surgical inserter for use in inserting an implant into a vertebral space comprises: (1) a handle having first and second ends for use by a surgeon; and, (2) an implant gripping mechanism comprising: a gripper having a first end attached to the second end of the handle and a second end having a pair of arms; and, a grip activator having an opening that threadingly receives the gripper. The grip activator can be rotated in a first direction with respect to the gripper to cause the arms to move toward each other to grip the inserter and can be rotated in a second direction with respect to the gripper to cause the arms to move away from each other to release the inserter.
• According to another embodiment of this invention, the surgical inserter further comprises: a connector having a first end attached to the second end of the handle and a second end attached to the first end of the gripper.
• According to another embodiment of this invention, the surgical inserter further comprises: an implant deployment mechanism for use in deploying the implant.
• According to still another embodiment of this invention, the implant deployment mechanism comprises: (1) a compression force member; and, (2) a compression force activator that can apply a force to the compression force member to extend the compression force member into contact with the implant.
• According to yet another embodiment of this invention, the implant deployment mechanism comprises: (1) a tension force member that is operatively connected to the implant; and, (2) a tension force activator that can apply a tension force to the tension force member to deploy the implant.
• According to another embodiment of this invention, the surgical inserter further comprises: an implant anti-deployment mechanism for use in preventing the implant deployment mechanism from operating until the surgeon is ready to operate it.
• According to another embodiment of this invention, the implant anti-deployment mechanism comprises: a tube member that can contact the implant; and, a securing device for use in securing the tube member in contact with the implant to prevent deployment of the implant.
• According to still another embodiment of this invention, a method comprises the steps of: (A) providing an implant made to be placed into a vertebral space; (B) providing a surgical inserter comprising: a handle having first and second ends for use by a surgeon; a gripper having a first end attached to the second end of the handle and a second end having a pair of arms; and, a grip activator having an opening in that threadingly receives the gripper; (C) preparing the vertebral space to receive the implant; (D) rotating the grip activator with respect to the gripper to cause the arms to move toward each other to grip the inserter; (E) moving the surgical inserter to insert the implant within the vertebral space; (F) rotating the grip activator with respect to the gripper to cause the arms to move away from each other to release the inserter; and, (G) moving the surgical inserter away from the vertebral space.
• According to another embodiment of this invention, the method may further comprise the step of: deploying the implant with the inserter.
• According to another embodiment of this invention, the method may further comprise the step of: adjusting an anti-deployment mechanism to permit deployment of the implant.
• One advantage of this invention is that the inventive surgical inserter permits an implant to be relatively easily placed into a vertebral space.
• Another advantage of this invention is that the implant may be relatively easily and securely attached to the inserter and then detached from the inserter.
• Another advantage of this invention is that the surgeon may make consistent and reproducible biplanar, midline placement of the interbody implant.
• Another advantage of this invention is that, in one embodiment, the inserter can be used to deploy the implant.
• Yet another advantage of this invention is that the surgical inserter allows for minimally invasive deployment via either an anterior, anterolateral, posterior or posterolateral approach, with the latter approach possible via either a transforaminal or extraforaminal approach.
• Still other benefits and advantages of the invention will become apparent to those skilled in the art to which it pertains upon a reading and understanding of the following detailed specification.
III. BRIEF DESCRIPTION OF THE DRAWINGS
• The invention may take physical form in certain parts and arrangement of parts, embodiments of which will be described in detail in this specification and illustrated in the accompanying drawings which form a part hereof and wherein:
• FIG. 1A is a side perspective view of a spinal segment showing a vertebral space defined by the intradiscal space usually occupied by a disc between two adjacent vertebral bodies.
• FIG. 1B is a side perspective view of a spinal segment showing a vertebral space defined by the space usually occupied by a vertebral body and its two adjacent discs.
• FIG. 2 is a side view of an inserter according to one embodiment of this invention.
• FIG. 3 is a perspective proximal end view of a handle according to one embodiment of this invention.
• FIG. 4 is a perspective distal end view of the handle shown inFIG. 3.
• FIG. 5 is a side sectional view of the handle shown inFIG. 3.
• FIG. 6 is a perspective proximal end view of a connector according to one embodiment of this invention.
• FIG. 7 is a perspective distal end view of the connector shown inFIG. 6.
• FIG. 8 is a perspective distal end view of a gripper according to one embodiment of this invention.
• FIG. 9 is a side view of the gripper shown inFIG. 8.
• FIG. 10 is a perspective proximal end view of the gripper shown inFIG. 8.
• FIG. 11 is a close up perspective view of the distal end of the gripper shown inFIG. 8.
• FIG. 12 is a close up perspective distal end view of the gripper shown inFIG. 8.
• FIG. 13 is a perspective view of the proximal end of the gripper shown inFIG. 8 but showing a deployed implant gripped by the gripper.
• FIG. 14 is a perspective proximal end view of the gripper shown inFIG. 13.
• FIG. 15 is a perspective proximal end view of a grip activator according to one embodiment of this invention.
• FIG. 16A is a perspective distal end view of the grip activator shown inFIG. 15.
• FIG. 16B is a perspective view of the grip activator similar to that shown inFIG. 15 but shown as if transparent so that the thread region can be seen.
• FIG. 17 is a side view of the gripper being received by the grip activator.
• FIG. 18 is a perspective view of the gripper and grip activator similar to that shown inFIG. 17 but showing the grip activator as if transparent.
• FIG. 19 is a perspective distal end view of a screw according to one embodiment of this invention.
• FIG. 20A is a side sectional view of the handle, the screw, a compression knob and a cap according to one embodiment of this invention.
• FIG. 20B is a side sectional view of the handle and a side view of a compression trigger mechanism according to one embodiment of this invention.
• FIG. 20C is a side sectional view of the handle, the screw, a tension knob and a cap according to one embodiment of this invention.
• FIG. 20D is a perspective sectional view of the handle, a tension knob and a cap according to another embodiment of this invention.
• FIG. 20E is a side sectional view of the handle and a side view of a tension trigger mechanism according to one embodiment of this invention.
• FIG. 21 is a perspective proximal end view of the tension knob according to one embodiment of this invention.
• FIG. 22 is a perspective distal end view of the tension knob shown inFIG. 21.
• FIG. 23 is a perspective proximal end view of the cap according to one embodiment of this invention.
• FIG. 24 is a perspective distal end view of the cap shown inFIG. 23.
• FIG. 25 is a side sectional view of the cap shown inFIG. 23.
• FIG. 26 is a perspective proximal end view of a tube member according to one embodiment of this invention.
• FIG. 27 is a view of the tube member similar to that shown inFIG. 26 but showing a nut attached to the tube member.
• FIG. 28 is a perspective proximal end view of the nut.
• FIG. 29 is a perspective distal end view of the tube member shown inFIG. 26.
• FIG. 30 is a close-up view of the distal end of the inserter showing an attached implant in a non-deployed condition.
• FIG. 31 is a perspective distal end view showing the inserter attached to a deployed implant.
• FIG. 32 is a close-up top view of the distal end of the inserter shown deploying an implant according to one embodiment.
• FIG. 33 is a close-up perspective view of the inserter and implant shown inFIG. 32.
• FIG. 34 is a perspective view of an implant in a deployed condition according to one embodiment of this invention.
• FIG. 35 is a perspective view of the implant shown inFIG. 34 but indicating how a cable may be removed.
• FIG. 36 is a perspective view of the implant shown inFIG. 34 but in a non-deployed condition.
• FIG. 37 is a perspective view of the implant similar to that shown inFIG. 36 but with the upper limbs removed for clarity.
• FIG. 38 is a perspective view of an implant in a deployed condition according to another embodiment of this invention.
• FIG. 39 is a perspective view of the implant shown inFIG. 38 but with the upper limbs removed for clarity.
• FIG. 40 is a perspective view of the implant shown inFIG. 39 but illustrating the cable being threaded through the upper hole inpost4.
• FIG. 41 is a perspective view of the implant shown inFIG. 40 but illustrating the cable being threaded through the upper hole inpost2.
• FIG. 42 is a perspective view of the implant shown inFIG. 41 but illustrating the cable being threaded through the upper hole inpost1
• FIG. 43 is a perspective view of the implant shown inFIG. 42 but illustrating the cable being wrapped aroundpost1 in a counter-clockwise manner.
• FIG. 44 is a perspective view of the implant shown inFIG. 43 but illustrating the cable being threaded through the lower hole inpost2.
• FIG. 45 is a perspective view of the implant shown inFIG. 44 but illustrating the cable being threaded through the lower hole inpost4.
• FIG. 46 is a perspective view of the implant shown inFIG. 45 but illustrating the cable threading completed.
• FIG. 47 shows various views of the insertion and deployment of the implant with a 20 degree insertion angle and with a 30 degree insertion angle.
• FIG. 48 shows various views of the insertion and deployment of the implant with a 45 degree insertion angle.
• FIG. 49A is a perspective view of a screw showing how a cable may be attached using a set screw.
• FIG. 49B is a perspective view of a screw showing how a cable may be attached using a collar.
• FIG. 49C is a perspective view of a screw showing how a cable may be attached using a reel member.
• FIG. 50 is a close-up top view of the distal end of the inserter shown deploying an implant in the closed or non-deployed condition according to another embodiment.
• FIG. 51 is a close-up top view similar to that shown inFIG. 50 but with the implant shown in the open or deployed condition.
IV. DETAILED DESCRIPTION OF THE INVENTION
• Referring now to the drawings wherein the showings are for purposes of illustrating embodiments of the invention only and not for purposes of limiting the same, thesurgical inserter200 of this invention can be used to insert and, in some embodiments such as shown inFIGS. 30 and 31, deploy animplant100 into avertebral space22. By vertebral space it is meant the space in a spinal column where theimplant100 will be placed. In one embodiment, shown inFIG. 1A, aspinal segment10 is made up of twovertebrae12,14 attached together by ligaments with adisc16 separating them. Facet joints18 fit between the twovertebrae12,14 and allow for movement. Theneural foramen20 between thevertebrae12,14 allow space for the nerve roots to travel freely from thespinal cord28 to the body. If it is required to remove thedisc16 and replaced it with animplant100, the space occupied by thedisc16, the intradiscal space between the two adjacentvertebral bodies12,14, defines thevertebral space22. In another embodiment, shown inFIG. 1B, aspinal segment30 is made up of threevertebrae32,34,36 attached together by ligaments. If it is required to remove the middle vertebra34 (it is shown diseased) along with theadjacent discs38,40, such as may be required because of a corpectomy defect, and replaced them with animplant100, the space between the two outervertebral bodies32,36, defines thevertebral space22. It should be understood that these are simply two non-limiting examples of thevertebral space22 into which animplant100 can be inserted according to this invention because any vertebral space chosen with the sound judgment of a person of skill in the art can be used. As the components and operation of a spinal column is well known to those of skill in the art, further detail will not be provided here.
• With reference now toFIG. 2, theinserter200 of this invention in some embodiments may include ahandle mechanism300, an implantgripping mechanism400, animplant deployment mechanism500, and animplant anti-deployment mechanism600. Each of these mechanisms will be described in more detail below. Note that throughout this patent the term “proximal” shall refer to direction A as shown inFIG. 2 (toward the handle end of the inserter) and the term “distal” shall refer to direction B as shown inFIG. 2 (toward the implant end of the inserter). These terms are not used to limit this invention in any way but only to provide a direction reference.
• With reference now toFIGS. 2-5 thehandle mechanism300 includes ahandle302 that may be held by the surgeon and used to manipulate theinserter200 during surgery. Thehandle302 may be generally cylindrical and may have anopening304 throughout its length. Thisopening304 can be used for purposes described below and may be positioned substantially in the radial center of thehandle302. The outer surface of thehandle302 may be contoured along the handle length, as shown, and may have a texturedregion306 to improve the grip for the surgeon. The proximal end of thehandle302 may be adapted to attach to theimplant deployment mechanism500 and may include a pair ofproximal holes308,309 for this purpose. The distal end may be adapted to attach to theimplant gripping mechanism400 and may include adistal hole310 for this purpose.
• With reference now to FIGS.2 and4-7, while in one embodiment theimplant gripping mechanism400 attaches directly to the distal end of thehandle302, for the embodiment shown thehandle mechanism300 includes aconnector360. A connector provides for ease of assembly; namely a “quick connect” type attachment and may also make it easier to clean the inserter components. Theconnector360 may have anopening362 throughout its length for purposes described below and may be positioned substantially in the radial center of theconnector360. The proximal end of theconnector360 may have a generally rectangular cross-section and may be adapted to attach to the distal end of thehandle302. Agroove364 may be formed in theconnector360, as shown. While thegroove364 is shown on one side of theconnector360 is to be understood that this groove could be positioned elsewhere and could, in another embodiment, be replaced with a hole extending through theconnector360. To attach theconnector360 to thehandle302, the proximal end of theconnector360 is inserted into theopening304 at the distal end of thehandle302 until theconnector groove364 and the handledistal hole310 are aligned. A dowel pin (not shown) may then be inserted through thedistal hole310 and groove364 to secure theconnector360 to thehandle302. In one embodiment, shown, the substantially square cross-section of the proximal end of theconnector360, when received within the substantially circular cross-section of theopening304 in the distal end of thehandle302, helps to prevent relative motion and thereby helps to maintain the inserter components in proper position as theinserter200 is used.
• With continuing reference to FIGS.2 and4-7, the distal end of the connector may be generally cylindrical and may have an outer surface that is contoured along the connector length and may have a texturedregion366 to improve the grip for the surgeon. The distal end may be adapted to attach to theimplant gripping mechanism400 and the distal end of theopening362 may have a specific shape for this purpose. The opening shape shown has a cross-section that is semi-circular with aflat edge368 but it is to be understood that the opening shape can be any chosen with the sound judgment of a person of skill in the art in order to attach to theimplant gripping mechanism400.
• With reference now to FIGS.2 and7-14, theimplant gripping mechanism400, which is used to grip and release theimplant100, will now be described. The implantgripping mechanism400 includes agripper420 that may be generally cylindrical and may have anopening422 throughout its length. Thisopening422 can be used for purposes described below and may be positioned substantially in the radial center of thegripper420. The proximal end of thegripper420 may be adapted to attach to the distal end of theconnector360. More specifically, the proximal end of thegripper420 may be shaped to fit into the distal end of theopening362 formed in theconnector360. For the embodiment shown, the proximal end of thegripper420 has a cross-section that is semi-circular with aflat edge440 to match theopening362. To further secure the proximal end of thegripper420 to the distal end of theconnector360, thegripper420 may have acircumferential groove424 that is received in a mating extension (not shown) that extends from theopening362 within theconnector360.
• With continuing reference to FIGS.2 and7-14, the distal end of thegripper420 may be used to both grip and release theimplant100. A pair ofarms426,427, forming a V-shape, may extend outwardly and end with a pair ofhands428,429, respectively, as shown. There is aspace430 between thearms426,427 which can be narrowed as will be described further below. Eachhand428,429 has acontact surface432 that is used to physically contact a surface of theimplant100. As shown, onehand428 has agap434 between two hand portions for a purpose to be described below. However, other embodiments would also work well with this invention. Neither hand, for example, may have a gap. In another embodiment, three or more hand portions may be used. The contact surface of each hand portion may be textured, as shown, to improve the gripping characteristics of thehands428,429. Theother hand429 may have acontinuous contact surface432 and may include atang436 positioned substantially central to the hand, as shown. Thetang436 is also used to improve the gripping characteristics of thehands428,429. In one specific embodiment, thetang436 is adapted to be received within a corresponding groove102 (seeFIG. 14) formed in the implant. In other embodiments, multiple tangs and/or multiple grooves may be used. It should be understood that the contact surfaces432 described here are non-limiting examples because the contact surfaces432 used can be any chosen with the sound judgment of a person of skill in the art. Positioned proximally from thearms426,427 the outer surface of thegripper420 has a threadedregion438 for purposes to be described below.
• With reference now to FIGS.2 and11-18, theimplant gripping mechanism400, may also include agrip activator460 which can be used by the surgeon to activate thegripper420 to grip or release theimplant100. Thegrip activator460 may be generally cylindrical and may have anopening462 throughout its length. Thisopening462 may be positioned substantially in the radial center of thegrip activator460 and may be used to receive thegripper420, as shown. The proximal end of thegrip activator460 may have an outer surface having atextured region464 to improve the grip for the surgeon. The proximal end of thegrip activator460 may be adapted to attach to and activate thegripper420. In a specific embodiment, theopening462 may be at least partially defined by a threaded region466 (seeFIGS. 16A and 18) that engages the threadedregion438 of thegripper420, for purposes to be described below.
• With reference now toFIGS. 2,30 and31, theimplant deployment mechanism500, which is used to deploy an implant will now be described. First, however, it should be noted that the term “deploy” as used in this patent refers to any adjustment of an implant after the implant has been initially placed into the vetebral space that involves relative motion of one portion of the implant with respect to another portion of the implant. Non-limiting examples of deployment include implants that have one portion that pivots or moves curvilinearly with respect to another portion and implants that have one portion that slides or moves linearly with respect to another portion. Implants that expand in any manner and in any direction fall under the definition of “deploy.” Second it should be noted that not all implants may require deployment. If this is the case, it should be noted that theinserter200 of this invention as described above will work well to insert such an implant. Third, it should be noted that the inventors contemplate multiple devices and methods for deploying an implant. While specific embodiments will be described, they should not be understood to be limiting but rather exemplary only.
• With reference now toFIGS. 2,13,20A,20B,32-33 and50-52, in one embodiment a compression force is used to deploy theimplant100. In this case, a compression force member may be used to “push” or “shove” theimplant100 for deployment. In one specific embodiment, the compression force member is a rigid rod orwire520 that is positioned within thehandle opening304, theconnector opening362, and thegripper opening422. To deploy theimplant100 it is only necessary to apply a compression force to the proximal end of thewire520 causing thewire520 to move in the distal direction B until the distal end of thewire520 extends out of the distal end of thegripper420 and contacts theimplant100 for deployment, as shown for example inFIGS. 32 and 50. This compression force can be activated by the surgeon using acompression force activator700.
• With reference now toFIGS. 2,13,20A,20B,32 and33, in one embodiment, shown inFIG. 20A, thecompression force activator700 includes ascrew702 and acompression knob704. Thescrew702 may be generally cylindrical and may have acontact surface706 at its distal end that is used to contact and move thecompression force member520. Thescrew702 may also have an opening720 throughout its length substantially in the radial center of thescrew702 that receives thecompression force member520. The outer surface of thescrew702 may have a threadedregion708 to engage thecompression knob704 as will be described below. While the threadedregion708 is shown to substantially cover the entire outer surface of thescrew702, it is to be understood that the threadedregion708 need not be that big. It is only necessary for the threadedregion708 to be sufficient in size to accomplish the purpose of this invention as determined with the sound judgment of a person of skill in the art. The distal end of thescrew702 may be inserted into thehandle opening304 on the proximal end of thehandle302 and may, in a more specific embodiment, threadably engage threads formed on the inside diameter of the proximal end of thehandle opening304. In an alternate embodiment, the proximal end of thehandle opening304 does not include threads that engage the threadedregion708 of thescrew702.
• With reference now toFIGS. 2,19,20A and23, thecompression knob704 may be used by the surgeon to increase or decrease compression force on thecompression force member520 during surgery. Thecompression knob704 may be generally cylindrical and may have anopening710 throughout its length that may be positioned substantially in the radial center of thecompression knob704. Thecompression knob704 may have a threadedregion712 defining at least a portion of the outer edge of theopening710 to engage with the threadedregion708 of thescrew702. The outer surface of thecompression knob704 may be contoured along the compression knob length, as shown, and may have a texturedregion714 to improve the grip for the surgeon. The proximal end of thecompression knob704 may be adapted to attach to acap580 as will be described further below. More specifically, thecompression knob704 may have a second threadedregion716 defining at least a portion of the outer edge of the opening710 (which may have a greater diameter, as shown) to engage with a threadedregion582 of thecap580. The distal end of thecompression knob704 may be adapted to engage the proximal end of thescrew702. More specifically, the distal end of thecompression knob704 may include a “nut-like”portion718 having an outer surface that is substantially shaped as a typical nut used to receive a bolt. Rotation of thecompression knob704 in a first direction F1 causes thescrew702 to move in the distal direction B with respect to thehandle302 until thecontact surface706 of thescrew702 contacts the proximal end of thecompression force member520. Continued rotation of thecompression knob704 in the first direction F1 causes thescrew702 and thecompression force member520 to move in the distal direction B so that the distal end of thecompression force member520 can contact theimplant100. Rotation of thecompression knob704 in a second direction F2 causes thescrew702 to move in the proximal direction A and reduces the force on thecompression force member520. For this embodiment, thecompression knob704 does not move distally or proximally with respect to thehandle302 as it is rotated.
• With reference now toFIGS. 2,19,20A and23-25, in one embodiment the previously mentioncap580 may be used with theinserter200 of this embodiment. Thecap580 may be generally cylindrical and may have anopening584 extending partially through its length that may be positioned substantially in the radial center of thecap580. The outer surface of thecap580 may be contoured along the cap length, as shown. The proximal end of thecap580 may have anouter surface586 that is adapted to receive a direct force from a surgical mallet, slap hammer or the like for use in positioning theinserter200. For this reason thecap580 is preferably centered on the longitudinal axis of theinserter200. It should be noted, however, that thecap580 can be positioned anywhere chosen with the sound judgment of a person of skill in the art. The distal end of thecap580 may be adapted to receive the proximal end of thescrew532 and to attach to the proximal end of thecompression knob704. In a specific embodiment, the distal end of thecap580 may have an outer surface with a threadedregion582 that engages the second threadedregion716 of thecompression knob704. Theopening584 may receive the proximal end of thescrew702 as thecompression knob704 is rotated as explained above. It should also be noted that thecap580 can be easily removed to access thescrew702 and thecompression force member520 for loading and removal of thecompression force member520 from theimplant200.
• With reference now toFIG. 20B,32-33 and50-51, in another embodiment shown inFIG. 20B, thecompression force activator700 is acompression trigger mechanism750. Thecompression trigger mechanism750 may include abody752, ahold member754 and atrigger756. Thetrigger756 may have acontact surface758 at a first end that is used to contact and move thecompression force member520. At the second end, thetrigger756 may have agrip surface760. Between its ends, thetrigger756 may be pivotally connected, such as with apivot pin762, to thebody752 or to thehold member754. The distal end of thebody752 may be connected to the proximal end of thehandle302 in any manner chosen with the sound judgment of a person of skill in the art. Thebody752 may have anopening764 that is collinear with theopening304 formed in thehandle302. To increase the compression force on thecompression force member520 during surgery, the surgeon simply places thehold member754 in his/her palm, places his/her fingers on thegrip surface760 of thetrigger756 and squeezes. This squeezing causes the second end of thetrigger756 to move in proximal direction A and to thus pivot thetrigger756 aboutpivot pin762. This motion in turn causes thecontact surface758 to move in distal direction B until thecontact surface758 contacts the proximal end of thecompression force member520. Continued squeezing of thetrigger756 causes thecompression force member520 to move in the distal direction B so that the distal end of thecompression force member520 can contact theimplant100.
• With reference now toFIGS. 2,13,19,20C and34-46, in another embodiment a tension force is used to deploy theimplant100. In this case, a tension force member may be used to “pull” on some portion of theimplant100 for deployment. In one specific embodiment, the tension force member is acable560 that is positioned within thehandle opening304, theconnector opening362, and thegripper opening422. To deploy theimplant100 it is only necessary to apply a force to the proximal end of thecable560 causing thecable560 to move in the proximal direction A until the desired motion occurs at theimplant100. This tension force can be activated by the surgeon using atension force activator530. In one embodiment, thetension force activator530 includes ascrew532 and atension knob550. Thescrew532, as seen best inFIGS. 19-20, may be generally cylindrical and may have anopening534 throughout its length substantially in the radial center of thescrew532 that receives thecable560. The outer surface of thescrew532 may have a threadedregion536 to engage thetension knob550 as will be described below. While the threadedregion536 is shown to substantially cover the entire outer surface of thescrew532, it is to be understood that the threadedregion536 need not be that big. It is only necessary for the threadedregion536 to be sufficient in size to accomplish the purpose of this invention as determined with the sound judgment of a person of skill in the art. Thescrew532 may also have one or more spherical radii538 (four used in the shown embodiment).
• With reference now toFIGS. 2,5,19 and20C, the distal end of thescrew532 may be inserted into thehandle opening304 on the proximal end of thehandle302. At least one ball plunger540 (two used in the shown embodiment) may be inserted into theproximal holes308,309 formed in the proximal end of thehandle302. Eachball plunger540 engages one of thespherical radii538 to secure thescrew532 to thehandle302 in a manner known in the art. The proximal end of thescrew532 may extend out of thehandle302 and engage thetension knob550 as will be described below.
• With reference now toFIGS. 2,19,20C and23, thetension knob550 may be used by the surgeon to increase or decrease tension force on thecable560 during surgery. Thetension knob550 may be generally cylindrical and may have anopening552 throughout its length that may be positioned substantially in the radial center of thetension knob550. Thetension knob550 may have a threadedregion554 defining at least a portion of the outer edge of theopening552 to engage with the threadedregion536 of thescrew532. The outer surface of thetension knob550 may be contoured along the tension knob length, as shown, and may have a texturedregion556 to improve the grip for the surgeon. In one embodiment, the proximal end of thetension knob550 may be adapted to attach to thecap580. More specifically, thetension knob550 may have a second threadedregion558 defining at least a portion of the outer edge of the opening552 (which may have a greater diameter, as shown) to engage with a threadedregion582 of thecap580. Thecap580 can be easily removed to access thetension force member560. The distal end of thetension knob550 may be adapted to engage the proximal end of thescrew532. More specifically, the distal end of thetension knob550 may include a “nut-like”portion559 having an outer surface that is substantially shaped as a typical nut used to receive a bolt.
• With reference now toFIGS. 2,19,20C,49A,49B and49C, the tension force member, which may becable560, may be attached to theimplant deployment mechanism500 in any manner chosen with the sound judgment of a person of skill in the art. In one embodiment, thecable560 is attached to thescrew532. In one more specific embodiment shown inFIG. 49A, aset screw800 may be received in a hole formed in the proximal end of thescrew532. The proximal end of thecable560 can be wrapped around theset screw800 and theset screw800 can then be tightened to thescrew532 to secure thecable560. For one embodiment using bothcable560 ends or in another embodiment where twocables560 are used, a pair ofset screws800,800 may be used to secure the cable(s) as shown. In another embodiment shown inFIG. 49B, one or more collars802 may be attached to thescrew532. A cable end is then inserted through anopening804 in the collar802 and the collar802 is rotated to tighten against thecable560, to secure thecable560, in a manner known in the art. In yet another embodiment shown inFIG. 49C, areel device806 may be attached to thescrew532. A cable end is then received on and rotated about thereel device806 to secure thecable560 in a manner known in the art. While the previous discussed concerned various embodiments for attaching thecable560 to thescrew532, it should be understood that the same embodiments could also be used to attach thecable560 to another portion of theinserter200, such as to thetension knob550. It should also be understood that while theset screw800, collar802 andreel device806 where described as receiving one cable end, they each could receive multiple cable ends or non-end portions of thecable560. In this case, only oneset screw800, collar802 orreel device806 is required even if multiple cables or cable portions are secured to theimplant deployment mechanism500.
• With reference now toFIGS. 19 and 20D, in another embodiment thetension knob550 may be used without the previously describedscrew532. Thetension knob550 may be attached to arotatable shaft562 that can be rotated by thetension knob550 and about which thecable560 can be wound. Thetension knob550 may extend laterally from theinserter200, as shown. Thetension knob550 may, in one embodiment, be ratcheted so that successive turns of thetension knob550 increase the tension on thecable560. In yet another embodiment, theimplant deployment mechanism500 may include an axle/cam mechanism (not shown). The surgeon may choose from a series of suture or cabling materials that have diameters allowing passage through theinserter200 and cable receiving holes in theimplant100. Each of these materials has an intrinsic tensile strength with differing loads to failure. In one embodiment, theimplant deployment mechanism500 may be calibrated to match the various tensile strengths of the suture/cabling material. In a more specific embodiment, thetension knob550 may be designed to provide audible sounds, “clicks” for example. As thetension knob550 is rotated, it may provide a first audible sound that signifies that theimplant100 has been deployed. As thetension knob550 is rotated further, it may provide a second audible sound that signifies that the cabling material is about to fail.
• With reference now toFIG. 20E, in another embodiment thetension force activator530 includes atension trigger mechanism850. Thetension trigger mechanism850 may include abody852, ahold member854 and atrigger856. Thetrigger856 may have anattachment surface858 at a first end that is used to attach to and move thecable560. Thecable560 may be attached to thetrigger856 in any manner chosen with the sound judgment of a person of skill in the art. At the second end, thetrigger856 may have agrip surface860. Between its ends, thetrigger856 may be pivotally connected, such as with apivot pin862, to thebody852 or to thehold member854. The distal end of thebody852 may be connected to the proximal end of thehandle302 in any manner chosen with the sound judgment of a person of skill in the art. Thebody852 may have anopening864 that is collinear with theopening304 formed in thehandle302. To increase the tension force on thecable560 during surgery, the surgeon simply places thegrip surface860 of thetrigger856 in his/her palm, places his/her fingers on thehold member854 and squeezes. This squeezing causes the second end of thetrigger856 to move in distal direction B and to thus pivot thetrigger856 aboutpivot pin862. This motion in turn causes theattachment surface858 to move in proximal direction A until theattachment surface858 exerts a tension force on thecable560. Continued squeezing of thetrigger856 causes thecable560 to move in the proximal direction A so that the distal end of thecable560 can exert a tension force on theimplant100.
• With reference now to FIGS.2 and26-33, theinserter200 of this invention may also include animplant anti-deployment mechanism600 that prevents theimplant deployment mechanism500 from operating until the surgeon is ready to operate it. In one embodiment, theimplant anti-deployment mechanism600 includes atube member620 that may be adjusted by the surgeon to permit operation of theimplant deployment mechanism500. Thetube member620 may be generally cylindrical and may have anopening622 throughout its length. Thisopening622 may be positioned substantially in the radial center of thetube member620 and may receive thegrip activator460. The proximal end of thetube member620 may have two ormore arms624, four shown, separated by aspace626 between thearms624. A threadedregion628 may be formed on the outer surfaces of thearms624 to receive a securing device, which in one embodiment includes anut650 as shown in FIGS.2 and27-28. Thenut650 may be generally cylindrical and may have anopening652 throughout its length that may be positioned substantially in the radial center of thenut650 and may be used to receive thetube member620, as shown. Thenut650 may have an outer surface having atextured region654 to improve the grip for the surgeon. Theopening652 may have a threadedregion656 that engages the threadedregion628 of the tube member.
• With continuing reference to FIGS.2 and26-33, thetube member620 may have a generally circumferential extendingsurface630 distally positioned from the threadedregion628 that extends from the outer surface of thetube member620. The extendingsurface630 may serve two functions. First, it may act as a motion limiter to limit the movement of the nut in the distal direction B once thenut650 has been disengaged from the threadedregion628 of thetube member620. The second function of the extendingsurface630 is to serve as a textured region to improve the grip for the surgeon when the surgeon is moving thetube member620. The distal end of thetube member620 may be adapted to prevent theimplant deployment mechanism500 from operating by interfering with theimplant100. In a specific embodiment, aclip632 extends from the distal end of thetube member620 and it contacts theimplant100, as shown inFIG. 30, preventing theimplant100 from being deployed. In yet a more specific embodiment, shown best inFIG. 31, the distal end of theclip632 may be sized to be received within thegap434 formed in thehand428. This provides for a secure arrangement and minimizes the required length of theclip632. Thegap434 also provides a resting place for theclip632, also shown inFIG. 31, as the tip of theclip632 rests on thehand428 at the proximal end of thegap434 after thetube member620 has been adjusted to permit deployment of theimplant100. Theclip632 may have three sections along its length, aproximal section631, a mid-section633, and adistal section635. Theproximal section631 is attached to thetube member620 and is at the same radial position as thetube member620. The mid-section633 is relatively radially inward and has aninner surface636 that contacts the outer surface of thegrip activator460. Thedistal section635 extends even farther radially inward to contact the implant and to rest against thehand428, as described above.
• With reference now toFIGS. 2,30-48 and50-51, theinserter200 of this invention may be used to insert and, if required, deploy any implant chosen with the sound judgment of a person of skill in the art. The implant may be, for non-limiting examples, any of the implants described in commonly owned U.S. patent application Ser. No. 11/236,068, publication number US 2007/0073398, published on Mar. 29, 2007, titled SPINE SURGERY METHOD AND IMPLANT, which is incorporated herein by reference. While the embodiments discussed below are to implants having four outer posts, it should be understood that other post arrangements are also contemplated. In one embodiment, for example, more than four posts may be used. In another embodiment, less than four posts may be used. In yet another embodiment, one of the posts (or the only post or central support structure) is positioned substantially in the axial center of the implant. In this case it may be desirable to contact the central post for insertion purposes and/or for deployment purposes.
• With continuing reference toFIGS. 2,30-48 and50-51, as noted above with regard to the rod orwire520, in one embodiment a given implant may be deployed by exerting a compression force on some portion of the implant. Two specific wire deployed implants will now be described. In both cases, as shown by comparingFIG. 30 withFIG. 32 and by comparingFIG. 50 withFIG. 51, theimplant100 may deploy by rotating one portion of the implant with respect to the other to expand the effective surface area of theimplant100. Also in both cases, the implant is formed ofupper limbs104 andlower limbs106 connected to each other with fourposts110.
• The first embodiment is shown inFIGS. 32-33. For this embodiment thewire520 takes a linear path as it exits theinserter200 and contacts theimplant100. In one specific embodiment, thepost110 gripped by thegripper420 has alinear opening114 that receives thewire520 when it is extended out from theinserter200. Continued extension of thewire520 causes the distal end of thewire520 to contact another implant surface, such as anotherpost110, to cause theimplant100 to deploy.
• The second embodiment is shown inFIGS. 50-51. For this embodiment thewire520 takes a curvilinear path as it contacts theimplant100. In one specific embodiment, thepost110 gripped by thegripper420 has acurvilinear opening116 that receives thewire520 when it is extended out from theinserter200. Continued extension of thewire520 causes the distal end of thewire520 to contact another implant surface, such as anotherpost110, to cause theimplant100 to deploy. In a more specific embodiment, the portion of theimplant100 that contacts the distal end of thewire520 has adivot118 on its surface that matches the surface shape of the distal end of thewire520. In this way, the distal end of thewire520 is received in thedivot118 making it easier for thewire520 to stay in contact with the implant surface as it moves through the curvilinear motion.
• With reference now toFIGS. 34-46, as also noted above with regard to acable560, in another embodiment a given implant may be deployed by exerting a tension force on a cable to cause the implant to deploy. Two specific cable deployed implants will now be described. In both cases, as with the previous embodiments, theimplant100 may deploy by rotating one portion of the implant with respect to the other to expand the effective surface area of theimplant100. Also, theimplant100 is formed ofupper limbs104 andlower limbs106 connected to each other with fourposts110. For the embodiment shown inFIGS. 34-37, only two of theposts110 are used to deploy theimplant100. For the embodiment shown inFIGS. 38-46, three of theposts110 are used to deploy theimplant100. In both cases theposts110 required for deployment havepost holes112 that receive thecable560 in any manner chosen with the sound judgment of a person of skill in the art.
• With reference now to all the FIGURES but especiallyFIG. 2, the operation of theinserter200 of this invention will now be described. First, the surgeon decides what type, style and size of implant to be inserted. The surgeon then assembles the appropriate inserter accordingly. It should be noted that thesame handle mechanism300 can be used with numerous implant gripping mechanisms and, if required, numerous implant deployment mechanisms and implant anti-deployment mechanisms. If a compression force member such asrigid wire520 is to be used as theimplant deployment mechanism500, theinserter200 can be assembled and therigid wire520 can be inserted and positioned into thehandle opening304, theconnector opening362, and thegripper opening422. If a tension force member such ascable560 is to be used as theimplant deployment mechanism500, thecable560 can be attached to the implant (in the non-deployed condition) and then inserted through thegripper opening422, theconnector opening362, and thehandle opening304. With thecap580 removed, thecable560 can then be connected to theimplant deployment mechanism500 in a manner consistent with thetension force activator530 being used. Thecap580 can then be attached.
• With continuing reference to all the FIGURES but especiallyFIGS. 1A,1B and47-48, with theinserter200 of this invention thevetebral space22 may be approached using universally accepted methods for anterolateral, posterior, or posterolateral (transforaminal) discectomy. Assuming a standard approach to the posterior/posterolateral annulus of the targeted disc, appropriate retraction of the neighboring neural structures is accomplished with universally available nerve root retractors. For a posterior/posterolateral approach this would include retraction of the dural sac towards the midline and retraction of the adjacent cephalad and caudad nerve roots, as would normally be done for routine discectomy. Upon isolating the annular surface of the targeted disc or targeted vertebra, variable needle sounds are placed in thevetebral space22 with a range of radii of curvature. The range of these sounds would have been selected on the basis of pre-operative templating of available imaging studies, including plain radiographs, CT or MRI imaging. This preoperative templating provides a narrower range of radii for intraoperative confirmation, decreasing trial and error sounding. The objective of this intraoperative needle sound placement is to locate the center of thevetebral space22. The placement of this sound would be confirmed via biplanar intraoperative fluoroscopic imaging.
• Still referring to all the FIGURES but especiallyFIGS. 1A,1B and47-48, once the surgeon is satisfied with the centralization of the needle tipped sound, routine discectomy is carried out using universally accepted instruments. Thevetebral space22 is then initially distracted with short, straight interbody spacers, progressively sized until sufficient annular tension is achieved. Once this point is reached, longer, variable radii, curvilinear box chisels may be advanced into thevetebral space22 to remove disc and/or vertebral material and cartilaginous endplate. Once a majority of intradiscal material is removed, an endplate cutter may be advanced to the entry point to make graduated cuts in the periphery of the endplate to remove the normal concave tapering of the bony endplate towards the periphery of the vertebrae. This process would insure true distraction of thevetebral space22 from the center. A distractor is then placed within thevetebral space22 and distraction to the selected level of annular tension is achieved. The degree of this distraction would be based on surgeon preference and/or thevetebral space22 height of neighboring non-degenerative discs or vertebra. With this optimal distraction, further discectomy, or removal of disc material, may be accomplished. The distractor is then placed at the presumed center of thevetebral space22 and centralized placement confirmed by intraoperative fluoroscopic imaging. Adjustments, if necessary, may be made in anterior-posterior and medial-lateral orientation until centralization of the distractor is confirmed. The distractor used may be of any type or style chosen with the sound judgment of a person of skill in the art. A non-limiting example is the distractor as described in commonly owned U.S. patent application Ser. 11/756,168, titled SPINE SURGERY METHOD AND INSTRUMENTATION, which is incorporated herein by reference.
• With reference now to all the FIGURES, theimplant100 is then affixed to or gripped by theinserter200 with theimplant gripping mechanism400. In one embodiment, to activate thegripper420 to grip theimplant100, the surgeon grips thetextured region464 of thegrip activator460 with one hand and, while holding thehandle302 with the other hand, rotates thegrip activator460 about its longitudinal axis in a first direction D1, as shown inFIG. 18. This causes thegrip activator460 to move longitudinally in the distal direction B with respect to thegripper420 as the threadedregion466 of thegrip activator460 meshes with the threaded region of thegripper420 in a known manner. As thegrip activator460 moves in distal direction B, it contacts the outer surfaces of thearms426,427, causing thearms426,427 as well as thehands428,429 to “squeeze” or move towards each other to thereby grip a portion, one of theposts110 for example as shown inFIG. 30, of theimplant100. The surgeon can continue to rotate thegrip activator460 until theimplant100 is sufficiently gripped for surgery.
• With continuing reference to all the FIGURES, theinserter200 is then moved to insert theimplant100 within thevertebral space22. If necessary, a surgical mallet or slap hammer may be used to transfer forces to thecap580 to advance theimplant100 to the proper location. Biplanar fluoroscopic imaging may be used to confirm proper positioning of theimplant100. Adjustments, if necessary, can be made at this time by adjusting the amount of distraction and/or orientation of the distractor in the axial or frontal planes.
• Still referring to all the FIGURES, if no deployment is required, theinserter200 and distractor can be removed and bone grafting is completed by packing in the open profile of theimplant100. If deployment is required, theimplant deployment mechanism500 must be activated. However, if animplant anti-deployment mechanism600 is used, it must first be adjusted by the surgeon to permit deployment.FIG. 30 shows theimplant anti-deployment mechanism600 positioned to prevent implant deployment. In one specific embodiment, the surgeon grips thetextured region654 of thenut650 with one hand and, while holding thehandle302 with the other hand, rotates thenut650 about its longitudinal axis in a first direction R1 as shown inFIG. 27. This causes thenut650 to move longitudinally in the distal direction B with respect to thetube member620 as the threadedregion558 of thenut650 meshes with the threaded region of thetube member620 in a known manner. As thenut650 moves in distal direction B, it releases or “un-tightens” from thetube member620. The surgeon can then let go of the nut650 (its motion is limited by the extending surface630) and grip instead the tube member620 (at the extendingsurface630, if desired) and move it in proximal direction A, as shown inFIGS. 32 and 33. As thetube member620 moves in proximal direction A, theclip632 moves out of contact with theimplant100 permitting deployment of theimplant100.FIGS. 31-32 show theimplant anti-deployment mechanism600 adjusted to permit implant deployment.
• With continuing reference to all the FIGURES, after theimplant anti-deployment mechanism600 is adjusted to permit deployment (or, if noimplant anti-deployment mechanism600 is used), theimplant deployment mechanism500 can be activated. If a compression force member such asrigid wire520 is used as theimplant deployment mechanism500, thewire520 is extended out of the distal end of thegripper opening422 where it contacts and deploys theimplant100 in a manner consistent with the particularcompression force activator700 that is used. If a tension force member such ascable560 is used as theimplant deployment mechanism500, thecable560 is tensioned to deploy theimplant100 in a manner consistent with the particulartension force activator530 that is used.
• Still referring to all the FIGURES, at this point, confirmation ofsatisfactory implant100 alignment within thevetebral space22 may be confirmed by intraoperative biplanar fluoroscopic imaging. Adjustments, if necessary, can be made at this time by changing the degree of distraction and medial-lateral and anterior-posterior translation of theimplant100 by impaction/retraction or rotation with theinserter200 still in place. Oncesatisfactory implant100 alignment is achieved, it must be released from theimplant gripping mechanism400. In one embodiment, to activate thegripper420 to release theimplant100, the surgeon grips thetextured region464 of thegrip activator460 with one hand and, while holding thehandle302 with the other hand, rotates thegrip activator460 about its longitudinal axis in a second direction D2, as shown inFIG. 18. This causes thegrip activator460 to move longitudinally in the proximal direction A with respect to thegripper420 as the threadedregion466 of thegrip activator460 meshes with the threaded region of thegripper420 in a known manner. As thegrip activator460 moves in proximal direction A, it moves out of contact with the outer surfaces of thearms426,427, permitting thearms426,427 as well as thehands428,429 to move away from each other to thereby release theimplant100. Theinserter200 is then removed followed by the distractor. With theimplant100 now inserted, bone grafting is completed by packing in the open profile of theimplant100.
• With continuing reference to all the FIGURES, all the implant embodiments may be formed of any material that is appropriate for insertion into an vetebral space, including, but not limited to metal, metal alloy, titanium, titanium alloy, ceramic, carbon-fiber, PEEK or any other osteobiologic or inert, biocompatible material. All the inserter embodiments may be formed of any biocompatible material suitable for surgical instruments.
• With continuing reference to all the FIGURES, the lengths of the various inserter components may be varied depending on patent parameters (such as patient size) and whether the spinal surgery is done open or via MIS techniques. In one specific embodiment,connectors360 of various lengths may be provided. In this case, the remaining components (handle302,gripper420, etc.) can be of the same length but be used withconnectors360 of different lengths in order to accommodate the specific patent and surgery methodology.
• Numerous embodiments have been described, hereinabove. It will be apparent to those skilled in the art that the above methods and apparatuses may incorporate changes and modifications without departing from the general scope of this invention. It is intended to include all such modifications and alterations in so far as they come within the scope of the appended claims or the equivalents thereof.
• Having thus described the invention, it is now claimed:

Claims (68)

1. A device comprising: a surgical inserter for use in inserting an implant into a vertebral space, the inserter comprising:

a handle having first and second ends for use by a surgeon;

an implant gripping mechanism comprising: a gripper having a first end attached to the second end of the handle and a second end having a pair of arms; and, a grip activator having an opening that threadingly receives the gripper;

wherein the grip activator can be rotated in a first direction with respect to the gripper to cause the arms to move toward each other to grip the inserter; and,

wherein the grip activator can be rotated in a second direction with respect to the gripper to cause the arms to move away from each other to release the inserter.

2. The device ofclaim 1 wherein each arm has a hand having contact surface that is used to physically contact a surface of the implant.

3. The device ofclaim 2 wherein one hand has a gap between two hand portions and the other hand has a tang that is received within a groove in the implant.

4. The device ofclaim 1 wherein the surgical inserter further comprises:

a connector having a first end attached to the second end of the handle and a second end attached to the first end of the gripper.

5. The device ofclaim 1 wherein:

the gripper has an outer surface with a threaded region; and, the opening in grip activator is along the entire length of the grip activator and is at least partially defined by a threaded region that engages the threaded region of the gripper.

6. The device ofclaim 1 wherein the surgical inserter further comprises:

an implant deployment mechanism for use in deploying the implant.

7. The device ofclaim 6 wherein:

the gripper has an opening; and,

the implant deployment mechanism comprises:

(1) a compression force member, wherein at least a portion of the compression force member is received within the opening in the gripper; and,

(2) a compression force activator that can apply a force to the compression force member to extend the compression force member out of the opening from the second end of the gripper and into contact with the implant.

8. The device ofclaim 7 wherein:

the handle has an opening; and,

wherein at least a portion of the compression force member is received within the opening in the handle.

9. The device ofclaim 6 wherein:

the gripper has an opening; and,

the implant deployment mechanism comprises:

(1) a tension force member that is operatively connected to the implant, wherein at least a portion of the tension force member is received within the opening in the gripper; and,

(2) a tension force activator that can apply a tension force to the tension force member to deploy the implant.

10. The device ofclaim 9 wherein the tension force activator comprises:

a screw having a first end and a second end that is operatively connected to the first end of the handle, the screw having a threaded region;

a tension knob having an opening that is at least partially defined by a threaded region that engages the threaded region of the screw;

wherein the handle, the screw, and the tension knob each have an opening that receives at least a portion of the tension force member; and,

wherein the tension knob is rotatable with respect to the screw to apply the tension force to the tension force member to deploy the implant.

11. The device ofclaim 6 wherein the surgical inserter further comprises:

an implant anti-deployment mechanism for use in preventing the implant deployment mechanism from operating until the surgeon is ready to operate it.

12. The device ofclaim 11 wherein the implant anti-deployment mechanism comprises:

a tube member that can contact the implant and that has an opening that receives the grip activator; and,

a securing device for use in securing the tube member in contact with the implant to prevent deployment of the implant.

13. The device ofclaim 12 wherein:

the tube member has an outer surface with a threaded region;

the securing device comprises a nut having an opening that is at least partially defined by a threaded region that engages the threaded region of the gripper.

14. The device ofclaim 13 wherein the tube member comprises:

a motion limiter that limits the movement of the nut toward the implant, the motion limiter defined by an extending surface that extends from the outer surface of the tube member.

15. The device ofclaim 13 wherein:

the threaded region of the tube member is positioned at a first end of the tube member; and,

a clip for use in contacting the implant extends from a second end of the tube member.

16. The devise ofclaim 15 wherein:

one hand has a gap between two hand portions; and,

the clip is received within the gap when contacting the implant.

17. The device ofclaim 7 wherein the compression force activator comprises:

a screw having a first end with a contact surface that contacts the compression force member and a second end that is operatively connected to the first end of the handle, the screw having a threaded region;

a compression knob having an opening that is at least partially defined by a threaded region that engages the threaded region of the screw;

wherein the handle, the screw, and the compression knob each have an opening that receives at least a portion of the compression force member; and,

wherein the compression knob is rotatable with respect to the screw to apply the compression force to the compression force member to deploy the implant.

18. The device ofclaim 17 wherein the surgical inserter further comprises:

a cap comprising: a first end that is attached to the compression knob; a second end that has an outer surface that is adapted to receive a direct force from a surgical mallet; and, an opening that receives at least a portion of the screw.

19. The device ofclaim 7 wherein the compression force activator comprises a compression trigger mechanism comprising:

a body that is operatively connected to the first end of the handle;

a hold member;

a trigger that has a contact surface that contacts the compression force member and that is pivotally connected to the compression trigger mechanism; and,

wherein the trigger can be pivoted toward the hold member to apply the compression force to the compression force member to deploy the implant.

20. The device ofclaim 10 wherein the surgical inserter further comprises:

a cap comprising: a first end that is attached to the tension knob; a second end that has an outer surface that is adapted to receive a direct force from a surgical mallet; and, an opening that receives at least a portion of the screw.

21. The device ofclaim 10 wherein the tension force activator further comprises:

at least one set screw that tightens at least a portion of the tension force member to the inserter.

22. The device ofclaim 21 wherein the at least one set screw tightens the at least a portion of the tension force member to the screw.

23. The device ofclaim 10 wherein the tension force activator further comprises:

at least one collar having an opening that receives at least a portion of the tension force member and that tightens the at least a portion of the tension force member to the inserter.

24. The device ofclaim 23 wherein the at least one collar tightens the at least a portion of the tension force member to the screw.

25. The device ofclaim 10 wherein the tension force activator further comprises:

at least one reel device that receives at least a portion of the tension force member and that tightens the at least a portion of the tension force member to the inserter.

26. The device ofclaim 25 wherein the at least one reel device tightens the at least a portion of the tension force member to the screw.

27. The device ofclaim 9 wherein the tension force activator comprises:

a shaft that receives at least a portion of the tension force member and that extends laterally from the inserter;

a tension knob operatively connected to the shaft; and,

wherein the tension knob is rotatable with respect to the handle to apply the tension force to the tension force member to deploy the implant.

28. The device ofclaim 9 wherein the tension force activator comprises a tension trigger mechanism comprising:

a body that is operatively connected to the first end of the handle;

a hold member;

a trigger that has an attachment surface that attaches to the tension force member and that is pivotally connected to the tension trigger mechanism; and,

wherein the trigger can be pivoted toward the hold member to apply the tension force to the tension force member to deploy the implant.

29. A surgical system comprising:

an implant comprising:

(a) a first portion having an opening;

(b) a second portion; and,

(c) wherein the implant may be deployed by moving the second portion with respect to the first portion; and,

a surgical inserter for use in inserting the implant into a vertebral space and deploying the implant within the vertebral space, the inserter comprising:

(a) a handle having first and second ends for use by a surgeon;

(b) an implant gripping mechanism comprising: a gripper having a first end attached to the second end of the handle and a second end having a pair of arms that can grip and release the first portion of the inserter, the gripper also having an opening; and,

(c) an implant deployment mechanism comprises:

(1) a compression force member, wherein at least a portion of the compression force member is received within the opening in the gripper; and,

(2) a compression force activator that applies a force to the compression force member to extend the compression force member through the gripper opening, through the opening in the first portion of the implant, and into contact with the second portion of the implant to deploy the implant.

30. The surgical system ofclaim 29 wherein the implant may be deployed by rotating the second portion with respect to the first portion.

31. The surgical system ofclaim 29 wherein the opening in the first portion of the implant is linear.

32. The surgical system ofclaim 29 wherein the opening in the first portion of the implant is curvilinear.

33. The surgical system ofclaim 29 wherein the second portion of the implant has a divot that receives an end of the compression force member during deployment of the implant.

34. The surgical system ofclaim 29 wherein the gripper opening is formed substantially in the radial center of the gripper.

35. The surgical system ofclaim 29 wherein:

the handle has an opening formed substantially in the radial center of the handle; and,

the compression force activator applies a force to the compression force member to extend at least a portion of the compression force member through the handle opening.

36. The surgical system ofclaim 29 wherein the compression force activator comprises:

a screw having a first end with a contact surface that contacts the compression force member and a second end that is operatively connected to the first end of the handle, the screw having a threaded region;

a compression knob having an opening that is at least partially defined by a threaded region that engages the threaded region of the screw;

wherein the handle, the screw, and the compression knob each have an opening that receives at least a portion of the compression force member; and,

wherein the compression knob is rotatable with respect to the screw to apply the compression force to the compression force member to deploy the implant.

37. The surgical system ofclaim 29 wherein the compression force activator comprises a compression trigger mechanism comprising:

a body that is operatively connected to the first end of the handle;

a hold member;

a trigger that has a contact surface that contacts the compression force member and that is pivotally connected to the compression trigger mechanism; and,

wherein the trigger can be pivoted toward the hold member to apply the compression force to the compression force member to deploy the implant.

38. A surgical system comprising:

an implant comprising:

(a) a first portion having a first opening;

(b) a second portion; and,

(c) wherein the implant may be deployed by moving the second portion with respect to the first portion; and,

a surgical inserter for use in inserting the implant into a vertebral space and deploying the implant within the vertebral space, the inserter comprising:

(a) a handle having first and second ends for use by a surgeon;

(b) an implant gripping mechanism comprising: a gripper having a first end attached to the second end of the handle and a second end having a pair of arms that can grip and release the first portion of the inserter, the gripper also having an opening; and,

(c) an implant deployment mechanism comprises:

(1) a tension force member that is operatively attached to the second portion of the implant, wherein at least a portion of the tension force member is received within the first opening in the first portion of the implant, and wherein at least a portion of the tension force member is received within the opening in the gripper; and,

(2) a tension force activator that applies a tension force to the tension force member to pull the tension force member through the first opening in the first portion of the implant, and through the gripper opening to deploy the implant.

39. The surgical system ofclaim 38 wherein the implant may be deployed by rotating the second portion with respect to the first portion.

40. The surgical system ofclaim 38 wherein:

the first portion of the inserter has a second opening; and,

at least a portion of the tension force member is received within the second opening in the first portion of the implant.

41. The surgical system ofclaim 38 wherein:

the second portion of the inserter has a first opening; and,

at least a portion of the tension force member is received within the first opening in the second portion of the implant.

42. The surgical system ofclaim 38 wherein:

the first portion of the implant comprises first and second posts;

the first opening in the first portion is formed in the first post;

a second opening in the first portion is formed in the second post; and,

at least a portion of the tension force member is received within the second opening in the second post.

43. The surgical system ofclaim 38 wherein the gripper opening is formed substantially in the radial center of the gripper.

44. The surgical system ofclaim 38 wherein:

the handle has an opening formed substantially in the radial center of the handle; and,

the tension force activator applies a force to the tension force member to extend at least a portion of the tension force member through the handle opening.

45. The surgical system ofclaim 38 wherein the tension force activator comprises:

a screw having a first end and a second end that is operatively connected to the first end of the handle, the screw having a threaded region;

a tension knob having an opening that is at least partially defined by a threaded region that engages the threaded region of the screw;

wherein the handle, the screw, and the tension knob each have an opening that receives at least a portion of the tension force member; and,

wherein the tension knob is rotatable with respect to the screw to apply the tension force to the tension force member to deploy the implant.

46. The surgical system ofclaim 38 wherein the tension force activator comprises a tension trigger mechanism comprising:

a body that is operatively connected to the first end of the handle;

a hold member;

a trigger that has an attachment surface that attaches to the tension force member and that is pivotally connected to the tension trigger mechanism; and,

wherein the trigger can be pivoted toward the hold member to apply the tension force to the tension force member to deploy the implant.

47. A method comprising the steps of:

(A) providing an implant made to be placed into a vertebral space;

(B) providing a surgical inserter comprising: a handle having first and second ends for use by a surgeon; a gripper having a first end attached to the second end of the handle and a second end having a pair of arms; and, a grip activator having an opening in that threadingly receives the gripper;

(C) preparing the vertebral space to receive the implant;

(D) rotating the grip activator with respect to the gripper to cause the arms to move toward each other to grip the inserter;

(E) moving the surgical inserter to insert the implant within the vertebral space;

(F) rotating the grip activator with respect to the gripper to cause the arms to move away from each other to release the inserter; and,

(G) moving the surgical inserter away from the vertebral space.

48. The method ofclaim 47 wherein:

step (D) comprises the step of rotating the grip activator in a first direction; and,

step (F) comprises the step of rotating the grip activator in a second direction that is substantially opposite to the first direction.

49. The method ofclaim 47 wherein:

step (D) comprises the step of moving the grip activator toward the implant; and,

step (F) comprises the step of moving the grip activator away from the implant.

50. The method ofclaim 49 wherein:

the step of, moving the grip activator toward the implant, comprises the step of: contacting the outer surfaces of the arms with the grip activator; and,

the step of, moving the grip activator away from the implant, comprises the step of: moving the grip activator out of contact with the arms.

51. The method ofclaim 47 wherein:

step (A) comprises the step of: providing the implant with a groove;

step (B) comprises the step of: providing one of the arms with a hand having a contact surface for use in contacting the implant, the hand having a tang extending from the contact surface; and,

step (D) comprises the step of: inserting the tang within the groove in the implant.

52. The method ofclaim 47 wherein:

step (B) comprises the step of: providing the inserter with a cap having a first end with an outer surface and a second end that is attached the first end of the handle; and,

step (E) comprises the step of: applying a force to the outer surface of the first end of the cap.

53. The method ofclaim 47 wherein:

step (A) comprises the step of: providing the implant to be deployable; and,

prior to step (G) the method further comprising the step of: (H) deploying the implant with the inserter.

54. The method ofclaim 53 wherein prior to step (H) the method further comprising the step of:

(I) adjusting an anti-deployment mechanism to permit deployment of the implant.

55. The method ofclaim 54 wherein:

step (B) comprises the step of: providing the surgical inserter with an anti-deployment mechanism comprising: a tube member having an opening that receives the grip activator; and,

step (I) comprises the steps of: moving the tube member out of contact with the implant.

56. The method ofclaim 55 wherein:

step (B) comprises the step of: providing the anti-deployment mechanism with a nut that threadingly receives the tube member; and,

prior to the step of, moving the tube member out of contact with the implant, the method comprises the step of: rotating the nut with respect to the tube member to release the tube member.

57. The method ofclaim 54 wherein:

step (B) comprises the step of: providing one of the arms with a hand having a gap between two hand portion; and,

step (I) comprises the step of: moving a portion of the tube member within the gap.

58. The method ofclaim 53 wherein

step (B) comprises the steps of: (1) providing the gripper with an opening; and, (2) providing the inserter with an implant deployment mechanism comprising: a compression force member, wherein at least a portion of the compression force member is received within the opening in the gripper; and,

step (H) comprises the step of: applying a force to the compression force member to extend the compression force member out of the opening from the second end of the gripper and into contact with the implant.

59. The method ofclaim 58 wherein:

step (B) comprises the step of: providing the surgical inserter with a compression force activator comprising: (1) a screw having a first end with a contact surface and a second end that is operatively connected to the first end of the handle, the screw having a threaded region; and, (2) a compression knob having an opening that is at least partially defined by a threaded region that engages the threaded region of the screw; and,

step (H) comprises the steps of:

(1) rotating the compression knob with respect to the screw;

(2) contacting a first end of the compression force member with the contact surface of the screw; and,

(3) contacting the implant with a second end of the compression force member.

60. The method ofclaim 59 wherein:

step (B) comprises the step of: providing the handle, the screw and the compression knob each with an opening; and,

step (H) comprises the steps of:

(1) extending at least a portion of the compression force member through the opening in the compression knob;

(2) extending at least a portion of the compression force member through the opening in the screw; and,

(3) extending at least a portion of the compression force member through the opening in the handle.

61. The method ofclaim 58 wherein:

step (B) comprises the step of: providing the surgical inserter with a compression force activator comprising: (1) a body that is operatively connected to the first end of the handle; (2) a hold member; and, (3) a trigger that has a contact surface and that is pivotally connected to the compression trigger mechanism; and,

step (H) comprises the steps of:

(1) pivoting the trigger toward the hold member;

(2) contacting a first end of the compression force member with the contact surface of the trigger; and,

(3) contacting the implant with a second end of the compression force member.

62. The method ofclaim 47 wherein:

step (B) comprises the steps of: (1) providing the gripper with an opening; and, (2) providing the inserter with an implant deployment mechanism comprising: a tension force member that is operatively connected to the implant, wherein at least a portion of the tension force member is received within the opening in the gripper; and,

step (H) comprises the step of: applying a tension force to the tension force member to deploy the implant.

63. The method ofclaim 62 wherein:

step (B) comprises the step of: providing the surgical inserter with a tension force activator comprising: (1) a shaft that receives at least a portion of the tension force member and that extends laterally from the inserter; and, (2) a tension knob operatively connected to the shaft; and,

step (H) comprises the steps of:

(1) rotating the tension knob;

(2) wrapping at least a portion of the tension force member about the shaft; and,

(3) applying a tension force to the implant.

64. The method ofclaim 62 wherein:

step (B) comprises the steps of: providing the surgical inserter with a tension force activator comprising: (1) a screw having a first end and a second end that is operatively connected to the first end of the handle, the screw having a threaded region, the screw operatively connected to the tension force member; and, (2) a tension knob having an opening that is at least partially defined by a threaded region that engages the threaded region of the screw; and,

step (H) comprises the steps of:

(1) rotating the tension knob;

(2) wrapping at least a portion of the tension force member about the shaft; and,

(3) applying a tension force to the implant.

65. The method ofclaim 64 wherein:

step (B) comprises the step of: providing the handle, the screw and the tension knob each with an opening; and,

step (H) comprises the steps of:

(1) extending at least a portion of the tension force member through the opening in the handle;

(2) extending at least a portion of the tension force member through the opening in the screw; and,

(3) extending at least a portion of the tension force member through the opening in the tension knob.

66. The method ofclaim 62 wherein:

step (B) comprises the steps of: providing the surgical inserter with a tension force activator comprising: (1) a body that is operatively connected to the first end of the handle; (2) a hold member; and, (3) a trigger that has an attachment surface that is attached to the tension force member and that is pivotally connected to the tension trigger mechanism; and,

step (H) comprises the steps of:

(1) pivoting the trigger toward the hold member; and,

(2) applying a tension force to the implant.

67. The method ofclaim 47 wherein:

step (C) comprises the step of: removing a disc to create an intradiscal space between two adjacent vertebrae that defines the vertebral space.

68. The method ofclaim 47 wherein:

step (C) comprises the step of: removing a vertebra and two adjacent discs to create a space between two remaining vertebrae that defines the vertebral space.

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