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WO2010047688A1 - Vis avec mécanisme de blocage et plaque osseuse rigide/dynamique - Google Patents

Vis avec mécanisme de blocage et plaque osseuse rigide/dynamique Download PDF

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Publication number
WO2010047688A1
WO2010047688A1 PCT/US2008/080616 US2008080616W WO2010047688A1 WO 2010047688 A1 WO2010047688 A1 WO 2010047688A1 US 2008080616 W US2008080616 W US 2008080616W WO 2010047688 A1 WO2010047688 A1 WO 2010047688A1
Authority
WO
WIPO (PCT)
Prior art keywords
collar
aperture
screw
plate
cross
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US2008/080616
Other languages
English (en)
Inventor
Carl Nilsson
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Innovative Delta Technology LLC
Original Assignee
Innovative Delta Technology LLC
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Innovative Delta Technology LLC filed Critical Innovative Delta Technology LLC
Priority to PCT/US2008/080616 priority Critical patent/WO2010047688A1/fr
Publication of WO2010047688A1 publication Critical patent/WO2010047688A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
    • A61B17/8047—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers wherein the additional element surrounds the screw head in the plate hole
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8605—Heads, i.e. proximal ends projecting from bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8685—Pins or screws or threaded wires; nuts therefor comprising multiple separate parts

Definitions

  • This invention relates to a locking mechanism for a screw and associated methods of its use. More particularly, this invention relates to a bone screw wherein the bone screw is locked into place and methods of use thereof. Even more particularly, this invention relates to a bone screw for an associated bone plate and methods of their use.
  • the spine is formed of a series of bones called vertebrae. There are 33 vertebrae, which are grouped as cervical, thoracic, lumbar, sacral, and coccygeal vertebrae, according to the regions of the spine they occupy.
  • a typical vertebra consists of two essential parts, an anterior segment or body, and a posterior part, or vertebral or neural arch.
  • the vertebral arch consists of a pair of pedicles and a pair of laminae.
  • a bone plate is attached to a plurality of cervical vertebrae by a number of bone screws.
  • a significant problem associated with the use of cervical plates is the rotational back-out of the bone screws over time due to normal movement of the patient.
  • a number of designs have been proposed to secure the bone screws in a spinal plate and prevent their back-out over time.
  • a cervical plate is attached to the vertebrae with bone screws and then a second cover plate is overlaid on top of the cervical plate and the heads of the bone screws and secured in place by a second set of screws, thereby preventing the back-out of the bone screws.
  • bone plate systems such as cervical plate systems
  • bone subsidence can also be a problem.
  • Wolf's law bone grows and remodels in response to stress that is placed on the bone. This is significant, for example, in cervical plate systems used to stabilize vertebrae for spinal fusion. When a cervical plate is used for spinal fusion, a bone graft is placed between adjacent vertebrae.
  • an automatically adjustable plate or dynamic plate which stabilizes the vertebral bodies without carrying the entire compressive load, as it is done with static cervical plates.
  • a dynamic cervical plate stabilizes the adjacent vertebrae, but does not carry the axial compressive load, hence allowing the compressive load to be maintained even if subsidence occurs.
  • a bone plate permits automatic adjustment of the distance between the adjacent vertebrae in response to any bone subsidence that can occur during spinal fusion.
  • Such a system is considered a dynamic bone plate system.
  • a variety of designs have been proposed for a locking mechanism for a bone screw. Many of these require the use of a locking washer or collar that is secured within an aperture of the bone plate through which the bone screw passes. These typically require multiple parts that are assembled during surgery with multiple tools.
  • the locking screw assembly comprises at least one screw having a shaft portion and a head portion.
  • the head portion may extend from the shaft portion in an arcuate manner, terminating in a flange portion.
  • the head portion may also include a column portion that extends from the flange portion and contains a bore therein, the bore being adapted to engage a first driver.
  • the column portion may have a non-circular or off-center circular cross-section and thereby have a first cross-sectional dimension and a second cross- sectional dimension greater than the first cross-sectional dimension.
  • the locking screw assembly may also comprise at least one collar containing a first collar portion and a second collar portion.
  • the first collar portion has a collar aperture, the collar aperture being defined by collar aperture walls.
  • the first collar portion is configured to be seated on the flange portion and to contact the column portion at the aperture walls.
  • the second collar portion extends from the first collar portion and is adapted to engage a second driver.
  • the collar is adapted to contact the column portion in a first position and in a second position.
  • the collar has a first outer diameter in a first position and a second outer diameter in the second position. The second outer diameter is larger than the first outer diameter.
  • the collar is C-shaped.
  • the collar aperture walls having a first cross-sectional dimension contact the column portion in the area of the first cross- sectional dimension, and in the second position the aperture walls contact the column portion only at points of the second cross-sectional dimension, thereby causing the collar to expand outwardly.
  • the column portion has an cross- section that is selected from the group consisting of an essentially rectangular cross- section, an essentially triangular cross-section or an off-center circular cross section. Variations on these cross sections may include those where one or more corners present are rounded corners.
  • the first and second cross-sectional dimensions may be measured from one side of the column portion to an opposite side of the column portion.
  • a first cross-sectional dimension may correspond to a side of the column portion and a second cross-sectional dimension may correspond to the distance between opposing corners of the column portion, diagonally bisecting the column portion.
  • the first and second cross-sectional dimensions may be measured from a central axis of the screw to a side of the column portion.
  • the aperture walls may additionally have one or more structures that restrict movement of the collar relative to column portion in the second position. These one or more structures may provide a seat for a part of the column portion contacting the aperture walls in the second position.
  • the second collar portion may also have an internal aperture that is configured to be in communication with the bore.
  • the locking screw assembly may additionally comprise a plate having an upper surface and a lower surface and being adapted to accept the screw and collar through at least one orifice.
  • the screw and collar have a first assembled maximum diameter in the relaxed position and a second assembled maximum diameter in the expanded condition.
  • the first assembled maximum diameter is smaller than a dimension of the at least one orifice and the second assembled maximum diameter is larger than the dimension of the at least one orifice.
  • the plate is a cervical plate.
  • the plate may include at least one orifice that may comprise at least one first aperture adapted to receive a first screw and collar assembly, at least one elongated second aperture, and at least one carrier slidably engaging the at least one elongated second aperture and having contoured walls adapted to receive a second screw and collar assembly.
  • the at least one carrier has a lower portion that abuts the lower surface of the plate.
  • the at least one elongated second aperture may have walls that are contoured and the at least one carrier may have an upper portion that conforms to the contour of the walls.
  • a first screw and collar assembly may be inserted into the at least one first aperture and the locking screw assembly may additionally comprise at least a second screw and collar assembly inserted into the carrier.
  • a method for attaching a plate to one or more bones includes providing at least one locking screw assembly and a plate, inserting the locking screw assembly through at least one first plate orifice and into a bone, and locking the screw and collar in place by rotating the collar from a first position to a second position.
  • the plate is a cervical plate and the one or more bones are cervical vertebrae.
  • the locking screw assembly contains a screw that includes a shaft portion and a head portion. The head portion extends from the shaft portion in an arcuate manner and terminates in a flange portion. The head portion also including a column portion that extends from the flange portion and contains a bore therein.
  • the column portion may have a non-circular or off-center circular cross-section, thereby having a first cross-sectional dimension and a second cross-sectional dimension greater than the first cross-sectional dimension.
  • the collar may contain a first collar portion and a second collar portion and in one embodiment, is C-shaped.
  • the first collar portion has a collar aperture defined by collar aperture walls.
  • the first collar portion is configured to be seated on the flange portion and to contact the column portion at the aperture walls.
  • the second collar portion extends from the first collar portion and is adapted to engage a driver.
  • the collar is adapted to contact the column portion in a first position and in a second position.
  • the collar has a first outer diameter in a first position and a second outer diameter in the second position.
  • the second outer diameter is larger than the first outer diameter
  • the plate may have at least one orifice having at least one dimension that is larger than the first outer diameter and smaller than the second outer diameter.
  • a bone plate may comprise an upper surface and a lower surface, at least one first aperture adapted to receive a first screw, at least one elongated second aperture, and at least one carrier adapted to slidably engage the at least one elongated second aperture and being adapted to receive a second screw.
  • the at least one elongated second aperture may have walls that are contoured and the at least one carrier may comprise an upper portion and a lower portion.
  • the upper portion may have a shape that conforms to the walls of the at least one elongated second aperture and the lower portion may be adapted to abut the lower surface of the bone plate.
  • Figure 1 is a perspective view of an embodiment of a screw and collar providing a locking mechanism
  • Figure 2 is an expanded view of the screw and collar shown in Fig. 1;
  • Figure 3 A is a side elevational view of the screw and collar shown in Fig. 1;
  • Figure 3B is a cross-sectional view of the screw and collar taken along line A-A, which runs along the center axis of the screw, in Fig. 3A;
  • Figure 4A is a side elevational view of a screw and collar in a first relaxed configuration
  • Figure 4B is a top cross-sectional view, taken along line B-B, of the screw and collar shown in Figure 4A;
  • Figure 4C is a side elevational view of a screw and collar in a second, partially expanded configuration
  • Figure 4D is a top cross-sectional view, taken along line C-C, of the screw and collar shown in Fig. 4C;
  • Figure 4E is a side elevational view of a screw and collar in a third, partially expanded configuration
  • Figure 4F is a top cross- sectional view, taken along line D-D, of the screw and collar shown in Fig. 4E;
  • Figure 4G is a side elevational view of a screw and collar in a fully expanded configuration
  • Figure 4H is a top cross-sectional view, taken along line E-E, of the screw and collar shown in Fig. 4G;
  • Figure 5A is a series of top cross-sectional views showing, from left to right, the progression of the movement of a collar clockwise relative to a square column portion with rounded corners, and transition of the collar from a relaxed to an expanded configuration;
  • Figure 5B is a series of top cross-sectional views showing, from left to right, the progression of the movement of a collar clockwise relative to a triangular column portion with rounded corners, from a relaxed to an expanded configuration;
  • Figure 5C is a series of top cross-sectional views showing, from left to right, the progression of the movement of a collar clockwise relative to a diamond- shaped column portion with rounded corners, from a relaxed to an expanded configuration;
  • Figure 5D is a series of top cross-sectional views showing, from left to right, the progression of the movement of a collar clockwise relative to a off-center circular column portion, from a relaxed to an expanded configuration;
  • Figure 6A is an expanded view of a plate and carriers adapted to be inserted therein;
  • Figure 6B is a perspective view of an embodiment of a bone plate, with screw and collar assemblies inserted therein;
  • Figure 7 is a perspective view of an embodiment of a bone plate, with screw and collar assemblies inserted therein, partially cut-away at the first apertures;
  • Figure 8 is a perspective view of an embodiment of a bone plate, with screw and collar assemblies inserted therein, partially cut-away at the second apertures.
  • a screw and an associated assembly comprises an elongated bone screw 10 having central axis with a shaft portion 12 and a head portion 14 and a collar 20.
  • the shaft portion 12 may include threads 13 for inserting screw 10 into a bone or other suitable substrate.
  • Threads 13 located on shaft portion 12 may be either right-handed or left- handed depending on the needs or preferences of associated with a particular application or user.
  • Screw 10 is configured to be inserted through an aperture in a plate, such as a cervical plate.
  • a plate such as a cervical plate.
  • Head portion 14 may extend away from shaft portion 12 in a generally arcuate manner around the entire circumference of head portion 14 forming arcuate section 15, terminating in a bottom flange 18.
  • Arcuate section 15 and bottom flange 18 may extend uninterrupted around the circumference of head portion 14.
  • Bottom flange 18 thereby forms a seat for collar 20.
  • a column portion 17 may extend from bottom flange 18 and includes a top flange 30 which is separated from bottom flange 18 by column groove 32.
  • Bore 16 may be configured to accept a driver such as a hexagonal driver (also known as an Allen wrench), a hexalobe driver, a star-shaped driver having any number of projections, or a similar tool.
  • a driver such as a hexagonal driver (also known as an Allen wrench), a hexalobe driver, a star-shaped driver having any number of projections, or a similar tool.
  • bore 16 is centered at the approximate location of the central axis of screw 10. In another example, bore 16 is displaced from the central axis of screw 10.
  • column portion 17 may have a generally polygonal cross-section.
  • column portion 17 may have a generally non-circular cross section such as a square-shaped, diamond- shaped or triangular- shaped cross section with rounded corners. Other polygon shapes are also possible.
  • column portion 17 has 4 or fewer sides. It is also possible for column portion 17 to have an off-center circular cross section, that is, column portion 17 may be displaced relative to the central axis of screw 10. Stated differently, column portion 17 may have a circular cross section where the center of the circular cross section is not coincident with the central axis of bone screw 10.
  • Collar 20 may be generally cylindrical or disk-shaped with a first collar portion 21 that is configured to be seated on bottom flange 18 and to engage column portion 17 at column groove 32. Collar 20 also includes a second collar portion 23 that is connected to first collar portion 21 and is configured to at least partially overlap column portion 17. In one embodiment, collar 20 is C- shaped by virtue of an opening 24 in the side of collar 20. Opening 24 functions to permit collar 20 to assume an expanded state in use, as described more fully below. Collar 20 has an internal aperture 22 that is oriented to be in communication with bore 16 in use. The aperture walls 26 of first collar portion 21 are shaped to essentially conform to the shape of column portion 17 in a first relaxed state.
  • collar aperture walls 26 fit against column portion 17 in a first relaxed state. In another embodiment, collar aperture walls 26 conform to the shape of column portion 17 but are minimally spaced from column portion 17. [0043] In one embodiment, collar aperture 22 is centered on the at least approximate location of the central axis of collar 20. Collar 20 may also have one or more additional slits or notches 25 that extend outward from aperture 22. One of slits 25 may be in communication with opening 24 as shown or may extend entirely through collar 20 in place of opening 24. The remainder of slits 25, if any, do not extend through collar 20 completely. Slits 25 are adapted to allow engagement of an instrument that will turn collar 20 relative to column portion 17. Alternatively, collar aperture 22 may have a shape that allows for the engagement of a driver.
  • Collar 20 is also configured to be capable of resilient expansion outwardly as follows. Collar 20 is configured to allow it to assume either of at least two positions relative to column portion 17. In a first, relaxed position, as illustrated in Figs. 4A and 5A-5D for example, first collar portion 21 contacts and is immediately adjacent a majority of column portion 17. Collar 20 has a first, narrower diameter and will therefore fit through a plate having an orifice or bore with a diameter only slightly larger than the diameter of the assemble screw 10 and collar 20. For example, in the relaxed state, screw 10 and collar 20 may have a maximum diameter of about 5.6 mm, which would permit placement of screw 10 and collar 20 through an orifice having a diameter of 5.9 mm.
  • both of these structures in the relaxed state, will have a first, minimum cross-sectional dimension di and a second, maximum cross-sectional dimension d 2 .
  • aperture walls 26 having dimension di engage column portion 17 having dimension d ⁇
  • aperture walls 26 having dimension d 2 engage column portion 17 having dimension d 2 .
  • column portion 17 has an approximately square cross section with rounded corners.
  • a first minimum cross-sectional dimension d ⁇ is the distance between two opposing sides of column portion 17
  • second maximum cross-sectional dimension d 2 is the distance between two opposing corners of column portion 17.
  • first minimum cross-sectional dimension di is the distance between a corner and the opposing side of triangular-shaped column portion 17
  • second maximum cross- sectional dimension d 2 is the distance between two adjacent corners of column portion 17.
  • column portion 17 is diamond-shaped.
  • first minimum cross-sectional dimension d ⁇ is the distance between the two opposing corners of column portion 17 that lie on the minor axis of the diamond shape.
  • Second maximum cross-sectional dimension d 2 is the distance between two opposing corners of column portion 17 that lie on the major axis of the diamond shape.
  • minimum cross-sectional dimension di is the smallest radius from the center of bore 16 (which may be centered on the central axis of screw 10) to the edge of column portion 17 and maximum cross-sectional dimension d 2 is the largest radius from the center of bore 16 to the edge of column portion 17.
  • aperture 22 of collar 20 has the same dimensions as column portion 17.
  • aperture walls 26 of collar 20 at minimal dimension di of collar aperture 22 in the relaxed state come in contact with areas of column portion 17 that have a greater dimension than minimal dimension (I 1 .
  • I 1 minimal dimension
  • collar 20 is pushed outwardly, increasing the maximum diameter of collar 20.
  • aperture walls 26 of collar 20 will contact column portion 17 at a location where column portion 17 has a maximum cross- sectional dimension d 2 .
  • aperture walls 26 will be in the regions of aperture 22 that only have the smaller cross-sectional dimension of di in the relaxed state.
  • collar 20 expands outwardly, increasing its outside diameter to a fully expanded position. The increased diameter of collar 20 prevents assembled screw 10 and collar 20 from passing through an orifice or bore in a bone plate in which it is placed, thereby securing screw 10 in place.
  • screw 10 and collar 20 may have a maximum diameter of about 6.0 or 6.05 mm, which would secure screw 10 and collar 20 in an orifice having a diameter of about 5.9 mm.
  • Column portion 17 and collar aperture 22 are offset relative to the central axis of screw 10 in the relaxed state. Stated differently, in the relaxed state, column portion 17 having dimension di contacts collar 20 at a relatively wider part of collar 20, while column portion 17 having dimension d 2 contacts collar 20 at a relatively narrow part of collar 20. As with previously described embodiments, as collar 20 rotates, the part of aperture 22 having minimal dimension di in the relaxed state comes in contact with areas of column portion 17 that have a greater dimension than minimal dimension di. To accommodate this larger dimension, collar 20 flexes outwardly, increasing the maximum diameter of collar 20. When collar 20 rotates a sufficient degree from the relaxed state, collar 20 will contact column portion 17 at a location where column portion 17 has a maximum cross-sectional dimension d 2 .
  • aperture wall 26 may have one or more notches 28, 28', 28", 28'" to provide a seat for one or more corners of column portion 17 in the relaxed or expanded positions thereby providing increased resistance to collar 20 rotating without aid from one state to another.
  • Column portion 17 may also cooperate with one or more collar slits 25, such that a part of column portion 17 partially protrudes into collar slits 25 in an expanded or partially expanded state.
  • collar 20 is seated on bottom flange 18 in a relaxed state.
  • Aperture wall 26 has several notches 28, 28', 28", 28'" into which the corners of triangular shaped column portion 17 may be seated.
  • notches 28'" may be further modified to provide a lip 29 to secure column portion 17 and to restrict collar 20 from rotating clockwise further beyond a fully expanded condition and back to a relaxed condition due to column 17 contacting notches 28 again.
  • screw 10 and collar 20 may be secured in an orifice or similar structure at a less than fully expanded condition, such as when collar 20 contacts column portion 17 at notches 28".
  • column portion 17 has an approximately rectangular cross-sectional shape such as a square or diamond shaped cross-section with rounded corners, and one or more notches 28, 28', 28", 28'" may be placed in aperture walls 26 to provide a seat for one or more corners of column portion 17 in the expanded position.
  • column portion 17 moves from contacting aperture walls 26 at notches 28 to 28', 28" and 28'" in series to finally assume a fully expanded state.
  • notch 28 is present in aperture walls 26, terminating in lip 29.
  • Notch 28 in this case, gradually decreases in its dimension rather than having the predetermined positions at notches 28', 28", 28". The gradual change will be reduced to the point that collar 20 is essentially locked in place relative to column portion 17. Collar 20 rotates relative to column portion 17, until it assumes a fully expanded state. There are no distinct partially expanded states in such an example.
  • column portion 17 and collar aperture 22 are at least approximately circular but are offset relative to the central axis of screw 10 in the relaxed state.
  • column portion 17 has a first minimal cross-sectional dimension di that is measured from the center axis of screw 10 to a side of column portion 17 and a second maximum cross-sectional dimension d 2 that is measured from the center axis of screw 10 to an opposite side of column portion 17 from the side used to determine dimension d ⁇ , because it is offset from the center axis.
  • the thickness of collar 20 adjoining dimension d ⁇ of column portion 17 is greater than the thickness of collar 20 adjoining dimension d 2 of column portion 17 in the relaxed state.
  • the part of collar 20 having minimal dimension di at collar aperture 22 in the relaxed state comes in contact with areas of column portion 17 that have a greater dimension than minimal dimension (I 1 .
  • collar 20 flexes outwardly, increasing the maximum diameter of collar 20.
  • collar 20 rotates a sufficient degree from the relaxed state, collar 20 will contact column portion 17 at a location where column portion 17 has a maximum cross-sectional dimension d 2 .
  • Bone screw 10 and collar 20 may be used with a bone plate as previously known or in combination with a bone plate 40 as shown in Figs. 6-8.
  • Bone plate 40 may be described as being generally flat. However, a predetermined amount of curvature may be present to conform to anatomical requirements. Alternatively, the plate may also be formed in sections, which can be used for additional bending during surgery.
  • Bone plate 40 comprises one or more circular first apertures 42, which are adapted to receive bone screw 10 and collar 20. First aperture 42 is configured such that arcuate section 15 on screw 10 and collar 20 contact the side wall 41 of aperture 42. First aperture 42 thereby provides an arcuate seat for assembled screw 10 and collar 20.
  • Plate 40 may also include one or more second apertures 48.
  • Second apertures 48 include a carrier 50.
  • Carrier 50 has an upper portion 52 which is adapted to contact and be seated in second aperture walls 54.
  • upper portion 52 is adapted to conform to the shape of second aperture walls 54 with outer carrier walls 55 that have an arcuate shape of approximately the same shape as second aperture walls 54 at the points of contact.
  • carrier 50 may slideably engage plate 40 at second aperture 48.
  • Carrier 50 also has a lower portion or lip 56 which abuts plate 40 on a lower surface 43 of plate 40 thereby restricting movement of carrier 50 upward in the orientation shown in the Figures.
  • Carrier 50 may include one or more slots 51 that permit carrier 50 to be compressed temporarily during insertion into second aperture 48.
  • Carrier 50 is adapted to receive assembled screw 10 and collar 20.
  • Carrier 50 has an internal bore 53 bounded by an inner carrier wall 57 that is configured such that arcuate section 15 of screw 10 and collar 20 contact inner carrier wall 57 of carrier 50.
  • Carrier 50 thereby provides a seat for assembled screw 10 and collar 20 in second aperture 48.
  • Carrier 50 may be slightly oval or oblong in shape to prevent or at least inhibit carrier 50 from rotating.
  • Carrier 50 may be further adapted to engage second aperture 48 in either of two ways.
  • collar 20 In a first condition, collar 20 has been partially, but not fully, expanded. Such a state is shown, for example, in Figs. 4C-4F. In this condition, collar 20 has expanded sufficiently to secure screw 10 and collar 20 in carrier 50, but does not significantly inhibit carrier 50 from sliding within second aperture 48.
  • collar 20 In a second condition, collar 20 has been fully expanded, as seen in Fig. 4G and 4H, for example.
  • Plate 40 may also contain one or more third apertures 44.
  • third aperture 44 permits the surgeon to view or monitor structures lying beneath the plate 40.
  • third aperture 44 may be also used as a location of a more traditional bone screw or graft screw, for example, when a PEEK (polyetheretherketone) implant is placed in the disc space for fusion purposes or any other bone graft material is used for fusion, know in the art.
  • Third aperture 44 may include one or more chamfers 45 on the upper edge of third apertures 44.
  • the peripheral edge 46 of plate 40 may also be chamfered to prevent plate 40 from damaging or irritating tissues surrounding plate 40.
  • Plate 40 is shown in Figures 6 A and 6B as having 5 apertures in a pattern of 2 first apertures 42, two second apertures 48 and one third aperture 44. However, any number or pattern of apertures may be present, depending on the requirements of a particular application.
  • screw 10 may be utilized, for example in spinal stabilization, by assembling screw 10 and collar 20 in the relaxed state.
  • the assembled screw 10 and collar 20 are then inserted through plate 40 into a bone (not shown) with a driver for which bore 16 is adapted.
  • a driver for which bore 16 is adapted.
  • a corresponding hexalobe driver is used.
  • a pair of screws 10 and collars 20, 20' are shown in cross-section as inserted into first apertures 42.
  • a collar in the first relaxed state is shown as collar 20, while a collar in the second expanded state is shown as collar 20'.
  • collar 20 may be rotated relative to column portion 17.
  • An instrument designed to engage one or more of collar slits 25 may be used to rotate collar 20 relative to column portion 17 may be used.
  • a flat headed screw driver might be used to rotate collar 20 relative to column portion 17.
  • an instrument designed to engage a plurality or even all of collar slits 25 may be used to rotate collar 20.
  • collar 20 When collar 20 has rotated a sufficient degree, it will contact column portion 17 at a location where column portion 17 has a maximum cross-sectional dimension d 2 , as described above. However, in the area of contact, the regions of collar 20' making contact will be the regions that previously had the smaller cross-sectional dimension of d ⁇ in the relaxed state.
  • collar 20' expands outwardly, increasing its outside diameter in a second expanded position. The increased diameter of collar 20' prevents assembled screw 10 and collar 20 from passing through the aperture in which it is placed, thereby securing assembled screw 10 and collar 20' in first aperture 42.
  • An assembled screw 10 and collar 20 may be secured in carrier 50 in a similar manner.
  • Carrier 50 is inserted into second aperture 48 as shown in Figs. 6A, 6B and 8. This may be accomplished prior to the start of surgery.
  • An empty carrier 50 is shown on the left side of plate 40 while a carrier 50' with an assembled screw 10 and collar 20' inserted is shown on the right side of plate 40.
  • carrier 50' collar 20' is in an expanded position.
  • assembled screw 10 and collar 20 are inserted through plate 40 into a bone (not shown).
  • assembled screw 10 and collar 20 are seated in carrier 50 instead of being seated directly in second aperture 48.
  • collar 20 is rotated relative to the screw 10 to secure screw 10 and collar 20 in carrier 50.
  • rotating collar 20 causes it to make a transition from a first relaxed state to a second, partially expanded state, locking assembled screw 10 and collar 20 into carrier 50 in a dynamic mode.
  • the elongated shape of second aperture 48 allows carrier 50 to move within second aperture 48 along the length of second aperture 48. This movement allows for at least some self- adjustment of the assembled plate system in use and at least partially compensate for bone remodeling that typically may occur in the area of placement of a bone screw and plate.
  • the full expansion places additional force on upper portion 52 of carrier 50. This additional force or stress causes upper portion 52 to expand outwardly and contact second aperture walls 54 with sufficient contact to restrict or prevent carrier 50 from sliding within second aperture 48.
  • plate 40 may therefore be used as either a dynamic plate or as a static plate.
  • bone can grow and remodel in response to stress placed on that bone.
  • the self-adjusting aspect of the bone screw and plate system allows a certain amount of load to be transferred to a bone graft that is being supported by the plate while the graft fuses adjacent bones.
  • the transfer of a portion of the load to the graft material facilitates the growth of bone and the eventual fusion of the cervical vertebrae.
  • the movement of carrier 50 within second aperture 48 permits automatic adjustment of the screws in response to any bone subsidence that occurs during spinal fusion.
  • the resulting bone screw and plate system may therefore be considered a dynamic bone plate system.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Neurology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un ensemble vis de blocage comprenant une vis comportant une tige et une tête. La tête s'étend depuis la tige et se termine en un collet. La tête comprend une colonne qui s'étend depuis le collet et contient un alésage pour insérer un entraînement. La section transversale de la colonne comporte une première dimension de section transversale et une deuxième dimension de section transversale supérieure à la première dimension de section transversale. L'ensemble comprend également un collier comportant une première partie et une deuxième partie. L'ouverture de collier de la première partie est définie par les parois de l'ouverture. La première partie est conçue de façon à se poser sur le collet et entrer en contact avec la colonne au niveau des parois de l'ouverture. La deuxième partie s'étend depuis la première partie et recouvre au moins partiellement la colonne. Le collet comprend un premier diamètre externe dans une première position et un deuxième diamètre externe, plus grand que le premier diamètre externe, dans la deuxième position.
PCT/US2008/080616 2008-10-21 2008-10-21 Vis avec mécanisme de blocage et plaque osseuse rigide/dynamique Ceased WO2010047688A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/US2008/080616 WO2010047688A1 (fr) 2008-10-21 2008-10-21 Vis avec mécanisme de blocage et plaque osseuse rigide/dynamique

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US2008/080616 WO2010047688A1 (fr) 2008-10-21 2008-10-21 Vis avec mécanisme de blocage et plaque osseuse rigide/dynamique

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WO2010047688A1 true WO2010047688A1 (fr) 2010-04-29

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Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8529611B2 (en) 2010-03-16 2013-09-10 Competitive Global Medical, Llc Distal interphalangeal fusion method and device
US8685067B2 (en) 2010-12-21 2014-04-01 Competitive Global Medical, Llc Compression plate apparatus
US8715326B2 (en) 2009-08-28 2014-05-06 Competitive Global Medical, Llc Distal interphalangeal fusion device and method of use
US20140228892A1 (en) * 2009-07-24 2014-08-14 Spinal Usa, Inc. Bone plate system and methods of using the same
EP2644141A4 (fr) * 2010-11-28 2016-08-17 Shandong Hangwei Orthopedics Medical Instr Co Ltd Dispositif de verrouillage et de compression universel pour plaque osseuse
EP3366243A4 (fr) * 2015-10-19 2019-07-31 L & K Biomed Co. Ltd. Vis chirurgicale et dispositif de fusion associé

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5578034A (en) * 1995-06-07 1996-11-26 Danek Medical, Inc. Apparatus for preventing screw backout in a bone plate fixation system
US20010014807A1 (en) * 1997-08-04 2001-08-16 Erik J. Wagner System and method for stabilizing the human spine with a bone plate
US7175623B2 (en) * 2002-06-24 2007-02-13 Lanx, Llc Cervical plate with backout protection
US20080234750A1 (en) * 2007-01-31 2008-09-25 Woods Richard W Anterior vertebral plate with taper lock screw

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5578034A (en) * 1995-06-07 1996-11-26 Danek Medical, Inc. Apparatus for preventing screw backout in a bone plate fixation system
US20010014807A1 (en) * 1997-08-04 2001-08-16 Erik J. Wagner System and method for stabilizing the human spine with a bone plate
US7175623B2 (en) * 2002-06-24 2007-02-13 Lanx, Llc Cervical plate with backout protection
US20080234750A1 (en) * 2007-01-31 2008-09-25 Woods Richard W Anterior vertebral plate with taper lock screw

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20140228892A1 (en) * 2009-07-24 2014-08-14 Spinal Usa, Inc. Bone plate system and methods of using the same
US8715326B2 (en) 2009-08-28 2014-05-06 Competitive Global Medical, Llc Distal interphalangeal fusion device and method of use
US8529611B2 (en) 2010-03-16 2013-09-10 Competitive Global Medical, Llc Distal interphalangeal fusion method and device
EP2644141A4 (fr) * 2010-11-28 2016-08-17 Shandong Hangwei Orthopedics Medical Instr Co Ltd Dispositif de verrouillage et de compression universel pour plaque osseuse
US8685067B2 (en) 2010-12-21 2014-04-01 Competitive Global Medical, Llc Compression plate apparatus
EP3366243A4 (fr) * 2015-10-19 2019-07-31 L & K Biomed Co. Ltd. Vis chirurgicale et dispositif de fusion associé

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