US20130197587A1 - Device and method to access the anterior column of the spine - Google Patents

Abstract

Methods and devices are configured to permit a surgeon to access the anterior column of the spine without significant manipulation of intervening nerve elements.

Description

REFERENCE TO PRIORITY DOCUMENT
• This application is a divisional of and claims priority to co-pending U.S. patent application Ser. No. 12/573,813 filed on Oct. 5, 2009 of the same title, and published as U.S. Patent Application Publication No. 2010/0087878 also of the same title, which is hereby incorporated by reference in its entirety, and which claims priority of co-pending U.S. Provisional Patent Application Ser. No. 61/195,191 filed Oct. 4, 2008. Priority of the aforementioned filing date is hereby claimed and the disclosure of the Provisional Patent Application is hereby incorporated by reference it its entirety.
BACKGROUND
• The surgical reconstruction of the bony skeleton is a common procedure in current medical practice. Regardless of the anatomical region or the specifics of the reconstructive procedure, many surgeons employ an implantable device that can adjust, align and maintain the spatial relationship(s) between adjacent bones. An extensive array of surgical techniques and implantable devices have been formulated to accomplish this goal.
• Symptomatic degeneration of the lumbar spine occurs most commonly at the L4/5 and L5/S 1 levels and fusion of one or both of these segments has emerged as a common surgical procedure. Currently, these vertebral bodies may be fused using an anterior, lateral or posterior approach and each has particular advantages and draw backs. Frequently, circumferential fusion of the unstable level with fixation of both the anterior and posterior aspect of the spine is desired. This requires that patients undergo a combination of the aforementioned approaches. The anterior or lateral approaches are used to insert the bone graft into the disc space between the adjacent vertebras while the posterior approach is used to place bone screws or similar fasteners that are used to immobilize the vertebral bodies.
• Access to the disc space for bone graft placement requires dissection through the vital tissues that lie anterior or lateral to the spine. U.S. Pat. No. 7,309,338 and others disclose a method for the access of the anterior column of the lumbar spine using a pre-sacral approach. (U.S. Pat. No. 7,309,338 is hereby incorporated by reference in its entirety.) The procedure has been popularized by the corporation TranS1, Inc of Wilmington, N.C. as the “AXLIF” procedure. The technology for both the L5 to S1 fusion procedure and the L4 to S1 fusion procedure are described on the web site “www.trans1.com”. All contents and disclosures of the web site are hereby incorporated by reference in their entirety. The procedure is further described in the article:A novel minimally invasive pre-sacral approach and instrumentation technique for anterior L5/S1intervertebral discectomy and fusion.By Marotta et al., Neurosurg. Focus 20 (1): E9, 2006. The article is hereby incorporated by reference in its entirety.
• With experience, an important shortcoming of the “AXLIF” procedure has been discovered. The procedure, which entails placement of a threaded screw or a threaded rod through an anterior segment of the sacrum and into the superior vertebral bones, fails to provide adequate segmental fixation in rotation and other planes of spinal motion. Thus, the “AXLIF” procedure must be supplemented with additional screw and orthopedic device stabilization in order to adequately immobilize the operative segment. Most commonly, posterior screw/rod fixation into the pedicle portion of the vertebral bones is used to supplement the “AXLIF” procedure. Unfortunately, the need to provide supplement fixation through alternative surgical corridors, such as the posterior approach to the spine, greatly limits the usefulness of the “AXLIF” procedure and obviates the advantages that the procedure provides over other current art.
SUMMARY
• It is a goal of the present disclosure to supplement the “AXLIF” procedure with additional fixation placed onto the sacrum and vertebral bodies of superior bones through a pre-sacral surgical corridor. The pre-sacral surgical corridor designates a soft tissue corridor developed onto the anterior surface of the sacrum and extending from a skin incision at about the level of the coccyx and extending cephalad to at least the level of the 83 vertebral bone. In this way, the need for additional fixation onto the posterior aspect of the lumbar spine is minimized.
• In one aspect, a method for fixation of a sacral bone is disclosed. In one embodiment, the fixation is with at least an immediately superior vertebral bone, and the method includes: (i) creating a first borehole into an anterior surface of the sacral bone, (ii) advancing a first fixation post through the first borehole, the sacral bone, and a disc space immediately superior to the sacral bone, and into a superior vertebral bone, the superior vertebral bone being immediately superior to the disc space, (iii) positioning a fixation element (e.g., plate in one variant) onto the anterior surface of the sacral bone, the fixation element configured to abut the anterior surface of the sacral bone and to remain separated from the disc space and the superior vertebral bone, and (iv) advancing at least a second fixation post through the sacral bone, the disc space, and into the superior vertebral bone, the second fixation post being further positioned within an aperture of the fixation element.
• In another aspect, an apparatus for fixation of a sacral bone is disclosed. In one embodiment, the fixation is with at least an immediately superior vertebral bone, and the apparatus includes: a first fixation post configured to be advanced through a first borehole created in an anterior surface of the sacral bone, and a disc space immediately superior to the sacral bone, and into a vertebral bone immediately superior to the disc space, a fixation element configured to abut the anterior surface of the sacral bone and to remain separated from the disc space and the vertebral bone, the fixation element comprising at least an aperture, and a second fixation post configured to be advanced through the sacral bone, the disc space, and into the vertebral bone, at least a portion of the second fixation post being positioned within the aperture of the fixation element.
• Other features and advantages should be apparent from the following description of various embodiments, which illustrate, by way of example, the principles of the disclosed devices and methods.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 shows a diagrammatic representation of a spinal vertebral bone in multiple views.
• FIG. 2A shows the posterior surface of adjacent vertebrae and the articulations between the vertebrae.
• FIG. 2B shows an oblique view of the vertebrae.
• FIG. 3 shows a posterior view of the sacrum.
• FIG. 4A shows an anterior view of the sacrum.
• FIG. 4B shows a lateral view of the sacrum.
• FIG. 5 shows an embodiment of a threaded screw.
• FIG. 6 shows sectional views of the screw.
• FIG. 7 shows an implanted screw.
• FIGS. 8 and 9 show a bone plate.
• FIGS. 10,11A and11B show the plate implanted onto the surface of the anterior bony surface of the sacrum.
• FIG. 11C illustrates a schematic representation of the L5 vertebra.
• FIG. 12 shows an implanted screw.
• FIG. 13 shows a locking cover.
• FIGS. 14 and 15 show a plate cover applied to a seated plate.
• FIG. 16 shows an exemplary screw with an expandable head and locking screw.
• FIG. 17 shows a bone anchor.
• FIG. 18 shows sectional views of the bone anchor.
• FIGS. 19 and 20 show the anchor advanced onto the left pedicle of L5 vertebra.
• FIG. 21 shows a joined screw and an additional anchor assembly without the bone elements.
• FIG. 22 shows sectional views of joined screw and an additional anchor assembly without the bone elements.
DETAILED DESCRIPTION
• In order to promote an understanding of the principals of the disclosure, reference is made to the drawings and the embodiments illustrated therein. Nevertheless, it will be understood that the drawings are illustrative and no limitation of the scope of the invention is thereby intended. Any such alterations and further modifications in the illustrated embodiments, and any such further applications of the principles of the invention as illustrated herein are contemplated as would normally occur to one of ordinary skill in the art.
• FIG. 1 shows a diagrammatic representation of a spinalvertebral bone802 in multiple views. For clarity of illustration, the vertebral bone ofFIG. 1 and those of other illustrations presented in this application are represented schematically and those skilled in the art will appreciate that actual vertebral bodies may include anatomical details that are not shown in these figures. Further, it is understood that the vertebral bones at a given level of the spinal column of a human or animal subject will contain anatomical features that may not be present at other levels of the same spinal column. The illustrated vertebral bones are intended to generically represent vertebral bones at any spinal level without limitation.
• Vertebral bone802 contains an anteriorly-placedvertebral body804, a centrally placed spinal canal and806 and posteriorly-placedlamina808. The pedicle (810) segments ofvertebral bone802 form the lateral aspect of the spinal canal and connect thelaminas808 to thevertebral body804. The spinal canal contains neural structures such as the spinal cord and/or nerves. A midline protrusion termed the spinous process (SP) extends posteriorly from the medial aspect oflaminas808. A protrusion extends laterally from each side of the posterior aspect of the vertebral bone and is termed the transverse process (TP). A right transverse process (RTP) extends to the right and a left transverse process (L TP) extends to the left. A superior protrusion extends superiorly above the lamina on each side of the vertebral midline and is termed the superior articulating process (SAP). An inferior protrusion extends inferiorly below the lamina on each side of the vertebral midline and is termed the inferior articulating process (IAP). Note that the posterior aspect of the pedicle can be accessed at anindentation811 in the vertebral bone between the lateral aspect of the SAP and the medial aspect of the transverse process (TP). In surgery, it is common practice to anchor a bone fastener into the pedicle portion of a vertebral bone by inserting the fastener throughindentation811 and into the underlying pedicle.
• FIGS. 2A and 2B illustrate a functional spinal unit (FSU), which includes two adjacent vertebrae and the intervertebral disc between them. The intervertebral disc resides between the inferior surface of the upper vertebral body and the superior surface of the lower vertebral body. (Note that a space is shown inFIGS. 2A and 2B where intervertebral disc would reside.)FIG. 2A shows the posterior surface of the adjacent vertebrae and the articulations between them whileFIG. 2B shows an oblique view. Note that FSU contains a three joint complex between the two vertebral bones, with the intervertebral disc comprising the anterior joint. The posterior joints include a facet joint814 on each side of the midline, wherein the facet joint contains the articulation between the SAP of the superior vertebral bone and the SAP of the inferior bone. Movement between a superior and inferior vertebral bone of a functional spinal unit (FSU) occurs about a center of rotation (termed IAR, seeFIG. 1) that is located within the posterior aspect of the vertebral body (but anterior to the spinal canal) and near the superior surface of the inferior vertebral body.
• The preceding illustrations and definitions of anatomical structures are known to those of ordinary skill in the art. They are described in more detail inAtlas of Human Anatomy, by Frank Netter, third edition, Icon Learning Systems, Teterboro, N.J. The text is hereby incorporated by reference in its entirety.
• Disclosed are methods and devices that permit a surgeon to access the anterior column of the spine without significant manipulation of the intervening nerve elements. (The “anterior column” is used here to designate that portion of the vertebral body and/or FSU that is situated anterior to the posterior longitudinal ligament. Thus, its use in this application encompasses both the anterior and middle column of Denis. SeeThe three column spine and its significance in the classification of acute thoracolumbar spinal injuries. By Denis, F. Spine1983 November-December; 8(8):817-31. The article is incorporated by reference in its entirety.)
• FIG. 3 shows a posterior view of the sacrum.FIG. 4A shows an anterior view andFIG. 4B shows a lateral view. The sacral promontory, sacral foramina, the S1/S2 vertebral intersection as well as other anatomical features are illustrated. Additional features of the sacrum are described in more detail inAtlas of Human Anatomy, by Frank Netter, third edition, Icon Learning Systems,Teterboro, N.J. The text is hereby incorporated by reference in its entirety.
• The “AXLIF” procedure is more fully described within the previously listed and incorporated article and web site. An abbreviated description of the procedure follows and those of ordinary skill in the art will understand that the description does not fully recite all of the features and operative steps of the “AXLIF” procedure.
• A skin incision is placed lateral to and at the approximate level of the coccyx. The surgeon's finger is used to bluntly dissect the colon and other soft tissues away from the anterior surface of the sacrum. Blunt dissection is continued with finger and instrument dissection until the anterior aspect of the S1 and S2 bones are reached. The anterior bony surface of the sacrum is entered at approximately the level of the intersection of the lower aspect of S1 and the superior aspect of S2. A hole is drilled through the S1 body portion of the sacrum and advanced into the L5/S1 disc space. An L5/S1 discectomy is performed through the formed sacral bore hole and the disc space is packed with bone graft or bone graft substitute. Preferably, the totality of the procedure is performed in a percutaneous manner, under X-ray guidance and through specifically designed hollow tubes. The bore hole is extended into the L5 vertebral body and a threaded screw is placed into the S1 body, across the L5/S1 disc space and into the L5 vertebral body. (See the previously listed referenced and incorporated web site and article for a full description of the “AXLIF” procedure).
• An embodiment of the threaded screw is shown in a perspective view inFIG. 5.FIG. 6 shows sectional views of the screw. Thescrew100 contains a first threadedsegment105 and a second threadedsegment110, wherein the threads of each segment are like-handed but of different pitch. (Further,segment105 is preferably of lesser diameter than segment110.) With advancement of the screw,segment105 comes to rest within the L5 vertebral body whilesegment110 comes to rest within the S1 vertebral body (FIG. 7). The threads of each of the two segments are of different pitch so that advancement of the screw within the vertebral bones produces a distraction force between the two vertebral bones and distracts the L5 and S1 vertebral bodies away from one another. Screws of different pitch segments are known in the art and have been used to produce distraction or compressive forces across bones. U.S. Pat. No. 4,175,555 granted to Timothy Herbert discloses a bone screw of variable thread segments. The patent is hereby incorporated by reference in its entirety. Screw100 of the current disclosure is of similar design.
• Aninternal bore102 rests withinscrew100 and contains threadedsegment103.Hex drive segment107 is located on an end ofinternal bore102 of screw100.Segment107 is used to engage a hex-ended screw driver (not shown), wherein the driver is adapted to rotate and drivescrew100 into bone.FIG. 7 illustrates a sectional view of thescrew100 within the L5 and 81 vertebral bodies. Note that the entry point forscrew100 is along the anteriorbony surface20 of the sacrum, at or about the intersection of the inferior aspect of 81 and superior aspect of S2.
• Plate120 is shown inFIGS. 8 and 9.Plate120 may contain atop surface1202, abottom surface1204, and side surfaces that include anupper side surface1206 and alower side surface1208. The plate further contains multiple bore holes that extend fromtop surface1202 tobottom surface1204. Each bore hole may be angled so that the long axis “A” of each bore hole is not perpendicular totop surface1202 ofplate120. The long axis of each bore hole may form an angle “B” of 10 to 80 degrees withsurface1202. Further, the long axis of each of the inferior bore holes X1 and X2 are angled away for one another so that the shank of a screw placed into bore hole X1 and the shank of a screw placed into bore hole X2 will diverge from each other. That is, the distance between the distal tip of each screw shank is greater than the distance between the head portion of each screw. Thebottom surface1204 of theplate120 preferably contains sharpenedprotrusions128, wherein the protrusions are preferably angled relative to surface1204—as shown inFIG. 9.
• In use, thebottom surface1204 of the plate is adapted to rest against the anterior bony surface of the sacrum.Protrusions128 are adapted to anchor into the anterior sacral surface and provide additional contact and fixation with the sacral bone. A threadedscrew131 is adapted to traverse the upper bore hole Y1 and engagethreads103 ofbore102 of screw100 (seeFIG. 12). Additional threaded screws133 (with threads adapted to engage bone) are adapted to traverse at least one of the lower bore holes X1 and X2 and enter the sacral bone at the level of the S1 body. Thescrews133 are further advanced across the L5/S1 disc space and into the L5 vertebral body. A central threaded bore hole Z rests within the center ofplate120, where bore Z is adapted to engage a threaded screw ofplate cover1222.
• FIG. 10 shows theplate120 implanted onto the surface of the anterior bony surface of the sacrum. Note that the sacral hole used to implantscrew100 is at least partially covered by a portion of theplate120. A lateral view is shown inFIG. 11A and an anterior-posterior view is shown inFIG. 11B. These figures show diagrammatic representation of the implanted device and, for clarity of illustration, the vertebral bone and other aspects of the drawing are represented schematically. Those skilled in the art will appreciate that actual vertebral bones and sacrum may include anatomical details that are not shown in these figures. As suggested in theFIGS. 11, thescrews133 are preferably positioned with the distal screws tips posterior to the screw heads, and wherein the distance between the distal screw tips is greater than the distance between the screw heads.
• Since the internal aspect of the vertebral body contains bone that is less dense and less resistant to screw pull-out than an exterior wall of the vertebral body, the distal tips ofscrews133 are preferably driven into the more dense surfaces of the exterior walls of the L5 vertebral body. For example, while not shown in theFIGS. 11A and 11B, the tips ofscrews133 are preferably advanced until they penetrate and rest within a cortical surface of the L5 vertebral body. That is, the distal tips ofscrews133 are preferably advanced into the lateral wall W1 of L5 vertebral body, or into the superior vertebral body surface W2 that abuts the L4/5 disc space, or into the posterior vertebral body surface W3. (FIG. 11C illustrates a schematic representation of the L5 vertebra. The surfaces W1-W3 are shown.) Alternatively, the distal screw tip may be advanced across the interface (FIG. 1) of the internal aspect of the L5 pedicle and the internal aspect of L5 vertebral body. That interface is known to have exceptional resistance to bone screw pull out.
• As an additional mechanism to strengthen the bony fixation provided by the plate and screw set, a locking mechanism is contemplated that would lock the head ofscrews131 and133 ontoplate120. This may be accomplished in a number of ways. In an embodiment,plate cover1222 is used to forcibly capture and frictionally lock the head ofscrews131 and133 ontoplate120. Lockingcover1222 is shown inFIG. 13. Full thickness borehole1225 ofcover1222 is adapted to permit a locking screw to attachcover1222 onto the bore hole Z ofplate120. As the threaded locking screw is advanced within the threaded bore hole Z ofplate120, the heads ofscrews131 and133 are immobilized between theplate cover1222 andplate120.
• FIGS. 14 and 15 show the plate cover122 applied to seatedplate120. (FIG. 14 is a rendered illustration whileFIG. 15 shows a line drawing.) Alternatively, each ofscrews131 and133 may be configured with an expandable head such that advancement of a locking screw within the expandable head of eachscrew131 and133 would outwardly expand the head of each ofscrew131 and133 and lock the screw head within the receiving bore hole ofplate120. Anexemplary screw220 with anexpandable head2202 and lockingscrew2204 is shown inFIG. 16. Screws with expandable heads are well known in the art and have been used to lock bone screws to an orthopedic plate. U.S. Pat. No. 5,713,900 illustrates one such expandable head screw configuration. The patent is hereby incorporated by reference in its entirety.
• It is a goal of the present disclosure to supplement the “AXLIF” procedure with additional fixation placed onto the sacrum and vertebral bodies of superior bones through a pre-sacral surgical corridor. In the preceding embodiments, a plate and bone screw assembly which has been implanted onto the anterior aspect of the sacrum using a pre-sacral surgical corridor is used to supplement the fixation of the “AXLIF” procedure. The pre-sacral surgical corridor designates a soft tissue corridor developed onto the anterior surface of the sacrum and extending from a skin incision at about the level of the coccyx and extending cephalad to at least the level of the S3 vertebral bone. The plate preferably attaches to the threadedscrew100 of the “AXLIF” procedure. The bone screws133 are preferably anchored distally onto a rigid aspect/wall of the L5 vertebral body and attached proximally onto the plate using a plate/screw locking mechanism. While the invention has been illustrated for use in L5 to sacrum fixation, it is understood that the procedure can be similarly applied in L4 to sacrum fixation. In the latter, the bone screws133 extend from the plate to the L4 vertebral body. As before, they preferably anchor distally onto a rigid aspect/wall of the L4 vertebral body (side walls, posterior body wall, superior body wall, inferior body wall and/or the internal aspect of the pedicle/vertebral body interface an the like) and attached proximally onto the plate using a plate/screw locking mechanism.
• In an additional embodiment, fixation of ascrew133 onto a vertebral bone cephalad to the sacrum (such as L5, L4 or above) can be further enhanced by advancing an additional bone anchor into the superior bone and joiningscrew133 to that anchor. Since the trajectory of the additional bone anchor may be different than that of ascrew133, the overall trajectory of the joinedscrew133/additional anchor assembly will differ than that ofscrew133 alone. This property can be advantageously used to place ascrew133 though a pre-sacral approach and have the distal aspect of the joinedscrew133/additional anchor assembly screw rest at a point that is posterior to the center of rotation (IAR) of the function spinal unit that is being fixated. This concept and method of use will be more fully discussed below.
• Anchor330 is shown inFIG. 17 and in section views inFIG. 18. The anchor has threadedshank334 withspherical head segment338. Ahexagonal segment342 resides atopsegment338.Segment342 is adapted to engage a complimentary screw driver with Hex-shaped indentation so that the screw driver can affix onto and drive theanchor330 into bone. Abore hole344 is placed across the threaded shank. A threadedbore hole346 is placed along the long axis ofanchor330—as shown inFIG. 18. While the method of fixation andanchor330 use is shown for L5 to sacrum fusion, it is understood that device and method may be similarly used to fixate L4 (and above levels) to the sacrum.
• In use for L5 to sacrum fixation,anchor330 is advanced into the pedicle portion of the L5 vertebral bone using a posterior surgical corridor so that theshank334 enters the vertebral bone at approximately location811 (FIG. 1). Preferably, theanchor330 is advanced untilsegment338 rests against thepedicle entry point811. Preferably, the procedure is performed in a percutaneous manner and under X-ray guidance/visualization.Anchor330 is advanced so thatbore344 is positioned within the vertebral body and immediately distal to the body/pedicle interface (that is, the shank ofanchor330 has traversed the body/pedicle interface and entered the vertebral bone). A jig or surgical guide (not shown) is attached onto the segment342 (using threads346) and used to guide the distal aspect ofscrew133 to bore344 ofanchor330. InFIG. 19,anchor330 had already been advanced onto left pedicle of L5 (the pedicle and screw are hidden inFIG. 19 and shown inFIG. 20). Awire365 is guided by the surgical guide so that the distal end of the wire traverses bore X2 of theplate120 and is advanced intobore hole344 ofshank334 ofanchor330.
• Screw133 hascentral bore1330 adapted to acceptwire365.Screw133 is rotated and advanced overwire365 until the distal end resides withinbore344 ofanchor330. The placedscrew133 is shown inFIG. 20. For clarity of illustration,FIG. 21 shows the joinedscrew133/additional anchor330 assembly without the bone elements. Sectional views are shown inFIG. 22. After the distal ofscrew133 is passed intobore344 ofanchor330, setscrew372 is tightened so as to rigidly retain133 withinbore344.
• With reference toFIG. 21, the joinedscrew133/additional anchor330 assembly forms a fixation assembly with the effective trajectory of vector V1. Thus, screw133 can be placed into the sacrum through a pre-sacral approach and traverse the L5/S1 disc space anterior to the center of rotation (see IAR inFIG. 1) but, when coupled toanchor330, can form an effect anchor assembly that traverses the disc space (in trajectory V1) posterior to the JAR. In this way,screw100 traverses the L5/S1 disc space anterior to the IAR while afirst screw133/additional anchor330 assembly attached to bore X1 ofplate12012 (using a screw to plate locking mechanism) will traverse the L5/S1 disc space posterior to the IAR and asecond screw133/additional anchor330 assembly attached to bore X2 ofplate120 will also traverse the L5/S1 disc space posterior to the IAR. This forms a three point fixation configuration around the IAR of the disc space to be fixated.
• While the preceding embodiment has be illustrated for L5 to sacral fusion, it is understood that the same devices and method can be used at fixate the L4 vertebral bone to the sacrum. In that embodiment, anadditional anchor330 is advanced into each of the two pedicle portions of the L4 vertebral bone. Ascrew133 is placed through each of bores X and guided to bore344 of thecorresponding anchor330 using a surgical guide andwire365 as previously described. Theset screw372 of eachanchor330 is tightened after placement ofscrew133. The proximal aspect of eachscrew133 is also locked to plate120 (which is in turn affixed to screw100 viascrew131 and bore Y) by a screw to plate locking mechanism.
• The preceding disclosure teaches multiple embodiments to supplement the bone fixation strength of the “AXLIF” procedure by placing a plate and screw assembly that has been placed through a pre-sacral surgical corridor. While describe as separate embodiments, the various mechanisms may be used in combinations to produce additional assemblies that have not been specifically described herein, but, nevertheless, would fall within the scopeof this invention.
• The disclosed devices or any of their components can be made of any biologically adaptable or compatible materials. Materials considered acceptable for biological implantation are well known and include, but are not limited to, stainless steel, titanium, tantalum, combination metallic alloys, various plastics, resins, ceramics, biologically absorbable materials and the like. Any components may be also coated/made with nanotube materials to further impart unique mechanical or biological properties. In addition, any components may be also coated/made with osteo-conductive (such as deminerized bone matrix, hydroxyapatite, and the like) and/or osteo-inductive (such as Transforming Growth Factor “TGF-B,” Platelet-Derived Growth Factor “PDGF,” Bone-Morphogenic Protein “BMP,” and the like) bio-active materials that promote bone formation. Further, any surface may be made with a porous ingrowth surface (such as titanium wire mesh, plasma-sprayed titanium, tantalum, porous Coer, and the like), provided with a bioactive coating, made using tantalum, and/or helical rosette carbon nanotubes (or other carbon nanotube-based coating) in order to promote bone in-growth or establish a mineralized connection between the bone and the implant, and reduce the likelihood of implant loosening. Lastly, the system or any of its components can also be entirely or partially made of a shape memory material or other deformable material.
• Although embodiments of various methods and devices are described herein in detail with reference to certain versions, it should be appreciated that other versions, embodiments, methods of use, and combinations thereof are also possible. Therefore the spirit and scope of the appended claims should not be limited to the description of the embodiments contained herein.
• Although embodiments of various methods and devices are described herein in detail with reference to certain versions, it should be appreciated that other versions, embodiments, methods of use, and combinations thereof are also possible. Therefore the spirit and scope of the appended claims should not be limited to the description of the embodiments contained herein.

Claims (31)

1. (canceled)

2. A method for fixation of a sacral bone with at least an immediately superior vertebral bone, comprising:

creating a first borehole into an anterior surface of said sacral bone;

advancing a first fixation post through said first borehole, said sacral bone, and a disc space immediately superior to said sacral bone, and into a superior vertebral bone, said superior vertebral bone being immediately superior to said disc space;

positioning a fixation element onto said anterior surface of said sacral bone, said fixation element configured to abut said anterior surface of said sacral bone and to remain separated from said disc space and said superior vertebral bone; and

advancing at least a second fixation post through said sacral bone, said disc space, and into said superior vertebral bone, said second fixation post being further positioned within an aperture of said fixation element.

3. The method ofclaim 2, further comprising causing at least a portion of said fixation element to at least partially cover said first borehole.

4. The method ofclaim 2, further comprising enhancing fixation of said fixation element onto said anterior surface of said superior vertebral bone via providing at least one protrusion on a surface of said fixation element configured to abut said anterior surface of said sacral bone.

5. The method ofclaim 2, wherein said acts of advancing said first and second fixation posts comprises advancement such that a trajectory thereof diverges within said sacral bone.

6. The method ofclaim 2, wherein said act of advancing said first fixation post into said superior vertebral bone comprises advancing said first fixation post into an L5 vertebral bone.

7. The method ofclaim 6, further comprising at least partially engaging a cortical surface of a side wall of said L5 vertebral bone via said second fixation post.

8. The method ofclaim 6, further comprising causing said second fixation post to at least partially extend into an L4 vertebral bone.

9. The method ofclaim 6, further comprising advancing a third fixation post through said sacral bone, said disc space, and into said L5 vertebral bone.

10. The method ofclaim 9, further comprising positioning said third fixation post within a second aperture of said fixation element.

11. The method ofclaim 9, wherein said acts of advancing said second and third fixation posts comprises advancement such that a trajectory thereof diverges within said sacral bone.

12. The method ofclaim 9, further comprising at least partially engaging a cortical surface of a side wall of said L5 vertebral bone via said third fixation post.

13. The method ofclaim 9, wherein said act of advancing said third fixation post further comprises causing said third fixation post to at least partially extend into an L4 vertebral bone.

14. The method ofclaim 2, further comprising inserting said first fixation post into a third aperture of said fixation element.

15. The method ofclaim 2, further comprising rigidly affixing said second fixation post onto said fixation element via a locking feature of said fixation element.

16. The method ofclaim 15, further comprising substantially immobilizing said second fixation post with respect to said first fixation post via said locking feature.

17. An apparatus for fixation of a sacral bone with at least an immediately superior vertebral bone, said apparatus comprising:

a first fixation post configured to be advanced through a first borehole created in an anterior surface of said sacral bone, and a disc space immediately superior to said sacral bone, and into a vertebral bone immediately superior to said disc space;

a fixation element configured to abut said anterior surface of said sacral bone and to remain separated from said disc space and said vertebral bone, said fixation element comprising at least an aperture; and

a second fixation post configured to be advanced through said sacral bone, said disc space, and into said vertebral bone, at least a portion of said second fixation post being configured to be positioned within said aperture of said fixation element.

18. The apparatus ofclaim 17, wherein said fixation element comprises a substantially plate-like structure which is further configured to at least partially cover said first borehole.

19. The apparatus ofclaim 18, wherein a surface of said fixation element configured to abut said anterior surface of said sacral bone comprises at least one protrusion configured to enhance plate fixation onto said sacral bone.

20. The apparatus ofclaim 17, wherein a trajectory of said first and said second fixation posts diverges within said sacral bone.

21. The apparatus ofclaim 17, wherein said immediately superior vertebral bone comprises an L5 vertebral bone.

22. The apparatus ofclaim 21, wherein said second fixation post is configured to at least partially engage a cortical surface of a side wall of said L5 vertebral bone.

23. The apparatus ofclaim 21, wherein said second fixation post is configured to at least partially extend into an L4 vertebral bone.)

24. The apparatus ofclaim 21, wherein a third fixation post is configured to advance through said sacral bone, said disc space, and into said L5 vertebral bone.

25. The apparatus ofclaim 24, wherein said third fixation post is further positioned within a second aperture of said fixation element.

26. The apparatus ofclaim 24, wherein a trajectory of said second and said third fixation posts diverge within said sacral bone.

27. The apparatus ofclaim 24, wherein said third fixation post is configured to at least partially engage a cortical surface of a side wall of said L5 vertebral bone.

28. The apparatus ofclaim 24, wherein said third fixation post is configured to at least partially extend into an L4 vertebral bone.

29. The apparatus ofclaim 17, wherein said first fixation post is inserted to a third aperture of said fixation element.

30. The apparatus ofclaim 17, wherein said fixation element comprises a locking feature configured to rigidly affix said second fixation post onto said fixation element, the locking feature configured to substantially immobilize said second fixation post with respect to said first fixation post.

31. An apparatus for fixation of a sacral bone, comprising:

a first fixation element configured to be advanced through a first hole created in a first surface of said sacral bone, and a disc space superior to said sacral bone, and into a vertebral bone superior to said disc space;

a fixation apparatus configured to abut said first surface of said sacral bone and to remain separated from said disc space and said vertebral bone, said fixation apparatus comprising at least an aperture; and

a second fixation element configured to be advanced through said sacral bone, said disc space, and into said vertebral bone, at least a portion of said second fixation element being configured to be positioned within said aperture of said fixation apparatus.

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