US20100211176A1 - Fixation device and method - Google Patents

Abstract

An implantable orthopedic stability device is disclosed. The device can have a contracted and an expanded configuration. A method of using the device between adjacent vertebral body surfaces surfaces for support and/or fixation of either or both of the adjacent vertebrae is also disclosed.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a continuation-in-part of U.S. patent application Ser. No. 12/617,663, filed Nov. 12, 2009, which claims the benefit of U.S. Provisional Application No. 61/113,691, filed on Nov. 12, 2008.
BACKGROUND OF THE INVENTION
• 1. Technical Field
• Devices and methods for fixation of tissue are disclosed. More specifically, the devices and methods can be for inter body vertebral fusion of vertebrae or fusion of other bones to one another.
• 2. Background of the Art
• A vertebroplasty device and method that eliminates or reduces the risks and complexity of the existing art is desired. A vertebroplasty device and method that may reduce or eliminate the need to inject a liquid directly into the compression fracture zone is also desired.
• Other ailments of the spine result in degeneration of the spinal disc in the intervertebral space between the vertebral bodies. These include degenerative disc disease and traumatic injuries. In either case, disc degeneration can cause pain and other complications. Conservative treatment can include non-operative treatment requiring patients to adjust their lifestyles and submit to pain relievers and a level of underlying pain. Operative treatment options include disc removal. This can relieve pain in the short term, but also often increases the risk of long-term problems and can result in motor and sensory deficiencies resulting from the surgery. Disc removal and more generally disc degeneration disease are likely to lead to a need for surgical treatment in subsequent years. The fusion or fixation will minimize or substantially eliminate relative motion between the fixed or fused vertebrae. In surgical treatments, adjacent vertebra can be fixated or fused to each other using devices or bone grafts. These may include, for example, screw and rod systems, interbody spacers (e.g., PEEK spacers or allograft bone grafts) threaded fusion cages and the like.
• Some fixation or fusion devices are attached to the vertebra from the posterior side. The device will protrude and result in additional length (i.e., needed to overlap the vertebrae) and additional hardware to separately attach to each vertebrae. Fusion cages and allografts are contained within the intervertebral space, but must be inserted into the intervertebral space in the same dimensions as desired to occupy the intervertebral space. This requires that an opening sufficient to allow the cage or graft must be created through surrounding tissue to permit the cage or graft to be inserted into the intervertebral space.
• A spinal fixation or fusion device that can be implanted with or without the need for additional hardware is desired. Also desired is a fixation or fusion device that can be deployed in a configuration where overlapping the fixated or fused vertebrae is not required.
• Also desired is an intervertebral device the may be inserted in to the intervertebral space at a first smaller dimension and deployed to a second, larger dimension to occupy the intervertebral space. The ability to insert an intervertebral spacer at a dimension smaller than the deployed dimension would permit less disruption of soft and boney tissue in order to access the intervertebral space.
SUMMARY OF THE INVENTION
• A device that can replace or supplement the screw or rod elements of a typical fusion system is disclosed. The device can be placed in the inter-vertebral space to fuse adjacent vertebrae and/or create a bone mass within the inter-vertebral space in a patient's spine.
• The device can be less invasive than typical existing devices. For example, the device can be in a compacted (i.e., small) configuration when inserted into a patient and transformed into an expanded (i.e., large) configuration when positioned at the target site. For example, the device can be expanded when the device is between the inferior and superior vertebral body surfaces. The device can create less soft tissue (e.g., bone) disruption than a typical fusion system. The device in an expanded configuration can improve anchoring within the joint, structural stability, and create an environment for bone healing and growth leading to fusion between adjacent vertebrae.
• During deployment into tissue (e.g., bone), one, two or more holes can be drilled into the target site to create a deployment hole in which to insert the device. The deployment hole can be round or non-round (e.g., by drilling more than one overlapping or adjacent hole, or crafting a square or rectangular hole), for example to substantially match the transverse cross-section of the device in a contracted configuration.
• The device can be cannulated, for example having a lateral (i.e., transverse or latitudinal) and/or lengthwise (i.e., longitudinal) channel through the device. The device can be deployed over a wire or leader, such as a guidewire. The device can be slid over the guidewire, with the guidewire passing through the longitudinal channel of the device.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is an exploded view of a variation of the expandable support device.
• FIGS. 2 through 4 illustrate variations of cross-section A-A ofFIG. 1.
• FIGS. 5 and 6 illustrate variations of cross-section B-B ofFIG. 1.
• FIG. 7 illustrates the variation of the expandable support device ofFIG. 1 with the ramps slidably attached to the base.
• FIGS. 8 and 9 are perspective and side views, respectively, of the variation of the expandable support device ofFIG. 7 with the top and ramps in pre-assembly positions.
• FIGS. 10,11 and12 are perspective, side and end views, respectively of the variation of the device ofFIG. 1 in an assembled configuration.
• FIG. 13 is a variation of close-up section E-E ofFIG. 12 in a first configuration.
• FIG. 14 is a variation of close-up section E-E ofFIG. 12 in a second configuration.
• FIGS. 15 and 16 are a variation close-up section D-D ofFIG. 11 in first and second configurations, respectively.
• FIGS. 17,18,20 and21 are perspective, side, end and top views, respectively, of the variation of the device ofFIG. 1 in a pre-deployment configuration.
• FIGS. 19 and 22 are side and top views, respectively, of a variation of the device ofFIG. 1 in a pre-deployment configuration.
• FIG. 23 illustrates a method of longitudinally compression and radially expanding the variation of the device ofFIG. 17, for example after deployment at a target site.
• FIGS. 24 and 25 are perspective and top views, respectively, of the variation of the device ofFIG. 1 in a deployed configuration.FIG. 22 is illustrated with the top and the base in see-through views for illustrative purposes.
• FIGS. 26 and 27 illustrate variations of the locking pin.
• FIGS. 28 and 29 illustrate a variation of a method for using the variation of the locking pin ofFIG. 26.
• FIGS. 30 and 31 illustrate a variation of a method for using the variation of the locking pin ofFIG. 27.
• FIGS. 32,33 and34 are top, side and end views, respectively, of a variation of the device with the locking pin.
• FIGS. 35 and 36 are side and end views, respectively, of a variation of the device with the locking pin.
• FIGS. 37 and 38 are side and end views, respectively, of a variation of the device with the locking pin.
• FIGS. 39a,39band39care bottom perspective, end and side views, respectively, of a variation of the device in a longitudinally expanded configuration.
• FIGS. 40a,40b, and40care bottom perspective, end and side views, respectively, of the device ofFIGS. 39athrough39cin a longitudinally compressed and radially expanded configuration.
• FIG. 41 illustrates a visualization of a variation of a method for deploying the device into the spine between adjacent vertebrae.
• FIGS. 42aand42billustrate visualizations of variations of the device deployed into the spine between adjacent vertebrae.
DETAILED DESCRIPTION
• Adevice2 is disclosed that can be inserted into a target site264 with thedevice2 in a compressed or contracted (i.e., small) configuration. Once positioned in the deployment site, thedevice2 can be transformed into an expanded (i.e., larger, bigger) configuration. Thedevice2 can be inserted and expanded in orthopedic target sites264 for fixation and/or support. For example, thedevice2 can be inserted and expanded over a guidewire between adjacent vertebral bodies.
• FIG. 1 illustrates that thedevice2 can have a first longitudinal end and a second longitudinal end along alongitudinal axis4. Thedevice2 can have a bottom or plate286 (bottom and base plate are used interchangeably) and atop plate6. The base138 orbottom plate10 andtop plate6 can be or haveplates286, panels, struts216 (e.g., legs), ports, cells88, and combinations thereof. Thebase plate10 andtop plate6 can be configured to be slidably attachable to the other. For example, the base (or top) plate can have one or more stability bars102. The top (or base) plate can have one ormore stability grooves128. The stability bars102 can be configured to be slidably attachable to thestability grooves128.
• The slidable attachment of the top and base plates can permit the base138 to move radially (with respect to the longitudinal axis4) relative to the top and vice versa.
• Thetop plate6 can have a high-friction and/or low-friction texture extending radially away from thebase138. For example, thetop plate6 can have one or numerous rows oftop teeth118. Thebottom plate10 can have a high-friction and/or low-friction texture extending radially away from the base plate. For example, thebottom plate10 can have one or numerous rows ofbottom teeth104. Thetop teeth118 and thebottom teeth104
• Thetop plate6 can have one ormore side ports114 and/or top ports. The base plate can have one or morebase ports120 and/orside ports114. Thebase ports120,side ports114, and/or top ports can be ingrowth channels28. The ports can be circular, square, triangular, oval, elongated in the longitudinal direction, elongated in the radial direction, or combinations thereof.
• Thetop plate6 can have atop chamfer156. The base plate can have a base chamfer. The chamfers can be atraumatic edges. The chamfers can extend along the perimeter of thebase138 and/or top.
• Thedevice2 can have one, two or more wedges18, for example afirst side ramp96 on a first longitudinal side of the base plate and asecond side ramp108 on a second longitudinal side of the base plate. The side ramps can be configured to be slidably attachable to the base plate.
• The ramps22 andtop plate6 can be brought within proximity of the base plate. The ramps22 can be slidably attached to the base plate. The ramps22 can have ramp second tongues andgrooves98. The base plate can have one or more base tongues andgrooves106. The ramp second tongues andgrooves98 can be configured to slidably attach to the base tongues andgrooves106.
• The ramps22 can be configured to be slidably attachable to thetop plate6. For example, the ramps22 can have ramp first tongues andgrooves100. Thetop plate6 can have top tongues andgrooves284. The ramp first tongues andgrooves100 can slidably engage the top tongues andgrooves284.
• The first tongues and grooves can be at aramp angle136 with respect to the second tongues and grooves. Theramp angle136 can be from about 15° to about 75°, more narrowly from about 30° to about 60°, for example about 45°.
• One or more of the ramps22 can have a ramp lockingplate port110. The ramp lockingplate ports110 can each be configured to receive a ramp locking plate. The ramps22 can each have ramp ports, such as the threaded ramp ports. The threaded ramp ports can pass through the ramps22, for example opening into the ramp lockingplate port110.
• FIG. 2 illustrates that each of the top, orbase138 or bottom plates can have aplate thickness122. Theplates286 can be thinned adjacent to some or all ports. Theplate thickness122 can be substantially constant along the length of the top orbase138. Theplate thickness122 can be non-constant, for example along the length and/or width of the top port orbase port120 and thetop teeth118 or base teeth. Eachplate286 of thefirst side ramp96 and thesecond side ramp108 can have a substantiallyconstant plate thickness122 along the height of theplate286 save for the respective ramp ports.
• FIG. 3 illustrates that the top and/or bottom plates can thin as theplate286 nears the port. For example, theplate286 can have amaximum plate thickness126 and aminimum plate thickness124. Themaximum plate thickness126 andminimum plate thickness124 can be measured with or without accounting for the change in thickness due to the teeth. Theminimum plate thickness124 can be substantially less than themaximum thickness126. Theminimum plate thickness124 can be substantially 0. Theplate286 can slope outward (as shown), inward, or a combination of both (e.g., sloping inward and outward concurrently to form the rim of the port at a radius from the longitudinal axis between the radii of the outer and inner surfaces of the plate286).
• When thedevice2 is in a deployed configuration in vivo, thedevice2 can be partially or substantially filled with a liquid, gel, or solid (e.g., in small parts or granules) filler262 material, or combinations thereof, such as bone morphogenic powder or any other material disclosed herein or combinations thereof. The filler262 material can contact or be in near contact with the surrounding tissue near the edge of the ports, for example where theplate286 is thinned. The filler262 can be inserted into thedevice2 before, and/or during (i.e., prepacked), and/or after thedevice2 is inserted and/or expanded in the target site.
• As thedevice2 is expanded and contracted, the volume of the interior channel of the device (i.e., defined between the top and base plates and the opposing ramps) can remain constant. For example, filler can be inserted into thedevice2 before the device is radially expanded. Thedevice2 can be longitudinally contracted and radially expanded (e.g., expanded in height). The ratio of the volume of filler to the volume of the interior channel of the device can then remain substantially constant as the device is radially expanded. For example, the decrease in volume of the interior channel of the device caused by the contracting ramps can be substantially equivalent to the increase in volume of the interior channel of thedevice2 caused by the radially expanding top and base plates.
• FIG. 4 illustrates that theplates286 of thefirst side ramp96 and/or thesecond side ramp108 can thin as theplate286 nears the threaded ramp port(s). Theminimum plate thickness124 can be substantially less than themaximum plate thickness126. Theminimum plate thickness124 can be substantially 0. Theplate286 can slope outward (as shown), inward, or a combination of both (e.g., sloping inward and outward concurrently to form the rim of the port at a radius from the longitudinal axis between the radii of the outer and inner surfaces of the plate286).
• FIG. 5 illustrates that the stability bars102 can be configured to slide into thestability groove128 when the top and base plates intersect. The radially inner surface of thestability bar102 can be substantially the same or a greater radius from the longitudinal axis of the expandable support device188 as the radius of the radially outer surface of thetop plate6 adjacent to the side port114 (i.e., within the stability groove128). Thestability bar102 can be configured to not directly attach to thetop plate6 when the top is translated into the base plate, or the stability bars102 can be configured to bias inward against and frictionally hold the top when thetop plate6 is translated into the base plate.
• FIG. 6 illustrates that the stability bars102 can have one ormore latches130 along the length of thestability bar102, for example at the terminal end of the stability bars102, as shown. Thelatch130 can be configured to attach to thetop plate6. Thelatch130 can protrude radially inward. Thelatch130 can have alatch top288 and alatch bottom134.
• Thelatch top288 can be configured to allow the top to pass over thelatch130. For example, thelatch top288 can be rounded and configured to push radially outward and clear of thetop plate6 when the top is pressed down into thelatch top288. Thelatch bottom134 can be configured to grasp or otherwise attach to the top when the top is translated to a particular location into the base plate.
• The stability bars102 can be configured to resiliently bend radially outward and/or inward.
• FIG. 7 illustrates that the ramps22 can be slidably attached, as shown by arrows, to the base plate before the ramps22 are slidably attached to thetop plate6. The ramp second tongues andgrooves98 can be slidably engaged with the base tongues andgrooves106, as shown inFIGS. 12,13 and14.
• FIGS. 8 and 9 illustrate that the ramps22 can be positioned, as shown by arrows, so that one or both ramp first tongues andgrooves100 can be aligned to slidably engage the top tongues andgrooves284 as thetop plate6 is translated toward the base plate, as shown by arrows. Thestability bar102 can be slid into thestability groove128.
• FIGS. 10 through 12 illustrate that as thetop plate6 is translated toward the base plate, as shown by arrows, thetop plate6 can slidably engage one or more of the ramps22. The first tongues and grooves can slidably engage the top tongues andgrooves284.
• FIG. 13 illustrates that there can be asubstantial ramp gap140 between the side ramp and the base plate, for example before the expandable support device188 is completely deployed. Theramp gap140 can have aramp gap height150. Theramp gap height150 can vary, for example, from about 0 mm (0 in.) to about 4 mm (0.2 in.). The side ramps can substantially slide along the base plate. For example, the ramp second tongue andgroove98 can slide along the base tongue andgroove106, separated by theramp gap140. Most or all of the friction in this configuration can be created by the ramp second tongue in contact with thebase tongue148 and/or side of thebase groove146.
• The wall of thebase groove146 can have an outwardly slanted configuration relative to the height of the wall of thebase groove146 from the bottom of the base plate.
• FIG. 14 illustrates that thefirst side ramp96 and the base138 can be pressed into or otherwise translated toward each other. For example, after implantation of thedevice2, the surrounding tissue in the in vivo environment can naturally compress thedevice2.
• Theramp gap140 can be substantially closed. Theramp gap height150 can be substantially about 0. The side ramps can be substantially friction fit along the base plate. For example, the friction in this configuration can be created along the top surface of substantially the entire base plate including the top of thebase tongue148, and the bottom surface of substantially the entire side ramps.
• As the side ramp is pushed, as shown by arrows, toward the base plate, the rampsecond tongues144 can be pressed between thebase grooves146, for example, frictionally fitting the side ramps into the base plate. Thebase grooves146 can be tapered, as shown, to force the rampsecond tongues144 to wedge fit or press fit into thebase grooves146 when the side ramp is pushed towards the base plate.
• The side ramps can have less friction with the base plate in the configuration of the expandable support device188 ofFIG. 13 than in the configuration of the expandable support device188 ofFIG. 14.
• FIG. 15 illustrates that the second side ramp108 (and/or thefirst side ramp96, not shown) can have rampbottom teeth152 on the side of the second side ramp108 (and/or first side ramp96) facing the base plate. The rampbottom teeth152 can extend into theramp gap140. Either or both side ramps can have teeth on any and/or all sides of the side ramp, for example the surfaces that contact the base plate and thetop plate6. Thetop plate6 can have additional teeth, not shown, along surfaces that contact the side ramps.
• The rampbottom teeth152 and/or baseinterior teeth154 can be unidirectionally or bidirectionally oriented (i.e., providing additional resistance against movement in one direction, or substantially the same resistance against movement in either direction).
• As the side ramp translates, as shown by arrows, with respect to the base plate, theramp gap height150 is substantially non-zero, as shown inFIGS. 13 and 15. When theramp gap height150 is substantially non-zero, the rampbottom teeth152 can slide over the baseinterior teeth154.
• FIG. 16 illustrates that when the side ramp and base plate are pressed together, as shown by arrows, for example when deployed in vivo, theramp gap height150 can be minimized, for example approaching about 0 mm (0 in.). The rampbottom teeth152 can interlock with the baseinterior teeth154. The interlocked rampbottom teeth152 and baseinterior teeth154 can provide an interference fit or otherwise prevent or minimize the side ramp translating relative to the base plate.
• In place of, or in addition to, the rampbottom teeth152 and/or the base top teeth, the respective surfaces can have high friction surfaces, for example a textured (e.g., knurled) surface and/or coated with a high friction material. The respective surfaces can also be smooth, having no teeth or texturing.
• The side ramp can be pulled away from the base plate by reducing the compressive force between the side ramp and the base plate and pulling or pushing the side ramp.
• The side ramp can have a belt and suspenders lock with the base plate.
• FIGS. 17,18, and20 illustrate that the ramps can be pushed outward, as shown by arrows, toward each ramp's respective longitudinal side of the base plate. The ramps22 can be pushed outward, for example, by a deployment or other tool. When the ramps22 are slid outward, as shown, thetop plate6 and base plate can translate toward each other, as shown by arrow. Thetop plate6 and base plate can then have a radially compressed (e.g., only in the “y”-axis or from the top of the page to the bottom of the page ofFIGS. 17,18, and20) configuration. Thetop plate6 can interference fit against thebottom plate10 when the expandable support device188 is fully radially compressed, as shown. The interference fit of the top against the bottom plate, and the slidable attachment of the ramps22 to the top and thebottom plate10 can lock thetop plate6, base plate and ramps22 together (e.g., not allowing any to separate). Thedevice2 can be attached to a deployment tool80 (e.g., by removably attaching to one or more ramp ports) and/or delivered to a target site264 in the radially compressed configuration.
• FIGS. 19 and 22 illustrate that one or morelocking pin channels164 can be defined transversely through thedevice2. A lockingpin162 can be inserted through each lockingpin channel164. Thelocking pin162 can be inserted through thelocking pin channel164 after thedevice2 has been inserted at the target site264 and expanded. Thelocking pin channel164 can be defined by lockingpin ports166 on the stability bars102 and theside port114. The lockingpin ports166 can be circular, as shown, oval, or combinations thereof.
• Thelocking pin162 can be configured to limit the vertical expansion of thedevice2. For example, the lockingpin162 can be configured to substantially prevent thedevice2 from disassembling.
• FIG. 23 illustrates that thedevice2 can be longitudinally compressed, as shown by arrows, resulting in radial and/or vertical expansion, as shown by arrow, for example performed after thedevice2 is positioned within a vertebra or between vertebrae. The ramps22 can be slidably translated along the longitudinal axis and inward and/or toward the center of thedevice2. The expansion92 of thedevice2 can increase the height and provide structure support for a compressed or otherwise damaged vertebra (e.g., when thedevice2 is deployed within a vertebra) and/or return adjacent vertebrae to a more natural/physiological configuration (e.g., when thedevice2 is deployed between adjacent vertebrae).
• FIGS. 24 and 25 illustrate thedevice2 in a deployed configuration, for example after completion of thelongitudinal compression160 and radial and/or vertical expansion as shown inFIG. 23.
• FIG. 26 illustrates a variation of thelocking pin162 that can have apin shaft170 with adriver slot172, for example, configured to receive a screw driver or drill bit. Thepin shaft170 can havepin thread168 configured to releasably or fixedly attach to one or both of the ramp ports. Thepin thread168 can extend along all or part of the length of thepin shaft170. Thepin shaft170 can be rotatably or fixedly attached to or integral with alocking plate290. The lockingplate290 can be at the end of thepin shaft170 with thedriver slot172. The lockingplate290 can be at the same or opposite end of thepin shaft170 from the thread.
• FIG. 27 illustrates that thepin shaft170 can have no lockingplate290. Thepin thread168 can be at the end of thepin shaft170 with thedriver slot172. One end of thepin shaft170, for example opposite thedriver slot172, can be anabutment end174.
• FIG. 28 illustrates that thelocking pin162 can be inserted, as shown by arrow, through thesecond side ramp108.FIG. 29 illustrates that thepin shaft170 can be translated and rotated, as shown by arrows, to screw thepin thread168 into the threaded ramp port in thefirst side ramp96. The ramp locking plate can fit into the ramp lockingplate port110. Thelocking pin162 can be screwed tightly enough to substantially fix thelocking pin162.
• FIG. 30 illustrates that thelocking pin162 can be inserted, as shown by arrow, through the threaded ramp port. Thesecond side ramp108 and/or the top and/or the bottom plates can have aramp abutment section180. Theramp abutment section180 can be configured to interference fit with and/or fixedly attach to theabutment end174.
• FIG. 31 illustrates that thepin shaft170 can be translated and rotated, as shown by arrows. Theabutment end174 can interference fit and/or fixedly attach to theramp abutment section180.
• A biocompatible adhesive or epoxy can be applied to thepin thread168, threaded ramp port,abutment end174,ramp abutment section180, or combinations thereof.
• FIGS. 32,33 and34 illustrate that one, two or morelocking pin channels164 can be defined longitudinally through thedevice2. One, two or more locking pins162 can be inserted in, each lockingpin channel164, for example during or after deployment of the remainder of thedevice2. The locking pins162 can prevent overexpansion and/or overcompression and/or disassembly of thedevice2.
• Thelocking pin channel164 can have lockingpin ports166 through the top, and/or bottom plates, and/or either or both side ramps.
• Two lockingpin channel164 can be located on opposite sides of the threaded ramp port. Thelocking pin channels164 and ports can have a circular cross-section (i.e., be cylindrical), as shown inFIG. 34.
• FIGS. 35 and 36 illustrates that thelocking pin162 can be cylindrical. Thelocking pin channel164 and lockingpin port166 can have elongated cross-sections, such as an oval or rectangular or oblong cross-sections. Thelocking pin162 can be free to move vertically within a range of motion within thelocking pin port166.
• FIGS. 37 and 38 illustrate that thelocking pin162 can be a substantially similar shape and size as thelocking pin channel164. Thelocking pin162 can be substantially unmovable within thelocking pin port166. Thelocking pin162, lockingpin channel164 and lockingpin port166 can all have elongated cross-sections, such as an oval or rectangular or oblong cross-sections.
• One or both of the ramps22 can have first fixing teeth192. The first fixing teeth192 can be in contact with the top and/or the bottom. The top and/or the bottom (shown as bottom only)plates286 can have second fixing teeth190.
• The first fixing teeth192 can mechanically interact with the second fixing teeth190 to allow relative translation in a first direction. The first fixing teeth192 and the second fixing teeth190 can interact to obstruct (e.g., by interference fitting the first fixing teeth192 against the second fixing teeth190) relative translation in a second direction. For example, the fixing teeth can obstruct the side ramps from moving longitudinally away from each other (i.e., and obstruct the top from moving closer to the bottom). Also for example, the fixing teeth can allow relative translation of the side ramps toward each other (i.e., and allow the top to move away from the bottom).
• Thesecond side ramp108 can have a first end186. The first end186 can be configured to dissect tissue. The first end186 can have a blunt or sharp point.
• Thesecond side ramp108 can have atool connector184, such as an externally and/or internally threaded cylinder extending longitudinally from thesecond side ramp108 away from thefirst side ramp96. Thetool connector184 can be configured to removably attach to adeployment tool80.
• Thefirst side ramp96 andsecond side ramp108 can be longitudinally compressed toward each other. For example, anexternal deployment tool80 can be attached to thefirst side ramp96 andsecond side ramp108 and apply a compressive force. Thebase138 andtop plates6 can expand away from each other.
• The first fixing teeth192 can unidirectionally interference fit the second fixing teeth190. The unidirectional interference fit of the first fixing teeth192 and the second fixing teeth190 can substantially impede or prevent the opposite ramps22 from moving longitudinally away from each other, for example, therefore impede or preventing compression196 of the top toward the bottom and vice versa.
• The unidirectional interference fit of the first fixing teeth192 and the second fixing teeth190 can allow the opposite ramps22 to move longitudinally toward each other, for example, therefore allowing the top to expand away from the bottom and vice versa.
• The expandable support devices188 can have textured and/or porous surfaces for example, to increase friction against bone surfaces, and/or promote tissue ingrowth. The expandable support devices188 can be coated with a bone growth factor, such as acalcium base138.
• FIGS. 39athrough39cillustrate that the bottom ports can be one or more circular ports, for example six ports. The bottom ports can be aligned in a single row parallel with the longitudinal axis of thedevice2.
• Theside ports114 can open against the edge of thetop plate6 on one or more sides (e.g., the bottom sides, as shown) of theside ports114.
• Thetop plate6 can have topplate side teeth198 on the external lateral sides of thetop plate6. Thebottom plate10 can have bottomplate side teeth202 on the external lateral sides of the bottom plate. The topplate side teeth198 and/or the bottomplate side teeth202 can be oriented from the top to the bottom of the device2 (i.e., perpendicular to the longitudinal axis of the device2). The topplate side teeth198 can be aligned with the bottomplate side teeth202.
• The external lateral sides of thefirst side ramp96 and/orsecond side ramp108 can haveramp side teeth200. Theramp side teeth200 can be oriented parallel with the longitudinal axis of thedevice2. The topplate side teeth198 and/or the bottomplate side teeth202 can be oriented perpendicular to the orientation of theramp side teeth200.
• FIGS. 40athrough40cillustrate that thetop plate6 and/orbottom plate10 can be expanded away from each other in the directions of the orientation of the longitudinal axes of the topplate side teeth198 and the bottomplate side teeth202. The first and/or second side ramps108 can be contracted toward one another in the direction of the orientation of the longitudinal axis of theramp side teeth200 of the first and second side ramps108. The topplate side teeth198, bottomplate side teeth202, and rampside teeth200 can act as low-friction rails42 against surrounding tissue when thedevice2 is radially expanded at the target site264.
• Theside ports114 that open to the bottom edge of thetop plate6 can create asingle side port114 that can extend to the bottom plate.
• Theplates286 and wedges18 can be rigid or exhibit ductile or deformable expansion92 during deployment. The transverse cross-section of thedevice2 can be non-round. For example, Thedevice2 can have a square or rectangular transverse cross-section. Thedevice2 can have a substantially triangular or quadrilateral (e.g., trapezoidal) cross-section. Thedevice2 can have a round, hexagonal, octagonal, or other transverse cross-sectional configuration.
• Thedevice2 can have one or more radiopaque and/or echogenic markers. For example, thedevice2 can have aligned markers on thetop plate6, middle plate8 and bottom plate. When thedevice2 is in a contracted pre-deployment configuration, the markers can be located immediately adjacent to one another, for example appearing as a single marker. When thedevice2 is in an expanded configuration, the markers can move apart from each other, indicating to a doctor performing the implantation and deployment procedure using visualization (e.g., x-ray or ultrasound-based) that thedevice2 has expanded. Under visualization the markers can also indicate the location and orientation of thedevice2.
Method of Using
• The devices can be made from PEEK, any medical grade polymer or metal, or any other material disclosed herein. For example, the side ramps can be made from titanium and/or a titanium alloy and the bottom and/or top plates can be made from PEEK. The device can be coated, for example with bone morphogenic protein (BMP), ceramic, and/or any other material disclosed herein, before, during or after deployment into the target site. The device can be deployed less (e.g., minimally) invasively, over the wire, percutaneously, used with a vertebral body replacement or fusion cage, or combinations thereof. The device can be expandable and un-expandable for removal or repositioning.
• FIG. 41 illustrates that the device can be removably attached to a delivery system or deployment tool. The deployment tool can insert the device into the target site. For example the deployment tool can be pushed over a guidewire.
• When the device is positioned as desired (e.g., between adjacent vertebral plates) and expanded and/or locked, the deployment tool can then be releases from the device. The device can be configured to lock itself into place with outward expansion, wedging, or interference force when receiving a release force from the deployment tool or otherwise. For example, the device can have unidirectionally sliding teeth oppositely located on the adjacent surfaces of the wedges and plates.
• A leader or wire, such as a guidewire, can be inserted or otherwise deployed into the target site, for example, the wire can be percutaneously inserted in a minimally invasive procedure. The wire can be inserted into the intervertebral space, for example between a first vertebral plate and an adjacent, second, vertebral plate. The wire can be anteriorly and/or posteriorly inserted. The wire can be laterally inserted.
• Whether or not the device is inserted over or along the wire, the device can be inserted into the target site (e.g., between adjacent vertebral bodies) from an anterior, lateral, posterior, transforaminal approach, or combinations thereof.
• FIG. 41 illustrates the deployment tool inserted to a target site in vivo between a first vertebra and a second vertebra. For example, the device can be placed at the target site after a partial or complete discectomy. When the device is in a contracted configuration, the tool can position the device between a first vertebral body of the first vertebra and a second vertebral body of the second vertebra. The device can be inserted into the target site a direction substantially parallel to the surfaces of the vertebral body end plates. The device can be placed between a first vertebral end plate of the first vertebral body and the adjacent second vertebral end plate of the second vertebral body. In this inter-vertebral location, the top plate of the device can be in contact with or directly adjacent to the first vertebral end plate. The bottom plate of the device can be in contact with or directly adjacent to the second vertebral end plate.
• FIGS. 42aand42billustrate that the deployment tool can radially expand the device between the first vertebral end plate and the second vertebral end plate. The top plate can press against and/or embed into the first vertebral end plate. The bottom plate can press against and/or embed into the second vertebral end plate. The device can fuse the first vertebra to the second vertebra.
• The device can be filled with a filled before or after radial expansion. Tissue ingrowth can occur into the top plate through the top ports, bottom plate through the bottom ports, and elsewhere through the device.
• The device can provide fusion between the adjacent vertebrae. The devices can have radiopaque and/or echogenic visualization markers, for example the markers can be along the top plate, bottom plate, and one or more panels of the plates. The deployment tool can also have one or more markers. The devices can be inserted into multiple interbody target sites of the spine to provide fusion between adjacent vertebral bodies. A first device can be inserted into a first interbody site and a second device can be inserted into a second interbody site. The first and second devices can be inserted bilaterally, for example both devices can be inserted between the same first vertebra and second vertebra from opposite lateral sides.
• Any or all elements of the device and/or other devices or apparatuses described herein can be made from, for example, a single or multiple stainless steel alloys, nickel titanium alloys (e.g., Nitinol), cobalt-chrome alloys (e.g., ELGILOY® from Elgin Specialty Metals, Elgin, Ill.; CONICHROME® from Carpenter Metals Corp., Wyomissing, Pa.), nickel-cobalt alloys (e.g., MP35N® from Magellan Industrial Trading Company, Inc., Westport, Conn.), molybdenum alloys (e.g., molybdenum TZM alloy, for example as disclosed in International Pub. No. WO 03/082363 A2, published 9 Oct. 2003, which is herein incorporated by reference in its entirety), tungsten-rhenium alloys, for example, as disclosed in International Pub. No. WO 03/082363, polymers such as polyethylene teraphathalate (PET), polyester (e.g., DACRON® from E. I. Du Pont de Nemours and Company, Wilmington, Del.), poly ester amide (PEA), polypropylene, aromatic polyesters, such as liquid crystal polymers (e.g., Vectran, from Kuraray Co., Ltd., Tokyo, Japan), ultra high molecular weight polyethylene (i.e., extended chain, high-modulus or high-performance polyethylene) fiber and/or yarn (e.g., SPECTRA® Fiber and SPECTRA® Guard, from Honeywell International, Inc., Morris Township, N.J., or DYNEEMA® from Royal DSM N.V., Heerlen, the Netherlands), polytetrafluoroethylene (PTFE), expanded PTFE (ePTFE), polyether ketone (PEK), polyether ether ketone (PEEK), poly ether ketone ketone (PEKK) (also poly aryl ether ketone ketone), nylon, polyether-block co-polyamide polymers (e.g., PEBAX® from ATOFINA, Paris, France), aliphatic polyether polyurethanes (e.g., TECOFLEX® from Thermedics Polymer Products, Wilmington, Mass.), polyvinyl chloride (PVC), polyurethane, thermoplastic, fluorinated ethylene propylene (FEP), absorbable or resorbable polymers such as polyglycolic acid (PGA), poly-L-glycolic acid (PLGA), polylactic acid (PLA), poly-L-lactic acid (PLLA), polycaprolactone (PCL), polyethyl acrylate (PEA), polydioxanone (PDS), and pseudo-polyamino tyrosine-based acids, extruded collagen, silicone, zinc, echogenic, radioactive, radiopaque materials, a biomaterial (e.g., cadaver tissue, collagen, allograft, autograft, xenograft, bone cement, morselized bone, osteogenic powder, beads of bone) any of the other materials listed herein or combinations thereof. Examples of radiopaque materials are barium sulfate, zinc oxide, titanium, stainless steel, nickel-titanium alloys, tantalum and gold.
• The device can be made from substantially 100% PEEK, substantially 100% titanium or titanium alloy, or combinations thereof.
• Any or all elements of the device and/or other devices or apparatuses described herein, can be, have, and/or be completely or partially coated with agents for cell ingrowth.
• The device and/or elements of the device and/or other devices or apparatuses described herein can be filled, coated, layered and/or otherwise made with and/or from cements, tillers, and/or glues known to one having ordinary skill in the art and/or a therapeutic and/or diagnostic agent. Any of these cements and/or fillers and/or glues can be osteogenic and osteoinductive growth factors.
• Examples of such cements and/or fillers includes bone chips, demineralized bone matrix (DBM), calcium sulfate, coralline hydroxyapatite, biocoral, tricalcium phosphate, calcium phosphate, polymethyl methacrylate (PMMA), biodegradable ceramics, bioactive glasses, hyaluronic acid, lactoferrin, bone morphogenic proteins (BMPs) such as recombinant human bone morphogenetic proteins (rhBMPs), other materials described herein, or combinations thereof.
• The agents within these matrices can include any agent disclosed herein or combinations thereof, including radioactive materials; radiopaque materials; cytogenic agents; cytotoxic agents; cytostatic agents; thrombogenic agents, for example polyurethane, cellulose acetate polymer mixed with bismuth trioxide, and ethylene vinyl alcohol; lubricious, hydrophilic materials; phosphor cholene; anti-inflammatory agents, for example non-steroidal anti-inflammatories (NSAIDs) such as cyclooxygenase-1 (COX-1) inhibitors (e.g., acetylsalicylic acid, for example ASPIRIN® from Bayer AG, Leverkusen, Germany; ibuprofen, for example ADVIL® from Wyeth, Collegeville, Pa.; indomethacin; mefenamic acid), COX-2 inhibitors (e.g., VIOXX® from Merck & Co., Inc., Whitehouse Station, N.J.; CELEBREX® from Pharmacia Corp., Peapack, N.J.; COX-1 inhibitors); immunosuppressive agents, for example Sirolimus (RAPAMUNE®, from Wyeth, Collegeville, Pa.), or matrix metalloproteinase (MMP) inhibitors (e.g., tetracycline and tetracycline derivatives) that act early within the pathways of an inflammatory response. Examples of other agents are provided in Walton et al, Inhibition of Prostaglandin E₂Synthesis in Abdominal Aortic Aneurysms, Circulation, Jul. 6, 1999, 48-54; Tambiah et al, Provocation of Experimental Aortic Inflammation Mediators and Chlamydia Pneumoniae, Brit. J. Surgery 88 (7), 935-940; Franklin et al, Uptake of Tetracycline by Aortic Aneurysm Wall and Its Effect on Inflammation and Proteolysis, Brit. J. Surgery 86 (6), 771-775; Xu et al, Spl Increases Expression of Cyclooxygenase-2 in Hypoxic Vascular Endothelium, J. Biological Chemistry 275 (32) 24583-24589; and Pyo et al, Targeted Gene Disruption of Matrix Metalloproteinase-9 (Gelatinase B) Suppresses Development of Experimental Abdominal Aortic Aneurysms, J. Clinical Investigation 105 (11), 1641-1649 which are all incorporated by reference in their entireties.
• Any elements described herein as singular can be pluralized (i.e., anything described as “one” can be more than one). Any species element of a genus element can have the characteristics or elements of any other species element of that genus. The above-described configurations, elements or complete assemblies and methods and their elements for carrying out the invention, and variations of aspects of the invention can be combined and modified with each other in any combination.

Claims (7)

1. A method of using an orthopedic support device comprising:

positioning the device at a target site, wherein the device has a longitudinal axis, and wherein the device comprises a first plate, a second plate opposite to the first plate, a first wedge between the first plate and the second plate at a first end of the device, and a second wedge between the first plate and the second plate at a second end of the device, wherein the first plate has a first extension extending in the direction of the second plate, and wherein the second plate has a first receiver configured to receive the first extension; and

expanding the device at the target site, wherein expanding the target site comprises longitudinally moving the first wedge and the second wedge toward the longitudinal middle of the device, and wherein the first extension slides in the first receiver during the expansion of the device.

2. The method ofclaim 1, wherein expanding further comprises restricting longitudinal translation between the first plate and the second plate.

3. The method ofclaim 2, wherein the restricting longitudinal translation comprises sliding of the first extension in the first receiver.

4. An implantable orthopedic device having a longitudinal axis comprising:

a first plate;

a second plate opposite to the first plate;

a first wedge between the first plate and the second plate at a first longitudinal end of the device; and

a second wedge between the first plate and the second plate at a second longitudinal end of the device;

wherein the first plate has a first extension extending in the direction of the second plate, and wherein the second plate has a first receiver configured to slidably receive the first extension; and

wherein the first wedge is longitudinally translatable toward the second wedge, and wherein the first extension slides.

5. The device ofclaim 4, wherein the first plate has a first plate face substantially defining a first plane, and wherein the first extension extends away from the first plate face in a direction perpendicular to the first plane.

6. The device ofclaim 5, wherein the second plate has a second plate face substantially defining a second plane, and wherein the first receiver is configured to slidably receive the first extension in a slidable direction perpendicular to the second plane.

7. The device ofclaim 6, wherein the second plane is parallel with the first plane.

Images