US20100030224A1 - Surgical tool and method for connecting a dynamic bone anchor and dynamic vertical rod - Google Patents

Abstract

A surgical tool and method is provided for connecting a dynamic vertical rod to a dynamic bone anchor. The tool has an internal shaft and an external sleeve arranged coaxially. The shaft can be turned relative to the sleeve. The sleeve has a head which engages the ball of a dynamic vertical rod. The shaft has a head which engages the deflectable post of the dynamic bone anchor. The tool is designed to turn the ball relative to the post securing the ball to the post. Optionally the post has a breakaway portion and the tool provided sufficient torque to remove the breakaway portion and also includes a mechanism for securing and retrieving the breakaway portion. The connection tool is sized to fit through a cannula to the operative site to allow minimally invasive implantation of the dynamic bone anchor.

Description

CLAIM TO PRIORITY
• This application claims priority to the following patents and patent applications:
• U.S. Provisional Application No. 61/100,593 filed Sep. 26, 2008, entitled “A Spine Implant With A Deflection Rod System Selectively Alignable And Selectively Lockable To A Bone Anchor And Method” (Attorney Docket No. SPART-01042US0); and
• U.S. Provisional Application No. 61/100,625 filed Sep. 26, 2008, entitled “Versatile Components And Methods For Dynamic Stabilization” (Attorney Docket No. SPART-01043US0); and
• U.S. Provisional Application No. 61/119,651 filed Dec. 3, 2008, entitled “Load-sharing Component Having A Deflectable Post And Methods For Dynamic Spinal Stabilization” (Attorney Docket No. SPART-01044US0); and
• U.S. Provisional Application No. 61/122,658 filed Dec. 15, 2008, entitled “Load-sharing Component Having A Deflectable Post And Methods For Dynamic Spinal Stabilization” (Attorney Docket No. SPART-01044US2); and
• U.S. Provisional Application No. 61/144,426 filed Jan. 13, 2009, entitled “Load-sharing Component Having A Deflectable Post And Methods For Dynamic Spinal Stabilization” (Attorney Docket No. SPART-01044US3); and
• U.S. Provisional Application No. 61/225,478 filed Jul. 14, 2009, entitled “Load-sharing Component Having A Deflectable Post And Methods For Dynamic Spinal Stabilization” (Attorney Docket No. SPART-01044US4); and
• U.S. Provisional Application No. 61/167,789 filed Apr. 8, 2009, entitled “Load-sharing Component Having A Deflectable Post And Spring And Methods For Dynamic Spinal Stabilization” (Attorney Docket No. SPART-01049US0); and
• U.S. Provisional Application No. 61/217,556 filed Jun. 1, 2009, entitled “Load-sharing Component Having A Deflectable Post And Axially-Compressible Spring And Methods For Dynamic Spinal Stabilization” (Attorney Docket No. SPART-01053US0).
• The present application is a continuation-in-part of U.S. patent application Ser. No. 12/130,395, filed May 30, 2008, entitled “A Deflection Rod System For A Dynamic Stabilization And Motion Preservation Spinal Implantation System And Method” (Attorney Docket No.: SPART-01037US1) which claims priority to U.S. Provisional Application No. 61/031,598 filed Feb. 26, 2008 and entitled “A Deflection Rod System For A Dynamic Stabilization And Motion Preservation Spinal Implantation System And Method” (Attorney Docket No. SPART-01037US0).
• The present application is also a continuation-in-part of U.S. patent application Ser. No. 12/130,095, filed May 30, 2008, entitled “A Spine Implant With A Deflection Rod System Including A Deflection Limiting Shield Associated With A Bone Screw And Method” (Attorney Docket No.: SPART-01039US2) which claims priority to U.S. Provisional Application No. 61/057,340 filed May 30, 2008, entitled “A Spine Implant With A Deflection Rod System Aligned With A Bone Anchor And Method” (Attorney Docket No.: SPART-01039US0).
• All of the afore-mentioned patent applications are incorporated herein by reference in their entireties.
CROSS-REFERENCES TO RELATED APPLICATIONS
• This application is related to all of the afore-mentioned patent applications. This application is also related to all of the following applications including:
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “A Modular In-Line Deflection Rod And Bone Anchor System And Method For Dynamic Stabilization Of The Spine” (Attorney Docket No. SPART-01042US1); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Versatile Polyaxial Connector Assembly And Method For Dynamic Stabilization Of The Spine” (Attorney Docket No. SPART-01043US1); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Versatile Offset Polyaxial Connector And Method For Dynamic Stabilization Of The Spine” (Attorney Docket No. SPART-01043US2); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Load-Sharing Bone Anchor Having A Deflectable Post and Method For Dynamic Stabilization Of The Spine” (Attorney Docket No. SPART-01044US1); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Load-Sharing Component Having A Deflectable Post And Method For Dynamic Stabilization Of The Spine” (Attorney Docket No. SPART-01044US5); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Load-Sharing Bone Anchor Having A Durable Compliant Member And Method For Dynamic Stabilization Of The Spine” (Attorney Docket No. SPART-01044US6); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Load-Sharing Bone Anchor Having A Deflectable Post With A Compliant Ring And Method For Stabilization Of The Spine” (Attorney Docket No. SPART-01044US7); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Load-Sharing Bone Anchor Having A Deflectable Post With A Compliant Ring And Method For Stabilization Of The Spine” (Attorney Docket No. SPART-01044US8); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Load-Sharing Bone Anchor Having A Deflectable Post And Method For Stabilization Of The Spine” (Attorney Docket No. SPART-01044US9); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Load-Sharing Bone Anchor Having A Deflectable Post And Method For Stabilization Of The Spine” (Attorney Docket No. SPART-01044USA); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Dynamic Spinal Rod And Method For Dynamic Stabilization Of The Spine” (Attorney Docket No. SPART-01044USC); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Dynamic Spinal Rod Assembly And Method For Dynamic Stabilization Of The Spine” (Attorney Docket No. SPART-01044USD); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Configurable Dynamic Spinal Rod And Method For Dynamic Stabilization Of The Spine” (Attorney Docket No. SPART-01044USE); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “A Spinal Prosthesis Having A Three Bar Linkage For Motion Preservation And Dynamic Stabilization Of The Spine” (Attorney Docket No. SPART-01044USF); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Surgical Tool And Method For Implantation of A Dynamic Bone Anchor” (Attorney Docket No. SPART-01045US1); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Surgical Tool And Method For Connecting A Dynamic Bone Anchor and Dynamic Vertical Rod” (Attorney Docket No. SPART-01045US2); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Load-Sharing Bone Anchor Having A Deflectable Post And Centering Spring And Method For Dynamic Stabilization Of The Spine” (Attorney Docket No. SPART-01049US1); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Load-Sharing Component Having A Deflectable Post And Centering Spring And Method For Dynamic Stabilization Of The Spine” (Attorney Docket No. SPART-01049US2); and
• U.S. patent application Ser. No. 12/______, filed Sep. 24, 2009, entitled “Load-Sharing Bone Anchor Having A Deflectable Post And Axial Spring And Method For Dynamic Stabilization Of The Spine” (Attorney Docket No. SPART-01053US1).
• All of the afore-mentioned patent applications are incorporated herein by reference in their entireties.
BACKGROUND OF INVENTION
• Back pain is a significant clinical problem and the costs to treat it, both surgical and medical, are estimated to be over $2 billion per year. One method for treating a broad range of degenerative spinal disorders is spinal fusion. Implantable medical devices designed to fuse vertebrae of the spine to treat have developed rapidly over the last decade. However, spinal fusion has several disadvantages including reduced range of motion and accelerated degenerative changes adjacent the fused vertebrae.
• Alternative devices and treatments have been developed for treating degenerative spinal disorders while preserving motion. These devices and treatments offer the possibility of treating degenerative spinal disorders without the disadvantages of spinal fusion. However, current devices and treatments suffer from disadvantages e.g., complicated implantation procedures; lack of flexibility to conform to diverse patient anatomy; the need to remove tissue and bone for implantation; increased stress on spinal anatomy; insecure anchor systems; poor durability, and poor revision options. Consequently, there is a need for new and improved devices and methods for treating degenerative spinal disorders while preserving motion.
SUMMARY OF INVENTION
• The present invention includes a spinal implant system and methods that can dynamically stabilize the spine while providing for the preservation of spinal motion. Embodiments of the invention provide a dynamic stabilization system which includes: versatile components, adaptable stabilization assemblies, and methods of implantation. An aspect of embodiments of the invention is the ability to stabilize two, three and/or more levels of the spine by the selection of appropriate components of embodiments of the invention for implantation in a patient. Another aspect of embodiments of the invention is the ability to accommodate particular anatomy of the patient by providing a system of versatile components which may be customized to the anatomy and needs of a particular patient and procedure. Another aspect of the invention is to facilitate the process of implantation and minimize disruption of tissues during implantation.
• Thus, the present invention provides new and improved systems, devices and methods for treating degenerative spinal disorders by providing and implanting a dynamic spinal stabilization assembly which supports the spine while preserving motion. These and other objects, features and advantages of the invention will be apparent from the drawings and detailed description which follow.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIGS. 1A and 1B are perspective views of a deflection system component mounted to an anchor system component according to an embodiment of the present invention.
• FIG. 1C is a perspective view of a connection system component mounted to an anchor system component according to an embodiment of the present invention.
• FIG. 1D is a perspective view of a different connection system component mounted to an anchor system component according to an embodiment of the present invention.
• FIG. 1E is a posterior view of an anchor system for a multi-level dynamic stabilization assembly utilizing the anchor components ofFIGS. 1A to 1D according to an embodiment of the present invention.
• FIG. 1F is a posterior view of a multi-level dynamic stabilization assembly utilizing the components ofFIGS. 1A to 1E according to an embodiment of the present invention.
• FIG. 2A is an exploded view of a deflection rod according to an embodiment of the present invention.
• FIG. 2B is a perspective view of the deflection rod assembly ofFIG. 2A, as assembled.
• FIG. 2C is a sectional view of the deflection rod assembly ofFIGS. 2A and 2B.
• FIG. 2D is a sectional view of the deflection rod assembly ofFIGS. 2A and 2B.
• FIGS. 2E and 2F are sectional views of the deflection rod assembly ofFIGS. 2A and 2B showing deflection of the post.
• FIG. 2G is a transverse sectional view of a vertebra illustrating the implantation of the deflection rod assembly ofFIGS. 2A and 2B.
• FIG. 3A is an exploded view of an alternative deflection rod assembly according to an embodiment of the present invention.
• FIG. 3B is a perspective view of the deflection rod assembly ofFIG. 3A, as assembled.
• FIG. 3C is a sectional view of the deflection rod assembly ofFIGS. 3A and 3B.
• FIG. 3D is a sectional view of the deflection rod assembly ofFIGS. 3A and 3B showing deflection of the post.
• FIG. 3E is a transverse sectional view of a vertebra illustrating the implantation of the deflection rod assembly ofFIGS. 3A and 3B.
• FIG. 3F is a transverse sectional view of a vertebra illustrating the implantation of an alternative deflection rod.
• FIG. 3G is a lateral view of a multi-level dynamic stabilization assembly utilizing the deflection rod assembly ofFIGS. 3A-3B according to an embodiment of the present invention.
• FIG. 3H is an oblique view of an offset connector mounted to the deflection rod assembly ofFIGS. 3A-3B according to an embodiment of the present invention.
• FIG. 3I shows a socket with interior features adapted to engage features of the housing of a deflection rod assembly according to an embodiment of the present invention.
• FIG. 3J shows a connector with interior features adapted to engage features of the housing of a deflection rod assembly according to an embodiment of the present invention.
• FIG. 4A is an exploded view of an alternative deflection rod assembly according to an embodiment of the present invention.
• FIG. 4B is a perspective view of the deflection rod assembly ofFIG. 4A, as assembled.
• FIG. 4C is a sectional view of the deflection rod assembly ofFIGS. 4A and 4B.
• FIG. 4D is a sectional view of the deflection rod assembly ofFIGS. 4A and 4B showing deflection of the post.
• FIG. 4E is a sectional view of an alternative deflection rod assembly according to an embodiment of the present invention.
• FIG. 4F is a sectional view of an alternative deflection rod assembly according to an embodiment of the present invention.
• FIG. 4G is a sectional view of an alternative deflection rod assembly according to an embodiment of the present invention.
• FIG. 5A is a graph showing the deflection/force response curves of various embodiments of deflection rods according to embodiments of the present invention.
• FIG. 5B is a sectional view of an alternative deflection rod.
• FIGS. 6A-6H are sectional views of alternative deflection rods according to embodiments of the present invention.
• FIGS. 7A-7E are perspective views of alternative combinations of deflection rods and bone anchors according to embodiments of the present invention.
• FIGS. 7F-7H are perspective and sectional views of an alternative bone anchors having a torque-limiting breakaway head according to an embodiment of the present invention.
• FIGS. 8A-8H show alternative deflection rods having different mechanisms to secure the deflectable post to the deflection rod assembly and/bone anchor.
• FIGS. 9A-9C show an alternative deflection rod assembly according to an embodiment of the invention.
• FIGS. 9D-9F show an alternative deflection rod assembly according to an embodiment of the invention.
• FIGS. 9G and 9H show an alternative deflection rod assembly according to an embodiment of the invention.
• FIGS. 10A-10E show a locking hinged mechanism for connecting a deflection rod assembly to a vertical rod according to an embodiment of the invention.
• FIGS. 11A-11D show a locking ball-joint mechanism for connecting a deflection rod assembly to a vertical rod according to an embodiment of the invention.
• FIGS. 11E-11F show a locking receiver mechanism attached to a deflection rod assembly for connecting the deflection rod assembly to a vertical rod according to an embodiment of the invention.
• FIGS. 12A-12D show a locking receiver mechanism for connecting a vertical rod to a post terminating in a ball according to an embodiment of the invention.
• FIGS. 13A and 13B show a deflection rod assembly having a pivoting head according to an embodiment of the invention.
• FIGS. 14A and 14B show a deflection rod assembly having a pivoting head according to an embodiment of the invention.
• FIGS. 15A-15C show views of a preferred deflection rod, bone anchor and vertical rod.
• FIGS. 16A-16B show perspective views show a deflection rod assembly having an adjustable vertical rod connector according to an embodiment of the invention.
• FIG. 17A shows a sectional view of an alternative deflection rod assembly according to an embodiment of the invention.
• FIG. 17B shows a perspective view of the sleeve of the deflection rod assembly ofFIG. 17A.
• FIGS. 17C-17E show views of alternative sleeves for deflection rod assembly according to embodiments of the present invention.
• FIG. 18A is an exploded view of an alternative deflection rod assembly according to an embodiment of the present invention.
• FIG. 18B is a perspective view of the deflection rod assembly ofFIG. 18A, as assembled.
• FIG. 18C is a sectional view of the deflection rod assembly ofFIGS. 18A and 18B.
• FIG. 18D is a sectional view of the deflection rod assembly ofFIGS. 18A and 18B showing deflection of the post.
• FIG. 18E is a partial sectional view of the o-ring ofFIG. 18A.
• FIG. 18F is a partial sectional view of an alternative o-ring.
• FIG. 18G is a partial sectional view of another alternative o-ring.
• FIG. 18H is a partial sectional view of another alternative o-ring.
• FIG. 19A is an exploded view of an alternative deflection rod assembly according to a preferred embodiment of the present invention.
• FIG. 19B is a perspective view of the deflection rod assembly ofFIG. 19A, as assembled.
• FIG. 19C is a sectional view of the deflection rod assembly ofFIGS. 19A and 19B.
• FIG. 19D is a sectional view of the deflection rod assembly ofFIGS. 19A and 19B showing deflection of the post.
• FIGS. 19E-19G show enlarged views of components of the deflection rod assembly ofFIGS. 19A-19D.
• FIG. 20A shows a perspective view of an implantation tool for a dynamic bone anchor according to an embodiment of the invention.
• FIGS. 20B and 20C show detailed sectional views of the head of the implantation tool ofFIG. 20A in relation to a dynamic bone anchor.
• FIG. 20D is a transverse view of the lumbar spine illustrating use of the implantation tool ofFIG. 20A to implant a dynamic bone anchor in the pedicles of a lumbar vertebra according to an embodiment of the invention.
• FIG. 21A shows a perspective view of an attachment tool for securing a dynamic vertical rod to a dynamic bone anchor according to an embodiment of the invention.
• FIG. 21B shows a detailed view of the head of the attachment tool ofFIG. 21A.
• FIGS. 21C and 21D show detailed sectional views of the head of the attachment tool ofFIG. 21A in relation to a dynamic vertical rod and bone anchor.
• FIG. 21E-21H are a lateral views of the lumbar spine illustrating steps to secure a dynamic vertical rod to a dynamic bone anchor assembly using the attachment tool ofFIG. 21A according to an embodiment of the invention.
• FIG. 22A is a lateral view of the lumbar spine illustrating the natural kinematics of the spine during extension and flexion.
• FIG. 22B is a lateral view of the lumbar spine illustrating the kinematic constraints placed on the spine by a rigid spinal rod system during extension and flexion.
• FIGS. 22C and 22D show the kinematic modes of an embodiment of the dynamic spine stabilization implant of the invention utilizing a dynamic bone anchor and dynamic vertical rod in accordance with embodiments of the invention.
• FIG. 22E is a graph illustrating the kinematics of a dynamic spine stabilization prosthesis including the dynamic bone anchor ofFIGS. 22C and 22D.
• FIG. 22F is a lateral views of the spine illustrating the kinematics of the spine supported by a dynamic spine stabilization prosthesis ofFIG. 22E.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• The present invention includes a versatile spinal implant system and methods which can dynamically stabilize the spine while providing for the preservation of spinal motion. Alternative embodiments can be used for spinal fusion. An aspect of the invention is restoring and/or preserving the natural motion of the spine including the quality of motion as well as the range of motion. Still, another aspect of the invention is providing for load sharing and stabilization of the spine while preserving motion.
• Another aspect of the invention is to provide a modular system which can be customized to the needs of the patient. Another aspect of embodiments of the invention is the ability to stabilize two, three and/or more levels of the spine by the selection of appropriate components for implantation in a patient. Another aspect of the invention is the ability to provide for higher stiffness and fusion at one level or to one portion of the spine while allowing for lower stiffness and dynamic stabilization at another adjacent level or to another portion of the spine. Embodiments of the invention allow for fused levels to be placed next to dynamically stabilized levels. Such embodiments of the invention enable vertebral levels adjacent to fusion levels to be shielded by providing a transition from a rigid fusion level to a dynamically stable, motion preserved, and more mobile level.
• Embodiments of the present invention provide for assembly of a dynamic stabilization system which supports the spine while providing for the preservation of spinal motion. The dynamic stabilization system has an anchor system, a deflection system, a vertical rod system and a connection system. The anchor system anchors the construct to the spinal anatomy. The deflection system provides dynamic stabilization while reducing the stress exerted upon the bone anchors and spinal anatomy. The vertical rod system connects different levels of the construct in a multilevel assembly and may in some embodiments include compound deflection rods. The connection system includes coaxial connectors and offset connectors which adjustably connect the deflection system, vertical rod system and anchor system allowing for appropriate, efficient and convenient placement of the anchor system relative to the spine. Alternative embodiments can be used for spinal fusion.
• Embodiments of the invention include a construct with an anchor system, a deflection system, a vertical rod system and a connection system. The deflection system provides dynamic stabilization while reducing the stress exerted upon the bone anchors and spinal anatomy. The anchor system anchors the deflection system to the spine. The connection system connects the deflection system to the vertical rod system. The vertical rod system connects dynamic stabilization system components on different vertebra to provide load sharing and dynamic stabilization.
• Embodiments of the present invention include a deflection rod assembly which provides load sharing while preserving range of motion and reducing stress exerted upon the bone anchors and spinal anatomy. The deflection rod assembly includes a deflectable post mounted within a bone anchor. Deflection of the deflectable post is controlled by a compliant sleeve. A contact surface of the deflection rod is positioned to limit deflection of the deflectable post. The force/deflection properties of the deflection rod assembly may be adapted to the anatomy and functional requirements of the patient.
• Common reference numerals are used to indicate like elements throughout the drawings and detailed description; therefore, reference numerals used in a drawing may or may not be referenced in the detailed description specific to such drawing if the associated element is described elsewhere. The first digit in a three digit reference numeral indicates the series of figures in which the referenced item first appears. Likewise the first two digits in a four digit reference numeral.
• The terms “vertical” and “horizontal” are used throughout the detailed description to describe general orientation of structures relative to the spine of a human patient that is standing. This application also uses the terms proximal and distal in the conventional manner when describing the components of the spinal implant system. Thus, proximal refers to the end or side of a device or component closest to the hand operating the device, whereas distal refers to the end or side of a device furthest from the hand operating the device. For example, the tip of a bone screw that enters a bone would conventionally be called the distal end (it is furthest from the surgeon) while the head of the screw would be termed the proximal end (it is closest to the surgeon).
Dynamic Stabilization System
• FIGS. 1A-1F introduce components of a dynamic stabilization system according to an embodiment of the present invention. The components include anchor system components, deflection rods, vertical rods and connection system components, including for example coaxial and offset connectors. The components may be implanted and assembled to form a dynamic stabilization system appropriate for the anatomical and functional needs of a patient.
• FIG. 1A shows abone anchor102 and adeflection rod104 connected to avertical rod106 by a ball joint108.Deflection rod104 is an example of a component of the deflection rod assembly system.Deflection rod104 is a component having controlled flexibility which allows for load sharing. Thedeflection rod104 provides stiffness and support where needed to support the loads exerted on the spine during normal spine motion, which loads, the soft tissues of the spine are no longer able to accommodate since these spine tissues are either degenerated or damaged. Load sharing is enhanced by the ability to select the appropriate stiffness of the deflection rod in order to match the load sharing characteristics desired. For embodiments of this invention, the terms “deflection rod” and “loading rod” can be used interchangeably. Deflection rods, deflection rod mountings and alternative deflection rods are described in more detail below.
• Deflection rod104 includes adeflectable post105 which may deflect relative to amount107.Mount107 is adapted to secure thedeflectable post105 tobone anchor102.Mount107 is received withincavity132 ofbone anchor102. When received incavity132,mount107 is secured into a fixed position relative tobone anchor102.Deflectable post105 may still deflect in a controlled manner relative tobone anchor102 thereby provide for load sharing while preserving range of motion of the patient. The stiffness/flexibility of deflection of thedeflectable post105 relative to mount107/bone anchor102 may be controlled and/or customized as will be described below.
• As shown inFIG. 1A, mount107 is designed to be received within acavity132 ofbone anchor102. As shown inFIG. 1A, mount107 includes acollar140. A threadedaperture142 extends obliquely throughcollar140. The threadedaperture142 receives a locking setscrew144 which, when seated (FIG. 1B), engages thehousing130 ofbone anchor102. Locking setscrew144 is positioned within threadedaperture142 throughcollar140. The locking setscrew144 thereby secures themount107 ofdeflection rod104 in place within thehousing130 ofbone anchor102.
• As shown inFIG. 1A,deflection rod104 is oriented in a co-axial, collinear or parallel orientation tobone anchor102. This arrangement simplifies implantation, reduces trauma to structures surrounding an implantation site, and reduces system complexity. Arranging thedeflection rod104, co-axial with thebone anchor102 can substantially transfer a moment (of) force applied by thedeflectable post105 from a moment force tending to pivot or rotate thebone anchor102 about the axis of the shaft, to a moment force tending to act perpendicular to the axis of the shaft. The deflection rod can thereby effectively resist repositioning of the deflection rod and/orbone anchor102 without the use of locking screws or horizontal bars to resist rotation. Further examples of coaxial deflection rods are provided below. Each of the deflection rods described herein may be used as a component of a dynamic stabilization system.
• Bone anchor102 is an example of a component of the anchor system.Bone anchor102 includes abone screw120 andhousing130. As shown inFIG. 1A,bone anchor102 is abone screw120 having one ormore threads124 which engage a bone to secure thebone anchor102 onto a bone. The anchor system may include one or more alternative bone anchors known in the art e.g. bone hooks, expanding devices, barbed devices, threaded devices, adhesive and other devices capable of securing a component to bone instead of or in addition tobone screw120.
• As shown inFIG. 1A,bone anchor102 includes ahousing130 at the proximal end.Housing130 includes acavity132 for receivingdeflection rod104.Cavity132 is coaxial with threadedbone screw120.Housing130 also comprises agroove134 for securingdeflection rod104 withinhousing130. As shown inFIG. 1A, groove134 is located at the proximal end ofhousing130.Groove134 is designed to be engaged by the locking mechanism of a component mounted withincavity132. For example, groove134 is designed to be engaged by locking setscrew144 ofdeflection rod104. Whendeflection rod104 has been positioned withincavity132 ofbone anchor102 as shown inFIG. 1B, locking setscrew144 is tightened to engagegroove134 ofhousing130 thus securingdeflection rod104 withinhousing130. Alternative mechanisms and techniques may be used to secure the deflection rod to the bone anchor including for example, welding, soldering, bonding, and/or mechanical fittings including threads, snap-rings, locking washers, cotter pins, bayonet fittings or other mechanical joints.
• Bone anchor102 also includes acoupling136 to which other components may be mounted. As shown inFIG. 1A, coupling136 is the external cylindrical surface ofhousing130.Housing130 thus provides two mounting positions, one coaxial mounting position and one external mounting position. Thus, asingle bone anchor102 can serve as the mounting point for one, two or more components. Adeflection rod104 may be coaxially mounted in thecavity132 of the housing and one or more additional components may be externally mounted to theouter surface136 of the housing. For example, a component of the connection system may be mounted to theouter surface136 of the housing—such a connector may be called an offset head or offset connector. In some applications a component of the connection system may be coaxially-mounted in thecavity132 in place of adeflection rod104—such a connector may be called a coaxial head or coaxial connector.
• It is desirable to have a range of different connectors which are compatible with the anchor system and deflection system. The connectors may have different attributes, including for example, different degrees of freedom, range of motion, and amount of offset, which attributes may be more or less appropriate for a particular relative orientation and position of two bone anchors and/or patient anatomy. It is desirable that each connector be sufficiently versatile to connect a vertical rod to a bone anchor in a range of positions and orientations while being simple for the surgeon to adjust and secure. It is desirable to provide a set of connectors which allows the dynamic stabilization system to be assembled in a manner that adapts a particular dynamic stabilization assembly to the patient anatomy rather than adapting the patient anatomy for implantation of the assembly (for example, by removing tissue\bone to accommodate the system). In a preferred embodiment, the set of connectors comprising the connection system have sufficient flexibility to allow the dynamic stabilization system to realize a suitable dynamic stabilization assembly in all situations that will be encountered within the defined patient population.
• In some embodiments of the present invention, a connection system component, e.g. a polyaxial connector may be mounted in thecavity132 of abone anchor102 to secure the bone anchor tovertical rod106. For example,FIG. 1C showscoaxial head150 which is a polyaxial connector which is coaxially mounted within thecavity132 of thehousing130 ofbone anchor102.Coaxial head150 is an example of a coaxial head or coaxial connector.Bone anchor102 is the same bone anchor previously described with respect toFIGS. 1A and 1B.Coaxial head150 comprises arod152 which is designed to fit withincavity132 ofhousing130.Coaxial head150 also comprises acollar154 and locking setscrew156. Locking setscrew156 is configured to engagegroove134 ofbone anchor102 in the same way as locking setscrew144 ofdeflection rod104.Rod152 andcavity132 may in some case be circular in section (e.g. cylindrical), in whichcase rod152 can rotate withincavity132 until locked into place by locking setscrew156. In alternative embodiments,rod152 may be polygonal in section such that it fits in one of a fixed number of possible positions.
• Referring again toFIG. 1C, attached torod152 ofcoaxial head150 is ayoke164.Yoke164 is connected to aball165 by ahexagonal pin162. Asaddle163 is also mounted toball165 such thatsaddle163 can pivot about two orthogonal axes relative toyoke164.Saddle163 has anaperture168 through which a vertical rod may be passed. On one side ofaperture168 is aplunger169. On the other side ofaperture168 is a locking setscrew167. When a vertical rod106 (not shown) is positioned withinaperture168 and locking setscrew167 is tightened down, the locking setscrew167 forces thevertical rod106 down onto theplunger169.Plunger169 is, in turn, forced down by thevertical rod106 againstball165.Plunger169 engagesball165, andball165 engageshexagonal pin162, to locksaddle163 in position relative toyoke164 and secure a rod (e.g. vertical rod106) tosaddle163. In this way, tightening setscrew167 secures thevertical rod106 to thecoaxial head150 and also locks orientation of thecoaxial head150.
• The ability to coaxially mountcoaxial head150 to abone anchor102 has several advantages over a standard polyaxial bone screw in which a polyaxial connector is an integral part of the device and may not be removed or exchanged. Thebone anchor102 is simpler to install and there is no risk of damage to the polyaxial connector during installation. A singlecoaxial head150 can be manufactured and designed to mount to a range of different bone anchors thus allowing bone anchors to be selected as appropriate for the patient anatomy. After the bone anchor is installed, the orientation of theyoke164 can be adjusted without changing the screw depth (this is not possible in a standard polyaxial bone screw without also turning the screw). After the bone anchor is implanted, one of a range of different coaxial heads may be installed without requiring removal of the bone anchor. Likewise, if a revision is required, the coaxial head may be exchanged for a different component without necessitating removal of thebone anchor102.
• As described above,bone anchor102 hashousing130 which can accept one coaxially-mounted component (e.g. a coaxial head) and one externally-mounted component (e.g. an offset connector).FIG. 1D shows a component of the connection system which may be mounted externally tohousing130 ofbone anchor102 in conjunction with a coaxially-mounted component.FIG. 1D shows a perspective view of offsetconnector170 mounted externally tohousing130 ofbone anchor102 in which adeflection rod104 is coaxially mounted.Connector170 may be termed an offset head or offset connector.
• Offsetconnector170 comprises six components and allows for two degrees of freedom of orientation and two degrees of freedom of position in connecting a vertical rod to a bone anchor. The six components of offsetconnector170 aredowel pin172, pivot pin174, locking setscrew176,plunger178,clamp ring180 andsaddle182.Saddle182 has aslot184 sized to receive a rod which may be a vertical rod, e.g.vertical rod106 ofFIG. 1A. Locking setscrew176 is mounted at one end ofslot184 such that it may be tightened to secure a rod withinslot184.
• Clamp ring180 is sized such that, when relaxed it can slide freely up and down thehousing130 ofbone anchor102 and rotate aroundhousing130. However, when locking setscrew176 is tightened on a rod, theclamp ring180 grips the housing and prevents the offsetconnector170 from moving in any direction.Saddle182 is pivotably connected to clampring180 by pivot pin174.Saddle182 can pivot about pivot pin174. However, when locking setscrew176 is tightened on a rod, theplunger178 grips theclamp ring180 and prevents further movement of thesaddle182. In this way, operation of thesingle set screw176 serves to lock theclamp ring180 to thehousing130 of thebone anchor102,fix saddle182 in a fixed position relative to clampring180 and secure a rod within theslot184 of offsetconnector170.
• The above-described coaxial connector and offset connector are provided by way of example only. Alternative embodiments of coaxial heads and offset connectors can be found in U.S. Provisional Patent Application No. 61/100,625, filed Sep. 26, 2008 entitled “Versatile Assembly Components And Methods For A Dynamic Spinal Stabilization System” (Attorney Docket No.: SPART-01043US0) which is incorporated by reference. These coaxial heads and offset connectors may be used in conjunction with the components herein described to permit assembly of a dynamic stabilization system appropriate to the functional needs and anatomy of a particular patient. In addition screws having an integrated connector may also be utilized to anchor components of the dynamic stabilization system in fixed relationship to a vertebra, for example polyaxial screws.
• The components of the dynamic stabilization system may be assembled and implanted in the spine of a patient to provide a multilevel dynamic stabilization assembly which provides dynamic stabilization of the spine and load sharing. In some embodiments, the first step is implantation of bone anchors in the vertebrae. In other embodiments, the bone anchors may be implanted with the deflection rod/connection component already installed.
• FIG. 1E, shows threeadjacent vertebrae191,192 and193. As a preliminary step, bone anchors102a,102band102chave been implanted in thevertebrae191,192 and193 on the right side of thespinous process194 between thespinous process194 and thetransverse process195. A driver is inserted into thecavity132a,132b,132cin order to drive the threaded portion of each bone anchor into the bone. In preferred procedures, the bone anchor is directed so that the threaded portion is implanted within one of thepedicles196 angled towards thevertebral body197. The threaded region of each bone anchor is fully implanted in thevertebrae191,192 and193. A driver may alternatively and/or additionally engage the exterior surface ofhousing130 in order to implant the bone anchor. The driver may have a torque-measuring and/or torque limiting function to assist in accurate implantation of the bone screw and avoid excess force being applied to the vertebrae. In alternative embodiments, the bone screw may incorporate a torque limiting element, for example a secondary head which breaks away when the driver torque exceeds a predetermined torque limit. See, e.g.FIGS. 7F-7H and accompanying text.
• As shown inFIG. 1E, thehousings130a,130b,130cof each bone anchor remain partly or completely exposed above the surface of the vertebrae so that one or more of a connection system component and deflection component can be secured to eachbone anchor102a,102band102c. Coaxial components may be coaxially-mounted inside each ofcavities132a,132b, and132c. Offset heads/connectors may also be externally-mounted to the outside surface of each ofhousings130a,130band130c. Note that bone anchors are also implanted on the left side of the spine.
• After installation of the bone anchors, the deflection system components, vertical rod systems components and connection system components may be installed and assembled.FIG. 1F shows one way to assemble deflection system components and connection system components. As shown inFIG. 1F, acoaxial head150 is installed inbone anchor102c. An offsetconnector170 is mounted externally to the housing ofbone anchor102b. Adeflection rod104ais coaxially mounted in the housing ofbone anchor102a. Adeflection rod104bis coaxially mounted in the housing ofbone anchor102b. Avertical rod106ais connected at one end todeflection rod104aby ball joint108a.Vertical rod106ais connected at the other end by in-line connector170 tobone anchor102b. A secondvertical rod106bis connected at one end todeflection rod104bby ball joint108b.Vertical rod106bis connected at the other end bycoaxial head150 tobone anchor102c.
• Thedynamic stabilization assembly190 ofFIG. 1E thus has avertical rod106a,106bstabilizing each spinal level (191-192 and192-193). Each of thevertical rods106a,106bis secured rigidly at one end to a bone anchor (102b,102c). Each of thevertical rods106a,106bis secured at the other end by a ball joint108a,108bto adeflection rod104a,104bthereby allowing for some movement and load sharing by the dynamic stabilization assembly. Offsetconnector170 andcoaxial head150 permit assembly ofdynamic stabilization assembly190 for a wide range of different patient anatomies and/or placements of bone anchors102a,102band102c. An identical or similar dynamic stabilization assembly would preferably be implanted on the left side of the spine. It should be noted thatdynamic stabilization assembly190 does not require horizontal bars or locking screws thereby reducing the exposure of tissue and/or bone to foreign bodies compared to systems with this additional hardware. The dynamic stabilization assembly ofFIG. 1F, thereby, has a small footprint, potentially reducing the amount of displacement of tissue and/or bone, reducing trauma to tissue and/or bone during surgery. Further, the smaller footprint can reduce the amount of tissue that needs to be exposed during implantation.
• The particular dynamic stabilization assembly shown inFIG. 1G is provided by way of example only. It is an aspect of preferred embodiments of the present invention that a range of components be provided and that the components may be assembled in different combinations and organizations to create different assemblies suitable for the functional needs and anatomy of different patients. Also, deflection rods having different force deflection characteristics may be incorporated at different spinal levels in accordance with the anatomical and functional requirements. Dynamic stabilization may be provided at one or more motion segments and in some cases dynamic stabilization may be provided at one or more motion segments in conjunction with fusion at an adjacent motion segment. Particular dynamic stabilization assemblies may incorporate combinations of the bone anchors, vertical rods, deflection rods, offset and coaxial connectors described herein, in the related applications incorporated by reference, and standard spinal stabilization and/or fusion components, for example screws, rods and polyaxial screws.
Deflection Rods/Loading Rods
• One feature of embodiments of the present invention is the load sharing and range of motion provided by a deflection rod. The deflection rod provides stiffness and support where needed to support the loads exerted on the spine during normal spine motion thereby recovering improved spine function without sacrificing all motion. The deflection rod also isolates the anchor systems components from forces exerted by the dynamic stabilization assembly thereby reducing stress on the bone anchors and the bone to which they are attached. Moreover, by selecting the appropriate stiffness of the deflection rod or loading rod to match the physiology of the patient and the loads that the patient places on the spine, a better outcome is realized for the patient.
• The deflection rod includes a deflectable post, a compliant sleeve and a mount. The deflectable post and mount are typically made of biocompatible metal or metals, e.g. titanium and stainless steel. The sleeve is made of a compliant material, for example a compliant polymer. The mount secures the deflection rod to an anchoring device in a manner which allows deflection of the deflectable post. The deflectable post is configured to connect to the vertical rod system. The deflectable post may deflect relative to the mount by compressing the compliant material of the sleeve. The deformation of the sleeve imparts force/deflection characteristics to the deflectable post. The movement of the post relative to the mount allows controlled movement of the bone anchor (and vertebra in which it is implanted) relative to the vertical rods thereby supporting the vertebrae to which the bone anchors are attached while allowing movement of the vertebrae.
• Deflection rods can be manufactured in a range from highly rigid configurations to very flexible configurations by appropriate selection of the design, materials and dimensions of the post, sleeve and mount. Deflection rods having a particular stiffness/flexibility may be selected for use in a dynamic stabilization assembly based upon the physiological needs of a particular patient. In a preferred embodiment deflection rod stiffness/flexibility is selected to provide load sharing in conjunction with from 50% to 100% of the normal range of motion of a patient and more preferably 70% to 100% of the normal range of motion of a patient.
• In some cases, certain of the deflection rods of a dynamic stabilization assembly can have a different stiffness or rigidity or flexibility than other of the deflection rods. Thus, in the same assembly, a first deflection rod can have a first flexibility or stiffness or rigidity, and a second deflection rod can have a second different flexibility or stiffness or rigidity depending on the needs of the patient. Particular embodiments of a dynamic stabilization assembly may utilize deflection rods having different deflection properties for each level and/or side of the dynamic stabilization assembly. In other words, one portion of a dynamic stabilization assembly may offer more resistance to movement than the other portion based on the design and selection of different stiffness characteristics, if that configuration benefits the patient.
• FIGS. 2A through 2G illustrate the design and operation of a first embodiment of a deflection rod according to an embodiment of the present invention.FIG. 2A shows an exploded view ofdeflection rod200.Deflection rod200 includesretainer202,deflectable post204,sleeve206,shield208,collar210,screw212 andball214.Deflection rod200 connects tovertical rod216 at a ball joint which includesball214,pocket218 andcap220.Shield208 andcollar210 are securely attached to each other (or formed in one piece) and make up themount207. A threadedaperture211 passes obliquely throughcollar210. Threadedaperture211 is configured to receive ascrew212.Sleeve206 is made of a compliant material which permits movement ofdeflectable post204 relative to shield208.Deflectable post204 may thus pivot in any direction about the center of ball-shapedretainer202 as shown byarrows230. Thesleeve206 controls and limits the deflection of thedeflectable post204. Thedeflectable post204 can also rotate about the longitudinal axis of the post and the bone anchor as shown byarrow232.
• Referring now toFIG. 2B, which shows a perspective view of a fully assembleddeflection rod200. When assembled,deflectable post204 is positioned withinsleeve206;sleeve206 is positioned withinshield208.Ball214 is connected to the proximal end ofdeflectable post204 to provide a component of a ball joint for connectingdeflection rod200 to avertical rod216.Ball214 may be formed in one piece withdeflectable post204 or may be securely attached todeflectable post204 using a joint, for example, a threaded joint, welded joint, adhesive joint.Retainer202 is attached to the distal end ofdeflectable post204 to preventdeflectable post204 from being pulled out ofsleeve206.
• As shown inFIG. 2A, theretainer202 may be a ball-shapedretainer202.Retainer202 may be formed in one piece withdeflectable post204 or may be securely attached todeflectable post204. Theretainer202 may be attached by laser welding, soldering or other bonding technology. For example,retainer202 in the form of a ball, disk, plate or other shape may be laser welded to the distal end ofdeflectable post204. Alternatively,retainer202 may mechanically engage thedeflectable post204 using, for example, threads. For example, a lock ring, toothed locking washer, cotter pin or other mechanical device can be used to securedeflectable post204 withinshield208.
• Theball214 ofdeflection rod200 is received in a pocket ofvertical rod216.Cap220 securesball214 within the pocket ofvertical rod216 creating a ball joint222 which allowsvertical rod216 to rotate 360 degrees around the axis of deflectable post204 (as shown by arrow234) and also tilt away from the plane perpendicular to the axis of deflectable post204 (as shown by arrow236). Thus, thevertical rod216 is allowed to rotate and/or have tilting and/or swiveling movements about a center which corresponds with the center ofball214 of ball joint222.Ball214 can also be displaced relative to shield208 by deflection of deflectable post204 (as shown by arrows230).
• FIG. 2C shows a sectional view of a fully assembleddeflection rod200 along the axis indicated by line C-C ofFIG. 2B. As shown inFIG. 2C,sleeve206 occupies the space betweendeflectable post204 and shield208 and is compressed by deflection ofdeflectable post204 towardsshield208 in any direction. In some embodiments,sleeve206 may be formed separately fromdeflection rod200. For example,deflectable post204 andsleeve206 may be press fit intoshield208. Alternatively or additionally, a biocompatible adhesive may be used to bond thesleeve206 to theshield208 and/ordeflectable post204. Alternatively,sleeve206 may be formed in place by positioning thedeflectable post204 within theshield208 and then filling the space between thedeflectable post204 and theshield208 with liquid polymer (polymer reagents) and allowing the polymer to solidify (polymerize).
• FIG. 2C, also illustrates the internal detail of ball joint222 which connectsvertical rod216 anddeflectable post204 ofdeflection rod200.Vertical rod216 includes disk-shapedpocket218 at one end. The proximal end ofdeflectable post204 is passed throughaperture219 in disk-shapedpocket218 of thevertical rod216. The diameter ofdeflectable post204 is smaller than the diameter ofaperture219. Once the proximal end ofdeflectable post204 is passed through theaperture219,ball214 is attached todeflectable post204 using threading, fusing, gluing, press fit and/or laser welding techniques, for example. The diameter of theaperture219 is less than the diameter ofball214 to preventball214 from passing back throughaperture219. Onceball214 is positioned within the disk-shapedpocket218 ofvertical rod216,cap220 is threaded, fused, glued, press fit and/or laser welded, for example, intopocket218 thereby securingball214 within disk shapedpocket218.FIG. 2C also shows anoptional ridge209 on the interior ofshield208 for retainingsleeve206.
• FIG. 2D shows a sectional view of a fully assembleddeflection rod200 along the axis indicated by line D-D ofFIG. 2B. As shown inFIG. 2D,sleeve206 occupies the space betweendeflectable post204 and shield208 and is compressed by deflection ofdeflectable post204 towardsshield208 in any direction.Sleeve206 resists deflection ofdeflectable post204 outwardly from a position that is collinear with the longitudinal axis ofsleeve206. The dimensions and material ofsleeve206 may be adjusted to generate the desired deflection/load characteristics for the deflection rod.
• FIGS. 2E and 2F illustrate deflection ofdeflectable post204. Applying a force to ball-joint222 causes deflection ofdeflectable post204 relative to mount207 including shield208 (and any bone anchor to which it may be mounted). Initiallydeflectable post204 pivots about apivot point203 indicated by an X. In thisembodiment pivot point203 is located at the center of ball-shapedretainer202. In other embodiments however, pivot point may positioned at a different location. As shown inFIG. 2E, deflection ofdeflectable post204 initially compresses the material ofsleeve206 betweendeflectable post204 andshield208. The force required to deflectdeflectable post204 depends upon the dimensions ofdeflectable post204,sleeve206 and shield208 as well as the attributes of the material ofsleeve206.
• By changing the dimensions ofdeflectable post204,sleeve206 andshield208, the deflection characteristics ofdeflection rod200 can be changed. The stiffness of components of the deflection rod can be, for example, increased by increasing the diameter of the post and/or by decreasing the diameter of the inner surface of the shield and deflection guide. Additionally, increasing the diameter of the post will increase the stiffness of the deflection rod while decreasing the diameter of the post will decrease the stiffness of the deflection rod. Alternatively and/or additionally changing the materials which comprise the components of the deflection rod can also affect the stiffness and range of motion of the deflection rod. For example, makingsleeve206 out of stiffer and/or harder material reduces deflection ofdeflectable post204.
• The stiffness of the deflection rod may thus be varied or customized according to the needs of a patient. The deflection characteristics of the deflection rod can be configured to approach the natural dynamic motion of the spine, while giving dynamic support to the spine in that region. It is contemplated, for example, that the deflection rod can be made in stiffness that can replicate a 70% range of motion and flexibility of the natural intact spine, a 50% range of motion and flexibility of the natural intact spine and a 30% range of motion and flexibility of the natural intact spine. In some cases, a kit is provided to a doctor having a set of deflection rods with different force/deflection characteristics from which the doctor may select the deflection rods most suitable for a particular patient. In other cases, the surgeon may select deflection rods prior to the procedure based upon pre-operative assessment.
• Sleeve206 is preferably made of a compliant biocompatible polymer.Sleeve206 may, for example, be made from a polycarbonate urethane (PCU) such as Bionate®. If the sleeve is comprised of Bionate®, a polycarbonate urethane or other hydrophilic polymer, the sleeve can also act as a fluid-lubricated bearing for rotation of thedeflectable post204 relative to the longitudinal axis of the deflectable post204 (seearrow232 ofFIG. 2B). In a preferred embodiment, the sleeve is made of PCU, is 2 mm thick when uncompressed and may be compressed to about 1 mm in thickness by deflection of the post.
• The sleeve may also include polymer regions having different properties. For example, the sleeve can include concentric rings of one or more polymers with each ring having a different hardness of stiffness or durometer. For example, each successive ring from the center outward can have a higher hardness or stiffness or durometer so that as the post is deflected outwardly from a position that is collinear with the longitudinal axis of the sleeve provides increased resistance to further deflection. The sleeve may also be designed to provide different force deflection characteristics in different directions. The deflectable post could also be designed so that less resistance occurs with increased deflection of the post.
• As shown inFIG. 2F, after further deflection,deflectable post204 comes into contact withlimit surface228 ofshield208.Limit surface228 is oriented such that whendeflectable post204 makes contact withlimit surface228, the contact is distributed over an area to reduce stress ondeflectable post204 and limitsurface228. As depicted,limit surface228 is configured such that as thedeflectable post204 deflects into contact withlimit surface228,limit surface228 is aligned/flat relative todeflectable post204 in order to present a larger surface to absorb any load and also to reduce stress ondeflectable post204 and limit surface damage. Additional deflection may cause elastic deformation ofdeflectable post204. Becausedeflectable post204 is relatively stiff, the force required to deflectdeflectable post204 increases significantly after contact ofdeflectable post204 withshield208. In a preferred embodiment,deflectable post204 may deflect from 0.5 mm to 2 mm in any direction before making contact withlimit surface228. More preferably,deflectable post204 may deflect approximately 1 mm before making contact withlimit surface228.
• Thus, as load or force is first applied to the deflection rod by the spine, the deflection of the deflection rod responds about linearly to the increase in the load during the phase when deflection ofdeflectable post204 causes compression ofsleeve206 as shown inFIG. 2E. After about 1 mm of deflection, whendeflectable post204 contacts limit surface228 (as shown inFIG. 2F) the deflection rod becomes stiffer. Thereafter, a greater amount of load or force needs to be placed on the deflection rod in order to obtain the same incremental amount of deflection that was realized prior to this point because further deflection requires bending ofdeflectable post204. Accordingly, the deflection rod provides a range of motion where the load supported increases about linearly as the deflection increases and then with increased deflection the load supported increases more rapidly in a non-linear manner in order to provide stabilization. Put another way, the deflection rod becomes stiffer as the deflection/load increases. In a dynamic stabilization assembly incorporating the deflection rod, the load sharing and deflection is provided by the deflection rod between the deflectable post and the bone screw or the overall bone anchor such asbone anchor102 and to a lesser degree or not in the vertical rod such as the vertical rod106 (FIG. 1B).
• FIG. 2G is a sectional view illustrating the implantation ofdeflection rod200 in avertebra240. As shown inFIG. 2G,bone anchor102 is oriented such that is passes throughpedicle242 intovertebral body244. Note that the length ofbone anchor102 is selected based upon the anatomy of the patient. Thus shorter bone anchors are used in smaller vertebrae and longer bone anchors are used in larger vertebrae. As shown inFIG. 2G,bone anchor102 hasshallower threads250adjacent housing130.Threads250 engage the hardercortical bone246 on the surface of thevertebra240.Bone anchor102 hasdeeper threads252 towards the distal end ofbone anchor102.Threads252 engage the softercancellous bone248 within thevertebral body244.
• As shown inFIG. 2G,deflection rod200 is mounted withinbone anchor102 such thatpivot point203 is positioned below the surface ofvertebra240.Deflectable post204 pivots about thispivot point203 positioned withinvertebra240. This is advantageous in that it placespivot point203 ofdeflectable post204 closer to thevertebral body244 and thus closer to the natural instantaneous center of rotation of the spine. Placingpivot point203 closer to thevertebral body244 promotes natural motion and reduces non physiological forces on the bones and strain on the system. Placing thepivot point203 closer to thevertebral body244 also helps isolatebone anchor102 from the relative motion betweenvertebra240 and thevertical rod216 which connects one vertebra to another vertebra.Pivot point203 is preferably at or below the surface of the vertebra and more preferably pivotpoint203 is within thecancellous bone248 of thevertebrae240. Even more preferably, thepivot point203 is positioned with thepedicle242 of thevertebra240. In some cases,pivot point203 may be positioned withinvertebral body244.
Alternative Deflection Rods/Loading Rods
• FIGS. 3A-3H illustrate a firstalternative deflection rod300.FIG. 3A shows an exploded view ofalternative deflection rod300.Deflection rod300 includes ball-shapedretainer302,deflectable post304,sleeve306,shield308,collar310, and mount314. In this embodiment,retainer302 is a spherical structure formed in one piece withdeflectable post304.Mount314, in this embodiment, is the proximal end ofdeflectable post304 suitable for connecting to a vertical rod. A ball may be used in place ofmount314 as previously described. In this embodiment, mount314 is formed in one piece withdeflectable post304 andretainer302. In alternative embodiments,deflectable post304 may be formed separately from and securely attached to one or more ofmount314 andretainer302 by laser welding, soldering or other bonding technology. Alternatively,deflectable post304 may be formed separately and mechanically engage one or more ofmount314 andretainer302 using, for example, threads. For example, a lock ring, toothed locking washer, cotter pin or other mechanical device can be used to securedeflectable post304 to one or more ofmount314 andretainer302.
• Sleeve306 is made of a compliant material which permits movement ofdeflectable post304 relative to shield308. Thesleeve306 effectively controls and limits the deflection of thedeflectable post304.Sleeve306 is preferably made of a compliant biocompatible polymer such as PCU by way of example only. The properties of the material and dimensions of thesleeve306 are selected to achieve the desired force/deflection characteristics fordeflectable post304. In a preferred embodiment, the sleeve is made of PCU (Bionate® 80A) and is 2 mm thick when uncompressed and may be compressed to about 1 mm in thickness by deflection of the post.Sleeve306 may also be shaped to modify the compliance ofsleeve306, for example by providingflutes307.Sleeve306 fits insideshield308 surroundingdeflectable post304.
• Deflection rod300 is configured to be mounted in abone anchor320, which comprises abone screw322 connected to ahousing330.Housing330 has acavity332 oriented along the axis ofbone anchor320 at the proximal end and configured to receivedeflection rod300.Housing330 also has anouter surface334 adapted for mounting a component e.g. an offset connector.Housing330 may in some embodiments be cylindrical as previously described. As shown inFIG. 3A,outer surface334 ofhousing330 is provided with splines/flutes336. Splines/flutes336 may be engaged by a driver that mates with splines/flutes336 for implantingbone anchor320.
• Referring now toFIG. 3B, which shows a perspective view of adeflection rod300 assembled with abone anchor320. When assembled,deflectable post304 is positioned withinsleeve306 ofFIG. 3A;sleeve306 is positioned withinshield308 ofFIG. 3A.Deflectable post304,sleeve306 and shield308 are then placed in thecavity332 ofFIG. 3A ofbone anchor320. Threadedcollar310 is then secured in the threaded proximal end ofcavity332. Threadedcollar310 has twosockets311 for receiving the pins of a pin wrench to allow threadedcollar310 to be tightened tothreads338 ofhousing330. Threadedcollar310 is laser welded tohousing330 after installation to further secure the components. Threadedcollar310 securesdeflectable post304,sleeve306 and shield308 withincavity332 ofbone anchor320.
• FIG. 3C shows a sectional view of adeflection rod300 assembled with abone anchor320 along the axis indicated by line C-C ofFIG. 3B. As shown inFIG. 3C,sleeve306 occupies the space betweendeflectable post304 and shield308 and is compressed by deflection ofdeflectable post304 towardsshield308 in any direction.Retainer302 fits into ahemispherical pocket339 in the bottom ofcavity332 ofhousing330.Shield308 includes aflange309 which secures ball-shapedretainer302 withinhemispherical pocket339 while allowing rotation of ball-shapedretainer302.Collar310 secures bothshield308 andsleeve306 withinhousing330. Ifsleeve306 is comprised of Bionate®, a polycarbonate urethane or other hydrophilic polymer,sleeve306 can act as a fluid lubricated bearing and allow the post to also rotate about the longitudinal axis of the post and the bone anchor. Other materials and configurations can also allow the post to rotate about the longitudinal axis of the post and the bone anchor.
• FIG. 3D illustrates the deflection ofdeflectable post304. Applying a force to mount314 causes deflection ofdeflectable post304 ofdeflection rod300. Initiallydeflectable post304 pivots about apivot point303 indicated by an X.Deflectable post304 may pivot aboutpivot point303 in any direction. Concurrently or alternatively,deflectable post304 can rotate about the long axis of deflectable post304 (which also passes through pivot point303). In this embodiment,pivot point303 is located at the center of ball-shapedretainer302. As shown inFIG. 3D, deflection ofdeflectable post304 initially compresses the material ofsleeve306. The force required to deflectdeflectable post304 depends upon the dimensions ofdeflectable post304,sleeve306 and shield308 as well as the attributes of the material ofsleeve306.
• After further deflection,deflectable post304 comes into contact withlimit surface313 ofcollar310.Limit surface313 is oriented such that whendeflectable post304 makes contact withlimit surface313, the contact is distributed over an area to reduce stress ondeflectable post304. Afterdeflectable post304 comes into contact withlimit surface313, further deflection requires deformation (bending) ofdeflectable post304. In a preferred embodiment,deflectable post304 is atitanium post 5 mm in diameter.Deflectable post304 is relatively stiff, and the force required to deflectdeflectable post304 therefore increases significantly after contact ofdeflectable post304 withcollar310. In a preferred embodiment,deflectable post304 may deflect from 0.5 mm to 2 mm in any direction before making contact withlimit surface313. More preferably,deflectable post304 may deflect approximately 1 mm before making contact withlimit surface313.
• The inner diameter of thecollar310 may be different in different collars so that the distance betweenlimit surface313 anddeflectable post304 is different in different deflection rods. This allows for the manufacture of deflection rods having a larger or smaller range of deflection before contact between the post and the limit surface. In this way, deflection rods may be manufactured having different ranges of motion. Moreover, the distance betweenlimit surface313 anddeflectable post304 need not be the same in all directions such that the range of motion of the deflection rod is different in different directions.
• Referring toFIG. 3D, as load or force is first applied to thedeflection rod300 by the spine, the deflection ofdeflectable post304 responds about linearly to the increase in the load during the phase when deflection ofdeflectable post304 causes compression ofsleeve306. After about 1 mm of deflection,deflectable post304 contacts limitsurface313 and the deflection rod becomes substantially stiffer. A greater amount of load or force needs to be placed on the deflection rod in order to obtain the same amount of incremental deflection that was realized prior to this point because further deflection requires bending ofdeflectable post304. The amount of deflection caused by the load applied is a non-linear function, in this embodiment. The deflection rod provides a range of motion where the load supported increases about linearly as the deflection increases and then with increased deflection the load supported increases more rapidly (upon contact of the post with the limit surface). Alternatively, if desired, this embodiment could be designed such that the rate of change of the amount of deflection could be a linear function for a larger range of motion by; for example, increasing the distance betweenlimit surface313 anddeflectable post304.
• FIG. 3E is a sectional view illustrating the implantation of adeflection rod300 in avertebra240. As shown inFIG. 3E,bone anchor320 is oriented such that is passes throughpedicle242 intovertebral body244. Note that the length ofbone anchor320 is selected based upon the anatomy of the patient. Thus shorter bone anchors are used in smaller vertebrae and longer bone anchors are used in larger vertebrae. As shown inFIG. 3E,housing330 ofbone anchor320 is mounted entirely above the surface ofvertebra240.Pivot point303 ofdeflection rod300 is positioned withinhousing330 such thatpivot point303 is, in this embodiment, positioned close to but outside ofvertebra240.
• In an alternative embodiment, as shown inFIG. 3F,deflectable post304 pivots about apivot point353 positioned withinvertebra240. This is advantageous in that it placespivot point353 ofdeflectable post304 closer to thevertebral body244 and thus the natural instantaneous center of rotation of the spine. Placing thepivot point353 closer to thevertebral body244 promotes natural motion and reduces non-physiological forces on the bones and strain on the dynamic stabilization assembly. In particular, placing thepivot point353 closer to thevertebral body244 helps isolatebone anchor320 from the relative motion betweenvertebra240 and a vertical rod of the dynamic stabilization assembly which connects one level of the spine to the adjacent level.Pivot point353 is preferably at or below the surface of thevertebra240. More preferably, thepivot point353 is positioned with thepedicle242 of thevertebra240. In some cases,pivot point353 may be positioned withinvertebral body244.
• FIG. 3G shows a lateral view of a dynamic stabilization assembly utilizingdeflection rod300. As shown inFIG. 3G,deflection rod300 is installed inbone anchor320.Bone anchor320 is implanted in one vertebra370 (see e.g.FIG. 3E). Apolyaxial screw350 is implanted in asecond vertebra372. Avertical rod360 is secured at one end to mount314 ofdeflection rod300.Mount314 in this embodiment passes through an aperture invertical rod360. The proximal end ofmount314 is threaded so thatvertical rod360 may be secured to mount314 with a threadednut362. In this embodiment, as shown inFIG. 3G, thevertical rod360 is secured rigidly todeflectable post304. The rigid connection provides a relatively stiff assembly. However, where greater range of motion is desired,deflectable post304 may be provided with a ball end andvertical rod360 may be connected todeflectable post304 by a ball joint as previously described with respect toFIGS. 1A-1B.
• Vertical rod360 is mounted at the other end to thepolyaxial head352 ofpolyaxial screw350. This screw may be a standard polyaxial screw, for example, a 5.5 mm polyaxial screw available in the marketplace. This screw may, alternatively, be a bone anchor with a polyaxial head e.g. the polyaxial head previously described with respect toFIG. 1C. In a preferred embodiment,vertical rod360 is a titanium rod 5.5 mm in diameter as used in rigid spinal implants. Thevertical rod360 is secured topolyaxial head352 using a threaded fitting, setscrew354, for example. Thevertical rod360 thereby supports the vertebrae whiledeflection rod300 provides for load sharing and allows relative motion ofvertebra370 relative tovertebra372. Thus, the dynamic stabilization assembly provides dynamic stabilization of the spine. The dynamic stabilization assembly may be expanded to two or more levels using an offset connector mounted to thehousing330 ofbone anchor320. It is to be understood that an offset connector can include a fluted ring to assist in engaging the housing330 (see e.g. shape ofopen wrench380 inFIG. 3H). Thus, a modular system is provided which provides for the creation of a multi-level dynamic stabilization assembly.
• FIG. 3H illustrates anopen wrench380 for drivingbone anchor320 into position.Bone anchor320 ofFIG. 3H has ahousing330. Adeflection rod300 is installed inhousing330 and secured in place by threaded collar310 (FIGS. 3A and 3B). Threadedcollar310 engages threads interior tohousing330.Collar310 has twoapertures311 which may be engaged by a pin wrench to tightencollar310 tohousing330.Collar310 may also be welded tohousing330 to furthersecure deflection rod300 withhousing330. In thisembodiment deflection rod300 is designed to be preassembled withbone anchor320 prior to implantation.
• As shown inFIG. 3H, theexterior surface334 ofhousing330 is provided with surface features in the form of a plurality ofsplines336.Splines336 are oriented parallel to the longitudinal axis ofbone anchor320 and project fromhousing330 at regular intervals.Open wrench380 has ahead382 designed to engage theexterior surface334 ofhousing330. With such a tool, thehousing330 can be engaged and rotated about the longitudinal axis of thebone anchor320 in order to drive the bone anchor into the bone.Open wrench380 may be provided with a torque limiting or torque measuring component to facilitate installation ofbone anchor320. In alternative embodiments a socket may be used to engagehousing330 in place of an open wrench.
• FIG. 3I shows a plan view ofbone anchor320 anddeflection rod300 observed from the deflection rod end of the assembly. As shown inFIG. 3I there are 16splines336 evenly spaced around theexterior surface334 ofhousing330. The diameter ofcollar310 is the same or smaller as the minimum diameter ofhousing330 in the region of thesplines336 to allow engagement of thesplines336 by a complementary tool or connector without interference fromcollar310. In other embodiments there may be a greater or lesser number of splines.
• FIG. 3I shows a sectional view of asocket wrench384 suitable for engaginghousing330.Socket wrench384 has a plurality ofsplines386 complementary tosplines336 ofhousing330.Socket wrench384 may therefore be slipped overdeflection rod300 andhousing330 and positioned as shown inFIG. 3I. When in position,socket wrench384 may be used to rotatehousing330 to installbone anchor320 in a bone (or remove the bone anchor from the bone).Socket wrench384 should be complementary in interior profile to theexterior profile334 ofhousing330.Socket wrench384 need not have asmany splines386 ashousing330 hassplines336 so long assplines386 are correctly positioned to engage some or all of thesplines336 ofhousing330. An open wrench or other driver may be designed with the same engagement surface to engage some or all of thesplines336 ofhousing330.
• Likewise, connectors that engage the housing of a bone anchor may also be readily adapted to engagesplines336 ofhousing330. By way of example,FIG. 3J showsconnector170 ofFIG. 1D adapted to engagesplines336.Connector170 mounts externally of thehousing330 of abone anchor320. The components ofconnector170 shown inFIG. 3J include locking setscrew176,clamp ring180 andsaddle182. As shown inFIG. 3J,clamp ring180 has, on the inside diameter, a plurality ofsplines396 complementary tosplines336 ofhousing330.Clamp ring180 may therefore be slipped overdeflection rod300 andhousing330 and positioned as shown inFIG. 3J after implantation ofbone anchor320 in a vertebra.Splines396 engagesplines336 ofhousing330.Clamp ring180 is prevented bysplines396 and336 from free rotation aroundhousing330. This is advantageous in that increases the stability of the dynamic stabilization assembly by preventing theclamp ring180 from slipping aroundhousing330 under load. Whenclamp ring180 is positioned at the desired angle relative tobone anchor320, setscrew176 may be tightened onto a vertical rod (not shown) to clamp the vertical rod to thesaddle182 and also tightenclamp ring180 against theexterior surface334 ofhousing330. Thusconnector180 may be used to securely attach a vertical rod to thehousing330 ofbone anchor320.
• Clamp ring180 (and thus connector170) may be installed in any of 16 positions around housing330 (22.5 degrees separation between positions). If smaller granularity of positioning is required, a larger number ofsplines336 may be used.Clamp ring180 should be complementary in interior profile to theexterior surface334 ofhousing330.Clamp ring180 need not have asmany splines396 ashousing330 hassplines336 so long as thesplines396 are correctly positioned to engage some or all of thesplines336 ofhousing330. Aclamp ring180 as shown inFIG. 1D without any splines may still be used to engagehousing330.
• Other connectors may be similarly adapted to engage thesplines336 ofhousing330 ofbone anchor320. Likewise, the other bone anchors discussed herein may be provided with splines on the exterior of the housing to facilitate installation and enhance the mounting of connectors. In alternative embodiments, different surface features may be utilized on the surface of a housing for engagement by a tool or connector. For example, a housing may be made polygonal in exterior section and have 8, 3, 12, 16 or more sides. A tool or connector for use with such a housing would have a complementary interior profile designed to engage the 8, 3, 12, 16 or more sides. Alternatively, a housing may be provided with a plurality of apertures at regular intervals. A tool or connector for use with such a housing may be provided with a one or more of pins designed to engage the apertures in a plurality of positions in the manner of a pin wrench. Conversely the housing may be provided with one or more protruding pins and the tool or connector with a plurality of complementary apertures. Alternatively, one or both of the housing and connector may be provided with shallow surface features such as dots, dimples, ridges or the like designed to increase the frictional engagement of the housing and connector. In the latter case, the features of the housing and connector need not necessarily be complementary to one another and the connector and housing may be free to engage one another at any angular position.
• FIGS. 4A-4D illustrate a secondalternative deflection rod400.FIG. 4A shows an exploded view of analternative deflection rod400.Deflection rod400 includesretainer402,deflectable post404,sleeve406,shield408,collar410, and mount414. In this embodiment,retainer402 is a ball-shaped structure formed in one piece withdeflectable post404.Mount414 is suitable for connecting to a vertical rod. A ball may be used in place ofmount414 as previously described. In this embodiment, mount414 is formed in one piece withdeflectable post404. In a preferred embodiment,mount414, ball-shapedretainer402 anddeflectable post404 are formed from a single piece of titanium. In alternative embodiments,deflectable post404 may be formed separately from, and securely attached to, one or more ofmount414 andretainer402 by laser welding, soldering or other bonding technology. Alternatively,deflectable post404 may be formed separately and mechanically engage one or more ofmount414 andretainer402 using, for example, threads, a lock ring, toothed locking washer, cotter pin or other mechanism.
• Sleeve406 is made of a compliant material which permits movement ofdeflectable post404 relative to shield408. Thesleeve406 controls deflection of thedeflectable post404.Sleeve406 is preferably made of a compliant biocompatible polymer. The properties of the material and dimensions of thesleeve406 anddeflectable post404 are selected to achieve the desired force/deflection characteristics fordeflectable post404. In a preferred embodiment, the sleeve is made of PCU, is 2 mm thick when uncompressed and may be compressed to about 1 mm in thickness by deflection of the post.Sleeve406 may also be shaped to modify the compliance ofsleeve406, for example by providing flutes407 (not shown).Sleeve406 fits insideshield408 surroundingdeflectable post404.
• Deflection rod400 is configured to be mounted in abone anchor420, which comprises abone screw422 connected to ahousing430.Housing430 has ashort cavity432 oriented along the axis ofbone anchor420 at the proximal end and configured to receive the threaded distal end ofshield408.Shield408 also has anouter surface434 adapted for mounting an offset connector.Outer surface434 may, in some embodiments, be cylindrical or may have surface features, for example flutes as previously discussed. Note that in this embodiment, the deflection rod is arranged coaxially withbone anchor422. In particular, post404 ofdeflation rod400 is arranged coaxially withbone anchor422.
• Referring now toFIG. 4B, which shows a perspective view of a fully assembleddeflection rod400. When assembled,deflectable post404 is positioned withinsleeve406;sleeve406 is positioned withinshield408.Retainer402 ofFIG. 4A and the threaded distal end of shield406 (seeFIG. 4A) are then placed in short cavity432 (not shown) ofbone anchor420.Shield408 is tightened tohousing430 using the threads and may also be laser welded to furthersecure shield408 tohousing430. Threadedcollar410 is then secured in the threaded proximal end ofshield408. Threadedcollar410 has twosockets411 for receiving the pins of a pin wrench to allow threadedcollar410 to be tightened to threads438 (seeFIG. 4A) ofshield408. Threadedcollar410 may also be laser welded to shield408 after installation to further secure the components.
• FIG. 4C shows a sectional view ofdeflection rod400 assembled with abone anchor420 along the axis indicated by line C-C ofFIG. 4B. As shown inFIG. 4C, ball-shapedretainer402 fits into ahemispherical pocket439 insidehousing430.Shield408 includes aflange409 which holds ball-shapedretainer402 withinhemispherical pocket439.Collar410 securessleeve406 withinshield408.Collar410 also provides alimit surface413 for limiting deflection ofdeflectable post404.Sleeve406 occupies the space betweendeflectable post404 and shield408 and is compressed by deflection ofdeflectable post404 towardsshield408 in any direction.
• FIG. 4D illustrates the deflection ofdeflectable post404. Applying a force to mount414 causes deflection ofdeflectable post404 ofdeflection rod400. Initiallydeflectable post404 pivots about apivot point403 indicated by an X.Deflectable post404 may pivot in any direction aboutpivot point403. In this embodiment,pivot point403 is located at the center of ball-shapedretainer402.Pivot point403 may be positioned closer to the distal end ofbone screw422, for example by projecting a virtual pivot point. As shown inFIG. 4D, deflection ofdeflectable post404 initially compresses the material ofsleeve406. The force required to deflectdeflectable post404 depends upon the dimensions ofdeflectable post404,sleeve406 and shield408 as well as the attributes of the material ofsleeve406. After further deflection,deflectable post404 comes into contact withlimit surface413 ofcollar410.
• Limit surface413 is shaped and oriented to reduce the possibility of wear and damage todeflectable post404 due to contact withlimit surface413. For example, limitsurface413 is oriented such that whendeflectable post404 makes contact withlimit surface413, the contact is distributed over an area to reduce wear and stress ondeflectable post404. Afterdeflectable post404 comes into contact withlimit surface413, further deflection requires deformation ofdeflectable post404. Becausedeflectable post404 is relatively stiff, the force required to deflectdeflectable post404 will increase significantly after contact ofdeflectable post404 withcollar410. In a preferred embodiment,deflectable post404 may deflect from 0.5 mm to 2 mm in any direction before making contact withlimit surface413. More preferably,deflectable post404 may deflect approximately 1 mm before making contact withlimit surface413.
• As depicted inFIG. 4D, when load or force is first applied to the deflection rod by the spine, the deflection of the deflection rod responds about linearly to the increase in the load during the phase when deflection ofdeflectable post404 causes compression ofsleeve406. After about 1 mm of deflection, whendeflectable post404 contacts limitsurface413 the deflection rod becomes stiffer. A greater amount of load or force needs to be placed on the deflection rod in order to obtain the same amount of deflection that was realized prior to this point because further deflection requires bending ofdeflectable post404. The relationship between deflection and load is thus a non-linear function. Accordingly, the deflection rod of this example provides a range of motion where the load supported increases about linearly as the deflection increases and then with increased deflection the load supported increases more rapidly in a non-linear manner in order to provide dynamic stabilization.
• FIG. 4E shows a modifiedversion400eofdeflection rod400. All parts are the same with the exception thatdeflectable post404eis modified to receive aball444.Ball444 is received in apocket442 at one end ofvertical rod450.Ball444 is secured withinpocket442 bycap446.Ball444 forms part of ball joint440 which connectsdeflectable post404etovertical rod450.Ball joint440 allows greater range of motion and reduces torsional stresses on the dynamic stabilization assembly and the bones to which it is attached. However, using a ball-joint in place of a fixed connection between the vertical rod and post also reduces the stiffness of the assembly. Thus the choice of ball-joint or fixed connection is a trade-off between stiffness and range of motion. The choice will be made based on the patient's anatomy and functional requirements.
• Deflection rod400 andbone anchor420 may be used in the same manner as previously described.Deflection rod400 may be utilized, for example, to provide load sharing and dynamic stabilization.Deflection rod400 may be connected to another level of a spine using a vertical rod connected to a polyaxial screw at that level or another deflection rod and bone anchor. By utilizing offset connectors mounted to the exterior surface ofshield408,deflection rod400 can connect to both adjacent vertebrae thereby providing the ability to construct a multi-level dynamic spinal stabilization assembly suitable for providing load sharing and stabilization.
• FIG. 4F shows a sectional view of an alternative embodiment of adeflection rod460. As shown inFIG.4F post464 includes aretainer462 which is engaged bysleeve468 to securepost464 tobone screw461. Indeflection rod460,retainer462 is a cone-shaped portion of a sphere instead of spherical in shape.Retainer462 pivots aboutpivot point463 marked by an X.Dotted line465 shows the diameter of a spherical retainer having the same effective pivot point. Theconical retainer462 requires a lower volume while providing an effective pivot point closer to the distal end ofbone screw461. The conical retainer can be accommodated in a smaller cavity withinbone screw461. This allowsbone screw461 to be stronger while allowingpivot point463 to be placed closer to the instantaneous center of rotation of the spine. Placing thepivot point463 closer to the instantaneous center of rotation of the spine also helps isolate the bone anchor from the relative motion between the vertebrae. When implanted,pivot point463 is preferably positioned at or below the surface of the vertebra. More preferably,pivot point463 is positioned within the pedicle or vertebral body of a vertebra. This retainer may be substituted for the retainers in the other deflection rods described herein.
• FIG. 4G shows a sectional view of another alternative embodiment of adeflection rod470. As shown inFIG.4G post474 includes aretainer472 which is engaged bysleeve478 to securepost474 tobone screw471. Indeflection rod470,retainer472 is segment of the surface of a sphere instead of being spherical.Retainer472 pivots aboutpivot point473 marked by an X.Dotted line475 shows the diameter of a spherical retainer having the same effective pivot point. The center of the sphere (if complete) is outside ofretainer472. However, post474 behaves as if pivoting about this virtual pivot point (so-called because it is external to the pivot mechanism).Retainer472 requires a lower volume than a spherical retainer.Retainer472 can therefore be accommodated in a smaller cavity withinbone screw471. This allowsbone screw471 to be stronger while allowingpivot point473 to be placed closer to the instantaneous center of rotation of the spine. Placing thepivot point473 closer to the instantaneous center of rotation of the spine also helps isolate the bone anchor from the relative motion between the vertebrae. When implanted,pivot point473 is preferably positioned at or below the surface of the vertebra. More preferably pivotpoint473 is positioned within the pedicle or vertebral body of a vertebra. This retainer may be substituted for the retainers in the other deflection rods described herein.
Deflection/Load Response Curve
• As previously stated, the deflection response of a deflection rod can be customized based on the choice of design, dimensions and materials. It is contemplated, for example, that the deflection rod can be made in stiffness that can replicate a 70% range of motion and flexibility of the natural intact spine, a 50% range of motion and flexibility of the natural intact spine and a 30% range of motion and flexibility of the natural intact spine for providing in a kit for a doctor to use.FIG. 5A is a graph showing the deflection/force response of three different deflection rod assemblies.
• Curve501 shows the force/deflection response of a deflection rod that is a little stiffer than a 70% stiffness deflection rod. Thedeflection rod504 tested to generate the force/deflection curve501 shown inFIG. 5A is shown schematically inFIG. 5B.Deflection rod504 has aPEEK sleeve512 of about 4 mm in diameter at its largest diameter and adeflectable post510 made of Nitinol.Sleeve512 anddeflectable post510 are press fit inside asleeve516. There is agap508 between thesleeve512 and shield516 which allows initial deflection ofdeflectable post510 without compression ofsleeve512. The working length of thedeflection rod504 is about 26 mm. Thedeflectable post510 is connected by a ball-joint522 to thevertical rod520. The deflection of thedeflectable post510 post in response to load applied on thevertical rod522 is shown by thecurve501. As is evident fromFIG. 5A, the deflection/force curve501 is non-linear. At about 1 mm of deflection,sleeve512 makes contact with theshield516 and further deflection requires compressions ofsleeve512 as well as bending of thedeflectable post510. Thedeflection rod504 therefore responds more stiffly as the load increases. As the deflection increases, the stiffness of the deflection rod increases such that the force required per unit of additional deflection increases in response to the load placed on the spine and deflection rod. This can be observed in the force/deflection curve as an increase in the slope of thecurve501.
• Curve502 shows the force/deflection response of an alternative deflection rod. The deflection rod tested to generate the force/deflection curve502 shown inFIG. 5A is of the same general design asdeflection rod300 ofFIGS. 3A-3C. The deflection rod has a 2 mm thick sleeve of Bionate® PCU having a durometer of 80. The deflectable post is made of titanium and varies between 4 mm and 5 mm in diameter. The length of the deflectable post (including retaining ball and ball joint) is about 20 mm. The deflection rod is connected by a ball-joint to the vertical rod. The deflection of the deflectable post in response to load applied on the vertical rod is shown by thecurve502. As is evident fromcurve502 the deflection rod responds gradually more stiffly as the load increases.Curve502 was obtained without a collar and limit surface. In deflection rods made according to the designs illustrated inFIGS. 3A-3H and4A-4D, the stiffness of the deflection rod should increase at about 1 mm of deflection the deflectable post makes contact with the limit surface. This is illustrated in the predicted force/deflection curve502bas a sudden increase in slope of the curve. Thus, as the deflection increases, the stiffness of the deflection rod increases such that the force required per unit of additional deflection increases rapidly in response to the load placed on the spine and deflection rod.
• Curve503 shows the force/deflection response of an alternative deflection rod. The deflection rod tested to generate the force/deflection curve502 shown inFIG. 5A is of the same general design asdeflection rod300 ofFIGS. 3A-3C. The deflection rod tested to generate the force/deflection curve503 shown inFIG. 5A also has a 2 mm thick sleeve of Bionate® PCU having a durometer of 80. The deflectable post is made of titanium and varies between 4 mm and 5 mm in diameter. The length of the deflectable post (including retaining ball and mount) was about 20 mm. The deflection rod is, however, connected by a rigid connection between the mount and the vertical rod (instead of a ball-joint). The deflection of the post in response to load applied on the vertical rod is shown by thecurve503. As is evident fromcurve503 the deflection rod responds much more stiffly than when connected via a ball-joint.Curve503 was also obtained without a collar and limit surface. In deflection rods made according to the designs illustrated inFIGS. 3A-3H and4A-4D, the stiffness of the deflection rod should increase further at about 1 mm of deflection when the post makes contact with the limit surface. This is illustrated in the predicted force/deflection curve503bas a sudden increase in the slope of the curve. Thus, as the deflection increases, the stiffness of the deflection rod increases such that the force required per unit of additional deflection increases rapidly in response to the load placed on the spine and deflection rod.
• As depicted inFIG. 5A, as load or force is first applied to the deflection rod by the spine, the deflection of the deflection rod responds about linearly to the increase in the load. After the post makes contact with the limit surface, the deflection rod responds more stiffly. In this region, a greater amount of load or force needs to be placed on the deflection rod in order to obtain the same amount of deflection that was realized prior to this point. Accordingly, the deflection rod of this example provides a range of motion where the load supported increases about linearly as the deflection increases and then with increased deflection the load supported increases more rapidly in a non-linear manner. The transition from lower stiffness to higher stiffness region depends upon the distance between the deflectable post and the limit surface of the collar. This distance may be customized as previously described so that the transition occurs after the desired amount of deflection, for example after about 1 mm of deflection or after about 2 mm of deflection.
Deflection Rods Having Anisotropic Deflection Characteristics
• The deflection system of the present invention provides in some embodiments the ability to control stiffness for extension, flexion, lateral bending and axial rotation, and to control stiffness for each of these motions independently of the other motions. The characteristics of the deflection rod can be changed, for example, by adjusting the diameter of post and/or the thickness of the sleeve and/or the distance between the post and the limit surface. For example,FIGS. 6A-6D show cross-sections through alternative embodiments of thedeflection rod200 ofFIG. 2B along the line D-D. Similar variations could be made of the other deflection rods described hereine.g. deflection rod300 ofFIGS. 3A-3C anddeflection rod400 ofFIGS. 4A-4C.
• InFIG. 6A, theshield208ais uniformly thicker andsleeve206aofdeflection rod200ais uniformly thinner than that ofdeflection rod200. As a consequence, deflection post204awith the cross-section shown inFIG. 6A is stiffer/less flexible in all directions.
• However, the deflection characteristics need not be isotropic. A bias can be introduced in the deflection rod by varying the inner surface of the shield and/or the thickness of the sleeve in different positions around the post. As shown inFIG. 6B, shield208bis designed such that thesleeve206bofdeflection rod200bis thicker on the left and right sides ofdeflectable post204bthan in the top and bottom sides (relative to the page). Adeflection rod200bhaving the cross-section shown inFIG. 6B is thus stiffer in the up and down directions and more flexible in the left and right directions.
• As shown inFIG. 6C, shield208cis designed so thatsleeve206cofdeflection rod200cis thicker on the right, top, and bottom sides ofdeflectable post204cthan on the left side. Adeflection rod200chaving the cross-section shown inFIG. 6C is thus stiffer in the left direction and more flexible in the right, up and down directions.
• As shown inFIG. 6D, shield208dis designed so thatsleeve206dofdeflection rod200dis thicker on the right side ofdeflectable post204dthan on the left, top, or bottom sides.Deflection rod200dhaving the cross-section shown inFIG. 6D is, thus, more flexible in the right direction than in any of the other directions.
• The characteristics of the deflection rod can also be changed by, for example, adjusting the compliance of the sleeve. For example, using PCU with different durometer ratings and or using different materials. Making the entire sleeve of a less compressible material for example will make the deflection rod stiffer, e.g. a larger load will be required to cause the same deflection. Conversely, making the entire sleeve of a more compressible material for example will make the deflection rod more flexible, e.g. a smaller load will be required to cause the same deflection. However, the deflection characteristics need not be isotropic. A bias can be introduced in thedeflection rod200 by having material with different compliance in different regions of the sleeve. This can be achieved, for example, using a multi-shot injection molding technique to make the sleeve and using PCUs having different durometer ratings in the multi-shot injection process. For example,FIGS. 6E-6H show cross-sections through alternative embodiments of thedeflection rod200 ofFIG. 2B along the line D-D in which the sleeves have regions with different properties.
• As shown inFIG. 6E,sleeve206eofdeflection rod200ehas a region of morecompliant material640 on the left side ofdeflectable post204eand a region of lesscompliant material680 on the right side (relative to the page). Accordingly,material640 can have a different durometer value thanmaterial680. Both can be a polymer. Adeflection rod200ehaving the cross-section shown inFIG. 6E is thus stiffer in the right direction and more flexible in the left direction.
• As shown inFIG. 6F,sleeve206fofdeflection rod200fhas a region of morecompliant material640 on the top and bottom sides ofdeflectable post204fand a region of lesscompliant material680 on the left and right sides (relative to the page). Adeflection rod200fhaving the cross-section shown inFIG. 6E is thus stiffer in the left and right directions and more flexible in the up and down directions.
• As shown inFIG. 6G,sleeve206gofdeflection rod200ghas a region of morecompliant material640 on the left and bottom sides ofdeflectable post204gand a region of lesscompliant material680 on the top and right sides (relative to the page). Adeflection rod200ghaving the cross-section shown inFIG. 6G is thus stiffer in the up and right directions and more flexible in the down and left directions.
• As shown inFIG. 6H,sleeve206hofdeflection rod200hhas a region of morecompliant material640 on the left, top, and bottom sides ofdeflectable post204hand a region of lesscompliant material680 on the right side (relative to the page). Adeflection rod200hhaving the cross-section shown inFIG. 6H is thus stiffer in the right direction and more flexible in the other directions.
• Furthermore, by varying the shape of the collar, the distance between the post and the limit surface of the collar may also be varied. By making the distance shorter, the amount of deflection can be reduced that occurs before the dramatic increase in stiffness caused by contact with the limit surface. The collar may be shaped to reduce the gap between the post and the limit surface uniformly or may be shaped to reduce the gap between the post and the limit surface more in some directions than in others (anisotropically).
• In embodiments where the deflection rod has anisotropic force-deflection response, it is important to ensure that the deflection rod is implanted in the correct orientation. The deflection rod is therefore provided with discernable visual or physical characteristics (e.g. an arrow, color, indentation or other observable indicator) which guide the surgeon to the correct orientation of implantation. When correctly installed, a deflection rod with anisotropic force-deflection response may be used to control stiffness for extension, flexion, lateral bending and axial rotation independently. For example, if a deflection rod is more flexible in the upward direction (relative to the spine after implantation—the head direction being up), the post can deflect more when the spine is placed in flexion and can deflect less when the spine is placed in extension. In effect, this arrangement is more restrictive with respect to movement of the spine with the spine in extension and less restrictive with respect to the movement of the spine with the spine in flexion. Conversely, if the deflection rod is more compliant in the down direction (relative to the spine after implantation—the head direction being up), the post can deflect more when the spine is placed in extension and can deflect less when the spine is placed in flexion. In effect, this arrangement is more restrictive with respect to movement of the spine in flexion and less restrictive with respect to the movement of the spine in extension.
Alternative Bone Anchors
• FIGS. 7A through 7H illustrate some possible variations in bone anchors of the anchoring system. The bone anchors each have a housing compatible with the deflection rods of the deflection system and the offset heads/connectors of the connector system. In some embodiments, the bone anchors are installed prior to implantation of the bone anchors in the body. In alternative embodiments, the bone anchors may be implanted in the body before installation of a deflection rod.
• Bone anchor710 ofFIG. 7A is a bone screw having a threadedregion714 which extends up over most of ahousing712. Adeflection rod704 is installed inhousing712. The threadedregion714 may extend over a greater or lesser amount ofhousing712 depending upon such factors as the length of the bone screw, the type of bone in which the screw is to be implanted and the desired height to which thehousing712 will extend above the bone surface after implantation.Bone anchor710 may be useful to lower the depth of the pivot point of thedeflection rod704 closer to the natural instantaneous center of rotation of the spine. Note also that thedistal thread depth716 may be deeper than theproximal thread depth718. Thedistal thread depth716 is adapted for engagement of the soft cancellous bone while theproximal thread depth718 is adapted for engagement of the harder cortical bone at the surface of the vertebra.
• Bone anchor720 ofFIG. 7B is a bone screw in which the screw-only section724 is shorter in length than inbone screw710 ofFIG. 7A. Adeflection rod704 is installed inhousing722. Different lengths of screw-only section may be useful in different patients or different vertebrae as the size of the bone in which the anchor needs be implanted may vary considerably. For example, short bone screws are desirable where the dynamic stabilization system is to be implanted in smaller vertebrae. The physician may determine the length of bone screw appropriate for a particular patient by taking measurements during the procedure of by determining measurements from non-invasive scanning, for example, X-ray NMR, and CT scanning. Note however, thathousing722 is preferably the same size and shape as the housings of the other bone anchors so as to be compatible with the same deflection rods and connectors.
• Bone anchor730 ofFIG. 7C is a bone screw in which the screw-only section734 has a smaller diameter and is shorter in length than inbone screw710 ofFIG. 7A. Adeflection rod704 is installed inhousing732. Different diameters of screw-only section may be useful in different patients or different vertebrae as the size of the bone in which the anchor needs be implanted may vary considerably. For example, smaller diameter bone screws may be desirable where the dynamic stabilization system is to be implanted in smaller vertebrae. The physician may determine the diameter of bone screw appropriate for a particular patient by taking measurements during the procedure by determining measurements from non-invasive scanning, for example, X-ray NMR, and CT scanning. Note however, thathousing732 is preferably the same size and shape as the housings of the other bone anchors to be compatible with the same deflection rods and connectors.
• Bone anchor740 ofFIG. 7D is a bone screw in which thehousing742 has arim744 extending away fromhousing742 where it transitions to the threadedregion746. Adeflection rod704 is installed inhousing742.Rim744 may serve to retain an offset head mounted tohousing742 in a way that it can rotate freely aroundhousing742 during installation.Rim744 may also serve to widen the contact area between thebone anchor740 where it meets the bone of the vertebra. This can act as a stop preventing over-insertion. This can also provide a wide base for stabilizing the housing against lateral motion and torque. Note thathousing742 is preferably the same size and shape as the housings of the other bone anchors so as to be compatible with the same deflection rods and connectors.
• Bone anchor750 ofFIG. 7E illustrates abone hook device751 having ahousing752. Adeflection rod704 is installed inhousing752.Bone hook device751 comprises abar754 to whichhousing752 is rigidly connected. At either end ofbar754 is abone hook756 having aset screw757 for securing thebone hook756 to thebar754. Eachbone hook756 has a plurality ofsharp points758 for engaging and securing thebone hook756 to a vertebra. During use, the bone hooks756 are urged towards each other until the sharp points engage and/or penetrate the surface of a bone. Setscrews757 are tightened to secure bone hooks756 in position relative to bar754 and thussecure housing752 relative to the bone. Different arrangements of bone hooks and bars may be made suitable for attachment of thehousing752 to different types, sizes, shapes and locations of vertebra. Note thathousing752 is preferably the same size and shape as the housings of the other bone anchors so as to be compatible with the same deflection rods and connectors.
• In some embodiments, the bone anchors may be provided with a torque-limiting and/or breakaway head which is engaged by a driver to drive the bone anchor into the vertebra. The torque-limiting and/or breakaway head is designed to prevent further driving of the bone anchor into the vertebra when the torque applied by the driver exceeds a predetermined torque limit. In preferred embodiments, the torque limit is selected so that the torque required to drive the bone anchor into a vertebra is lower than the torque limit. In preferred embodiments, when the bone anchor is fully implanted in the vertebra, further rotation of bone anchor requires significantly higher torque which is higher than the torque limit. Thus, when bone anchor is fully implanted in the vertebra, the driver torque exceeds the torque limit and torque-limiting and/or breakaway head prevents the bone anchor from being driven further into the bone. In some cases, the torque limit may be reached prior to complete installation of the bone anchor. In such cases, the bone anchor may be removed and a new bone anchor installed—the cavity in the bone in which the bone anchor is to be installed may be enlarged to facilitate implantation of the second bone anchor thereby reducing the torque necessary to implant the bone anchor.
• Bone anchor760 ofFIGS. 7F-7H is a bone screw having ahead770 extending beyond ahousing772.Housing772 is preferably the same size and shape as the housings of the other bone anchors so as to be compatible with the same deflection rods and connectors.Head770 is a torque-limiting head which is designed to break away frombone anchor760 when the torque applied to head770 exceeds a predetermined torque limit.Head770 may be a hex head (as shown) or may be of another design suitable for being driven by an installation tool for example a wrench or other driver, including, for example, slotted, Phillips, square, Allen, and Torx heads. During installation, a driver (for example a hex socket) engageshead770 and rotatesbone anchor760 to drive threadedregion764 into a vertebra. In preferred embodiments, the torque limit is selected so that the torque required to drive threadedregion764 into a vertebra is lower than the torque limit. In preferred embodiments, when the threadedregion764 is fully implanted in the vertebra, further rotation ofbone anchor760 requires significantly higher torque which is higher than the torque limit. Thus, when the threadedregion764 is fully implanted in the vertebra, the driver torque exceeds the torque limit and thehead770 breaks away frombone anchor760 as shown inFIG. 7G.
• As shown inFIG. 7G, when the torque limit is exceeded,head770 breaks away frombone anchor760.Head770 may then be removed fromcavity766 ofbone anchor760.Cavity766 may containinternal features768 designed to engage a driver to permit removal ofbone anchor760, if necessary or desired. Alternatively or additionally, theexterior surface763 ofhousing762 may be provided with features for example knurling or splines (not shown but see, e.g.,FIG. 7A) which allow a driver to engage theexternal surface763 ofhousing762 to permit removal ofbone anchor760 if necessary or desired. As shown inFIG. 7G,head770 comprises ashaft772 which extends intocavity766 ofhousing762. Whenhead770 has been removed,cavity766 is open, to receive a deflection system component or connection system component as previously described (not shown).
• FIG. 7H shows an enlarged sectional view ofbone anchor760 throughhead770. As shown inFIG. 7H,head770 is connected byshaft772 tobone anchor760.Shaft772 has aneck774 of smaller diameter than the remainder ofshaft772. Theneck774 is therefore subjected to higher stress than the remainder ofshaft772. The diameter and material ofneck774 is selected to control the torque limit. For a particular material, reducing the diameter of the neck reduces the maximum torque which can be transmitted by the head before the neck shears off. When the torque limit is exceeded, theshaft772 shears off at theneck774.Neck774 is positioned so that, whenneck774 is sheared, any portion ofshaft772 which remains attached tobone anchor760 is positioned so as not to obstruct installation of a deflection system component or connection system component withincavity766. As shown inFIG. 7H, for example,neck774 may be positioned within adepression767 in the distal end ofcavity766. Whenneck774 shears off,cavity766 is clear for installation of another component. In some cases,head770 andshaft772 may be formed in one piece withbone anchor760. In other embodiments,head770 andshaft772 may be formed separately frombone anchor760 and subsequently securely connected tobone anchor760 by a bonded, welded or mechanical joint.
Alternative Deflection Rods/Loading Rods
• One feature of embodiments of the present invention is load sharing provided by the deflection rod. The deflection rod provides stiffness and support where needed to support the loads exerted on the spine during normal spine motion thereby recovering improved spine function without sacrificing all motion. The deflection rod also isolates the anchor system components from forces exerted by the dynamic stabilization assembly thereby reducing stress on the bone anchors and the bone to which they are attached. In particular embodiments, the deflection rods of the present invention are oriented coaxial with the longitudinal axis of the bone anchor to which they are attached or in which they are incorporated. Moreover, by selecting the appropriate stiffness of the deflection rod or loading rod to match the physiology of the patient and the loads that the patient places on the spine, a better outcome is realized for the patient.
• FIGS. 8A-8H shows alternative deflection rods having different mechanisms to secure the deflectable post to the deflection rod and/or the bone anchor. The mechanisms ofFIGS. 8A-8H may be adapted for use in other of the deflection rods described herein. For example,FIGS. 8A-8C illustrate one alternative embodiment of a deflection rod/loading rod.Deflection rod800 ofFIGS. 8A-8C is similar in design and function todeflection rod300 ofFIGS. 3A-3E. However,deflection rod800 utilizes a different mechanism to secure the ball-shaped retainer to the housing of the bone anchor than is used indeflection rod300.
• FIG. 8A shows an exploded view ofalternative deflection rod800.Deflection rod800 includes ball-shapedretainer802,post804,sleeve806, lockingpin808,collar810, and mount814. In this embodiment, ball-shapedretainer802 is formed in one piece withpost804. Ball-shapedretainer802 is split along the longitudinal axis ofpost804 by one ormore slots803.Slots803 allow ball-shaped-retainer802 to deform to have a reduced diameter. Ashaft805 passes from the proximal end ofmount814 throughpost804 and communicates with the one ormore slots803. A lockingpin808 may be inserted throughshaft805 to occupy space in the one ormore slots803. With lockingpin808 secured in place, ball-shapedretainer802 is locked at its normal diameter and may not be compressed to a smaller diameter.
• Sleeve806 fits insidecavity832 ofhousing830 surroundingpost804.Sleeve806 is made of a compliant material which permits movement ofpost804 relative tohousing830.Deflection rod800 is configured to be mounted in abone anchor820, which comprises abone screw822 connected to ahousing830.Housing830 has acavity832 oriented along the axis ofbone anchor820 at the proximal end and configured to receivedeflection rod800.Housing830 also has anouter surface834 adapted for mounting a component, e.g. an offset connector. As shown inFIG. 8A,outer surface834 ofhousing830 is provided withflutes836.Flutes836 may be engaged by a driver for implantingbone anchor820.
• Referring now toFIG. 8B, which shows a perspective view of adeflection rod800 assembled with abone anchor820. When assembled,deflectable post804 is positioned withinsleeve806 ofFIG. 8A.Post804 andsleeve806 are then placed in thecavity832 of bone anchor820 (SeeFIG. 8A). Lockingpin808 is then inserted into shaft805 (not shown) to secure ball-shapedretainer802 tobone anchor820. Lockingpin808 may also be laser welded to mount814 after installation to further secure the components. Threadedcollar810 is then secured in the threaded proximal end ofcavity832. Threadedcollar810 has twosockets811 for receiving the pins of a pin wrench to allow threadedcollar810 to be tightened tothreads838 ofhousing830. Threadedcollar810 is laser welded tohousing830 after installation to further secure the components. Threadedcollar810 securessleeve806 withincavity832 ofbone anchor820.
• FIG. 8C shows a sectional view of adeflection rod800 assembled with abone anchor820 along the axis indicated by line C-C ofFIG. 8B. As shown inFIG. 8C,sleeve806 occupies the space betweenpost804 andhousing830.Sleeve806 is compressed by deflection ofpost804 towardshousing830 in any direction. Ball-shapedretainer802 fits into apocket839 in the bottom of cavity832 (not shown) ofhousing830.Pocket839 has the shape of a major spherical cap (a spherical cap comprising greater than half of the sphere). Consequently, theentrance aperture840 topocket839 is narrower than the major diameter ofpocket839. Ball-shapedretainer802 has the same diameter as the major diameter ofpocket839; however, in the absence of lockingpin808, ball-shapedretainer802 may be compressed sufficiently to pass throughaperture840. However, after ball-shaped retainer has been pushed intopocket839 and lockingpin808 has been installed inshaft805 andslot803, ball shapedretainer802 can no longer be compressed and is therefore locked intopocket839 while still allowing rotation of ball-shapedretainer802.Collar810 securessleeve806 withinhousing830. Thedeflection rod800 ofFIG. 8A-8C does not include a shield betweensleeve806 andhousing830. By removing the thickness of the shield, the size/strength properties of the device may be enhanced.
• As shown inFIG. 8D, analternative deflection rod850 may utilizeretainer852 which is a portion of a sphere rather than spherical. In other aspects, thedeflection rod850 is similar todeflection rod800 ofFIGS. 8A-8C. However, a full sphere may be unnecessary forretainer852 where, as here, thepost804 is limited bycollar810 to a few degrees of deflection. Over the range of deflection permitted, thespherical segment retainer852 maintains sufficient contact with the wall ofpocket854 to secureretainer852 withinpocket854. Thelower portion851 ofretainer852 is, in this embodiment, a sphere having a smaller diameter than the upper portion, but having the same center of rotation.Pocket852 can likewise be reduced in size by truncating the major spherical cap to form apocket854 in the shape of a spherical segment (which includes the center and thus maximum diameter of the sphere). A smallerlower pocket853 of the same diameter as the lower sphere serves to locate the retainer during its travel. As a consequence less material needs to be removed to formpocket854 and the strength ofbone anchor850 is therefore enhanced. Other shapes of retainer and pocket may also be used so long as they securepost804 tobone anchor820 and allow the desired range of travel forpost804.
• FIGS. 8E and 8F, show exploded and sectional views of analternative deflection rod860 which uses a retainer in the form of a split-ring862. Splitspherical ring862 fits inpocket864 inbone anchor861.Pocket864 has the shape of a major spherical cap (a spherical cap comprising greater than half of the sphere). Consequently, theentrance aperture865 topocket864 is narrower than the major diameter ofpocket864. Split-ring862 has the same diameter as the major diameter ofpocket864. However, split-ring retainer862 may be compressed sufficiently to pass throughaperture865. After split-ring retainer862 has been pushed intopocket864,post866 is pushed into the central aperture of split-ring retainer862. Withpost866 locked into the central aperture of split-ring retainer862, split-ring retainer862 can no longer be compressed and is therefore locked intopocket864 while still allowing rotation ofretainer862.Post866 can be secured to split-ring retainer862 with an internal split-ring868. Other fittings such as threads, clips and or tabs may also be utilized to securepost866 to split-ring retainer862. Alternatively bonding technology may be used to securepost866 to split-ring retainer862, e.g. laser welding.
• Deflection rod860 may be provided with a collar similar tocollar810 ofFIGS. 8A-8C. However,FIGS. 8E and 8F show an alternative embodiment in which post866 includes aflange870.Flange870 is shaped to remain in close proximity to the top surface ofhousing871 ofbone anchor861 aspost866 pivots.Flange870 retainssleeve806 withinhousing871 without need of a collar. The interior surface ofhousing871 is shaped to provide thelimit surface872 to limit deflection ofpost866. By removing the thickness of the shield and the need for a separate collar, the size/strength properties of the device may be enhanced.
• A ball may be locked in a ball-joint pocket in a variety of ways. Some suitable methods and devices for locking a ball in a ball-joint assembly are disclosed in U.S. Pat. No. 4,666,330 titled “Ball Joint Assembly” to O'Connell et al. which is incorporated herein by reference in its entirety.FIGS. 8G and 8H, show exploded and sectional views of analternative deflection rod880 which uses a ball-shapedretainer882. Ball-shapedretainer882 fits inpocket884 inbone anchor881.Pocket884 is hemispherical. Theentrance aperture885 topocket884 is the same diameter as ball-shapedretainer882. However,entrance aperture885 includes agroove883 which receives a split-ring888. Split-ring888 has a larger diameter thanaperture885 but split-ring888 is compressed slightly during installation. After passing throughaperture885, split-ring888 expands outwards to occupygroove883. Split-ring888, when positioned ingroove883, reduces the effective diameter ofaperture885 and prevents removal of ball-shapedretainer882.Sleeve806 is then inserted inhousing891 ofbone anchor881.Collar890 securessleeve806 withinhousing891 ofbone anchor881. By removing the thickness of the shield, the size/strength properties of the device may be enhanced.
• In some embodiments, as described above, the deflection rod includes a deflectable post, an outer sleeve, and a mount which includes a shield positioned around the sleeve. The movement of the deflectable post relative to the mount allows controlled movement of the bone anchor (and vertebra in which it is implanted) relative to the vertical rods thereby supporting the vertebrae to which the bone anchors are attached while allowing movement of the vertebrae. However, as illustrated inFIGS. 9A-9H controlled movement of the deflectable post (or other connection point for vertical rods) relative to a bone anchor may be achieved using a number of alternative designs for deflection rods/loading rods. In general, each mechanism includes a linkage by which deflection of the deflectable post is tied to compression of a compliant component. The compression of the compliant component imparts the deflection rod so formed with the force/deflection characteristics necessary or desirable for the application.
• FIGS. 9A-9C show views of analternative deflection rod900 according to an embodiment of the invention.FIG. 9A shows an exploded view of thedeflection rod900.FIGS. 9B and 9C show sectional views of thedeflection rod900 withFIG. 9C illustrating deflection ofdeflection rod900 under load. Referring first toFIG. 9A,deflection rod900 is assembled incavity924 ofhousing922 ofbone anchor920. Acompliant sleeve906 is first placed intocavity924.Sleeve906 is annular and has acentral opening907. Retainingring908 is then inserted intocavity924. The lower surface of retainingring908 is adapted to engagecompliant sleeve906 and secure it into position. The upper surface of retainingring908 has apocket909 adapted to receive the lower portion of aball902.Deflectable post904 is attached to the top ofball902. Acontrol rod905 extends from the bottom ofball902.Control rod905 is shaped to fit through retainingring908 into thecentral opening907 ofsleeve906. Withcontrol rod905 positioned insidesleeve906 andball902 in contact with retainingring908, a threadedcollar910 is tightened into the upper end ofcavity924. Thelower surface911 ofcollar910 is shaped to form the top half of a pocket in whichball902 may rotate.Collar910 has sockets for a pin wrench or other features allowing the collar to be secured tobone anchor920.Collar910 may also be bonded or welded into place.
• FIG. 9B shows a sectional view ofdeflection rod900 when fully assembled. As shown inFIG.9B control rod905 is surrounded bysleeve906.Ball902 is secured in a pocket formed by retainingring908 andcollar910.Post904 may pivot in any direction and rotate about its long axis. However, as shown inFIG. 9C, whenpost904 pivots,control rod905 also pivots (in the opposite direction) compressing the material ofsleeve906. Compression ofsleeve906 bycontrol rod905 imparts thedeflectable post904 with a controllable force/load response which can be customized as previously described. Alimit surface912 ofcollar910 is designed to make contact withdeflectable post910 after a predetermined deflection. Further deflection of the proximal end ofdeflectable post904 after contact withlimit surface912 requires bending ofdeflectable post904. Thus, the stiffness ofdeflectable post904 will typically increase dramatically upon contact betweendeflectable post904 and limitsurface912.
• FIGS. 9D-9F show views of analternative deflection rod930 according to an embodiment of the invention.FIG. 9D shows an exploded view of thedeflection rod930.FIGS. 9E and 9F show sectional views of thedeflection rod930 withFIG. 9F illustrating deflection ofdeflection rod930 under load. Referring first toFIG. 9D,deflection rod930 is assembled incavity954 ofhousing952 ofbone anchor950. Acompliant disc936 is first placed intocavity954. Withcompliant disc936 in position,deflectable post934 is then inserted intocavity954.Deflectable post934 has acontrol disc935 at the distal end.Control disc935 fits snuggly againstcompliant disc936.Collar940 is then secured into the end ofcavity954. Thelower surface941 ofcollar940 is shaped to form the top portion of a pocket in which controldisc935 may pivot and rotate. The edges ofcontrol disc935 and the walls ofcavity954 are radiussed so thatcontrol disc935 may pivot over the desired range of travel.Collar940 may also be bonded or welded into place.
• FIG. 9E shows a sectional view ofdeflection rod930 when fully assembled. As shown inFIG.9E control disc935 sits on top ofcompliant disc936.Control disc935 is secured in a pocket formed by the walls ofcavity954 andcollar940.Deflectable post934 may pivot in any direction and rotate about its long axis. However, as shown inFIG. 9F, whendeflectable post934 pivots,control disc935 also pivots compressing the material ofcompliant disc936. Compression ofcompliant disc936 bycontrol disc935 imparts thedeflectable post934 with a controllable force/load response which can be customized as previously described. Alimit surface942 ofcollar940 is designed to make contact withdeflectable post930 after a predetermined deflection. Further deflection of the proximal end ofdeflectable post934 after contact withlimit surface942 requires bending ofdeflectable post934. Thus the stiffness ofdeflectable rod930 will typically increase dramatically upon contact betweendeflectable post934 and limitsurface942.
• FIGS. 9G and 9H show views of analternative deflection rod960 according to an embodiment of the invention.FIG. 9G shows an exploded view of thedeflection rod960.FIG. 9H shows a sectional view of thedeflection rod960. Referring first toFIG. 9G,deflectable post964 has acavity965 which receives a portion ofbone anchor980.Deflectable post964 also has a threadedmount963 to which a vertical rod may be secured. Acompliant sleeve966 is first placed intocavity965.Compliant sleeve966 has acentral opening967. A retainingring968 is then placed incavity965. Retainingring968 has acentral opening969.Bone anchor980 comprises abone screw981, aball983 and acontrol rod985.Control rod985 is passed throughcentral opening969 of retainingring968 and intocentral opening967 ofcompliant sleeve966. Lastly, threadedcollar970 is screwed into theopening965. Threadedcollar970 combines with retainingring968 to form a pocket shaped to receiveball983.Ball983 is secured between retainingring968 andcollar970 but can rotate and pivot relative todeflectable post964.Collar970 may also be bonded or welded into place.
• FIG. 9H shows a sectional view ofdeflection rod960 when fully assembled. As shown inFIG. 9G,compliant sleeve disc966 sits aroundcontrol rod985.Deflectable post964 may pivot in any direction and rotate about its long axis. However, whendeflectable post964 pivots,control rod985 compresses the material ofsleeve966. Compression ofsleeve966 bycontrol rod985 imparts thedeflectable post964 with a controllable force/load response which can be customized as previously described. Alimit surface972 ofcollar970 is designed to make contact withbone anchor980 after a predetermined deflection. Further deflection ofdeflectable post964 after contact betweenbone anchor980 and limitsurface972 requires bending ofdeflectable post964 orbone anchor980. Thus the stiffness ofdeflectable rod960 will typically increase dramatically upon contact betweenbone anchor980 and limitsurface972.
Alternate Mechanisms for Mounting a Vertical Rod to a Deflection Rod
• In order to utilize deflection rods of the present invention to construct a dynamic stabilization assembly, the deflection rod is coupled with a vertical rod. The deflection rod may be coupled to the vertical rods in a fixed, pivoting or flexible manner depending on the requirements of the dynamic stabilization assembly. One mechanism for coupling a deflection rod to a vertical rod is the ball-joint222 illustrated for example inFIGS. 2A-2C andFIGS. 2E-2G. As shown inFIG. 2B, thevertical rod216 is coupled to thedeflectable post204 by the ball-joint222 in a manner that allows thevertical rod216 to rotate about the long axis of thedeflectable post204 and also pivot relative to thedeflectable post204. These two degrees of freedom are present both during implantation and also in the completed dynamic stabilization assembly. By comparingFIGS. 2C,2E and2F, it can be seen that the angle between thevertical rod216 and deflectable post204 changes asdeflectable post204 is deflected. This change in angle is accommodated by rotation ofball214 in ball joint222.
• A second mechanism for coupling a deflection rod to a vertical rod is the threadedmount314 ofdeflection rod300 illustrated inFIGS. 3A-3H. As shown inFIG. 3G, thevertical rod360 is secured to threadedmount314 by anut362. Thevertical rod360 can be rotated aroundmount314 beforenut362 is tightened but, thereafter,vertical rod360 is rigidly secured todeflectable post304. After completion of the dynamic stabilization assembly, vertical rod can still rotate around the long axis ofbone anchor320 becausedeflectable post304 may rotate relative to the long axis ofbone anchor320. However, the angle betweenvertical rod360 anddeflectable post304 is fixed. Thus, any angle change betweenvertical rod360 anddeflectable post304 resulting from movement of the vertebra must be accommodated by deformation (bending) ofvertical rod360 anddeflectable post304.Vertical rod360 anddeflectable post304 are relatively stiff and thus, the dynamic stabilization assembly is stiff as compared to a dynamic stabilization assembly which may accommodate the angle change without bending of the vertical rod and deflectable post using e.g. a ball-joint.
• Thus, the mechanism by which the vertical rod is coupled to a deflection rod affects the ease by which the dynamic stabilization system may be assembled and also the stiffness of the dynamic stabilization assembly.FIGS. 10A-12X show a range of alternative mechanisms for coupling the deflectable post of a deflection rod to the vertical rod to create the dynamic stabilization assembly.
• FIGS. 10A-10E show a hingedcoupling1000 for connecting a deflection rod to a vertical rod according to an embodiment of the invention. Hingedcoupling1000 is designed to be mounted to the threaded proximal end of a deflectable post of a deflection rod. Hingedcoupling1000 may be used with and deflection rod having a suitable proximal mount, for example,deflection rod300 ofFIGS. 3A-3H.
• FIG. 10A shows an exploded view of hingedcoupling1000. Hingedcoupling1000 comprises clevis1010, clevispin1012, lockingplate1020 and avertical rod1030. Hingedcoupling1000 is held in place by anut1002.Vertical rod1030 is configured to be received byclevis1010. One end ofvertical rod1030 includes adisc1032 having acentral aperture1034. The circumference ofdisc1032 is provided with locking features, for example,teeth1036.Disc1032 is received betweenarms1013,1014 ofclevis1010.Pin1012 is then inserted throughaperture1016 which passes through botharms1013,1014.Pin1012 also passes throughcentral aperture1034 ofdisc1032 ofvertical rod1030.Pin1012 is secured toclevis1010, either with a mechanical fitting and/or by bonding, for example threads and/or laser welding. Withpin1012 in place,vertical rod1030 is secured toclevis1010 but may pivot about the axis ofclevis pin1012.
• Clevis1010 also has a mountingplate1017 having anaperture1018 therethrough for receiving the deflectable post of a deflection rod.Aperture1018 may be circular or may be polygonal (as shown). Whereaperture1018 is polygonal (non-circular) it may engage a similarly polygonal post in such a way as to prevent rotation of mountingplate1017 relative to the post. This is advantageous in that such rotation may causenut1002 to be loosened. Moreover, the deflectable of the deflection rods of the present invention can typically rotate relative to the bone anchor and thus rotation of the mountingplate1017 is a redundant and therefore unnecessary degree of freedom. In embodiments where the post to which the hingedcoupling1000 is connected may not rotate, it may be desirable to provide a mounting by which mountingplate1017 may rotate around the post, however in such cases, care must be taken to ensure thatnut1002 or such other fastener that is used secures the mounting plate in position while allowing such rotation.
• FIG. 10B shows hingedcoupling1000 ready for installation on adeflection rod1001.Deflection rod1001 has at the end of deflectable post1004 amount1005 for receiving mountingplate1016 of hingedcoupling1000.Mount1005 has alip1006, apolygonal portion1007 and a threadedportion1008.Lip1006 provides a mechanical stop to catch mountingplate1017.Polygonal portion1007 fits snuggly inpolygonal aperture1018 to preclude rotation of mountingplate1017 relative todeflectable post1004. In use,aperture1018 is placed overmount1005 until mountingplate1017contacts lip1006 andpolygonal portion1007 is received withaperture1018.
• After mountingplate1017 is positioned,vertical rod1030 is oriented in the desired direction and angle relative todeflectable post1004. Typically,vertical rod1030 is oriented by securing thefree end1031 to another device on another vertebra of the spine, e.g. a bone screw, polyaxial screw, or deflection rod. Whenvertical rod1030 is correctly positioned, lockingplate1020 may be installed. Lockingplate1020 includes mounting plate1022 having an aperture1024 adapted to be received overmount1005 ofdeflectable post1004. Alocking arm1026 projects from mounting plate1022.Locking arm1026 is adapted to fit betweenarms1013,1014 ofclevis1010 and engagevertical rod1030 to securevertical rod1030 at the desired angle withdeflection post1004.Locking arm1026 is provided with locking features, for example,teeth1028 for engaging the circumference ofdisc1032 ofvertical rod1030. In this embodiment,teeth1028 of lockingarm1026 engageteeth1036 ofvertical rod1030 to lockvertical rod1030 at a fixed angle relative todeflectable post1004.Clevis1010 and lockingplate1020 are secured in place bynut1002 which engages threadedportion1008 ofmount1005 to securevertical rod1030 todeflectable post1004.FIG. 10C showsvertical rod1030 secured todeflectable post1004 by hingedcoupling1000 withvertical rod1030 at a fixed angle relative todeflectable post1004.
• In an alternative mode of installation shown inFIG. 10D, lockingplate1020 may be omitted. In such case,nut1002 is used to secure clevis1010 to mount1005 ofdeflectable post1004. In the absence of lockingplate1020,vertical rod1030 is free to pivot aboutpivot pin1012 even after installation and securing ofvertical rod1030 to deflectable post1004 (see arrow1038). Thus,vertical rod1030 is provided with an additional degree of freedom of motion as finally implanted. As described above, the resulting dynamic stabilization assembly will have reduced stiffness and greater range of motion than an embodiment in which the angle between the vertical rod and deflectable post is invariant.
• Referring toFIG. 10E, hingedcoupling1000 may also be used to securevertical rod1030 to astandard bone anchor1050 having a fixed threadedpost1052. Hingedcoupling1000 may be used with or without lockingplate1020 depending upon if it is desired to havevertical rod1030 pivot relative to thebone anchor1050 after installation. When used in conjunction with a standard bone anchor, hinged coupling functions as a polyaxial head in that it allows the direction and angle ofvertical rod1030 to be adjusted relative tobone anchor1050 during installation thereby facilitating implantation of a spinal implant assembly.
• FIGS. 11A-11D show an alternative ball-joint1100 for connecting a deflection rod to a vertical rod according to an embodiment of the invention. Ball-joint1100 is designed to be mounted to the threaded proximal end of a deflectable post of a deflection rod. Ball-joint1100 may however be used with any deflection rod (or bone anchor) having a suitable proximal mount, for example,deflection rod300 ofFIGS. 3A-3H.
• FIG. 11A shows an exploded view of ball-joint1100. Ball-joint1100 includes splitspherical bearing1110, lockingwasher1120 and avertical rod1130. Ball-joint1100 is held in place by anut1102.Vertical rod1130 is configured to receive splitspherical bearing1110. One end ofvertical rod1130 includes adisc1132 having apocket1134.Pocket1134 is shaped like a segment of a sphere and has a larger diameter in the interior than at the surface ofdisc1132. Splitspherical bearing1110 has the same diameter as the largest diameter ofpocket1134. However, splitspherical bearing1110 has acentral aperture1112 and a gap1114 which allows splitspherical bearing1110 to be compressed and inserted intopocket1134. When splitspherical bearing1110 is correctly positioned withinpocket1134 it is allowed to expand into position. Expansion ofbearing1110 secures it withinpocket1134, when splitspherical bearing1110 is ready for mounting.
• FIG. 11B shows splitspherical bearing1110 mounted withinpocket1134 ofvertical rod1130 ready for installation on adeflection rod1101. Splitspherical bearing1110 protrudes on either side ofdisc1132 to provide adequate spacing for the movement ofdisc1132.Central aperture1112 may be circular (as shown) or may be polygonal. Whereaperture1112 is polygonal (non-circular) it may engage a similarly-shaped polygonal post in such a way as to prevent rotation of bearing1110 relative todeflectable post1104. This is advantageous in that such rotation may causenut1102 to be loosened. Moreover,deflectable post1104 of the deflection rods of the present invention can typically rotate relative to the bone anchor and thus rotation ofspherical bearing1110 is a redundant and therefore unnecessary degree of freedom.
• As shown inFIG. 11B,deflection rod1101 has at the end of deflectable post1104 amount1105 for receiving mounting plate1116 of ball-joint1100.Mount1105 has alip1106, acylindrical portion1107 and a threadedportion1108.Lip1106 provides a mechanical stop to catch bearing1110.Cylindrical portion1107 fits snuggly inaperture1112 to preclude compression of splitspherical bearing1110 and thereby preventing splitspherical bearing1110 from being removed frompocket1134. In use,aperture1112 is placed overmount1105 until splitspherical bearing1110contacts lip1106 andcylindrical portion1107 is received withaperture1112.
• After bearing1110 is positioned,vertical rod1130 is oriented in the desired direction and angle relative todeflectable post1104. Typically,vertical rod1130 is oriented by securing thefree end1131 to another device on another vertebra of the spine, e.g. a bone screw, polyaxial screw, or deflection rod. Whenvertical rod1130 is correctly positioned, lockingwasher1120 may be installed. Lockingwasher1120 has anaperture1124 adapted to be received overmount1105 ofdeflectable post1104.Aperture1124 is smaller thanshoulder1109 ofmount1105. Lockingwasher1120 has alower lip1122 designed, in one orientation, to push down onbearing1110. In the other orientation, lockingwasher1120 is blocked byshoulder1109 before lockingwasher1120 can compressbearing1110.Bearing1110 and lockingwasher1120 are secured in place bynut1102 which engages threadedportion1108 ofmount1105 to securevertical rod1130 todeflectable post1104.
• FIG. 11C showsvertical rod1130 secured todeflectable post1104 by ball-joint1100 withvertical rod1130 at a fixed angle relative todeflectable post1104. As shown inFIG. 11C, splitspherical bearing1110 is engaged on one side bylip1106 ofmount1105. On the other side, splitspherical bearing1110 is engaged bylip1124 of lockingwasher1120 which extends pastshoulder1109 ofmount1105. Asnut1102 is tightened, splitspherical bearing1110 is compressed betweenwasher1120 andlip1106. Splitspherical bearing1110 is designed so that, in response to compression bynut1102, it shrinks in height and expands in diameter. For example, splitspherical bearing1110 may be provided with interior relief. When splitspherical ring1110 increases in diameter, it engages the surface ofpocket1134 sufficiently to preclude further movement of bearing1110 relative torod1130. Thus, by tighteningnut1102,vertical rod1130 is secured todeflectable post1104 and the angle betweenvertical rod1130 anddeflectable post1104 is fixed.
• In an alternative mode of installation shown inFIG. 11D, lockingwasher1120 may be omitted. In such case,nut1102 is used to secure splitspherical bearing1110 to mount1105 ofdeflectable post1104. In the absence of lockingwasher1120,nut1102 cannot compress splitspherical bearing1110 becausenut1102 does not extend beyondshoulder1109 ofmount1105. As a consequence, splitspherical bearing1110 is not compressed and may therefore still rotate withinpocket1134 ofvertical rod1130. Thus, in this mode,vertical rod1130 is free to pivot about bearing1110 even after installation and securing ofvertical rod1130 to deflectable post1104 (see arrow1138). Thusvertical rod1130 is provided with additional freedom of motion as finally implanted. As described above, the resulting dynamic stabilization assembly will have reduced stiffness and greater range of motion than an embodiment in which the angle between the vertical rod and deflectable post is invariant. Ball joint1100 may similarly be used (in either mode) to securevertical rod1130 to a conventional bone anchor having a fixed threaded post (see, e.g.,bone anchor1050 ofFIG. 10E).
• In alternative embodiments, shown inFIGS. 11E and 11F, a socket for a split spherical bearing is mounted to the deflection rod itself. A vertical rod may be slipped into the split spherical bearing and may be locked in position and angle by two set screws.FIG. 11E shows an exploded view of the components which includesocket1150, bearing1160 andscrews1170 and1172.Socket1150 includes a lower fitting1152 (e.g. a threaded aperture) for attachingsocket1150 todeflection rod1101.Socket1150 may also be bonded todeflection rod1101 by e.g. laser welding, or may, in some cases, be formed in one piece with the deflectable post of thedeflection rod1101.Socket1150 has aninternal pocket1154 which is the same diameter asspherical bearing1160.Socket1150 also has an upper threadedaperture1156 for receiving setscrew1170.
• Spherical bearing1160 has aspherical section1162, asleeve1164, acentral passage1166 and a threadedaperture1168.Spherical section1162 is provided with a split or other structural relief mechanism that allows it to be pressed into thepocket1154 of socket1150 (in the absence of a vertical rod).Sleeve1164 extends from one side ofspherical section1162.Central passage1166 extends throughsleeve1164 andspherical section1162 and is sized so that a vertical rod may slide therethrough. Threadedaperture1168 intersectspassage1166 such that, when inserted, lockingset screw1172 may secure avertical rod1180 withinpassage1166.
• Spherical bearing1160 is pressed intosocket1150 andsocket1150 is secured todeflection rod1101 prior to implantation in a patient as shown inFIG. 11F. Avertical rod1180 may then be inserted throughcentral passage1166 of spherical bearing1160 (shown inFIG. 11E). Whenvertical rod1180 is at the desired position, setscrew1172 may be tightened to secure thevertical rod1180 withinpassage1166. At this point, thevertical rod1180 is secured todeflection rod1101.Spherical bearing1160 is secure withinpocket1154 ofsocket1150 because, with vertical rod in position,spherical section1162 may no longer be compressed sufficiently to remove it frompocket1154. However,spherical section1162 may still rotate withinpocket1154 and thus the angle betweendeflection rod1101 andvertical rod1180 can change.
• In some embodimentsvertical rod1180 may be oriented to the desired angle and then screw1170 may be tightened.Screw1170 engages thespherical section1162 of bearing1160 and pushes it against the wall ofsocket1154 thereby lockingbearing1160 in a fixed position. As previously described, locking the angle of thevertical rod1180 relative to thedeflection rod1101 increases the stiffness of the system. However, if less stiffness and more range of motion is required,screw1170 can be removed andbearing1160 left free to rotate withinpocket1154 after final assembly.
• FIGS. 12A-12D show another ball-joint mechanism for connecting a deflection rod to a vertical rod according to an embodiment of the invention. In the embodiment ofFIGS. 12A-12D, the vertical rod is provided with a lockingball receiver1200 which can be secured to adeflection rod1201 having adeflectable post1204 which terminates in aball1206. The lockingball receiver1200 can be secured to theball1206 in two modes. In one mode, the lockingball receiver1200 is secured to theball1206 so that it cannot be removed from theball1206 but can still rotate and pivot relative to theball1206. In the other mode, the lockingball receiver1200 is secured to theball1206 such that it cannot be removed from theball1206 and nor can it rotate and pivot relative to theball1206.
• FIG. 12A shows an exploded view ofreceiver1200.Receiver1200 includesclamp1210,washer1220 and is attached tovertical rod1230. Thereceiver1200 is positioned at one end ofvertical rod1230 and includes apocket1234.Pocket1234 is shaped like a portion of a sphere having the same diameter asball1206. The entrance topocket1234 is the same diameter asball1206 or larger so thatball1206 may be inserted intopocket1234 during connection ofvertical rod1230 todeflectable post1204.Clamp1210 has apocket1216 also shaped like a portion of a sphere having the same diameter asball1206.Pocket1216 can be moved away frompocket1234 to allow the insertion ofball1206.Pocket1216 can be moved towardspocket1234 to secureball1206 withinpocket1234.
• Clamp1210 is held in place by ascrew1202. During assembly,screw1202 is passed through anaperture1212 inclamp1210.Aperture1212 is larger thanscrew1202.Clamp1210 fits withinslot1236 inreceiver1200.Slot1236 includes aramp1238 which engages aramp1214 ofclamp1210. Engagement oframp1238 withramp1214 causes tightening ofclamp1210 asclamp1210 is brought closer to the bottom ofslot1236.Screw1202 passes into a threadedaperture1235 invertical rod1230 so that tightening ofscrew1202 draws clamp1210 towards the bottom ofslot1236. In some modes,washer1220 is positioned betweenclamp1210 and the bottom ofslot1236 thereby spacingclamp1210 from the bottom ofslot1236 and limiting the clamping action ofclamp1210.
• As shown inFIG. 12B,deflectable post1204 has at the end ofdeflectable post1204ball1206 to whichreceiver1200 may be mounted.Ball1206 may be formed in one piece withdeflectable post1204 or may be formed separately and subsequently securely attached.FIG. 12B showsreceiver1200 positioned overball1206 of adeflectable post1204.Ball1206 is slipped intopocket1234 withclamp1210 removed or loosely attached tovertical rod1230. Afterball1206 is positioned withinpocket1234,vertical rod1230 is oriented in the desired direction and angle relative todeflectable post1204. Typicallyvertical rod1230 is oriented by securing thefree end1231 to another device on another vertebra of the spine, e.g. a bone screw, polyaxial screw, or deflection rod. Whenvertical rod1230 is correctly positioned,screw1202 may be tightened. Asscrew1202 is tightened,ramp1238 pushes onramp1214 to pushpocket1216 towardspocket1234. Ifwasher1220 is present, the approach ofpocket1216 towardspocket1234 is limited by thewasher1220 so thatclamp1210 does not lock toball1206. Ifwasher1220 is absent,clamp1210 is forced into contact withball1206 by the tightening ofscrew1202.
• FIG. 12C shows a sectional view ofvertical rod1230 secured todeflectable post1204 byreceiver1200. As shown inFIG. 12C,ball1206 is trapped betweenpocket1216 ofclamp1210 andpocket1234 ofvertical rod1230.Pockets1216 and1234 combine to form a pocket which trapsball1206. Asscrew1202 is tightened,pocket1216 is pushed further towardspocket1234 by the interaction orramps1214 and1238. However, wherewasher1220 is present, the approach ofpocket1216 towardspocket1234 is halted before any clamping pressure is applied toball1206. Thus,vertical rod1230 may still rotate and pivot relative toball1206 afterscrew1202 has been tightened. Thus,vertical rod1230 is provided with an additional degree of freedom of motion as finally implanted. As described above, the resulting dynamic stabilization assembly will have reduced stiffness and greater range of motion than an embodiment in which the angle between the vertical rod and deflectable post is invariant.
• In an alternative mode of installation shown inFIG. 12D, washer1220 (not shown) may be omitted. In the absence ofwasher1220,clamp1210 can be moved closer to the bottom ofslot1236. Asscrew1202 is tightened,pocket1216 is pushed further towardspocket1234 by the interaction orramps1214 and1238. Now that washer1220 (not shown) is absent, the approach ofpocket1216 towardspocket1234 is not halted until clamping pressure is applied toball1206. As a consequence,vertical rod1230 is fixed toball1206 and cannot rotate or pivot relative toball1206. As described above, the resulting dynamic stabilization assembly will have increased stiffness but less range of motion than an embodiment in which the angle between the vertical rod and deflectable post may vary. The receiver may similarly be used (in either mode) to securevertical rod1230 to a standard bone anchor having a fixed threaded poste.g. bone anchor1050 ofFIG. 10E).
• FIGS. 13A and 13B show another mechanism for connecting a deflection rod to a vertical rod according to an embodiment of the invention.FIGS. 13A and 13B show a deflection rod having a pivoting head according to an embodiment of the invention. In the embodiment ofFIGS. 13A-13B, the deflection rod has an integratedconnector1300 which can be secured to a vertical rod. Theconnector1300 can be secured to the vertical rod in two modes. In one mode theconnector1300 is secured to the vertical rod so that it cannot be removed from theconnector1300 but can still pivot relative to the deflection rod. In the other mode, theconnector1300 is secured to the vertical rod such that it cannot be removed from theconnector1300 and nor can it pivot relative to the deflection rod.
• FIG. 13A shows an exploded view ofconnector1300.Connector1300 includessaddle1310,plunger1320, setscrew1330,pivot pin1332 and is attached to adeflectable post1340 of adeflection rod1302.Deflectable post1340 has a disk-shapedmount1342 at the proximal end.Mount1342 has acentral aperture1344 sized to receivepivot pin1332.Saddle1310 is approximately tube shaped with abore1316 which passes through the long axis ofsaddle1310. At one end ofsaddle1310 is aclevis1312 sized to receive disk-shapedmount1342.Clevis1312 has anaperture1314 which passes throughclevis1312 and is sized to receivepivot pin1332. To assembleconnector1300, disk-shapedmount1342 is inserted intoclevis1312 andpivot pin1332 is passed throughaperture1314 andaperture1344.Pivot pin1332 is then secured to one or both sides ofclevis1312 using mechanical means and/or bonding e.g. laser welding.Saddle1310 is then free to pivot relative todeflectable post1340 around the axis ofpivot pin1332.
• Bore1316 now communicates with disk-shapedmount1342. Aplunger1320 may now be introduced intobore1316.Plunger1320 has surface features, for example,ribs1326 designed to engage the surface features of disk-shapedmount1342. The end ofsaddle1310 oppositeclevis1312 has aslot1318 which passes therethrough.Slot1318 is sized to receive a vertical rod. At theclosed end slot1318 intersect the position ofplunger1320. At the open end ofslot1318, bore1316 is threaded to receive setscrew1330. When a vertical rod (not shown) is inserted intoslot1318, tightening ofset screw1330 forces the vertical rod down inslot1318 towardsplunger1320 which is in turn pushed down into contact with disk-shapedmount1342.
• FIG. 13B showsconnector1300 assembled with adeflection rod1302 andbone anchor1304. As assembled,connector1300 may pivot about the axis ofpivot pin1332 as shown byarrow1306.Connector1300 may also rotate around the long axis ofbone anchor1304 as shown byarrow1308.Rotation1308 is possible becausedeflectable post1340 may rotate around its long axis withindeflection rod1302.
• FIGS. 14A and 14B show another mechanism for connecting a deflection rod to a vertical rod according to an embodiment of the invention.FIGS. 14A and 14B show a deflection rod having a pivoting head according to an embodiment of the invention. In the embodiment ofFIGS. 14A and 14B, the deflection rod has an integratedconnector1400 which can be secured to a vertical rod. Theconnector1400 can be secured to the vertical rod in two modes. In one mode, theconnector1400 is secured to the vertical rod so that it cannot be removed from theconnector1400 but can still pivot relative to the deflection rod. In the other mode, theconnector1400 is secured to the vertical rod such that it cannot be removed from theconnector1400 and nor can it pivot relative to the deflection rod.
• FIG. 14A shows an exploded view ofconnector1400.Connector1400 includessaddle1410,plunger1420, setscrew1430, pivot pins1432,1434 and is attached to adeflectable post1440 of a deflection rod1402 (seeFIG. 14B).Deflectable post1440 has clevis1442 at the proximal end.Clevis1442 has anaperture1444 which passes through both arms ofclevis1442 and is configured to receivepivot pins1432,1434.Saddle1410 is approximately tube shaped with abore1416 which passes through the long axis ofsaddle1410.Clevis1442 has anaperture1414 which passes through clevis1412 and is sized to receivepivot pins1432,1434. To assembleconnector1400,saddle1410 is inserted intoclevis1442 andpivot pins1432,1434 are passed throughapertures1444 intoapertures1414. Pivot pins1432,1434 is then secured to both sides ofclevis1442 using mechanical means and/or bonding e.g. laser welding.Saddle1410 is then free to pivot relative todeflectable post1440 around the axis ofpivot pins1432,1434.
• Bore1416 now communicates with ribbed surface1446 ofclevis1442. Aplunger1420 may now be introduced intobore1416.Plunger1420 has surface features, for example,ribs1426 designed to engage the ribbed surface1446 ofclevis1442. The proximal end ofsaddle1410 has aslot1418 which passes therethrough.Slot1418 is sized to receive a vertical rod (not shown). At the closed end,slot1418 intersects the position ofplunger1420. At the open end ofslot1418, bore1416 is threaded to receive setscrew1430. When a vertical rod (not shown) is inserted intoslot1418, tightening ofset screw1430 forces the vertical rod down inslot1418 towardsplunger1420 which is in turn pushed down into contact with ribbed surface1446 ofclevis1442. Contact betweenplunger1420 andclevis1442 locks saddle1410 so that it can no longer pivot relative to the plunger. However, in an alternative configuration,plunger1420 is omitted, and setscrew1430 can be used to lock the vertical rod (not shown) to thesaddle1410 while still allowingsaddle1410 to pivot with respect toclevis1442.
• FIG. 14B showsconnector1400 assembled with adeflection rod1402 andbone anchor1404. As assembled,connector1400 may pivot about the axis ofpivot pin1432 as shown byarrow1406.Connector1400 may also rotate around the long axis ofbone anchor1404 as shown byarrow1408.Rotation1408 is possible becausedeflectable post1440 may rotate around its long axis withindeflection rod1402. A vertical rod (not shown) may be inserted intoslot1418. Tighteningset screw1430 secures the vertical rod to thesaddle1410. Ifplunger1420 is present, tighteningset screw1430 also locks the relative positions ofsaddle1410 andclevis1442 preventing pivoting after implantation. Ifplunger1420 is absent, tighteningset screw1430 does not locksaddle1410 toclevis1442 and thesaddle1410 may still pivot after implantation. As described above, the resulting dynamic stabilization assembly will have reduced stiffness and greater range of motion in an embodiment that allows pivoting between the vertical rod and deflectable post rod after implantation than an embodiment in which the angle between the vertical rod and deflectable post is locked.
• FIG. 15A illustrates a preferred embodiment of thedeflection rod300 andbone anchor320 ofFIG. 3A. As shown inFIG. 15A, mount314 ofdeflection rod300 includes apolygonal section1502 for secure mounting to a vertical rod component.Polygonal section1502 may be hexagonal, octagonal or the like.Polygonal section1502 is shaped to match the shape of a receiver in the vertical rod component (not shown) such that when the two are mounted together there will be no rotation. As shown inFIG. 15A, the proximal end ofmount314 is threaded1504 to receive a fastener to secure a vertical rod component to mount314.Deflection rod300 is otherwise as previously described.
• FIG. 15A also shows a preferred embodiment ofvertical rod1510 for use withdeflection rod300. As shown inFIG. 15A,vertical rod1510 comprises arod1511 which is preferably a 5.5 mm diameter titanium rod.Vertical rod1510 has apocket1512 at one end sized to receive aball1520.Ball1520 is preferably a cobalt chrome ball.Ball1520 has apolygonal aperture1522 designed to closely engage thepolygonal section1502 ofmount314.Ball1520 is inserted intopocket1512 and secured into place with threadedcap1530.Pocket1512 is threaded to receivecap1530.Ball1520 is placed inpocket1512 and then cap1530 is screwed into the threaded portion ofpocket1512.Cap1530 is preferably titanium and may be laser welded or otherwise secured tovertical rod1510 after assembly. The components ofvertical rod1510—titanium rod1511,titanium cap1530 andcobalt chrome ball1520 are assembled prior to use.
• FIGS. 15B and 15C shows a sectional view throughvertical rod1510 after assembly.FIG. 15B showsball1520 positioned withinpocket1512 ofrod1511. As shown inFIG.15B cap1530 andpocket1512capture ball1530 such that it cannot be removed fromvertical rod1510.Ball1530 can, however, rotate 360 degrees around the axis ofaperture1522 as shown byarrow1550. This allowsvertical rod1510 to rotate 360 degrees around the long axis of the deflection rod or bone anchor to whichball1530 is mounted.Ball1530 can also tilt from the position shown inFIG. 15B as shown inFIG. 15C byarrows1552. In apreferred embodiment ball1530 can tilt 15 degrees in any direction therefore allowingvertical rod1510 to tilt 15 degrees from perpendicular relative to the deflection rod or bone anchor to whichball1530 is mounted. Note that themount314 and a nut to secure thevertical rod1510 to mount314 are designed so not as to interfere with the range of motion either in rotation or tilting.
• Vertical rod1510 may be used with a standard bone anchor, a deflection rod and bone anchor (forexample bone anchor320 anddeflection rod300 ofFIG. 15A), or a polyaxial screw. Likewise, the assembly ofdeflection rod300 andbone anchor320 ofFIG. 15A may be utilized withvertical rod1510, but may also be utilized in conjunction with a vertical rod not having a ball joint.
• FIGS. 16A and 16B show an alternative embodiment ofdeflection rod1600 which includesmount1670 for connecting the deflection rod to a vertical rod. As shown inFIG. 16A,mount1670 includes acircular plate1674; the face of which is parallel to the longitudinal axis ofdeflectable post1604. A threadedpin1672 projects from the center ofcircular plate1674. Threadedpin1672 is perpendicular to the longitudinal axis ofdeflectable post1604. On the face ofcircular plate1674 surroundingpin1672 are a plurality ofradial splines1676.
• Mount1670 is designed to mate withvertical rod1680 as also shown inFIG. 16A.Vertical rod1680 has at one end acircular plate1684; the face of which is parallel to the longitudinal axis ofvertical rod1680. Anaperture1682 passes through the center ofcircular plate1684 and is sized to receive threadedpin1672.Aperture1682 is perpendicular to the longitudinal axis ofvertical rod1680. On the face ofcircular plate1684 surroundingaperture1682 are a plurality ofradial splines1686. The radial splines1686 ofvertical rod1680 are designed to mate with and engage thesplines1676 ofmount1670.
• As shown inFIG. 16B,aperture1682 ofvertical rod1680 is received over threadedpin1672 ofmount1670. The angle ofvertical rod1680 is relative todeflectable post1604 may be adjusted as shown byarrow1692. Adjustment of the relative angle ofdeflectable post1604 andvertical rod1680 combined with the ability ofdeflectable post1604 to rotate about its long axis (as shown by arrow1694) is relative tobone anchor1620 provides two degrees of freedom and thus sufficient flexibility of installation to alignvertical rod1680 with a bone anchor implanted in another vertebrae. As shown inFIG. 16B, anut1690 engages threadedpin1672 to secureplate1674 toplate1684.Splines1676 ofplate1674 are arranged facingsplines1686 ofplate1684. Whennut1690 is tightened,splines1686 engagesplines1676 to prevent rotation ofvertical rod1680 aboutpin1672. Thus, whennut1690 is tightened, the angle betweendeflectable post1604 andvertical rod1680 is fixed. The vertical rod mounting mechanism ofFIGS. 16A and 16B may be readily applied to any of the deflection rod systems described herein.
Further Alternative Deflection Rods/Loading Rods
• FIG. 17A shows analternative deflection rod1700.FIG. 17A shows thedeflectable post304 and also shows (in dotted lines) the position ofdeflectable post304 upon deflection.Deflection rod1700 has most of the same components asdeflection rod300 ofFIGS. 3A-3E. Applicants found, that upon deflection ofdeflectable post304 ofdeflection rod300 ofFIGS. 3A-3E there was a propensity forsleeve300 ofFIGS. 3A-3E to expand longitudinally during compression bydeflectable post304 and become trapped betweendeflection rod300 andcollar310.Deflection rod1700 therefore has a modifiedsleeve1706 and modifiedcollar1710.
• As shown inFIG. 17A,sleeve1706 is provided with arelief1720 on the upper surface.Relief1720 allows space for longitudinal expansion ofsleeve1706 during radial compression ofsleeve1706 bypost304. Thus,sleeve1706 does not become trapped betweendeflectable post304 andcontact surface1713 ofcollar1710 upon deflection of deflectable post304 (as shown by dotted lines). This design reduces wear onsleeve1706 and ensures thatdeflectable post304 may freely travel through its designed range of deflection.
• As shown inFIG. 17A,collar1710 may also be provided with arelief1712 to further assist in preventingsleeve1706 from becoming trapped betweencollar1710 anddeflectable post304. Additionally,sleeve1706 may be provided with alower relief1722 in order to preventsleeve1706 from being trapped betweendeflectable post304 andshield308 in the region ofretainer302.
• FIG. 17B shows a perspective view ofsleeve1706.Sleeve1706 is made of a compliant material which permits movement ofdeflectable post304 relative to shield308 (FIG. 17A). Thesleeve1706 effectively controls the deflection of thedeflectable post304.Sleeve1706 is preferably made of a compliant biocompatible polymer such as PCU by way of example only. The properties of the material and dimensions ofsleeve1706 are selected to achieve the desired force/deflection characteristics for deflectable post304 (FIG. 17A). In a preferred embodiment, the sleeve is made of PCU, is 2 mm thick when uncompressed and may be compressed to about 1 mm in thickness by deflection of the post.
• As can be seen fromFIG. 17B,relief1720 forms a conical depression in the proximal surface ofsleeve1706 surrounding thecentral aperture1707 which receives deflectable post304 (not shown). The removal of material from the proximal surface of sleeve1706 (as compared withsleeve306 ofFIGS. 3A-3E) allows room for expansion ofsleeve1706 withoutsleeve1706 becoming trapped betweendeflectable post304 and collar1710 (FIG. 17A).Sleeve1706 may also be shaped to modify the compliance ofsleeve1706, for example by providing additional regions of relief or voids within the body of sleeve1706 (see,e.g. flutes307 ofFIG. 3A).
• FIG. 17C shows a perspective view of analternative sleeve1706c, also having arelief1720cin the proximal surface surrounding thecentral aperture1707cwhich receivesdeflectable post304. Therelief1720cis curved—the curve extending from the perimeter ofcentral aperture1707cto theflat region1705cofsleeve1706cwhich is engaged bycollar1710 upon assembly. In this embodiment, the outer circumference ofsleeve1706cis provided with a plurality ofscallops1704c. The scallops are larger in depth at the proximal end ofsleeve1706c(top inFIG. 17C) and taper towards this distal end ofsleeve1706c(bottom inFIG. 17C).Scallops1704cserve to make thesleeve1706cmore compliant/flexible. In thesleeve1706c, the scallops make the proximal end ofsleeve1706cmore compliant than the distal end ofsleeve1706c. This is advantageous as the geometry ofdeflection rod1700 results in greater compression at the proximal end ofsleeve1706cthan at the distal end ofsleeve1706c. Increasing the flexibility of the proximal end ofsleeve1706cthus serves to balance out the forces applied to the deflectable post by the proximal and distal regions ofsleeve1706callowing for a more even distribution of loading and “work” within thesleeve1706c.Scallops1704calso serve to reduce the volume of material at the proximal end ofsleeve1706c. During deflection of deflectable post304 (FIG. 17A) thesleeve1706ccan expand into the void left byscallops1704cfurther reducing the possibility thatsleeve1706cwill become trapped betweendeflectable post304 andcollar1710.
• FIG. 17D shows a perspective view of anotheralternative sleeve1706d.Sleeve1706dhas arelief1720din the proximal surface surrounding thecentral aperture1707d.Relief1720dtakes the form of a conical depression in the proximal surface ofsleeve1706d.Sleeve1706dalso has a plurality ofvoids1704dwhich penetrate from the proximal surface ofsleeve1706dinto the body ofsleeve1706dalong an axis parallel to the axis ofcentral aperture1707d. As shown inFIG. 17D, voids1704dare circular in section.Voids1704dmay be, for example cylindrical apertures which pass all the way throughsleeve1706d. Alternatively, thevoids1704dmay be cylindrical apertures which pass part of the way but not all of the way throughsleeve1706d. Alternatively, voids1704dmay be conical voids in which the size of the void diminishes as the void passes throughsleeve1706d. The voids serve similar functions asscallops1704cofFIG. 17C. For example, voids1704dserve to increase the compliance of the material/region ofsleeve1706dand provide space for the sleeve to be pushed into bydeflectable post304 thereby avoiding pinching betweendeflectable post304 and collar1710 (SeeFIG. 17A).
• FIG. 17E shows a sectional view of anotheralternative sleeve1706e. As shown inFIG. 17E,sleeve1706eincludes a plurality ofvoids1704ewithin the body ofsleeve1706e.Voids1706espiral out from a position adjacentcentral aperture1707etowards the outer edge ofsleeve1706e. As shown, voids1704emay be larger towards the outer edge ofsleeve1706ewhere there is more material. As previously discussedvoids1704emay have a different cross-section at different levels insleeve1706e. For example, voids1704emay have a larger area at the proximal end ofsleeve1706e(closest tocollar1710 ofFIG. 17A) than at the distal end of sleeve (closest toretainer302 ofFIG. 17A) thereby increasing the flexibility ofsleeve1706ewheredeflectable post304 has the greatest amount of deflection. Thevoids1704eserve similar functions asscallops1704cofFIG. 17C. For example, thevoids1704eserve to increase the compliance of the material/region ofsleeve1706eand provide space for thesleeve1706eto be pushed into bydeflectable post304 thereby avoiding pinching betweendeflectable post304 and collar1710 (SeeFIG. 17A).
• Thesleeves1706,1706c,1706dand1706eshow alternative configurations designed to achieve the function of controlling the movement of a deflectable post. Such sleeves may be incorporated into any of the deflection rod systems described herein. Different designs and combinations of relief and voids than those illustrated may be utilized to adjust the flexibility of the sleeve and prevent pinching of the sleeve between the deflectable post and other components of the deflection rod system.
• FIGS. 18A-18D illustrate anotheralternative deflection rod1800.FIG. 18A shows an exploded view ofalternative deflection rod1800.FIG. 18B shows the deflection rod assembled with a bone anchor.FIGS. 18C-18D show sectional views ofdeflection rod1800 and illustrate deflection of the deflection rod. As shown inFIG. 18A,deflection rod1800 includes four components: ball-shapedretainer1802,deflectable post1804, o-ring1806,cap1810.
• Deflectable post1804 has aretainer1802 at one end.Retainer1802 is a spherical structure formed in one piece withdeflectable post1804. At the other end ofdeflectable post1804 is amount1814.Mount1814, in this embodiment, is suitable for connecting to a vertical rod. A ball may be used in place ofmount1814 as previously described. In this embodiment,mount1814 is also formed in one piece withdeflectable post1804 andretainer1802. In alternative embodiments,deflectable post1804 may be formed separately from and securely attached to one or more ofmount1814 andretainer1802 by laser welding, soldering or other bonding technology. Alternatively,deflectable post1804 may be formed separately and mechanically engage one or more ofmount1814 andretainer1802 using, for example, threads. For example, a lock ring, toothed locking washer, cotter pin or other mechanical device can be used to securedeflectable post1804 to one or more ofmount1814 andretainer1802.
• As shown inFIG. 18A,mount1814 may be provided with ahexagonal extension1815 which may be utilized when securing a vertical rod to mount1814.Extension1815 may be gripped by a wrench to prevent rotation ofmount1814 as a nut is tightened onto the threaded region ofmount1814.Extension1815 may be formed in one piece withmount1814. Agroove1816 betweenmount1814 andextension1815 reduces the cross-section of material such thatextension1815 breaks away frommount1814 when a desired torque is achieved. In this way a vertical rod may be secured to mount1814 and thenextension1815 removed.
• Deflection rod1800 is configured to be mounted in abone anchor1820, which comprises abone screw1822 connected to ahousing1830.Housing1830 has acavity1832 oriented along the axis ofbone anchor1820 at the proximal end and configured to receivedeflection rod1800.Housing1830 also has anouter surface1834 adapted for mounting a component e.g. an offset connector.Housing1830 may, in some embodiments, be cylindrical as previously described. As shown inFIG. 18A,outer surface1834 ofhousing1830 is provided with splines/flutes1836. Splines/flutes1836 may be engaged by a driver that mates with splines/flutes1836 for implantingbone anchor1820.
• Cap1810, in this embodiment is designed to perform multiple functions including securing o-ring1806 as well as securingretainer1802 incavity1832 ofbone anchor1820.Cap1810, by integrating the functions of the collar and sleeve, reduces the complexity of thedeflection rod1800 and also increases the strength of thedeflection rod1800 or allows a reduction in size for the same strength.Cap1810 comprises acylindrical shield section1808 connected to acollar section1809.Cap1810 is designed to mate withaperture1832 ofhousing1830. Theshield section1808 andcollar section1809 are preferably formed in one piece, however, they may be formed separately and then secured together.Shield section1808 is threadedadjacent collar section1809 in order to engage threadedaperture1832.Cap1810 may alternatively or additionally be joined tohousing1830 by for example laser welding.
• O-ring1806 is made of a compliant material. O-ring1806 fits within agroove1805 ofshield1808 of cap1810 (seeFIG. 18C). O-ring1806 is circular in section but may also be differently shaped to modify the characteristics of o-ring1806, including, for example, compliance (seeFIGS. 8E-8G). O-ring1806 has acentral aperture1807 through whichdeflectable post1804 may be positioned. O-ring1806 permits movement ofdeflectable post1804 relative to shield1808. The o-ring1806 effectively controls and limits the deflection of thedeflectable post1804. O-ring1806 is preferably made of a compliant biocompatible polymer such as PCU by way of example only. The properties of the material and dimensions of the o-ring1806 are selected to achieve the desired force/deflection characteristics fordeflectable post1804. O-ring1806 may be made of a compliant implantable polymer having the desired compliance and durability. For example, o-ring1806 may be made from polycarbonate urethane. In a preferred embodiment, o-ring1806 may be made from BIONATE®. If the o-ring1806 is comprised of Bionate®, a polycarbonate urethane or other hydrophilic polymer, the o-ring1806 can act as a fluid lubricated bearing.
• Referring now toFIG. 18B, which shows a perspective view of adeflection rod1800 assembled with abone anchor1820. When assembled,deflectable post1804 is positioned withincap1810 which is positioned withinhousing1830 ofbone anchor1820. O-ring1806 (not seen in this view) is first positioned withinshield1808 ofcap1810.Deflectable post1804 is then positioned through o-ring1806 andcap1810.Deflectable post1804, o-ring1806 andcap1810 are then positioned within thecavity1832 ofhousing1830. Thecap1810 is then secured to the threaded proximal end ofcavity1832.Cap1810 has twosockets1811 for receiving the pins of a pin wrench to allowcap1810 to be tightened tohousing1830.Cap1810 may be, alternatively or additionally, laser welded tohousing1830 after installation to secure the components.Cap1810 securesdeflectable post1804 and o-ring1806 withincavity1832 ofbone anchor1820. (SeeFIG. 18C).
• As shown inFIG. 18B,deflectable post1804 extends out ofhousing1830 andcap1810 such thatmount1814 is accessible for connection to a vertical rod. There is a gap betweendeflectable post1804 andcap1810 which permits deflection ofdeflectable post1804 through a predefined range before deflection is limited by contact withcap1810.
• FIG. 18C shows a sectional view of adeflection rod1800 assembled with abone anchor1820 along the axis indicated by line C-C ofFIG. 18B.Retainer1802 fits into ahemispherical pocket1839 in the bottom ofcavity1832 ofhousing1830. The bottom edge ofcap1810 includes aflange1815 which secures ball-shapedretainer1802 withinhemispherical pocket1839 while allowing rotation of ball-shapedretainer1802.Collar1809 thereby secures bothretainer1802 and o-ring1806 withinhousing1830. If the o-ring1806 is comprised of Bionate®, a polycarbonate urethane or other hydrophilic polymer, the o-ring1806 can act as a fluid lubricated bearing and allow thedeflectable post1804 to also rotate about the longitudinal axis of thedeflectable post1804 and thebone anchor1820. Other materials and configurations can also allow the post to rotate about the longitudinal axis of the post and the bone anchor.
• As shown inFIG. 18C, o-ring1806 occupies the space betweendeflectable post1804 andshield1808 ofcap1810. O-ring1806 is secured withingroove1805 ofcap1810. O-ring1806 may be compressed by deflection ofdeflectable post1804 towardsshield1808 in any direction. O-ring1806 is circular in section and this configuration avoids pinching of o-ring1806 betweendeflectable post1804 andshield1808. The circular section or o-ring1806 reduces the area of contact betweendeflectable post1804 and o-ring1806 thereby reducing wear. O-ring1806 may be slightly larger than the space between the deflectable post and the bottom ofgroove1805. This provides preload which reduces slack in the deflection characteristics of thedeflection rod1800. The preload is also useful to reduce the occurrence of slack if the o-ring becomes worn during use.
• FIG. 18D illustrates the deflection ofdeflectable post1804. Applying a force to mount1814 causes deflection ofdeflectable post1804 ofdeflection rod1800. Initiallydeflectable post1804 pivots about apivot point1803 indicated by an X.Deflectable post1804 may pivot aboutpivot point1803 in any direction. Concurrently or alternatively,deflectable post1804 can rotate about the long axis of deflectable post1804 (which also passes through pivot point1803). In this embodiment,pivot point1803 is located at the center of ball-shapedretainer1802. As shown inFIG. 18D, deflection ofdeflectable post1804 compresses the material of o-ring1806. O-ring1806 is compressed intogroove1805.Groove1805 may be slightly wider than necessary to accommodate o-ring1806 in order that o-ring1806 may expand axially while being compressed radially. The extra space ingroove1805 reduces the possibility that o-ring1806 will become pinched betweendeflectable post1804 and the inside ofcap1810. The force required to deflectdeflectable post1804 depends upon the dimensions ofdeflectable post1804, o-ring1806,groove1805 andshield1808 ofcap1810 as well as the attributes of the material of o-ring1806. The o-ring exerts a centering force back ondeflectable post1804 pushing it back towards a position coaxial withbone anchor1820.
• After further deflection,deflectable post1804 comes into contact withlimit surface1813 ofcollar1809.Limit surface1813 is oriented such that whendeflectable post1804 makes contact withlimit surface1813, the contact is distributed over an area to reduce stress ondeflectable post1804. Afterdeflectable post1804 comes into contact withlimit surface1813, further deflection requires deformation (bending) ofdeflectable post1804. In a preferred embodiment,deflectable post1804 is atitanium post 5 mm in diameter.Deflectable post1804 is relatively stiff, and the force required to deflectdeflectable post1804 therefore increases significantly after contact ofdeflectable post1804 withcap1810. In a preferred embodiment,deflectable post1804 may deflect from 0.5 mm to 2 mm in any direction before making contact withlimit surface1813. More preferably,deflectable post1804 may deflect approximately 1 mm before making contact withlimit surface1813.
• The inner diameter of thecap1810 may be different in different caps so that the distance betweenlimit surface1813 anddeflectable post1804 is different in different deflection rods. This allows for the manufacture of deflection rods having a larger or smaller range of deflection before contact between thepost1804 and thelimit surface1813. In this way deflection rods may be manufactured having different ranges of motion. Moreover the distance betweenlimit surface1813 and deflectable post1804 need not be the same in all directions such that the range of motion of the deflection rod is different in different directions.
• Referring toFIG. 18D, as load or force is first applied to thedeflection rod1800 by the spine, the deflection ofdeflectable post1804 responds about linearly to the increase in the load during the phase when deflection ofdeflectable post1804 causes compression of o-ring1806. After about 1 mm of deflection,deflectable post1804 contacts limitsurface1813 and the deflection rod becomes substantially stiffer. A greater amount of load or force needs to be placed on the deflection rod in order to obtain the same amount of incremental deflection that was realized prior to this point because further deflection requires bending ofdeflectable post1804. The amount of deflection caused by the load applied is a non-linear function, in this embodiment. The deflection rod provides a range of motion where the load supported increases about linearly as the deflection increases and then with increased deflection the load supported increases more rapidly (upon contact of the post with the limit surface). Alternatively, if desired, this embodiment could be designed such that the rate of change of the amount of deflection could be a linear function for a larger range of motion by; for example, increasing the distance betweenlimit surface1813 anddeflectable post1804.
• FIG. 18E shows a partial sectional view of o-ring1806. As shown inFIG. 18E, o-ring1806 is circular in section. The circular section helps reduce the area of contact with deflectable post1804 (See (FIGS. 18A-18B). The reduced contact results in less wear. However, the o-ring may have different shapes. As shown inFIG. 18F, an o-ring1856 may have a flatouter edge1852 for engaginggroove1805 ofcap1810 while still having a curvedinner edge1854 for engagingdeflectable post1804. An o-ring1856 of this design would be less compliant than o-ring1806, all other factors being equal. Thus, o-ring1806 would exert a greater return force upon adeflectable post1804 for the same amount of deflection.
• As shown inFIG. 18G, the compliance of an o-ring1866 may also be modified by having a void1862 (or voids) within o-ring1866. The voids may contain gas or other fluid and thereby provide pneumatic or hydraulic force/deflection characteristics. As previously discussed, o-rings may be designed that exhibit anisotropic force deflection characteristics by for example having anisotropic variations in shape or material.
• FIG. 18H shows another alternative o-ring1876. O-ring1876 has a flatouter edge1872 for engaginggroove1805. O-ring1876 has a curvedinner edge1874 for engagingdeflectable post1804. O-ring1876 also has angled reliefs1877,1878, one either side ofinner edge1874, which serve to reduce the area of contact between o-ring1876 anddeflectable post1804.
• FIGS. 19A-19D illustrate a preferred embodiment of a bone anchor for dynamic stabilization of the spine having an in-linedeflection rod assembly1900 built into abone anchor1920.FIGS. 19A-19D also show a preferred embodiment of a dynamicvertical rod1950 for use with thedeflection rod assembly1900.FIG. 19A shows an exploded view of dynamicvertical rod1950 anddeflection rod assembly1900 built into abone anchor1920.FIG. 19B shows the deflection rod assembled with a bone anchor and dynamic vertical rod.FIGS. 19C-19D show sectional views ofdeflection rod assembly1900 and illustrate deflection of the deflection rod.FIGS. 19E and 19F show enlarged views of components ofdeflection rod assembly1900.
• Referring now toFIG. 19A,deflection rod assembly1900 includes, in this embodiment, four components: ball-shapedretainer1902,deflectable post1904, o-ring1906 andcap1910.Retainer1902 anddeflectable post1904 form theball rod1960 as shown inFIG. 19band will be discussed herein.Deflection rod assembly1900 is configured to be mounted in abone anchor1920, which comprises abone screw1922 connected to ahousing1930.Housing1930 has acavity1932 oriented along the axis ofbone anchor1920 at the proximal end and configured to receivedeflection rod assembly1900. In this embodiment,housing1930 is truncated relative to thebone anchor1820 ofFIG. 18A.Housing1930 andbone anchor1920 are preferably formed in one piece from titanium or titanium alloy.
• Deflectable post1904 has aretainer1902 at one end.Retainer1902 is a spherical structure formed in one piece withdeflectable post1904. At the other end ofdeflectable post1904 is amount1914. As shown inFIG. 19A,mount1914 is a low profile mount configured to fit within a ball joint1940 of a vertical rod component.Mount1914 is configured to be secured to a spinal vertical rod component and comprises a threaded cylinder to which the vertical rod component may be secured. An integrated ball may be used in place ofmount1914 as previously described.Mount1914 includes amale hex extension1912 which may be engaged by a tool to holdmount1914 during attachment to a vertical rod. At the proximal end of male hex extension is a feature for securinghex extension1912 in a tool, in this embodiment anipple1918. In apreferred embodiment mount1914,deflectable post1904,retainer1902,hex extension1912 andnipple1918 are made in one piece from cobalt chrome allowing for enhanced wear characteristics. Alternatively, titanium or titanium alloy may be used either alone or with a cobalt chrome coating. The combination ofmount1914,deflectable post1904 andretainer1902 may be referred to as aball rod1960.
• FIG. 19G shows an enlarged perspective view ofball rod1960. Referring toFIG. 19G,ball rod1960 is formed in one piece with four main sections, which are, starting from the distal end, ball-shapedretainer1902,deflectable post1904,mount1914 andhex extension1912. It should be noted thathex extension1912 also comprises thenipple1918 on the most proximal end.Hex extension1915 is breakaway component andnipple1918 allowshex extension1915 to be secured by a tool upon breakaway. Wherehex extension1912 meetsmount1914 is agroove1916.Groove1916 reduces the diameter ofball rod1960 such thathex extension1912 breaks away frommount1914 when a desired level of torque is reached during attachment of a vertical rod. The breakaway torque is determined by the diameter of remaining material and the material properties. In a preferred embodiment the breakaway torque is approximately 30 foot pounds. Thus,hex extension1912 breaks away during implantation and is removed. Ifmount1914 needs to be removed from a vertical rod, it is necessary to grip another area of theball rod1960. Thus,deflectable post1904 is provided withflats1917 immediatelyadjacent mount1914.Flats1917 allowball rod1960 to be engaged by a tool to remove a vertical rod afterhex extension1912 has been removed.
• Referring again toFIG. 19A, acap1910, in this embodiment is designed to perform multiple functions including securing o-ring1906 as well as securingretainer1902 incavity1932 ofbone anchor1920.Cap1910 is also larger thancap1810 ofFIG. 18A. In the embodiment ofFIG. 19A,cap1910 has anouter surface1934, with the below discussed splines/flutes1936, adapted for mounting a component, e.g. an offset connector.Housing1930 may in some embodiments be cylindrical as previously described. As shown inFIG. 19A,outer surface1934 ofhousing1930 is provided with the splines/flutes1936. Splines/flutes1936 may be engaged by a driver that mates with splines/flutes1936 for implantingbone anchor1920.Cap1910, by integrating the functions of the collar and sleeve, reduces the complexity of thedeflection rod assembly1900 and also increases the strength of thedeflection rod assembly1900 or allows a reduction in size for the same strength.Cap1910 is preferably formed in one piece of titanium or titanium alloy.
• As shown inFIG. 19A,cap1910 comprises acylindrical shield section1908 connected to acollar section1909.Cap1910 is designed to mate withcavity1932 ofhousing1930.Shield section1908 is threadedadjacent collar section1909 in order to engage threadedaperture1932 ofhousing1930. The distal end ofshield section1908 comprises aflange1911 for securingball1902 withinhousing1930.FIG. 19E shows a detailed view ofcap1910 in partial section. As shown inFIG. 19E,flange1911 at the distal end ofcylindrical shield section1908 has a curved surface having the same radius of curvature asball1902. The curved surface offlange1911 in combination with thepocket1932 inhousing1930 forms a spherical pocket which trapsball1902 in a manner that allows pivoting and rotation. Inside the central bore ofcap1910 is acircumferential groove1905 designed to hold an o-ring1906.Groove1905 is cut within the interior ofcollar section1909. At the distal end ofcollar section1909 are the limit surfaces1913.Groove1905 is shaped to support o-ring1906, reduce wear to o-ring1906 and reduce creep of the o-ring over time. In thisembodiment groove1905 has a rectangular section.
• Referring again toFIG. 19A, an o-ring1906 fits withinshield1908 ofcap1910 betweendeflectable post1904 andcap1910. In a preferred embodiment o-ring1906 is a ring with a radiussed square section. O-ring1906 has a roundcentral aperture1907.Aperture1907 is slightly smaller than the diameter ofdeflectable post1904 to provide some preload on assembly.FIG. 19F shows a detailed view of o-ring1906 in partial section.FIG. 19E shows o-ring1906 in position withcircumferential groove1905 ofcap1910. Note that the external diameter of o-ring1906 is larger than the interior bore diameter ofshield1908/cap1910. Thus, o-ring1906 is compressed during assembly and expands withingroove1905 thereby being retained bygroove1905. Note also that the interior diameter ofaperture1907 is smaller than the diameter of the bore ofshield1908 so that o-ring1906 protrudes fromgroove1905 into the bore around deflectable post1904 (seeFIGS. 19C and 19D). This o-ring1906 is formed by a compliant member that is compressed by deflection ofdeflectable post1904. In a preferred embodiment o-ring1906 is made from polycarbonate urethane (Bionate® 55D or 80A). But other biocompatible polymers with suitable compliance and durability may be used. This material is further described in U.S. Pat. No. 5,133,742, issued Jul. 28, 1992, and entitled and U.S. Pat. No. 5,229,431, issued Jul. 20, 1993, and entitled “Crack-Resistant Polycarbonate Urethane Polymer Prostheses and the Like,” both of which are incorporated herein by reference. The o-ring1906 inFIG. 19F has a preferred shape of flat sides and rounded corners that are transitioned between the flat sides. The flat sides allow the o-ring to fit more securely ingroove1905 and thus distribute the load placed thereon byball rod1960 more evenly to reduce wear, creep and deformation of the o-ring. One reason for these advantages is that the flat sides provide more contact surface with thegroove1905 in thecap1910 and more contact surface with theball rod1960.
• FIG. 19A also shows the components of a preferred embodiment of a dynamicvertical rod1950 for use withdeflection rod assembly1900. Dynamicvertical rod1950 includes aball1944 andrace1946.Ball1944 is preferably made of cobalt chrome alloy for better wear.Ball1944 may alternatively be made of titanium or titanium alloy with a cobalt chrome coating.Ball1944 has acentral aperture1945 designed to be secured to mount1914.Central aperture1945 is threaded to enableball1944 to be secured to the threads ofmount1914.Central aperture1945 also has afemale hex socket1947 which may mate with a wrench and by whichball1944 may be tightened to the threaded end ofmount1914.Ball1944 is received in aspherical pocket1942 in the end ofvertical rod1950.Ball1944 is secured inspherical pocket1942 byrace1946.Race1946 is secured tovertical rod1950 by, for example, threads and/or laser welding. When secured,ball1944 may rotate and pivot in thespherical pocket1942. Advantageously, there is no nut extending beyondball1944 thus reducing the profile of the connection betweenmount1914 andvertical rod1950. To put it another way, theball1944 acts as its own nut to secureball1944 to mount1914. Ball joint1940 allows greater range of motion and reduces torsional stresses on the dynamic stabilization assembly and the bones to which it is attached.
• Referring now toFIG. 19B, which shows a perspective view of adeflection rod assembly1900 assembled with abone anchor1920 having abone screw1922. When assembled,deflectable post1904 is positioned withincap1910 which is positioned withinhousing1930 ofbone anchor1920. O-ring1906 (not seen in this view) is first positioned withinshield1908 ofcap1910. O-ring1906 is compressed during introduction to cap1910 and expands into agroove1905 within cap1906 (seeFIGS. 19C and 19D). A mandrel is used during insertion to prevent damage to o-ring1906.Deflectable post1904 is then positioned through o-ring1906 andcap1910 withmount1914 extending from the proximal end ofcap1910.Deflectable post1904, o-ring1906 andcap1910 are then positioned within thecavity1932 ofhousing1930. Thecap1910 is then secured to the threaded proximal end ofcavity1932.Cap1910 may alternatively or additionally be laser welded tohousing1930 after installation to secure the components.Cap1910 securesdeflectable post1904 and o-ring1906 withincavity1932 of bone anchor1920 (seeFIGS. 19C and 19D).Deflectable post1904 extends out ofhousing1930 andcap1910 such thatmount1914 is accessible for connection to avertical rod1950.
• Deflection rod assembly1900 andbone anchor1920 are assembled prior to implantation and then implanted in a bone prior to attachment of a dynamic vertical rod or other spinal rod. A special tool may be used to engagecap1910 during implantation (SeeFIGS. 20A-20D).Cap1910 has surface features1936 for engagement by a wrench to allowcap1910 to be tightened tohousing1930. For example,cap1910 may be hexagonal or octagonal in shape or may have splines and/or flutes and/or other registration elements on thesurface1934.
• FIG. 19B also shows a perspective view of dynamicvertical rod1950 secured todeflection rod assembly1900. Dynamicvertical rod1950 is assembled by placingball1944 inpocket1942 ofrod1950.Race1946 is then secured intopocket1942 by threads and/or laser welding. Once assembledball1944 is free to pivot and rotate with the spherical pocket of dynamicvertical rod1950.Central aperture1945 is accessible from either end ofpocket1942 for attachment ofdeflectable post1904. To attach the dynamicdeflection rod assembly1950 todeflectable post1904,ball1944 is threaded onto the threads ofmount1914 and tightened into place with a special tool (seeFIGS. 21A-21D).Hex extension1912 breaks away when sufficient torque is applied to lockball1944 to mount1914 andhex extension1912 is then removed.
• FIG. 19C shows a sectional view of adeflection rod assembly1900 assembled with abone anchor1920 along the axis indicated by line C-C ofFIG. 19B.Retainer1902 fits into ahemispherical pocket1939 in the bottom ofcavity1932 ofhousing1930. The bottom edge ofcap1910 includes acurved flange1911 which secures ball-shapedretainer1902 withinhemispherical pocket1939 while allowing rotation of ball-shapedretainer1902. As shown inFIG. 19C, o-ring1906 occupies the space betweendeflectable post1904 andshield1908 ofcap1910. O-ring1906 is secured withingroove1905 ofcap1910.Cap1910 thereby secures bothretainer1902 and o-ring1906 withinhousing1930. O-ring1906 may be compressed by deflection ofdeflectable post1904 towardsshield1908 in any direction.Deflectable post1904 may pivot about ball-shapedretainer1902 up to 1 mm in any direction before contacting cap1910 (approximately 3 degrees in a preferred embodiment). Dashedline1937 shows the approximate level of the bone surface whenbone anchor1920, having abone screw1922, is implanted. In a preferred embodiment the distance H representing the height of mount1914 (and thus dynamic vertical rod1950) above the bone surface is 16 mm. Also shown inFIG. 19C is dynamicvertical rod1950. Dynamic vertical rod has been secured todeflectable post1904 by securingball1944 to mount1914.
• FIG. 19D illustrates the deflection ofdeflectable post1904. Applying a force to mount1914 throughvertical rod1950 and ball joint1940 causes deflection ofdeflectable post1904 ofdeflection rod assembly1900. Initially,deflectable post1904 pivots about apivot point1903 indicated by an X.Deflectable post1904 may pivot aboutpivot point1903 in any direction. Concurrently or alternatively,deflectable post1904 can rotate about the long axis of deflectable post1904 (which also passes through pivot point1903). In this embodiment,pivot point1903 is located at the center of ball-shapedretainer1902. As shown inFIG. 19D, deflection ofdeflectable post1904 compresses the material of o-ring1906. O-ring1906 is compressed intogroove1905.Groove1905 may be slightly wider than necessary to accommodate o-ring1906 in order that o-ring1906 may expand axially while being compressed radially. The extra space ingroove1905 reduces the possibility that o-ring1906 will become pinched betweendeflectable post1904 and the inside ofcap1910. The force required to deflectdeflectable post1904 depends upon the dimensions ofdeflectable post1904, o-ring1906,groove1905 andshield1908 ofcap1910 as well as the attributes of the material of o-ring1906. The o-ring1906 exerts a centering force back ondeflectable post1904 pushing it back towards a position coaxial withbone anchor1920. Note that due to ball joint1940,vertical rod1950 may also pivot relative todeflectable post1904 and rotate relative todeflectable post1904 without compressing o-ring1906.
• After further deflection,deflectable post1904 comes into contact withlimit surface1913 ofcollar section1909 ofcap1910.Limit surface1913 is oriented such that whendeflectable post1904 makes contact withlimit surface1913, the contact is distributed over an area to reduce stress ondeflectable post1904. Afterdeflectable post1904 comes into contact withlimit surface1913, further deflection requires deformation (bending) ofdeflectable post1904. In a preferred embodiment,deflectable post1904 is atitanium post 5 mm in diameter.Deflectable post1904 is relatively stiff, and the force required to deflectdeflectable post1904 therefore increases significantly after contact ofdeflectable post1904 withcap1910. In a preferred embodiment,deflectable post1904 may deflect from 0.5 mm to 2 mm in any direction before making contact withlimit surface1913. More preferably,deflectable post1904 may deflect approximately 1 mm before making contact withlimit surface1913.
Implantation and Assembly Tools
• FIGS. 20A-20D and21A-21F show various steps in the implantation and connection of a dynamic stabilization assembly utilizing embodiments of the dynamic bone anchor and dynamic vertical rod described herein. The implantation and assembly is preferably performed in a minimally invasive manner and, thus, tools are provided to facilitate installation and assembly through cannulae. These tools can also be used in open procedures. One suitable minimally invasive approach to the lumbar spine is the paraspinal intermuscular approach. This approach is described for example in “The Paraspinal Sacraspinalis-Splitting Approach to the Lumber Spine,” by Leon L. Wiltse et al.,The Journal of Bone&Joint Surgery, Vol. 50-A, No. 5, July 1968, which is incorporated herein by reference. In general the patient is positioned prone. Incisions are made posterior to the vertebrae to be stabilized. The dorsal fascia is opened and the paraspinal muscle is split to expose the facet joints and lateral processes of the vertebra. Dynamic bone anchors according to embodiments of the present invention and conventional pedicle screws are placed in the vertebrae as necessary for the selected assembly. The screws are placed lateral to the facet joints and angled in towards the vertebral body. The dynamic rods according to embodiments of the present invention are then inserted into position adjacent the dynamic bone anchors according to embodiments of the present invention, screws and conventional pedicle screws. The balls of the dynamic rods according to embodiments of the present invention are then secured to the deflectable posts of the dynamic bone anchors according to embodiments of the present invention the other end of the dynamic rod is then connected to the conventional screws with the desired interpediclular distance. The implantation of the dynamic bone anchors and connection of the dynamic rods can be facilitated by the implantation tool (FIGS. 20A-20D) and connection tool (FIGS. 21A-21F) described below.
• FIG. 20A shows a perspective view of animplantation tool2050 for use in implanting adynamic bone anchor2000.Dynamic bone anchor2000 may for example be the assembly ofdeflection rod assembly1900 andbone anchor1920 as shown inFIG. 19B.Implantation tool2050 includes aninner shaft2060 received within atubular sleeve2070.Inner shaft2060 is free to rotate withinsleeve2070.Sleeve2070 may also be slid towards the proximal end ofinner shaft2060 by pulling ongrip2074. Acoil spring2072 is connected between thesleeve2070 andinner shaft2060 to holdsleeve2070 in its more distal position relative toshaft2060. The length and diameter ofimplantation tool2050 is selected so as to allow use through a cannula in a minimally invasive surgical technique thereby reducing disruption of tissues adjacent the implantation site, reducing patient recovery and improving surgical outcomes.
• Referring again toFIG. 20A,shaft2060 has at a proximal end aquick release mount2062 to which a handle (not shown) may be attached for turninginner shaft2060. Suitable handles for attachment toshaft2060 include ratcheting handles, torque sensing handles and torque limiting handles. In alternative embodiments, a handle may be permanently connected to or integrated with the proximal end ofshaft2062. Inner shaft has at a distal end ahead2064.Head2064 includes means for engaging and securingdynamic bone anchor2000 during implantation as is described below.
• As also shown inFIG. 20A,head2064 can be received over the proximal portion ofdynamic bone anchor2000 with theball rod2006 received within shaft2060 (see dashed line). In use,dynamic bone anchor2000 is inserted into thehead2064 ofshaft2060 with thecap2010 engaged byhead2064 and theball rod2006 secured withinhead2064.Dynamic bone anchor2000 is thus secured toimplantation tool2050.Dynamic bone anchor2000 will not be released unless and until the surgeon pulls back ongrip2074. Thus,dynamic bone anchor2000 and implantation tool can be inserted as one unit through a cannula to the implantation location in the spine facilitating the positioning and implantation ofdynamic bone anchor2000.
• FIG. 20B shows a detailed sectional view of thehead2064 of theimplantation tool2050 ofFIG. 20A engaged with adynamic bone anchor2000. As shown inFIG. 20B,head2064 includes asocket2065 for receiving and engagingcap2010 ofdynamic bone anchor2000.Socket2065 is designed to mate withcap2010 in order to rotate the threadedshank2020 ofdynamic bone anchor2000. Thus, the interior ofsocket2065 may be hexagonal, octagonal or provided with flutes/splines etc., depending on the particular configuration of thecap2010.Socket2065 should be able to apply sufficient torque to cap2010 to implant thedynamic bone anchor2000 in a pedicle.
• Referring again toFIG. 20B,head2064 also includes abore2065 for receivingball rod2006 of dynamic bone anchor. As shown inFIG. 20B,ball rod2006 includes anipple2018 at the proximal end. Aball2052 is positioned within anaperture2067 which passes from the exterior ofshaft2060 intersecting bore2065adjacent nipple2018.Ball2052 is held bysleeve2070 in a position in whichball2052 protrudes intobore2065 so as totrap nipple2052 withinbore2065. In a preferred embodiment, there are three such balls, however, only one is shown in this sectional view. Thus,cap2010 is received insocket2065 anddynamic bone anchor2000 is locked toimplantation tool2050 by the interaction ofnipple2018 and ball(s)2052.
• FIG. 20C shows a detailed sectional view of thehead2064 of theimplantation tool2050 ofFIG. 20A configured to release adynamic bone anchor2000. After implantation ofdynamic bone anchor2000 it is necessary to removeimplantation tool2050. The first step is to slidesleeve2070 proximally relative toshaft2060 as shown by arrow A. This is achieved by pulling back ongrip2074 against the force of spring2072 (SeeFIG. 20A). Assleeve2060 is pulled proximally, ball(s)2052 enters a portion ofsleeve2060 with a larger internal diameter. Ball(s)2052 can move away from engagement withball rod2006 as they passramp2065 releasingnipple2018. At this stage bothshaft2060 andsleeve2070 can be pulled together away fromdynamic bone anchor2000.
• FIG. 20D shows a transverse view of the lumbar spine illustrating use of theimplantation tool2050 ofFIG. 20A to implantdynamic bone anchors2000 in thepedicles2082 of alumbar vertebra2084 according to an embodiment of the invention. As shown inFIG. 20D,implantation tool2050 may be used through acannula2080 to implant the dynamic bone anchor in a minimally invasive procedure. Thecannula2080 is introduced to the patient to approach the pedicles posteriorly. Thepedicle2082 of the vertebra is2084 is exposed in the conventional fashion. Ahole2086 is then drilled through thepedicle2082 into thevertebral body2083 of the vertebra. Next adynamic bone anchor2000 is selected having of suitable length, diameter and force/deflection characteristics is selected for implantation. Thecap2010 of the selecteddynamic bone anchor2000 is inserted into thehead2064 ofimplantation tool2050 and secured in place.
• Referring now to the left side ofFIG. 20D,dynamic bone anchor2000 andimplantation tool2050 are inserted as one assembly throughcannula2080 to the implantation site. Then dynamic bone anchor is implanted by turning ahandle2088 attached to the quick release on the proximal end ofshaft2060. Thedynamic bone anchor2000 is driven intohole2086 until the housing is at the surface of the vertebra2084 (see arrow2090). The torque to drivedynamic bone anchor2000 is provided byhandle2088 throughshaft2060 to cap2010 ofdynamic bone anchor2000.
• Referring now to the right side ofFIG. 20D, whendynamic bone anchor2000 is correctly positioned inpedicle2082, the physician pulls back ongrip2074 against the force ofspring2072.Sleeve2070 moves proximally relative toshaft2060.Shaft2060 releases the grip ondynamic bone screw2000 and the bothshaft2060 andsleeve2070 move away fromcannula2080 and out of the patient (see arrow2092).Dynamic bone anchor2000 is now correctly implanted and prepared for attachment to spinal rod and/or other spinal stabilization assembly components.
• FIGS. 21A-21D show views of an attachment tool for securing a dynamicvertical rod2100 to adynamic bone anchor2000 according to an embodiment of the invention.FIG. 21A shows a perspective view of anattachment tool2150 for securing a dynamicvertical rod2100 to a dynamic bone anchor2000 (shown inFIG. 21C) according to an embodiment of the invention. Dynamicvertical rod2100 may be, for example, the dynamicvertical rod1950 ofFIG. 19B.Dynamic bone anchor2000 may be, for example, the assembly ofdeflection rod assembly1900 andbone anchor1920 as shown inFIG. 19B.
• Referring first toFIG. 21A,attachment tool2150 includes aninner shaft2160 received within atubular sleeve2170. The length and diameter ofattachment tool2150 is selected so as to allow use through a cannula in a minimally invasive surgical technique thereby reducing disruption of tissues adjacent the implantation site, reducing patient recovery time and improving surgical outcomes.Inner shaft2160 is free to rotate and slide withinsleeve2170.Inner shaft2160 has at a proximal end an attachedhandle2162. Inalternative embodiments shaft2160 may have a fitting to which a handle might be attached, for example, ratcheting handles, torque sensing handles and torque limiting handles. Inner shaft has at a distal end ahead2164 for engaging and securing the hex extension of a dynamic vertical rod2100 (seeFIG. 21B).
• Referring again toFIG. 21A,sleeve2170 includes abutterfly grip2174 at the proximal end thereof.Sleeve2170, has at the distal end thereof, means for engaging and securing the female hex socket of a ball of a dynamicvertical rod2100 during connection to a dynamic bone anchor as is described below. In apreferred embodiment head2164 includes a male hex fitting2172 with acentral aperture2173.FIG. 21B shows an enlarged view ofhead2164 from the distal end ofattachment tool2150.FIG. 21B shows male hex fitting2172 withcentral aperture2173. Throughcentral aperture2173 is visiblefemale hex socket2165 ofhead2164. Protruding intofemale hex socket2165 are twospring tabs2167.
• FIGS. 21C and 21D show detailed sectional views of the distalend attachment tool2150 in relation to a dynamicvertical rod2100 anddynamic bone anchor2000. Referring first toFIG. 21C, which shows a detailed sectional view of the distal end of theattachment tool2150 ofFIG. 21A, engaged with a dynamicvertical rod2100 and adynamic bone anchor2000. As shown inFIG. 21C, male hex fitting2172 ofhead2164 ofouter sleeve2170 fits into the female hex socket ofball2144. At the same time ahex extension2115 ofball rod2006 is received withinfemale hex socket2165 ofinner shaft2160. When thus engaged, turning handle2162 relative to butterfly grip2174 (SeeFIG. 21A) can rotateball rod2006 relative toball2144.Attachment tool2150 is designed to apply sufficient torque toball rod2006 relative toball2144 to secureball rod2006 toball2144 and breakaway thehex extension2115 ofball rod2006. In a preferred embodiment,attachment tool2150 should be able to provide greater than 30 foot pounds of torque.
• FIG. 21D shows a detailed sectional view of the distal end of theattachment tool2150 ofFIG. 21A after break away ofhex extension2115 ofball rod2006. As shown inFIG. 21D, whenball2144 has been tightened ontoball rod2006,tabs2167 oncentral aperture2173 engage either side of anipple2118 ofhex extension2115 to securehex extension2115 withinfemale hex socket2165. Thus, whenhex extension2115 beaks away it can be removed from the patient withconnection tool2150 as shown.
• FIGS. 21E-21H are lateral views of the lumbar spine illustrating steps of attaching a dynamicvertical rod2100 to adynamic bone anchor2000 utilizing the attachment tool ofFIG. 21A according to an embodiment of the invention. As shown inFIG. 21E, the dynamicvertical rod2100 is implanted after thedynamic bone anchor2000 and apolyaxial screw2140 have already been implanted. Dynamicvertical rod2100 is implanted in a cranially direction—preferably in a minimally invasive manner until dynamicvertical rod2100 is positioned adjacentdynamic bone anchor2000 andpolyaxial screw2140. Thehex extension2115 ofdynamic bone anchor2000 is then fed throughball2144 of dynamicvertical rod2100 as shown.
• Next, as shown inFIG. 21F,connection tool2150 is inserted through acannula2080 to engageball2144 andhex extension2115.Ball2144 is then turned relative tohex extension2115 until it is fully secured toball rod2006. Whenball2144 is fully secured toball rod2006, further torque is applied until hex extension2115 (not shown) is sheared off. In a preferred embodiment, this requires 30 foot pounds of torque and is sufficient to lockball2144 toball rod2006. Next, as shown inFIG. 21G,connection tool2150 can be removed fromcannula2080. As previously described, hex extension2115 (not shown) is retained insideattachment tool2150 for easy removal from the patient. As shown inFIG. 21H aconventional tool2184 is then inserted throughcannula2180 to operatepolyaxial screw2140 to secure the other end of dynamicvertical rod2100.
Preserving Anatomically Correct Motion of the Spine
• FIG. 22A is a lateral view of the lumbar spine illustrating the natural kinematics of the spine during extension and flexion. A superior vertebra2200 (for example L4) is shown relative to an inferior vertebra2210 (for example L5). The primary load bearing structures are thevertebral bodies2202 and2102. Between the vertebral bodies lies anintervertebral disc2220. Dorsal of the spinal bodies lie thepedicles2204,2214,facets2206,2216 andspinous processes2208,2218. Between the spinous process is a ligamentous band called theinterspinous ligament2222. In the healthy lumbar spines significant extension and flexion of the spine is possible in the lumbar region—approximating 35 degrees of total flexion over the entire lumbar region. As the spine flexes and extends the vertebrae move relative to one another while maintaining alignment of the vertebral bodies to support the weight of the upper body.
• Between extension and flexion, thesuperior vertebra2200 may move through an angle or range of about 15 degrees with respect to theinferior vertebra2210. In the healthy spine the natural center ofrotation2224 for this rotation is located within theintervertebral disc2220. Rotation about the natural center ofrotation2224 causes elongation of theinterspinous ligament2222 and slight separation of thefacets2206,2216. However, this rotary motion does not occur alone. The healthy spine exhibits a phenomenon called coupling in which rotation or translation about or along one axis or plane is consistently associated with another motion about or along a second axis or plane. The dashedline2200ashows the position of the superior vertebra during flexion. As can be seen, during flexion, not only does thesuperior vertebra2200 rotate about the natural center ofrotation2224, but it also translates cranially and dorsally. As a consequence, normal flexion also induces up to approximately an 8 mm increase in the distance between thepedicles2204,2214 from a combination of elevation and forward translation. This is enabled by elongation of the interspinous band and facet separation. Similarly, lateral bending of the spine is coupled with relative axial rotation of the vertebrae.
• With age, the vertebral bodies of the spine and intervertebral discs can degenerate. This spinal degeneration reduces the load-bearing ability of the spine, causes pain, reduces range of motion and can induce compensatory bone growth. The bone growth can lead to further reduction in range of motion and spinal stenosis in which the bone compresses blood vessels and nerves passing along the spine leading to inflammation and more pain. A number of spinal prosthesis have been proposed to maintain or restore the load-bearing capability of the spine, reduce discogenic instability, provide pain relief after discectomy, to top off degenerative discs above or below vertebral fusion, and/or to support degenerative discs without fusion. The basic objectives of such prostheses are load sharing and stabilization of the spine to remediate the problems identified above and reduce pain. Unfortunately, the spine is a very complex structure and it is very difficult to provide a prosthesis for load sharing and stabilization that does not also change the natural kinematics of the spine causing additional artifacts, instabilities and as a result further degeneration of the spine.
• FIG. 22B is a lateral view of the lumbar spine illustrating the kinematic constraints placed on the spine by a rigid spinal rod system during extension and flexion during extension and flexion.FIG. 22B shows apedicle screw2230 implanted in thesuperior vertebra2200 and apedicle screw2232 implanted in theinferior vertebra2210. The pedicle screws are connected by a rigidvertical rod2234. Thevertical rod2234 and screws form a theoretically rigid system. The vertical rod thus transmits some of the load from thesuperior vertebra2200 to theinferior vertebra2210 thereby reducing the load on thevertebral bodies2202,2212 and theintervertebral disc2220.
• However, an artifact of a rigid prosthesis as shown inFIG. 22B, is that the relative rotation of the vertebra is constrained and the interpedicular distance is fixed. During flexion of the spine, some rotation is permitted by flexing of thevertical rod2234 and the connections between thevertical rod2234 and thepedicle screws2230 and2232. However, because the interpedicular distance remains essentially fixed, no elongation of theinterspinous ligament2222 is possible and the center ofrotation2236 is moved significantly dorsally of the natural center of rotation to the dorsal edge of the intervertebral disc or even further. The dashedlines2200bshow the relative movement of thesuperior vertebra2200. Moreover, not only is facet separation prevented but the flexure about the new center of rotation can actually push the facets together increasing loading of thefacet joints2206,2216. The prosthesis also interferes with the natural coupling of the spine by precluding and/or limiting the translation of the superior vertebra which is associated with rotation in natural flexion. Additionally, the flexing of the vertical rod places significant strain upon the pedicle screws and the interface between the pedicle screws2230,2232 and the bone which can lead either to device failure, backing out of the screws or damage to the pedicles. Furthermore, constraining motion at one segment of the spine is thought to create additional stress at adjacent segments and might therefore accelerate degeneration at those spinal segments (adjacent-level disease).
• In order to overcome the problems caused by a rigid spinal prosthesis, a dynamic spine stabilization prosthesis attempts to preserve anatomical spinal motion and motion quality. An ideal prosthesis should be able to maintain intersegmental stability and permit appropriate motion at a spinal segment, e.g. ˜15 degrees of flexion/extension, ˜2 degrees of axial rotation, ˜6 degrees lateral bending as well as relative translation of the vertebrae ˜2 mm of left-right yaw, ˜2 mm of elevation (separation), and/or ˜2 mm of dorsal-ventral shift. The ideal prosthesis should also allow complex combinations of these motions and permit the coupling exhibited in the anatomical spine. The prosthesis should be able to preserve these motions required for normal spinal function while providing load sharing without abnormal load distribution, and spinal segment stabilization including limiting motion beyond anatomically desirable limits.
• FIGS. 22C and 22D show the kinematic modes of a dynamic spine stabilization prosthesis utilizing a dynamic bone anchor and dynamic vertical rod in accordance with embodiments of the invention.FIGS. 22C and 22D show kinematic modes of adynamic bone anchor2240 in conjunction with a dynamicvertical rod2250.Dynamic bone anchor2240 includes aball rod2242 that pivots aboutball2244 at the distal end relative to threadedanchor2246.Ball rod2242 is connected at its proximal end toball2254 of dynamicvertical rod2250. Deflection ofball rod2242 relative to threadedanchor2246 of thedynamic bone anchor2240 is controlled by compression ofcompliant ring2245 and limited by hard contact surfaces at the proximal end of thecap2248. The three links—vertical rod2250,ball rod2242, and threadedanchor2246—and twoball joints2244,2254 are connected in series and, thus, the movements of the linkages can be combined to provide a complex range of kinematic modes.
• FIG. 22C shows the kinematic modes ofball rod2242 relative to dynamicvertical rod2250 assuming no motion internal todynamic bone anchor2240. As shown inFIG. 22C,ball rod2242 pivots and rotates aboutball2254 of dynamicvertical rod2250. Ball rod2242 (and threaded anchor2246) can pivot 15 degrees in any direction from perpendicular relative to dynamicvertical rod2250 as shown by arrow2260 for a total range of motion of 30 degrees. Ball rod2242 (and threaded anchor2246) can also rotate 360 degrees relative to dynamicvertical rod2250 as shown byarrow2262.
• FIG. 22D shows the kinematic modes of threadedanchor2246 relative toball rod2242 based solely on internal motion withindynamic bone anchor2240. As shown inFIG. 22D, threadedanchor2240 pivots and rotates aboutball2244 ofball rod2242. Threadedanchor2246 can pivot 3 degrees in any direction from perpendicular relative toball rod2242 as shown byarrow2264 for a total range of motion of 6 degrees. Dynamic vertical rod can also rotate 360 degrees relative toball rod2242 as shown byarrow2266.
• The kinematics of theball rod2242 relative to dynamicvertical rod2250 and the threadedanchor2246relative ball rod2242 combine to generate more complex kinematics than would be available with either component alone. The compound kinematics more closely approximate the natural kinematics of the spine.FIGS. 22E and 22F illustrate the compound kinematics of a dynamic spinal stabilization prosthesis incorporating adynamic bone anchor2240 and dynamicvertical rod2250.FIG. 22E is a simplified illustration of the kinematics of a dynamic spine stabilization prosthesis showing the movement ofdynamic bone anchor2240 relative to a fixedbone anchor2241.FIG. 22F is a lateral view of the spine illustrating the kinematics of a spinal segment supported by the dynamic spine stabilization prosthesis ofFIG. 22E.
• As shown inFIGS. 22E and 22F, a dynamic spinal prosthesis incorporating both thedynamic bone anchor2240 and dynamicvertical rod2250 allows not only rotary motion (arrow2270) but also coupled translation (arrow2272) of adynamic bone anchor2240 relative to abone anchor2241. Furthermore the center ofrotation2274 is maintained at an anatomically desirable position in the intervertebral disc (SeeFIG. 22F). Maintenance of the natural center of rotation helps prevent uneven loading of thevertebral bodies2202,2212. The pivoting motion and translation are coupled and compliantly modulated by compression of the compliant member of the dynamic bone anchor (seeFIG. 22D). Moreover, the prosthesis also limits the availability movement by, for example, contact between theball rod2242 and thecap2248 thus providing segmental stability. The kinematics of threadedanchor2246 ofdynamic bone anchor2240 thus closely approximate the natural kinematics of the vertebra shown inFIG. 22A. Consequently, a dynamic spinal stabilization prosthesis incorporating both dynamicvertical rod2250 anddynamic bone anchor2240 can stabilize the spine and provide load sharing while maintaining the center of rotation of implant vertebra within theintervertebral disc2220 close to the natural center of rotation (seeFIG. 22A) of the spine preserving natural range of motion. The kinematics of the prosthesis by allowing translation ofvertebra2200 relative tovertebra2210 also serve to preserve facet separation during flexion seen in the natural spine. By allowing more natural kinematics, stain on the components and the bone interface is reduced leading to enhanced durability, safety and efficacy.
• The rotation of theball rod2242 relative to the dynamicvertical rod2250 and threadedanchor2246 relative to the ball rod2242 (seeFIGS. 22C,22D) also permit kinematics impossible with rigid pedicle screw systems. For example, lateral bending of the spine couples with relative rotation of the vertebrae. In the rigid spinal implant ofFIG. 22B, there is no provision for such rotation which would therefore resolve as strain upon the components and component/bone interface. However, in a dynamic spinal prosthesis incorporating both dynamicvertical rod2250 anddynamic bone anchor2240, rotation is provided aboutball2244 andball2254, thus allowing both changes in the side-to-side intervertebral distance and coupled axial rotation of the vertebrae closely approximating the natural kinematics of the spine. Dynamic stabilization assemblies incorporating embodiments of the present invention can also support complex combinations of natural movements and the coupled rotations and translations of the spine, for example, lateral bending with twisting, lateral bending with flexion. Thus, anatomically correct motion of the spine is stabilized and preserved.
• The close approximation of the kinematics of the dynamic spinal prosthesis and the natural kinematics of the spine results in reduced stresses at the implant/bone interface and, by using a natural center of rotation, allows even stress distribution across the vertebral bodies and intervertebral disc. The prosthesis has a decreased stiffness and increased range of motion compared to conventional rigid vertical rod systems supporting the implant segment while reducing stresses on adjacent segments. However, the dynamic spine stabilization prosthesis, with the compliant element located in-line within the dynamic bone anchor, is more robust than flexible rod systems. The degree of compliance in the dynamic bone anchor can also be tailored for the individual based upon load and anatomy. The result is anatomical load displacement curves, stabilization and preservation of anatomically correct motion and a robust surgical remediation of spinal degeneration.
Deflection Rod/Loading Rod Materials
• Movement of the deflectable post relative to the bone anchor provides load sharing and dynamic stabilization properties to the dynamic stabilization assembly. As described above, deflection of the deflectable post deforms the material of the sleeve. The characteristics of the material of the sleeve in combination with the dimensions of the components of the deflection rod assembly affect the force-deflection curve of the deflection rod. The dimensions and materials may be selected to achieve the desired force-deflection characteristics.
• By changing the dimensions of the deflectable post, sleeve and the shield, the deflection characteristics of the deflection rod assembly can be changed. The stiffness of components of the deflection rod assembly can be, for example, increased by increasing the diameter of the deflectable post and/or by decreasing the diameter of the inner surface of the shield. Additionally, decreasing the diameter of the deflectable post will decrease the stiffness of the deflection rod assembly while decreasing the diameter of the post and/or by increasing the diameter of the inner surface of the shield will decrease the stiffness of the deflection rod. Alternatively and/or additionally, changing the materials which comprise the components of the deflection rod assembly can also affect the stiffness and range of motion of the deflection rod. For example, making the sleeve out of stiffer and/or harder material reduces deflection of the deflectable post.
• The deflectable post, bone anchor and vertical rods are preferably made of biocompatible implantable metals. The deflectable post can, for example, be made of titanium, titanium alloy, cobalt chrome, a shape memory metal, for example, Nitinol (NiTi) or stainless steel. In preferred embodiments, the deflectable post is made of cobalt chrome. In preferred embodiments, the bone anchor and vertical rods are made of titanium alloy; however, other materials, for example, stainless steel may be used instead of or in addition to the titanium components. Furthermore, the ball of the dynamic vertical rod is preferably made of cobalt chrome for good wear characteristics.
• The material of the sleeve/compliant member/or-ring is a biocompatible and implantable polymer having the desired deformation characteristics. The material of the sleeve should also be able to maintain the desired deformation characteristics. Thus the material of the sleeve is preferably durable, resistant to oxidation and dimensionally stable under the conditions found in the human body. The sleeve may, for example be made from a polycarbonate urethane (PCU) such as Bionate®. If the sleeve is comprised of Bionate®, a polycarbonate urethane or other hydrophilic polymer, the sleeve can also act as a fluid-lubricated bearing for rotation of the deflectable post relative to the longitudinal axis of the deflectable post.
• Suitable materials for the sleeve include polyurethanes including polycarbonate-urethanes (PCU). Suitable PCUs are available under the trade name BIONATE® from the Polymer Technology Group—DSM PTG, Inc. (Berkeley, Calif.). Bionate® PCU has good biocompatibility and has been FDA approved for long-term implantation. Bionate® PCU has good oxidative stability, biocompatibility, mechanical strength and abrasion resistance and suitable physical properties including load bearing, dimensional stability and resistance to environmental stress cracking. Bionate® PCU is also available in five hardness grades 80A, 90A, 55D, 65D and 75D—the different hardness grades imparting different deflection characteristics to components incorporating them. In a preferred embodiment, the sleeve is made of grade 80A Bionate® PCU which is 2 mm thick when uncompressed and may be compressed to about 1 mm in thickness by deflection of the post.
• The sleeve can be formed by extrusion, injection, compression molding and/or machining techniques, as would be appreciated by those skilled in the art. In some embodiments, the sleeve is formed separately. For example, a sleeve may be cut or machined from a biocompatible polymer and then assembled with the deflectable post and sleeve such as by being press fit into the shield. Alternatively or additionally, a biocompatible adhesive may be used to bond the sleeve to the shield and/or post. In alternative embodiments, the sleeve may be formed in place by positioning the post and inside the shield and then filling the space between the deflectable post and the shield with liquid polymer (polymer reagents) and allowing the polymer to solidify.
• A one piece PCU sleeve/compliant member/o-ring may be produced, for example by multi-shot or insert injection molding yielding density gradients which can be used to control the force/deflection response curve of the deflection rod. Voids, gaps or other structural features may also be provided to modify the compliance of the sleeve and consequently the force/deflection response curve of the deflection rod. The density gradients may be patterned in order to control the response curve of the deflection rod. The density gradients need not be symmetric. Directional variations in the density gradients may be used to create a deflection rod assembly having different force/deflection responses in different directions.
• The sleeve may also include polymer regions having different properties. For example, the sleeve can include concentric rings of one or more polymers with each ring having a different hardness of stiffness or durometer. For example, each successive ring from the center outward can have a higher hardness or stiffness or durometer so that as the post is deflected outwardly from a position that is collinear with the longitudinal axis the sleeve provides increased resistance to further deflection. The sleeve may also be designed to provide different force deflection characteristics in different directions. The deflectable post could also be designed so that less resistance occurs with increased deflection of the post.
• Other polymers or thermoplastics may be used to make the sleeve including, but not limited to, polyether-etherketone (PEEK), polyphenylsolfone (Radel®), or polyetherimide resin (Ultem®). Other polymers that may be suitable for use in some embodiments, for example other grades of PEEK, for example 30% glass-filled or 30% carbon filled, provided such materials are cleared for use in implantable devices by the FDA, or other regulatory body. Glass-filled PEEK is known to be ideal for improved strength, stiffness, or stability while carbon filled PEEK is known to enhance the compressive strength and stiffness of PEEK and lower its expansion rate.
• Still other suitable biocompatible thermoplastic or thermoplastic polycondensate materials may be suitable, including materials that have good memory, are flexible, and/or deflectable have very low moisture absorption, and good wear and/or abrasion resistance, can be used without departing from the scope of the invention. These include polyetherketoneketone (PEKK), polyetherketone (PEK), polyetherketoneetherketoneketone (PEKEKK), and polyetheretherketoneketone (PEEKK), and generally a polyaryletheretherketone. Further, other polyketones can be used as well as other thermoplastics.
• PCU materials suitable for implantation are described in U.S. Pat. No. 5,133,742 titled “Crack-Resistant Polycarbonate Urethane Polymer Prostheses” and U.S. Pat. No. 5,299,431 titled “Crack-Resistant Polycarbonate Urethane Polymer Prostheses And The Like”, both of which patents are incorporated herein by reference. Other polymers that can be used in the sleeve are disclosed in the following documents, all of which are incorporated herein by reference. These documents include: PCT Publication WO 02/02158 A1, dated Jan. 10, 2002 and entitled Bio-Compatible Polymeric Materials; PCT Publication WO 02/00275 A1, dated Jan. 3, 2002 and entitled Bio-Compatible Polymeric Materials; and PCT Publication WO 02/00270 A1, dated Jan. 3, 2002 and entitled Bio-Compatible Polymeric Materials.
• The materials of the sleeve may thus be selected to create a deflection rod assembly having stiffness/deflection characteristics suitable for the needs of a patient. By selecting appropriate materials of the sleeve, the deflection characteristics of the deflection rod assembly can be configured to approach the natural dynamic motion of the spine of a particular patient, while giving dynamic support to the spine in that region. It is contemplated, for example, that the deflection rod assembly can be made in stiffness that can replicate a 70% range of motion and flexibility of the natural intact spine, a 50% range of motion and flexibility of the natural intact spine and a 30% range of motion and flexibility of the natural intact spine.
• 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. Many 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 claims and their equivalents.

Claims (10)

1. A surgical tool adapted to connect a threaded ball of a dynamic rod to a threaded post of a dynamic bone anchor implanted in a vertebra, the surgical tool comprising:

an elongate shaft having a handle at a proximal end and having at a distal end a first head configured to engage the threaded post;

an elongate tube having a grip at a proximal end and having at a distal end a second head configured to engage the threaded ball;

the elongate tube being received over the elongate shaft;

the second head having an aperture therethrough which permits engagement of the threaded post by the first head; and

whereby with the first head engaged with the threaded post and the second head engaged with the threaded ball, turning one of the handle and the grip relative to the other, turns the threaded ball relative to the threaded post and secures the threaded ball to the threaded post.

2. The surgical tool ofclaim 1, wherein the threaded ball has a female hex socket and wherein the second head comprises a male hex fitting having an aperture therethrough.

3. The surgical tool ofclaim 1, wherein the threaded post has a male hex extension which passes through an aperture in the threaded ball and wherein the first head comprises a female hex socket.

4. The surgical tool ofclaim 1, wherein the threaded ball has a female hex socket and the threaded post has a male hex extension which passes through an aperture in the threaded ball and wherein the first head comprises a female hex socket and the second head comprises a male hex fitting having an aperture therethrough.

5. The surgical tool ofclaim 1, wherein the threaded post has a breakaway male hex extension which passes through an aperture in the threaded ball and wherein the first head comprises a female hex socket, the female hex socket having a retainer adapted to secure the breakaway male hex extension within the hex socket after detachment from the threaded post.

6. The surgical tool ofclaim 5, wherein the retainer comprises a spring tab which intersects a portion of the hex socket to secure the breakaway male hex extension within the hex socket after detachment from the threaded post.

7. The surgical tool ofclaim 1, wherein the surgical tool is adapted to apply sufficient torque to the threaded post to detach a portion of the threaded post and wherein the first head includes a retainer adapted to secure the breakaway portion to the first head after detachment.

8. A method for connecting a threaded ball of a dynamic rod to a threaded post of a bone anchor where both the ball and post can rotate, the method comprising:

(a) obtaining a coaxial surgical tool having an elongate shaft received within an elongate tube;

(b) engaging the threaded post with a first head attached to a distal end of the elongate shaft;

(c) engaging the threaded ball with a second head attached to a distal end of the elongate tube; and

(d) operating a handle attached to a proximal end of the elongate shaft and a grip attached to a proximal end of the elongate tube to secure the threaded ball to the threaded post.

9. The method ofclaim 8, wherein the threaded post has a breakaway extension and wherein the method further comprises:

(e) operating the handle and the grip to apply sufficient torque to detach the breakaway extension.

10. The method ofclaim 8, wherein the threaded post has a breakaway extension and wherein the method further comprises:

(e) operating the handle and the grip to apply sufficient torque to detach the breakaway extension; and

(f) removing the coaxial surgical tool with the breakaway extension retained therein.

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