US20120143207A1 - Bone fixation tensioning tool and method - Google Patents
Bone fixation tensioning tool and method Download PDFInfo
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- US20120143207A1 US20120143207A1 US13/369,824 US201213369824A US2012143207A1 US 20120143207 A1 US20120143207 A1 US 20120143207A1 US 201213369824 A US201213369824 A US 201213369824A US 2012143207 A1 US2012143207 A1 US 2012143207A1
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- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
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- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7053—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant with parts attached to bones or to each other by flexible wires, straps, sutures or cables
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- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
- A61B17/707—Devices acting on, or attached to, a transverse process or rib; Tools therefor
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- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
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- 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, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
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Abstract
A tensioning tool and method for tensioning a conformable ligature of a bone fixing system are disclosed. The ends of a conformable ligature can be passed around bones, bone grafts, tendons, plates, rods, fasteners, or other anatomical or implanted structures, and the like to form a loop. Another portion of the conformable ligature can be coupled to a tensioning tool. The tensioning tool can include a first portion and a second portion in threaded engagement with each other. Rotation of one portion relative to the other can cause tensioning of the conformable ligature through translation of a tensioning member.
Description
- This application is a continuation of U.S. patent application Ser. No. 11/877,160, filed on Oct. 23, 2007, the entire disclosure of which is incorporated herein by reference.
- This disclosure relates generally to systems and method for fixing bone. In particular, embodiments of the disclosure may be helpful for holding bones, rods, or other structures in a desired configuration or in particular relative position. Even more particularly, the disclosure relates to instruments and methods for installing bone fixing systems.
- The spine is formed of superposed vertebrae, normally aligned along a vertebral axis, from the lumbar vertebrae to the cervical vertebrae, each having a posterior wall from which projects a spinous process and two lateral edges from the walls of which there project ribs and/or transverse processes. If the spine of a person has abnormal curvature, the vertebrae are typically inclined relative to one another and relative to said vertebral axis. The lateral edges of the vertebrae on one side are therefore closer together and form a concave shape while the lateral edges on the other side are farther apart and form a convex shape.
- In order to straighten the vertebral column as a remedy for this situation, the lateral edges of the vertebrae on the concave side can be moved away from one another and supported at distances from one another substantially equivalent to the distances between the lateral edges on the other side. Devices known in the art to hold the vertebrae relative to one another include screws that are inserted into the vertebrae or hooks that are inserted along the internal wall of the spinal canal and rods adapted to connect the screws or hooks.
- When using a hook and rod system, pairs of hooks are generally inserted into each vertebra, one on each side, near the pedicle. The hooks typically have heads that project from the posterior wall of the vertebra, one on each side of the spinous process. The heads can be tulip-shaped and adapted to receive a rod that is immobilized by a nut screwed onto the head and contacting the rod. The heads of the hooks situated on either side of the spinous process can then be connected together and fixed in position by two rods approximately parallel to one another and to the axis of the spine.
- However, using such hooks can be difficult because their use increases the risk that the physician (or other operative) might contact and potentially damage the spinal cord that extends along the center of the spinal canal (which can result in paralysis of the patient).
- Using a screw and rod system reduces this risk, but has other drawbacks. The screws typically have tulip-shaped heads and are inserted in pairs into the pedicles on each side of the spinous process on the posterior wall of the vertebrae. The screws therefore constitute fixing points on the vertebrae for holding the vertebrae in a fixed position relative to one another. However, the screws are inserted into the pedicles of the vertebrae, which in some cases are small or have deteriorated and can be damaged or do not provide sufficient purchase to permanently hold the screw.
- According to various embodiments described herein, a surgical procedure can be performed using a tensioning tool that provides continuous control over tensioning the ligature. A user can form a loop about one or more structures in a patient's body with a conformable ligature and a ligature capturing implant. The ligature capturing implant can be a ligature capturing implant that include rods, compression members or can be another type of ligature capturing implant. The structures can include, for example, a bone, a bone fastener, a tendon, a bone graft, a plate, a rod or other structure in the body. The user can attach a portion of the conformable ligature to a tensioning member of a tensioning tool that provides a continuous range of control. The tensioning tool can comprise a first portion in threaded engagement with a second portion. For example, the tensioning tool can comprise a drive shaft that engages with a carriage, a column that engages with a threaded shaft, a threaded shaft that engages with another shaft or other threaded portions that engage with each other to translate rotational motion of the portions relative to each other into linear motion of the tensioning member. The user can rotate the first portion relative to the second portion to move the tensioning member to tension the loop. For example, a user can rotate a drive shaft to move a carriage carrying the tensioning member. In some embodiments, the user can disengage the carriage from the drive shaft and slide the carriage along the drive shaft to a selected position. As another example, the user can rotate one portion of the tool to move a shaft that is coupled to the tensioning member. The first portion can also be rotated relative to the second portion in an opposite direction to release tension from the loop.
- According to one embodiment, a spinal reduction can be performed using tensioning tools. A method of progressive spinal reduction can comprise forming multiple loops about structures in a patient's body with multiple conformable ligatures and ligature capturing implants and partially tensioning each conformable ligature in turn with a corresponding tensioning tool until each conformable ligature is at a desired tension to perform spinal reduction procedure. Tensioning each conformable ligature may comprise attaching a portion of that conformable ligature to a tensioning member of the corresponding tensioning tool, the corresponding tensioning tool comprising a first portion in threaded engagement with a second portion and rotating the first portion relative to the second portion to move the tensioning member away from a corresponding ligature capturing implant to tension that conformable ligature about at least a portion of a vertebra. The first portion is rotated relative to the second portion about an axis that is substantially parallel to a primary direction of movement of the tensioning member.
- Another embodiment of a method comprises providing a tensioning tool comprising, a tool body defining a slot, a threaded drive shaft running through at least a portion of the tool body, a tensioning member and a carriage coupled to the tensioning member. The carriage defines a drive shaft passage having at least one thread engaging portion to engage threads on the drive shaft. The drive shaft passes through the drive shaft passage. The method further comprises forming a loop about one or more structures in a patient's body with a conformable ligature and a ligature capturing implant and coupling a portion of the conformable ligature to the tensioning member. The method can further include rotating the drive shaft to move the carriage away from the ligature capturing implant to tension the conformable ligature. Embodiments can also include rotating the drive shaft the opposite direction to release tension from the loop. The structures about which the loop is formed can include, for example, a bone, a bone fastener, a tendon, a bone graft, a plate, a rod or other structure in the body.
- According to one embodiment, the drive shaft passage includes one or more additional unthreaded portions. The method can further comprise rotating the carriage to disengage the at least one thread engaging portion from the threaded drive shaft and sliding the carriage along the drive shaft to a desired position.
- Another embodiment of a method for holding a bone in a position, the method comprises passing a conformable ligature around one or more structures in a body, passing first and second ends of the conformable ligature through a loop passage in a ligature capturing implant to form a loop, adjusting the ligature capturing implant to increase to resistance on the movement of the conformable ligature to a selected amount that allows the conformable ligature to move through the ligature capturing implant when a force is applied to the conformable ligature, attaching a portion of the conformable ligature to a tensioning member of a tensioning tool, rotating a threaded drive shaft of the tensioning tool to move the tensioning member to apply tension to the conformable ligature and adjusting the ligature tensioning implant to prevent the loop from loosening. According to one embodiment, rotating a threaded drive shaft of the tensioning tool to move the tensioning member comprises rotating the threaded drive shaft to move a carriage coupled to the tensioning member. The carriage can define a drive shaft passage having at least one thread engaging portion to engage threads on the drive shaft and wherein the drive shaft passes through the drive shaft passage. The method can further comprise positioning the tensioning tool so that a connecting portion of the tensioning tool abuts the ligature capturing implant. According to one embodiment the drive shaft can be rotated in an opposite direction to release tension from the conformable ligature.
- According to one embodiment a drive shaft passage can include one or more additional unthreaded portions. The method can further include rotating the carriage to disengage the at least one thread engaging portion from the threaded drive shaft and sliding the carriage along the drive shaft to a desired position.
- Another embodiment comprises a tensioning tool providing continuous control of conformable ligature tension, the tensioning tool comprising a tool body defining a slot, a connection portion shaped to at least abut a ligature capturing implant, a threaded drive shaft running through at least a portion of the tool body, a tensioning member and a carriage coupled to the tensioning member, the carriage defining a drive shaft passage having at least one thread engaging portion to engage threads on the drive shaft and wherein the drive shaft passes through the drive shaft passage, wherein rotation of the drive shaft causes the carriage to move towards or away from the connection portion. According to one embodiment, the carriage is configured to be rotated from a first position in which the at least one thread engaging portion is engaged with threads on the drive shaft to a second, slidable position, in which the at least one thread engaging portions is not engaged with the threads of the drive shaft.
- The tensioning tool can further comprise a drive shaft seat in which a first end of the drive shaft is seated, a spring that compresses between the drive shaft seat of and the tool body, and a removable handle connected to a second end of the drive shaft distal from the first end.
- Embodiments of the disclosed systems and methods can provide the advantage of providing progressive and continuous tensioning of a ligature used in bone fixing procedures.
- Embodiments of the disclosed systems and methods can provide the advantage of allowing tension of the ligature to be progressively reduced in an easily controlled manner.
- Embodiments of the disclosed systems and methods provide another advantage by allowing a tensioning tool used to tension one ligature to be left in place while the other ligatures are tightened.
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FIG. 1 is a fragmentary diagrammatic perspective view showing a vertebral fixing system of the disclosure and a rod. -
FIG. 2 is a diagrammatic view in vertical section of the subject matter of the disclosure mounted on a rod. -
FIG. 3 is a diagrammatic perspective view in section of the subject matter of the disclosure. -
FIG. 4 is a diagrammatic view in elevation of the subject matter of the disclosure mounted on a vertebra. -
FIG. 5 is a perspective view of a first embodiment of a vertebral fixing system. -
FIGS. 6A , 6B, and 6C are vertical section views of the fixing system showing the use of said system as shown inFIG. 5 . -
FIG. 7 is a face view showing theFIG. 5 fixing system put into place on a vertebra. -
FIG. 8 is a perspective view of a second embodiment of the fixing system, the ligature not being shown. -
FIG. 9 is an exploded view of the connection device ofFIG. 8 . -
FIG. 10 is a plan view of a portion of theFIG. 9 connection device. -
FIG. 11 is a section view on line AA ofFIG. 10 . -
FIG. 12 is a face view of the fixing system of the second embodiment. -
FIGS. 13A and 13B are section views on line VII-VII ofFIG. 12 showing two ways in which the flexible ligature can be put into place. -
FIG. 14 depicts a cross-sectional end view of one embodiment of a bone fixing system. -
FIG. 15 depicts an exploded perspective view of one embodiment of a blocking body. -
FIG. 16 depicts a perspective view of one embodiment of a compression member. -
FIG. 17 depicts a cross-sectional end view of one embodiment of a bone fixing system. -
FIG. 18 depicts a side view of one embodiment of a bone fixing system. -
FIG. 19 depicts an exploded view of one embodiment of a blocking body. -
FIG. 20 depicts an exploded view of one embodiment of a bone fixing system. -
FIG. 21 depicts a side view of one embodiment of a blocking body. -
FIG. 22 depicts an exploded view of a portion of a blocking body. -
FIG. 23 depicts a cross-sectional end view of one embodiment of a bone fixing system. -
FIG. 24 depicts a side view of one embodiment of a blocking body. -
FIG. 25 depicts an exploded view of one embodiment of a blocking body. -
FIG. 26 depicts a perspective view of one embodiment of a blocking body. -
FIG. 27 depicts a cross-sectional side view of one embodiment of a bone fixing system. -
FIG. 28 depicts a perspective view of one embodiment of a bone fixing system. -
FIG. 29 depicts a perspective view of one embodiment of a bone fixing system attached to a portion of bone. -
FIG. 30 depicts a posterior view of one embodiment of a bone fixing system attached to a portion of a bone. -
FIG. 31 depicts a sagittal view of one embodiment attached to a portion of a spine, illustrating a method for repairing a spine. -
FIGS. 32-38 depict views of a bone fixing system implanted on a spine. -
FIG. 39 depicts a side view of one embodiment of a tensioning tool for a bone fixing system. -
FIG. 40 is a diagrammatic representation of another embodiment of tensioning tool. -
FIG. 41 is a cross sectional view of one embodiment of a tensioning tool. -
FIGS. 42A-42B are diagrammatic representations of another embodiment of a tensioning tool. -
FIGS. 43A-43B are diagrammatic representations of a portion of a tensioning tool. -
FIG. 44 is a diagrammatic representation of yet another embodiment of a tensioning tool. - The disclosure and the various features and advantageous details thereof are explained more fully with reference to the non-limiting embodiments that are illustrated in the accompanying drawings and detailed in the following description. Descriptions of well known starting materials, processing techniques, components and equipment are omitted so as not to unnecessarily obscure the disclosure in detail. Skilled artisans should understand, however, that the detailed description and the specific examples, while disclosing preferred embodiments of the disclosure, are given by way of illustration only and not by way of limitation. Various substitutions, modifications, additions or rearrangements within the scope of the underlying inventive concept(s) will be apparent to those skilled in the art after reading this disclosure.
- A bone fixing system may be installed in a patient to hold or fix one structure in a selected relation with one or more other structures. As used herein, the term structure may refer to bones, portions of bones, or bone implants, as well as rods, elongated members, plates, or other implanted man-made devices. Among other methods, a bone fixing system as described herein may be installed using a minimally invasive surgery (MIS) procedure. In one embodiment, the bone fixing system and method of use may include instruments and bone fixing components for maintaining one or more structures in a selected alignment.
- Components of bone fixing systems in accordance with the disclosure may be made of materials including, but not limited to, titanium, titanium alloys, stainless steel, ceramics, and/or polymers. Some components of a bone fixing system may be autoclaved and/or chemically sterilized. Components that may not be autoclaved and/or chemically sterilized may be made of sterile materials. Components made of sterile materials can be used with other sterile components during assembly of a bone fixing system.
- Embodiments of bone fixing systems disclosed herein are useful in repairing broken bones, correcting curvatures of the spine and for other surgical procedures that hold structures (e.g., bones) in a fixed relative position. Embodiments of the bone fixing system and method of use disclosed herein can be particularly useful for minimally invasive surgery (MIS) procedures, which can reduce trauma to soft tissue due to the relatively small incision made in a patient. For example, a surgical procedure may be performed through a 2 cm to 4 cm incision formed in the skin of the patient. Dilators, a targeting needle, and/or a tissue wedge may be used to provide access to structures without the need to form a larger incision with a scalpel through muscle and other tissue. A minimally invasive surgery (MIS) procedure may reduce an amount of post-operative pain felt by a patient as compared to invasive procedures. A minimally invasive procedure may also reduce recovery time for the patient as compared to invasive procedures. In some embodiments, the natural flexibility of skin and soft tissue may be used to limit the length and/or depth of an incision or incisions needed during the procedure. Minimally invasive procedures may provide limited direct visibility in vivo.
- Bone fixing systems may be used to correct problems due to spinal injury, deformity, or disease. For example, various embodiments of a bone fixing system may be used from the C1 vertebra to the sacrum to correct spinal problems. For example, a bone fixing system may be implanted posterior to the spine to maintain distraction between adjacent vertebral bodies in a lumbar portion of the spine. Various embodiments of a bone fixing system may be used to correct orthopedic deficiencies. Embodiments of the disclosure may be useful for holding tendons, bones, or muscles during the healing process and may be implanted using MIS procedures and thus it is in this context that embodiments of the disclosure may be described. It will be appreciated, however, that embodiments of the systems and methods of the present disclosure may be applicable for stabilizing other areas of the body.
- In general, a flexible ligature can be used to secure bones or other structures. The ligature comprises an elongate flexible member capable of conforming to the contour of the parts that it connects. The ligature can be passed through a ligature capturing implant to form a loop that is looped about the structures to fixed relative to each. The ligature capturing implant can be any body through which the ligature passes to form a loop and that allows the loop to be tightened and left in a patient's body in a tightened state. According to one embodiment, force is applied to the ligature to tension the loop. The instrument used to tighten the ligature can include a first shaft, a second shaft drivably engaged with the first shaft and a tensioning member. The tensioning member can be coupled to the first shaft or the second shaft or can be drivably engaged with one or both of the first shaft and the second shaft. A portion of the ligature couples to the tensioning member such that movement of tensioning member can increase the tension in the ligature. For example, a portion of the ligature can be formed into a loop that is looped around the tensioning member. Movement of the tensioning member can be driven by rotational movement of the first shaft relative to the second shaft. Embodiments of an instrument tensioning the ligature are discussed below in conjunction with
FIGS. 40-44 . - By way of context,
FIG. 1 shows one embodiment of a bone fixing system, specifically a vertebral fixing system 10 of the disclosure mounted on arod 18. The vertebral fixing system comprises a connectingpart 12 having two longitudinal members, of which a firstlongitudinal member 22 extends between afirst end 22 a and asecond end 22 b and a secondlongitudinal member 20 extends between afirst end 20 a and asecond end 20 b. The twolongitudinal members first end 22 a of thelongitudinal member 22 has anotch 26 with twoopposite edges first end 20 a of the otherlongitudinal member 20 may be inserted. Apivot pin 24 passes through the two first ends 20 a and 22 a and is free to rotate in at least one of said ends 20 a and/or 22 a. Thesecond end 22 b of the firstlongitudinal member 22 includes abore 28 into which ascrew 26 may be inserted. Thesecond end 20 b of the secondlongitudinal member 20 comprises athread 38 which is aligned with said bore 28 when the two longitudinal members are disposed facing each other, with the result that thescrew 26 may be screwed into saidthread 38 in order to drive the second ends 20 b and 22 b of the twolongitudinal members screw 26 into thethread 38, thereby forming the adjustable locking means, are explained in more detail hereinafterFIG. 1 also shows afirst orifice 40 through which a ligature may be stretched. The method of connecting said ligature to said connecting part is described with reference toFIG. 2 . -
FIG. 2 shows the connectingpart 12 comprising of the firstlongitudinal member 22 and the secondlongitudinal member 20, saidlongitudinal members pin 24 that joins them. The adjustable locking means comprising of said screws 26 passing through thebore 28 and screwed into thethread 38 to immobilize said connectingpart 12 relative to therod 18 and fix in position a portion of aligature 14 shown in part inFIG. 2 . - The
ligature 14 consists of an elongate flexible member capable of conforming to the contour of the parts that it must connect. - The
ligature 14 has afirst end 44 that is ligated around thepin 24 and a freesecond end 42 that is inserted into apassage 48 between therod 18 and theinternal walls longitudinal members rod 18. As shown inFIG. 2 , the secondlongitudinal end 20 a includes asecond orifice 54 through which saidligature 14 passes. Moreover, as shown inFIG. 4 , theligature 14 may be formed into aloop 56 in which the transverse process is trapped. In some embodiments, theligature 14 may also trap the rib. - As shown in
FIG. 3 , which shows the secondlongitudinal member 20, the middle part has a first portion through which saidligature 14 passes and asecond portion 58 adapted to bear directly on therod 18. In some embodiments, thepassage 48, which is symmetrical inside the firstlongitudinal member 14, is produced by a groove formed in each of the two facing faces of the middle parts of thelongitudinal members - In some embodiments, the first portion of the middle part forms an edge with cylindrical symmetry and that the corresponding second portion of the
middle part 58 of the firstlongitudinal member 22 forms a substantiallycylindrical space 60 into which saidrod 18 is inserted. -
FIG. 2 shows that thesecond portion 58 of the middle part comes into contact with therod 18 and is adapted to bear on top of it and the first portion presses the free second end of saidligature 14 against therod 18. The adjustable locking means therefore drive thelongitudinal members rod 18 and simultaneously against theligature 14, which is also forcibly pressed against therod 18. - In some embodiments, as shown in
FIG. 2 , thepassage 48 has a section S1 in the vicinity of theorifice 54 greater than the section S2 in the vicinity of thefirst orifice 40, the section of saidpassage 48 decreasing progressively in the direction from thesecond orifice 54 to thefirst orifice 40. Theligature 14 is therefore progressively compressed around a portion of therod 18 with a pressure that increases in the direction from thesecond orifice 54 towards thefirst orifice 40. -
FIG. 4 shows a vertebral fixing system of the disclosure mounted on a vertebra having a transverse process. This figure shows again therod 18 and the twolongitudinal members ligature 14 against saidrod 18. - In
FIG. 4 , theflexible ligature 14 consists of a flexible strip of substantially constant width and thickness whose first end is ligated to thepin 24, theligature 14 surrounding the transverse process of the vertebra being inserted through the connectingpart 12. The section of theflexible strip 14 is substantially rectangular so that, thepin 24 and therod 18 being substantially perpendicular to the transverse process, theligature 14 has to be partly twisted in order to insert it into thepassage 48 and between thepin 24 and the point at which it contacts the transverse process. The connectingpart 12 is fixed in position against the posterior wall of the vertebra despite these partially twisted portions, theligature 14 being forcibly tensioned by stretching the freesecond end 14. - The
ligature 14 is advantageously made from a flexible material such as polyester that may be lightly crushed locally to immobilize it with a clamping effect. - One aspect of the disclosure relates to a spine straightening assembly comprising a plurality of vertebral fixing systems conforming to the present disclosure and mounted on a plurality of successive vertebrae, on all the transverse processes of one lateral wall thereof, and connected to a single rod that is disposed substantially parallel to said spine. The transverse processes of a portion of the spine can therefore be connected together by a single longitudinal rod, to fix them in position relative to each other, by means of the above vertebral fixing system.
- In some embodiments,
flexible ligature 14 may not be ligated aroundpin 24 or otherwise fixed to connectingpart 12. As shown inFIG. 5 , in one embodiment, a vertebral fixing system comprises a connectingpart 12, aflexible ligature 14, and adjustable locking means 16. Theflexible ligature 14 is of elongate shape and is capable of matching the outline of the parts it is to connect together. In this figure, there can also be seen therod 18 that is to be secured to the vertebra by means of the vertebral fixing system. In the first embodiment, the connectingpart 12 is constituted by two longitudinal elements givenrespective references first end second end - In
FIG. 6A , thelongitudinal elements pivot pin 24. - In the embodiment described, the locking means are constituted by a
screw 26 having ahead 26 a that is engaged in abore 28 formed in thefirst end 22 a of thelongitudinal element 22. Thefirst end 20 a of thelongitudinal element 20 is pierced by a tapped bore 38 for co-operating with the threadedshank 26 b of thescrew 26. Eachlongitudinal element outside face inside face longitudinal elements longitudinal elements recesses recesses pivot axis 24. Finally,slots recesses longitudinal elements recesses rod 18 together with a strand of theligature 14, theslots ligature 14. - With reference to
FIGS. 6A , 6B and 6C, there follows an explanation of how the fixing system is used. - In
FIG. 6A , there can be seen thelongitudinal elements shank 26 b of thescrew 26 not being engaged in thebore 38. Theligature 14 is engaged in theslots recesses rod 18 is then introduced into therecess 30 of thelongitudinal element 20 so that the twostrands ligature 14 are disposed between the inside wall of therecesses rod 18. These two surfaces define apassageway 48 for passing theligature 14 and havingportions ligature 14 placed therein. - As shown in
FIG. 6B , theportions ligature 14 define a portion of theligature 14 that forms a loop that extends beyond theoutside face 20 c of thelongitudinal element 20, and also twofree portions outside face 22 c of thelongitudinal element 22. When thelongitudinal elements FIG. 6B , theligature 14 can slide freely along thepassageway 48. Once theligature 14 is placed around the transverse process or a rib or indeed a portion of the posterior arc of a vertebra, the surgeon engages the threadedshank 26 b of thescrew 26 in the tapped bore 38, causing thelongitudinal element 22 to come progressively closer to thelongitudinal element 20. This approach simultaneously reduces the section of thepassageway 48 in which theportions ligature 14 are engaged and simultaneously introduces a certain coefficient of friction between the ligature and respectively therod 18 and the walls of therecesses ligature 14 until sufficient tension is obtained in the ligature around the vertebral process. Once the tension in the ligature is sufficient for providing appropriate fastening, the surgeon finishes off tightening thescrew 26 in the tapped bore 38, thus locking thelongitudinal elements portions ligature 14 are pinched between therod 18 and the wall of therecesses - In this locking position, the
rod 18 is thus secured to theligature 14 via the connectingpart 12. - Advantageously, because the surgeon exerts traction only on the free ends 42 and 44 of the
ligature 14, there is no risk of jamming between theligature 14 and the bottom face of the transverse process or of the rib, thus guaranteeing that effective fastening is provided with the transverse process or the rib or indeed a portion of the posterior arc of a vertebra.FIG. 7 depicts a face view where reference AT identifies the transverse process. - In the above description, both of the
portions ligature 14 are disposed in therecesses rod 18. In some embodiments, theportions ligature 14 may be placed on opposite sides of therod 18. Under such circumstances, it should be considered that the outside face 18 a of therod 18 and the inside walls of therecesses portions ligature 14. -
FIGS. 8 to 13B depict various view of one embodiment of the fixing system. In these figures, there can be seen therod 18, the connectingpart 12, and theflexible ligature 14. - In this embodiment, the connecting
part 12 is constituted by apart 55 that is generally U-shaped. The inside wall of thispart 55 is constituted by a bottom 57 of substantially semicylindrical shape and by two substantially planeportions part 55. The width of therecess 58 formed in thepart 55 is substantially equal to the diameter of therod 18. On its outside face 59 which is circularly symmetrical about a longitudinal axis of thepart 55, there is provided athread 60 occupying its upper portion. Thethread 60 is located entirely above therod 18 when it is put into place in therecess 58. Thethread 60 is designed to co-operate with a clampingring 62 that constitutes the adjustable locking means. This ring has a slightlyfrustoconical bore 64 with aninside face 66 that carries tapping 68. - In some embodiments, when the
ring 62 is screwed tight on the threadedportion 60 of thepart 55, it deforms the limbs of thepart 55 elastically, thereby pinching and clamping strands of theligature 14 between therod 18 and the inside wall(s) of therecess 58, in a manner explained below. - As shown in
FIGS. 10 and 11 , thepart 55 includes in its bottom 70 apassage 72 for passing theligature 14 in a manner explained below. - With references to
FIGS. 12 , 13A, and 13B, there follows a description of two different ways of putting theflexible ligature 14 into place inside the connectingpart 12 in the second embodiment. The side wall of therod 18 and the inside wall of therecess 58 of thepart 55 potentially define twopassageways flexible ligature 14. In the configuration shown inFIG. 13A , only thepassageway 74 is used. Thus, bothintermediate portions flexible ligature 14 are disposed in thepassage 74. - In the configuration shown in
FIG. 13B , themiddle portions flexible ligature 14 are disposed respectively one in each of thepassageways rod 18. Advantageously, the free ends of theligature 14 are accessible for exerting the desired traction in order to obtain suitable clamping on the spinous process prior to locking the clampingring 62 on thepart 55. - One advantage to this type of embodiment may be the ability to avoid making two longitudinal parts constituting a kind of clamp hinged on the
pin 24. In some embodiments, the locking means are constituted by an element that is distinct from the connecting part and that is removable therefrom. In some embodiments, the locking means co-operate with the connecting part by screw engagement. It is thus possible to adjust accurately the dimensions of the ligature-passing passageway(s) as defined by the connecting part and the rod. In an initial stage, the coefficient of friction between the coefficient of the ligature and secondly the rod and the connecting part can be adjusted. In the final stage, very effective clamping of the ligature is obtained between the rod and the locking part. - In some embodiments, including for example the embodiments shown in
FIGS. 14-39 ,rod 18 may not be needed in order for the bone fixing system to effectively hold a bone in a relative position. The embodiments of the bone fixing system 100 shown inFIGS. 14-39 can includeconformable ligature 14 and blockingbody 120, which may includecompression member 140. In these embodiments that do not require the use ofrod 18, theconformable ligature 14 may be passed around one or more bones, tendons, muscles, rods, plates, screws, or other structures in a body and passed throughloop passage 126 in blockingbody 120 to form a loop extending from a first portion of blockingbody 120 and a first end and a second end ofconformable ligature 14 may be passed out one ormore exit passages 128 in blockingbody 120 to extend in a free configuration from a second portion of blockingbody 120. Thus, althoughconformable ligature 14 may, in some uses, pass aroundrod 18 to capturerod 18 in a loop portion,rod 18 is not necessary for bone fixing system 100 to hold a bone in a secure position. - With reference to
FIGS. 14-38 , in embodiments that do not require the use ofrod 18 to hold a structure in a relative position, bone fixing system 100 may includecompression member 140 having afirst surface 146 for contact withconformable ligature 14 and for cooperating withinside surface 125 of blockingbody 120 to form a passageway for one or more ends ofconformable ligature 14.Compression member 140 may be inserted into blockingbody 120 beforeconformable ligature 14 is passed through blockingbody 120. In some embodiments,closure member 130 may engage withengagement portion 123 of blockingbody 120 before insertingcompression member 140 and/or passingconformable ligature 14 through blockingbody 120. - In other embodiments that do not require the use of
rod 18 to hold a structure in a relative position, bone fixing system 100 may includeclosure member 130 for engagement withengagement portion 123 of blockingbody 120 and for contact withcompression member 140 so that advancingclosure member 130 into blockingbody 120biases compression member 140 ontoconformable ligature 14.Closure member 130 may be advanced into blockingbody 120 for biasingcompression member 140 againstconformable ligature 14 to create a friction force betweenconformable ligature 14 and blockingbody 120. A friction force betweenconformable ligature 14 and blockingbody 120 may holdconformable ligature 14 in place without significant movement relative to blockingbody 120. In some embodiments,closure member 130 may be advanced into blockingbody 120 for impingingconformable ligature 14 betweencompression member 140 and blockingbody 120 to prevent any relative movement. - Advantageously, the use of
compression member 140 in these embodiments enable bone fixing system 100 to be used in circumstances in whichrod 18 may be undesirable or unnecessary. Another advantage of the embodiments illustrate inFIGS. 14-38 is the ability for the surgeon to more easily seeconformable ligature 14 as it is passed through various passages in the bone fixing system. Another advantage to this embodiment is the reduced size of blockingbody 120 over prior art devices that couple to a rod. In particular, the use ofcompression member 140, particularly having a hemispherical profile, can reduce the height and overall profile of blockingbody 120. -
FIG. 14 depicts a cross-sectional view of a portion of one embodiment of bone fixing system 100 useful for holding a bone in a position without requiringrod 18. Bone fixing system 100 ofFIG. 14 includes blockingbody 120 withcompression member 140 andclosure member 130, ligature 14, andtensioning tool 250. Blockingbody 120 ofFIG. 14 includesclosure member passage 123 for receivingclosure member 130 andloop passage 126 and exitpassages 128 for receivingligature 14 through blocking body 120 (e.g., as shown). As shown inFIG. 14 ,ligature 14 has been passed through blockingbody 120 such that eachend 14 ofligature 14 extends out of one ofexit passage 128 and ligature 14 passes throughloop passage 126 to formligature loop portion 14. In some embodiments, ligature 14 may have a round profile, which can often provide the highest strength per unit of cross-sectional area ofligature 14, enable passing ligature through small openings, and/or reduce the area of contact with a structure. As shown inFIG. 14 , ligature 14 may have a wide, flat (or approximately flat) profile which may distribute forces over a larger area, provide higher strength, and/or prevent rolling (e.g. as compare to a round profile).Compression member 140 includesfirst surface 146 for cooperating withinner surface 125 of blockingbody 120 to form a passageway betweenloop passage 126 and exitpassages 128. As shown inFIG. 14 ,closure member 130 includesthreads 132 for engagingthreads 122 inengagement portion 123 of blockingbody 120 andbottom surface 135 for contact withcompression member 140. As shown inFIG. 14 ,closure member 130 has been engaged withthreads 122 in blockingbody 120 andbottom surface 135contacts compression member 140 such thatligature 14 is held in place relative to blockingbody 120 due to compression in the passageways formed byfirst surface 146 andinner surface 125 betweenloop passage 126 and exitpassages 128. As shown inFIG. 14 , bone fixing system 100 includestensioning tool 250 havingcentral passage 152 for passage ofends 14 ofligature 14 anddistal end 154 for contact with blockingbody 120. - As shown in
FIG. 14 (andFIG. 15 ), blockingbody 120 may be manufactured withinner surface 125 for cooperating withfirst surface 146 ofcompression member 140 to form a space through whichconformable ligature 14 passes and for contacting with a portion ofconformable ligature 14 to holdconformable ligature 14 in position. In some embodiments,inner surface 125 may be manufactured with a grooved, knurled, or otherwise textured surface to aid in holdingconformable ligature 14 in place.Inner surface 125 of blockingbody 120 may be coated, layered, or otherwise treated to aid in holdingconformable ligature 14 in place. In some embodiments,inner surface 125 may allow one-way passage ofconformable ligature 14 through blockingbody 120, for example, by manufacturinginner surface 125 with an asymmetric saw-tooth profile to allow passage ofconformable ligature 14 through blockingbody 120 in a first direction but to resist movement in the opposite direction. - As shown in
FIG. 14 ,loop passage 126 is located along the arclength opposite (i.e., facing)first surface 146 ofcompression member 140 positioned in blockingbody 120, but it should be understood thatloop passage 126 could be positioned at other places around blockingbody 120. As shown in the embodiment ofFIG. 14 ,exit passages 128 are located on opposing portions of blockingbody 120 and each is located higher than the uppermost portion ofcompression member 140 when positioned in blockingbody 120. However it should be understood thatexit passages 128 can be located at other positions around blockingbody 120. In various embodiments,loop passage 126 and exitpassages 128 may be circular, oval, elliptical, or other shape, may be symmetric or asymmetric, and may be oriented such thatconformable ligature 14 may enter or exit blockingbody 120 at an angle, normal, or substantially tangential to a portion of blockingbody 120. In alternative embodiments, there may only be asingle exit passage 128 through which both ends 14 ofligature 14 pass. - As shown in
FIG. 14 , tensioning tool 250 (discussed in further detail below) hasdistal end 154 for detachable engagement with a portion of blockingbody 120. In some embodiments,distal end 154 oflongitudinal member 260 may havepassage 152 for accessingclosure member 130. As shown inFIG. 14 ,distal end 154 may be curved for engagement with a portion of blockingbody 120 having a generally curved profile. - In some uses, ligature 14 may have one or both ends passed around a structure in the body. Both ends of
ligature 14 may be inserted inloop passage 126 to form a loop around the structures.Compression member 140 may be inserted incompression member opening 124.Ligature 14 may be passed through the passageway formed betweenfirst surface 146 ofcompression member 140 andinner surface 125 of blockingbody 120. Ends ofligature 14 may be passed out one ormore exit passages 128.Closure member 130 may be inserted inengagement portion 123 to engagethreads 122. Ends ofligature 14 may be connected totensioning tool 250, such astensioning tool 250 shown inFIG. 39 ,Ligature 14 may be tightened, andclosure member 130 may be inserted inengagement portion 123 and advanced untilclosure member 130contacts compression member 140. Advancingcompression member 140 creates a friction force betweenligature 14 and blockingbody 120. The friction force may be great enough to impingeligature 14 relative to blockingbody 120 or may be enough to resist movement ofligature 14 relative to blockingbody 120. -
FIG. 15 depicts an exploded perspective view of the embodiment of blockingbody 120 shown inFIG. 14 , includingcompression member 140 andclosure member 130. As shown inFIG. 15 , blockingbody 120 includesengagement portion 123 havingthreads 122 for receivingclosure member 130, andcompression member opening 124 through whichcompression member 140 may be inserted to “side-load”compression member 140 within blockingbody 120. As shown in the embodiment ofFIG. 15 ,closure member 130 includestool portion 134 andthread 132 andcompression member 140 includesfirst surface 146,second surface 145, andflanges 142. - As shown in
FIG. 15 , blockingbody 120 can includecompression member openings 124 on either side of blockingbody 120 for insertion ofcompression member 140. In the embodiment ofFIG. 15 ,compression member opening 124 has a constant diameter, while in alternative embodiments opening 124 may have a first diameter large enough to accommodateflanges 142 and a second diameter smaller thanflange 142 but large enough to seatcompression member 140.Compression member 140 can be inserted, positioned, and/or removed from blockingbody 120. In various embodiments,compression member 140 may be short enough to fit inside blockingbody 120,compression member 140 may be substantially the same length as blockingbody 120, orcompression member 140 may extend some distance beyond blockingbody 120. Advantageously,compression member 140 enables embodiments of the bone fixing system 100 to operate in areas of the body or in situations in which a rod may be difficult or undesirable. An advantage to blockingbody 120 havingcompression member opening 124 oriented for side-loading compression member 140 is the ability to adjust the positioning ofcompression member 140 afterclosure member 130 has engagedengagement portion 122. - Extensions 142 (such as flanges 142) of
compression member 140 can operate to preventcompression member 140 from shifting or moving out of position onceclosure member 130 has engagedengagement portion 123 of blockingbody 120. In operation,closure member 130 will contactcompression member 140 to holdligature 14 substantially in place whenligature 14 has been positioned to hold a bone or other structure in a relative position. In some embodiments,extensions 142 may extend around the entire arclength offirst surface 146 ofcompression member 140, such asflanges 142 depicted inFIG. 15 , while in other embodiments,extensions 142 may extend around a portion of the arclength offirst surface 146. In some embodiments, a radius ofextension 142 may allow insertion or removal ofcompression member 140 in a first orientation and may prevent removal or insertion in a second orientation. For example, in some embodiments,extensions 142 may have a radius to enablecompression member 140 to be inserted into blockingbody 120 whencompression member 140 is rotated to a first angle, while preventingcompression member 140 from being removed whencompression member 140 is rotated (e.g., 90 degrees) from the first angle. In some embodiments,compression member 140 may have a variable radius. - As shown in the embodiment of
FIG. 15 ,first surface 146 ofcompression member 140 can form a passageway in cooperation withinner surface 125 of blockingbody 120 for passingligature 14 and for contactingconformable ligature 14. In some embodiments,first surface 146 may be knurled, grooved, or otherwise machined, may be coated, layered, or otherwise treated for contact withconformable ligature 14, and/or may allow one-way passage ofconformable ligature 14 through compression member 140 (e.g., having an asymmetric saw-tooth profile for allowing passage ofconformable ligature 14past compression member 140 in a first direction but resisting passage in an opposite direction). - Various mechanisms can be used to allow
closure member 130 to engageengagement portion 123 of blockingbody 120. In some embodiments,closure member 130 has helically woundthread 132 and can be advanced in blockingbody 120 throughengagement passage 123 by rotatingclosure member 130 to engage threads ofengagement portion 123 of blockingbody 120. In some embodiments,tool portion 134 onclosure member 130 can be a hex shaped receiving are that would allow a surgeon to use a hex tool to engage and rotateclosure member 130 so thatthreads 132 engage with the threads ofengagement portion 123. In some embodiments,closure member 130 may have a sawtooth profile or other profile for ratchetingclosure member 130 into blockingbody 120. Those of ordinary skill in the art will recognize a variety of other mechanisms (some of which will be described herein) for engagingclosure member 130 withengagement portion 123 in order to enableclosure member 130 to contactcompression member 140 and secure inplace ligature 14. - Advantages to embodiments of bone fixing systems 100 such as the one depicted in
FIGS. 14 and 15 include the curved profile of blockingbody 120, which can result in an overall lower profile and/or in less stress on surrounding tissue based on friction contact. -
FIG. 16 depicts a perspective view of an alternative embodiment ofcompression member 140 ofFIGS. 14 and 15 havinglongitudinal slot 144 andstress reducer 148. In some embodiments,compression member 140 may have a length and width such that whencompression member 140 is positioned inside blockingbody 120,first surface 146 is in contact withinner surface 125 of blocking body 120 (orfirst surface 146 is in contact withconformable ligature 14 which is in contact withinner surface 125 of blockingbody 120, for example as shown inFIG. 14 ). In various embodiments, compressing onsecond surface 145 may biasfirst surface 146 againstinner surface 125 and the radius of curvature offirst surface 146 may effectively change some amount, based at least in part on the length and depth oflongitudinal slot 144. One advantage tocompression member 140 havinglongitudinal slot 144 is the capability to adjust the compressive force exerted bycompression member 140 onligature 14. In addition to the length and depth oflongitudinal slot 144, the amount that the radius of curvature can change can depend on the compression force applied to second surface 147, the shape ofinner surface 125, the deformability of any coating, layer, a machined feature ofinner surface 125 orfirst surface 146, the thickness ofconformable ligature 14, or the original shape offirst surface 146. As shown in the embodiment ofFIG. 16 ,longitudinal slot 144 can includestress reducer 148, which can advantageously prevent or reduce the likelihood ofcompression member 140 cracking or other material failure due to a change in curvature offirst surface 146. While other shapes can be employed,stress reducer 148 may be generally circular or other non-angular shape to prevent the build-up of stresses associated with bending forces. The radius and position ofstress reducer 148 may be based on the material used forcompression member 140, the radius of curvature offirst surface 146, the depth and width oflongitudinal slot 144, the anticipated compression force applied to second surface 147, or the length ofcompression member 140. -
FIGS. 17-19 illustrate another embodiment of the bone fixing system 100.FIG. 19 is a perspective view of this embodiment of blockingbody 120, in whichcompression member 140 andclosure member 130 may be top-loaded or side-loaded into blockingbody 120 viaU-shaped channel 127. In this embodiment, blockingbody 120 is shown to include two upwardly extending walls forming a generallyU-shaped channel 127.Compression member 140 is shown with a similar “dual cylinder” shape as thecompression member 140 ofFIG. 16 (in fact, the compression member ofFIG. 16 can be used in theFIG. 17 embodiment) withfirst surface 146 andflanges 142. As shown inFIG. 18 ,compression member 140 may extend some distance beyond blockingbody 120 withextensions 142 oncompression member 140 designed to preventcompression member 140 from moving laterally oncecompression member 140 is positioned in blockingbody 120. As shown in theFIG. 18 embodiment,extensions 142 may be located exterior to blocking body 120 (while in alternative embodiments,extensions 142 may be located interior to blocking body 120). -
Compression member 140 can be placed withinchannel 127 withsurface 146 contactinginner wall 125 at the bottom ofchannel 127.Closure member 130 may be inserted into channel 127 (e.g., by engaging the exterior threads on the body ofclosure member 130 with the interior threads of channel 127) for engagingengagement portion 122. Advancingclosure member 130 down channel 127 (e.g., rotating closure member 130) can forcecompression member 140 againstligature 14 to holdligature 14 in place without significant movement (or with complete impingement) relative to blockingbody 120. -
FIG. 17 shows a cross-sectional view of this embodiment of bone fixing system 100 using the blockingbody 120 ofFIG. 19 in whichcompression member 140 is either side or top-loaded into blockingbody 120. As shown inFIG. 17 ,conformable ligature 14 may be passed throughloop passage 126 in blockingbody 120 to form a loop extending from blockingbody 120 and first and second ends may be passed out one ormore exit passages 128 to extend from a second portion of blockingbody 120. In order to use the bone fixing system 100 to hold a bone in position,compression member 140 may be inserted in blockingbody 120 afterconformable ligature 14 has been passed through blockingbody 120.Closure member 130 may be engaged toengagement portion 122 of blockingbody 120 afterconformable ligature 14 has been passed through blockingbody 120 and aftercompression member 140 has been positioned in blockingbody 120. -
Engaging closure member 130 inengagement portion 122 of blockingbody 120 prevents all or significant movement ofconformable ligature 14 relative to blockingbody 120. - As shown in
FIG. 17 ,exit passages 128 can be positioned higher thanfirst surface 146 ofcompression member 140 in order to provide a longer passage betweenfirst surface 146 ofcompression member 140 andinner surface 125 of blockingbody 120 to provide a higher friction coefficient or reduced point stresses onconformable ligature 14, blockingbody 120, and/orcompression member 140. In alternative embodiments, exitpassages 128 may be positioned nearengagement portion 122 such thatclosure member 130 may contactconformable ligature 14. In various embodiments,closure member 130 may impinge a portion ofconformable ligature 14. As shown inFIG. 17 ,exit passages 128 may be located on blockingbody 120 such that whendistal end 154 oftensioning tool 250 engages blockingbody 120, first and second ends ofligature 14 are external ofdistal end 154. However, it should be understood thatexit passages 128 may be located at a number of locations on the blockingbody 120 and relative totensioning tool 250.Distal end 154 oftensioning tool 250 may engage a portion of blockingbody 120 to enable a surgeon to tensionconformable ligature 14 in order to hold a bone or structure in position. In various embodiments,distal end 154 oftensioning tool 250 may be flanged for engaging blockingbody 120.Tensioning tool 250 may includepassage 152 along the entire length oftensioning tool 250 for accessingclosure member 130 orpassage 152 may extend a selected length oftensioning tool 250. -
FIG. 18 depicts a side view of this embodiment of bone fixing system 100 whereconformable ligature 14 passes throughloop passage 126 to form a loop extending from a first portion of blockingbody 120, and further passes through a passage formed bycompression member 140 and blockingbody 120, and passes out both exit passages 128 (thoughligature 14 could in various embodiments pass both ends through a single exit passage 128).FIG. 18 illustrates theflanges 142 extending outside of blockingbody 120. - As described,
closure member 130 may be top-loaded into blockingbody 120 for the embodiments ofFIGS. 17-19 . One advantage to top-loading closure member 130 andcompression member 140 is thatclosure member 130 may be integrated withcompression member 140 to form a unitary piece, which reduces the number of components that the surgeon has to implant during surgery. In various embodiments,closure member 130 may be connected tocompression member 140 by a pin (not shown) to form a unitary piece. In some embodiments,closure member 130 may rotate whilecompression member 140 does not rotate. One advantage to this unitary closure member/compression member embodiment is thatcompression member 140 may apply only compression forces to ligature 14. In contrast, ifcompression member 140 rotates inside blockingbody 120, torsion may be applied to ligature 14. -
FIGS. 20-22 depict yet another embodiment of bone fixing system 100 in which conformable ligature may be passed around one or more bones, tendons, muscles, rods, plates, screws, or other structures in the body, and then passed throughloop passage 126 in blockingbody 120 to form a loop extending from a first portion of blockingbody 120.Ligature 14 can then be passed through a passageway formed byfirst surface 146 ofcompression member 140 andinner surface 125 of blockingbody 120, and passed out through the center of blockingbody 120 to extend out of blockingbody 120 so that ends 14 ofligature 14 can be in a free configuration.Tensioning tool 250 may have acentral passage 152 to allow first end and second end ofligature 14 to pass through. -
FIG. 21 depicts a side view of a portion of one embodiment of blockingbody 120, in whichcompression member 140 may be side-loaded throughcompression member opening 124 into blockingbody 120. As shown, blockingbody 120 ofFIG. 21 has a similar shape to the blockingbody 120 ofFIG. 19 , except that theFIG. 21 embodiment of blockingbody 120 encloses compression member 140 (as opposed to the “open” top of the blockingbody 120 ofFIG. 19 ). Thus, in theFIG. 21 embodiment,compression member 140 may be pre-loaded into blockingbody 120 or even manufactured to be permanently enclosed within blockingbody 120. In an alternative embodiment,compression member 140 and/orextensions 142 may be manufactured with dimensions such that oncecompression member 140 is inserted in blockingbody 120, the position ofcompression member 140 may be altered butcompression member 140 may not be removed from blockingbody 120. In other words, in the embodiment shown inFIG. 21 ,compression member 140 may be moved around inside blockingbody 120, but may not be removed. In various embodiments, blockingbody 120 may be manufactured withcompression member opening 124 having a first set of dimensions and aftercompression member 140 is inserted into blockingbody 120 throughopening 124, the size ofopening 124 may be altered (e.g., by adding material or altering the shape of blockingbody 120 at opening 124) to reduce opening 124 dimension to prevent removal ofcompression member 140. Alternatively,compression member 140 may be manufactured having a first set of dimensions, inserted into opening 124 of blockingbody 120, and then altered, such as by adding material, to increase the dimensions ofcompression member 140 to prevent removal ofcompression member 140. In various embodiments,compression member 140 may be compression fit or sweat-locked throughopening 124 into blockingbody 120. In another embodiment, blockingbody 120 may be manufactured with two upwardly extending walls,compression member 140 may be inserted in a channel formed by the two walls, and material may be added to convert the channel intoopening 124. -
FIG. 22 depicts an exploded perspective view of the embodiment of blockingbody 120 ofFIGS. 20 and 21 in whichcompression member 140 may be side-loaded into blockingbody 120 andclosure member 130 may threadably engageengagement portion 122 of blockingbody 120. A tool may engage withtool portion 134 for rotatingclosure member 130 to engageexternal threads 132 onclosure member 130 withinternal threads 122 in blockingbody 120.Tool portion 134 ofclosure 130 can be hollow to enable one or more ends ofconformable ligature 14 to pass through and extend outexit passage 128. -
FIGS. 23-25 show another embodiment of a bone fixing system 100 having an alternate closure mechanism and exit passage.FIG. 23 depicts a cross sectional end view of bone fixing system 100 in whichconformable ligature 14 may be passed throughloop passage 126 in blockingbody 120 to form a loop extending from a first portion of blockingbody 120, through a passage formed byfirst surface 146 ofcompression member 140 andinner surface 125 of blockingbody 120, and extend out throughexit passage 128. As shown inFIGS. 23 and 25 , in this embodiment, ring-style closure member 130 may haveinternal threads 132 for engagingexternal threads 122 on blockingbody 120. This type of embodiment will provide the advantage of allowing the surgeon to seeconformable ligature 14 as it passes throughloop passage 126 in blockingbody 120 and to seecompression member 140 as it is positioned in blockingbody 120. -
FIG. 24 depicts a side view of theFIG. 23 embodiment in whichbottom surface 135 ofclosure member 130 is in contact withsecond surface 145 of compression member external to blockingbody 120, and in this embodimentbottom surface 135 ofclosure member 130 contactssecond surface 145 atextensions 142 ofcompression member 140. An advantage to this type of embodiment is the ability for the surgeon to see the engagement betweenthreads 132 onclosure member 130 withthreads 122 on blockingbody 120. As shown inFIG. 24 ,tool portions 134 ofclosure member 130 may be positioned on an exterior portion ofclosure member 130. An advantage to this type of embodiment is the ability for a tool (not shown) to engagetool portions 134 exterior to distal end 154 (not shown) engaged with a portion of blockingbody 120. This exterior engagement can provide a superior tightening mechanism to engageclosure member 130 with blockingbody 120 in certain embodiments. -
FIG. 25 depicts an exploded perspective view of theFIG. 24 view with the various portions of blockingbody 120 separated prior to engagement ofclosure member 130 onto blockingbody 120. An advantage to this embodiment is the reduced number of passages, which may reduce the time needed to implant the system. -
FIGS. 26-28 illustrate an alternative embodiment of bone fixing system 100 that provides a hinged closing mechanism offset fromligature 14 that also does not require a rod, and which can provide certain advantages over other embodiments.FIG. 26 shows blocking body 120 withfirst portion 170 hingedly connected viahinge pin 178 tosecond portion 180.Conformable ligature 14 can pass throughloop passage 126 infirst portion 180 of blockingbody 120 to form a loop extending fromfirst portion 180 of blockingbody 120, further passed through a passage formed betweenfirst surface 146 ofcompression member 140 andinner surface 125 of blockingbody 120, and then passed throughexit passage 128 insecond portion 170. As with every embodiment described, ligature 14 may get to this desired configuration (with a loop portion extending from blocking body 120) in a variety of ways. An advantage to this embodiment is the low profile possible due to the configuration ofclosure member 130 offset fromcompression member 140. - In various embodiments,
hinge pin 178 connectsfirst portion 170 tosecond portion 180 in either a permanent manner or alternatively the hinged connection may be disconnectable. The hinged connection can be formed so as to allow two-way hinged motion for engaging or disengagingfirst portion 170 fromsecond portion 180. In an alternative embodiment, the hinged connection may allow one-way hinged motion for engagingfirst portion 170 fromsecond portion 180 but may subsequently preventfirst portion 170 from disengagingsecond portion 180. In various embodiments,first portion 170 and/orsecond portion 180 may allow hinged motion between a selected arclength, for example,first portion 170 andsecond portion 180 may move through an arc of approximately 180 degrees. - As further shown in
FIGS. 26-28 ,closure member 130 will be used to close the hinged bone fixing system 100 in a manner to holdligature 14 in a relatively or completely stable position relative to blockingbody 120.Closure member 130 ofFIG. 27 is shown havingexternal threads 132 for engaginginternal threads 122 inengagement portion 123 of blockingbody 120.Second portion 180 may includeengagement portion 122 for engagement bythreads 132 onclosure member 130. In one embodiment,closure member 130 may be positioned withinfirst portion 170 such thatclosure member 130 is free to rotate infirst portion 170 to joinfirst portion 170 withsecond portion 180, but may not be removed fromfirst portion 170 after such engagement. In other words, in some embodiments,closure member 130 may be rotated to engage threads onclosure member 130 withengagement portion 122 to collapsefirst portion 170 andsecond portion 180, and the direction of rotation may be reversed to disengageclosure member 130 fromengagement portion 122, butclosure member 130 may not be removed fromfirst portion 170. In the embodiment shown inFIG. 26 ,closure member 130 can be rotatably positioned insecond portion 180 such thatclosure member 130 is free to rotate insecond portion 180 but may not be removed fromsecond portion 180, which can provide the advantage of reducing the risk of having loose hardware (which can be lost inside a patient during surgery) associated with bone fixing system 100. -
FIG. 27 depicts a cross-sectional side view of a portion of the embodiment of bone fixing system 100 depicted inFIG. 26 , in whichconformable ligature 14 may be passed throughloop passage 126 infirst portion 170 to form a loop extending fromfirst portion 170 of blockingbody 120, passed through a passage formed byfirst surface 146 ofcompression member 140 andinner surface 125 of blockingbody 120, and extend fromexit passage 128 insecond portion 180. As shown inFIG. 27 ,first portion 170 andsecond portion 180 rotate abouthinge pin 178 to open orclose blocking body 120.Tool portion 134 onclosure member 130 may be rotated sothreads 132 onclosure member 130 engagethreads 122 inengagement portion 123. Oncebottom surface 135 ofclosure member 130 reaches a selected point,first portion 170 andsecond portion 180 compress to impinge movement ofligature 14 relative to blockingbody 120. -
First surface 146 ofcompression member 140 andinner surface 125 of blockingbody 120 provide a passageway through blockingbody 120. In some embodiments,inner surface 125 may be located onfirst surface 170 andfirst surface 146 ofcompression member 140 may be located onsecond portion 180 as depicted inFIG. 27 . In some embodiments,inner surface 125 may be located onsecond surface 180 andfirst surface 146 ofcompression member 140 may be located onfirst portion 170. -
Closure member 130 may be offset fromcompression member 140 such that threaded engagement ofthreads 132 ofclosure member 130 withengagement portion 122 of blockingbody 120 may indirectly apply compression tocompression member 130. In other words,compression member 140 may be positioned some distance L.sub.b fromhinge pin 178 andclosure member 130 may be positioned some distance L.sub.s fromhinge pin 178. Compression ofcompression member 140 ontoconformable ligature 14 may not be accomplished by directly contactingbottom surface 135 ofclosure member 130, but may instead be accomplished by rotatably engagingthreads 132 withthreads 122 to advanceclosure member 130 in blockingbody 120 such thatsecond portion 180 may be leveraged around the fulcrum created byhinge pin 178. An advantage to one embodiment uses the mechanical advantage of L.sub.s/L.sub.b to apply compression forces onconformable ligature 14. Another advantage to one embodiment is the ability for the surgeon to apply large compression forces toconformable ligature 14 due to the mechanical advantage based on the position ofhinge pin 178,compression member 140, andclosure member 130. The compression forces available may also be based on the radius of curvature ofcompression member 140, the size or pitch ofthreads hinge pin 178. Another advantage may be the precision in which a friction coefficient may be selected betweenconformable ligature 14 and blockingbody 120. In some embodiments, the pitch, shank diameter, or other dimensions ofclosure member 130 may enable control of the application of compression. For example, a large number of threads per inch may allow more compression due to the mechanical advantage ofthreads 122 engaging withthreads 132, and the application may be more controlled due to the greater angular rotation needed to advanceclosure member 130 the same distance asclosure members 130 having lower numbers of threads per inch. Another advantage to this embodiment relates to the outer surface offirst portion 170 and/orsecond portion 180. Because blockingbody 120 can achieve a mechanical advantage through the use ofhinge pin 178,closure member 130 may be made smaller than prior art approaches, which allows blockingbody 120 to have asmaller opening 123. As shown inFIG. 27 ,second portion 180 has an outer surface that is curved, which may reduce pain, discomfort, or other undesirable effects that result from using an angular implant. -
FIG. 28 depicts a perspective view of the embodiment ofFIGS. 26 and 27 shown in a closed configuration, whereligature 14 is held completely or substantially in place relative to blockingbody 120. One advantage to this type of embodiment may be the ability to passconformable ligature 14 around one or more bones, tendons, muscles, rods, plates, screws, or other structures in the body, passconformable ligature 14 through blockingbody 120 out asingle exit passage 128, and engageclosure member 130 on blockingbody 120, but offset fromconformable ligature 14 and/orcompression member 140. One advantage may be that tensioningtool 250 may not needpassage 152 indistal end 154 because closure member 130 (e.g., tool portions 134) may be accessed outsidetensioning tool 250. - It should be understood that the various closure mechanisms, closure members, exit passages, and blocking bodies, and other design features shown in the various embodiments of bone fixing system 100 of
FIGS. 14-28 may potentially be used in the other embodiments ofFIGS. 14-28 . For example, the ring-style closure member 130 of theFIG. 25 embodiment can be used on the embodiment ofFIG. 22 by modifying the blocking body ofFIG. 22 to have external threads onto which the internal threads of the ring-style closure member 130 would engage. -
FIGS. 29-38 depict embodiments of bone fixing system 100 in various configurations, arrangements and orientations. InFIGS. 29-38 , the embodiment of blockingbody 120 is the embodiment depicted inFIGS. 26-28 . However, any of the embodiments depicted inFIGS. 14-28 and variations may be used without departing in scope from the present disclosure. -
FIG. 29 depicts a perspective view of one embodiment of bone fixing system 100 for holding a bone in a position. Bone fixing system 100 may be useful for orthopedic applications, such as holding a bone near a tendon or muscle.Portions 214 ofconformable ligature 14 may be passed through or around a portion of a muscle and through or around a portion of a femur to provide support while a tear or cut in the muscle heals. Advantageously, blockingbody 120 may be positioned at various locations near the muscle, tendon, or bone based on the type or extent of the injury, trauma, or illness, surgical preferences such as MIS access, or patient health such as age or weight, or the like Advantageously, embodiments of bone fixing system 100 may be implanted near other surgical implants without affecting their placement or function. In various embodiments, bone fixing system 100 may include blockingbody 120 indirectly applying tension toconformable ligature 14. For example, in the embodiment depicted inFIG. 29 , bone fixing system 100 may be implanted to maintainbone 219 in a position withmuscle 209 whilewound 211 heals. In this embodiment,conformable ligature 14 may be passed aroundbone 219 and throughmuscle 209, and through blockingbody 120 located onportion 112 ofconformable ligature 14 such that substantially all tension betweenmuscle 209 andbone 219 may be supported byportion 111 ofconformable ligature 14. - Bone fixing systems 100 may be implanted without affecting plates, rods, or other implanted structures. Bone fixing systems may be implanted without affecting bone screws, hooks, bolts, or other implanted hardware.
FIG. 30 depicts one embodiment ofconformable ligature 14 passed around a part ofbone 219,muscle 209 and/ortendon 213 and through blockingbody 120, and further depictsbone screw 212 andplate 210 implanted on a portion ofbone 219. In this type of embodiment, bone fixing system 100 including blockingbody 120 may be positioned onportion 111 ofconformable ligature 14 such that some of the tension betweenmuscle 209 andbone 219 may be supported by blockingbody 120. - Bone fixing system 100 may be advantageous for correcting alignment of one or more bones. Conformable ligatures 14 and blocking
bodies 120 may be useful for correcting alignment of a portion of the spine.FIGS. 31 and 32 depict posterior and sagittal views of a portion of the spine in which bone fixing system 100 may be useful for aligning vertebra L5 with adjacent vertebrae L4 and sacrum S. In some embodiments,bone fastener assemblies 212 may be implanted in lumbar vertebra L4 and sacrum S. In some embodiments,bone fastener assemblies 212 may be inserted through an incision in the skin and implanted using Minimally Invasive Surgery (MIS) techniques, and ligature 14 may be passed around one or more structures. - In some embodiments, passing may include going into, through, or out of a structure. In some embodiments, passing may include going over, under, or around a structure. In some embodiments, passing may include crossing over
other ligatures 14 or portions ofligatures 14. In some embodiments, passing may include multiple passes along the same pathFIGS. 33-38 depict various embodiments of bone fixing systems in place on a portion of a spine. InFIGS. 33-38 , bone fixing system 100 is shown holdingbone graft 230, which may be useful for supporting a portion of the spine. However, embodiments of bone fixing system 100 may be used to correct problems with the spine without rods, bone grafts, plates, or other implants.Conformable ligature 14 may be passed around a portion of a bone, such as spinous processSP Conformable ligature 14 may be passed around a portion ofbone graft 230. Passingconformable ligature 14 around a portion ofbone graft 230 may include passing a portion ofconformable ligature 14 through a portion ofbone graft 230. One end ofconformable ligature 14 may be inserted and passed through blockingbody 120 from one side and the other end ofconformable ligature 14 may be inserted and passed through blockingbody 120 from another side, as depicted inFIG. 33 . - Advantageously,
conformable ligature 14 may be selectively passed around structures such as bones and bone grafts.Conformable ligature 14 may be passed around a bone, bone graft, tendon, or other tissue due to disease, injury, tumor, degenerative effects or the like. For example,FIG. 33 depicts a posterior view of one embodiment in whichconformable ligature 14 may be passed around a portion of spinous process SP on lower vertebra L5.FIG. 33 further depicts one embodiment in which conformable ligature may be passed through bone, such as the pedicle of lower vertebra L5. As another example,FIG. 34 depicts a sagittal view of one embodiment in whichconformable ligature 14 may be passed around the posterior portion of spinous process SP. As another example,FIG. 35 depicts a posterior view of one embodiment in whichconformable ligature 14 may be passed around a portion of the pedicle portion of lower vertebra L5. As another example,FIG. 36 depicts a sagittal view of one embodiment in whichconformable ligature 14 may be passed around the pedicle portion and the posterior portion of spinous process SP. In some embodiments, ligature 14 may not be passed around a structureFIG. 37 depicts a posterior view of one embodiment in whichconformable ligature 14 may be passed around a portion of the pedicle portion of lower vertebra L5 and the transverse process of upper vertebra L4 but not the spinous process for either vertebraFIG. 38 depicts a sagittal view of one embodiment in whichconformable ligature 14 may be passed around the pedicle portion and through the posterior portion of spinous process SP on lower vertebra L5. - In some embodiments, the surgeon may pass
conformable ligature 14 alternative ways due to disease, injury, tumor, degenerative effects or the like. For example,FIG. 33 depicts a posterior view of one embodiment in whichconformable ligature 14 may be passed through a portion of the pedicle of lower vertebra L5, which may allow system 100 to apply direct tension on lower vertebra L5. As another example,FIG. 34 depicts a sagittal view of one embodiment in whichconformable ligature 14 may be passed aroundbone graft 230 and spinous process SP on lower vertebra L5 such that the lower portion ofbone graft 230 may be prevented from moving posterior to the spine but may move anterior to the spineFIG. 35 depicts a posterior view of one embodiment in whichconformable ligature 14 may be passed around a portion of the pedicle portion of lower vertebra L5, which may allow system 100 to indirectly apply tension on lower vertebra L5.FIG. 36 depicts a sagittal view of one embodiment in whichconformable ligature 14 may be passed aroundbone graft 230 and spinous process SP on lower vertebra L5 such that the lower portion ofbone graft 230 may be prevented from moving posterior or anterior to the spine.FIG. 37 depicts a posterior view of one embodiment in which first and second conformable ligatures 110 may be passed around a portion of the pedicle portion of lower vertebra L5. Advantageously, the system 100 may be able to selectively apply tension to either side of the spine. Furthermore, system 100 may be able to control movement between vertebrae L4 and L5 similarly to the embodiments depicted inFIGS. 33 and 34 , but without contacting the spinous process SP of lower vertebra L5.FIG. 38 depicts a sagittal view of one embodiment in whichconformable ligature 14 may be passed around the pedicle portion and through the posterior portion of spinous process SP on lower vertebra L5. Advantageously, vertebrae L4 and L5 may be able to move relative to each other butbone graft 230 may be held in place. - An advantage to bone fixing system 100 is that the position of blocking
body 120 may be based on disease, injury, tumor, degenerative effects or the like. For example,FIG. 33 depicts one embodiment in which asingle blocking body 120 may be positioned off-center of the spine. As another example,FIG. 34 depicts one embodiment in which blockingbody 120 may be positioned abutting a bone such as spinous process SP.FIG. 35 depicts one embodiment in which blockingbody 120 may be positioned centered on the midline of the spine.FIG. 36 depicts one embodiment in which blockingbody 120 may be positioned some distance away from spinous process SP.FIG. 37 depicts one embodiment in which two blockingbodies 120 may be positioned lateral tobone graft 230FIG. 38 depicts one embodiment in which blockingbody 120 may be positioned centered between spinous processes SP. - Two or more
conformable ligatures 14 and/or two ormore blocking bodies 120 may be used to hold a bone, bone graft, tendon, rod, shaft, or other structure in a body.FIG. 36 depicts a posterior view andFIG. 37 depicts a sagittal view of one embodiment of a bone fixing system having two blockingbodies conformable ligatures conformable ligature 14 passed around a bone such as transverse process TP on lumbar vertebra L4 and transverse process TP on lumbar vertebra L5, and a secondconformable ligature 14′ passed around a bone such as transverse process TP on lumbar vertebra L4 and transverse process TP on lumbar vertebra L5. Bone fixing system 100 with afirst blocking body 120 on a first side of the spine and asecond blocking body 120′ on the second side of the spine may be used to straighten a spine. For example, tensioning oneconformable ligature 14 greater thanconformable ligature 14′ may bias vertebrae to help straighten a curved spine. -
FIG. 39 depicts a side view of a portion of one embodiment oftensioning tool 250, which may be used to apply tension toconformable ligature 14. As shown inFIG. 39 ,tensioning tool 250 includestool body 266 for engagingconformable ligature 14,longitudinal member 260 for advancement intool body 266, and distal end (such asdistal end 154 depicted inFIGS. 14 , 17, and 20) for engagement with blockingbody 120. As shown inFIG. 39 ,tool body 266 includes attachment point 274 (with flange 258) for connection to ligature 14, fixed handle 254,movable handle 252 for rotation aboutaxis 256,return spring 262,catch mechanism 264, returnspring adjustment member 270, and spring adjustment member 268. -
Attachment point 274 can attach first and second ends ofconformable ligature 14 totensioning tool 250. In some embodiments,attachment point 274 may includeflange 258 for preventing first and second ends ofconformable ligature 14 from detaching from tensioningtool 250. Distal end 154 (such as the embodiments shown inFIGS. 14 , 17, and 20) oftensioning tool 250 may engage to a portion of blockingbody 120. Fixed handle 254 may be gripped by a surgeon,movable handle 252 may be rotated aboutaxis 256, such as by squeezingmovable handle 252, tolongitudinal member 260 through tool body 266 a selected distance. Advancinglongitudinal member 260 to move blockingbody 120 away fromtool body 266 while maintaining first and second ends ofconformable ligature 14 onattachment point 274 applies tension toconformable ligature 14. In some embodiments, the selected distancelongitudinal member 260 advances throughtool body 266 may be proportional to the tension applied to conformable member 110. - In some embodiments,
tool body 266 may includereturn spring 262,catch mechanism 264, and returnspring adjustment member 270 for controlling the distance thatlongitudinal member 260 is allowed to return whenmovable handle 252 is released. In some embodiments,return spring 262 may biascatch mechanism 264 such that movement is permitted in one direction only. In some embodiments,return spring 262 may biascatch mechanism 264 such thatlongitudinal member 260 may only move forward throughtool body 266. Advantageously,return spring 262 may ensure that a surgeon does not inadvertently relieve tension fromconformable ligature 14. In other words, tensioningtool 250 may have a default configuration for tensioningconformable ligature 14. In some embodiments, actuating catch mechanism 264 (such as a surgeon pressing oncatch mechanism 264 with a thumb) may change the positioning ofcatch mechanism 264 such that movement oflongitudinal member 260 is permitted in a reverse direction as well. In some embodiments, movement oflongitudinal member 260 in a reverse direction may include changing the positioning ofcatch mechanism 264 in relation tolongitudinal member 260 as well as pulling in a reverse direction on graspingmember 272. - In some embodiments,
tensioning tool 250 may include spring adjustment member 268 for adjusting the compression on a spring (not shown) inbody 266. In some embodiments, rotating spring adjustment member 268 one direction, spring adjustment member 268 may be advanced some distance intobody 266 such that a spring may be compressed. In some embodiments, rotating spring adjustment member 268 in the other direction, spring adjustment member 268 may be advanced some distance out ofbody 266 such that compression forces on the spring may be relieved. By changing the compression forces on the spring, the spring may exert more or less force onlongitudinal member 260, which may affect how much tension can be applied to the ends ofconformable ligature 14. - In some embodiments, ligature 14 may be passed around
elongate members 210,bone fastener assemblies 212, vertebrae (such as L5), and other tendons, muscles, plates or other anatomical or implanted structures and the ends ofligature 14 may be passed into a portion of blockingbody 120, such that a loop is formed extending from a first portion of blockingbody 120. In some embodiments, first and second ends ofligature 14 may be passed through a passage in blockingbody 120. In some embodiments, a passage may be formed byinner surface 125 of blockingbody 120 andfirst surface 146 ofcompression member 140. In some embodiments, first and second ends ofligature 14 may exit by passing out of one ormore exit passages 128 in blockingbody 120. -
Distal end 154 oftensioning tool 250 engages blockingbody 120. In some embodiments,distal end 154 oflongitudinal member 260 may conform to the shape or profile of blockingbody 120. In some embodiments,distal end 154 oflongitudinal member 260 may be configured with features for engaging one or more features on blockingbody 120. In some embodiments, first and/or second ends ofligature 14 may be attached totensioning tool 250. In some embodiments, first and/or second ends ofligature 14 may be attached toattachment point 274 located ontool body 266. In some embodiments,movable handle 252 oftensioning tool 250 may be rotated aboutaxis 256 to advancelongitudinal member 260 throughtool body 266. The advancement oflongitudinal member 260 throughtensioning tool 250 movesattachment point 274 away from blockingbody 120, pulling ends ofligature 14 to decrease the size of the loop, and further advancement tensions ligature 14. In some embodiments, the tension applied to ligature 14 may be sufficient to hold one or more structures in a desired position. In some embodiments, the tension applied to ligature 14 may be sufficient to hold a bone in a position. In some embodiments, the tension applied to ligature 14 may be sufficient to pull one or more bones or structures into alignment. For example,tensioning tool 250 may provide sufficient tension to one or more ends of ligatures 14 (depicted inFIG. 31 ) to pull vertebra L5 (depicted inFIG. 32 ) in alignment with the natural curvature of the spine. - In some embodiments, once an appropriate tension has been applied to ligature 14,
closure member 130 may be actuated to create a friction force to restrict movement ofligature 14 relative to blockingbody 120, or to impingeligature 14 in blockingbody 120. In some embodiments,closure member 130 may be pre-installed in blockingbody 120. In some embodiments,closure member 130 may be inserted in blockingbody 120 after engagement of blockingbody 120 by tensioningtool 250. In some embodiments,closure member 130 may be inserted throughdistal end 154 oflongitudinal member 260 into blockingbody 120. - In some embodiments, once
closure member 130 has engagedthreads 122 in blockingbody 120 to provide a desired friction force to impingeligature 14 in blockingbody 120, first and second ends ofligature 14 may be disconnected from tensioningtool 250. Onceligature 14 has been disconnected from tensioningtool 250,tensioning tool 250 may be disengaged from blockingbody 120. - The tensioning tool of
FIG. 39 can use a ratcheting motion to advancelongitudinal member 260. Each time the surgeon squeezes handles 252 and 254 together,longitudinal member 260 advances a predefined distance, typically greater than 10 mm. Whiletensioning tool 250 works well in surgical procedures, it has several shortcomings. Becauselongitudinal member 260 advances the same amount with each pull ofhandle 252, the surgeon must tension ligature 14 in relatively large increments, but cannottension ligature 14 to a position between the increments. In other words, tensioningtool 250 does not offer a full range of tensioning control as the attachment point can only be positioned at the increments determined by the ratcheting mechanism (e.g., every 10 mm or so). A corollary of this problem is that tension is applied in a pulsed manner to ligature 14 as the surgeon squeezes and releases the handles. - Another issue with
tensioning tool 250 is that it is difficult for a surgeon to release a selected amount of tension inligature 14. If a surgeon believes thatligature 14 has been over tensioned, the surgeon must typically release all or a large amount of tension inligature 14 and begin tensioningligature 14 again. - Moreover,
tensioning tool 250 is relatively bulky. This makes it difficult to have multiple tensioning tools in place at the same time during a procedures. Consequently, tensioning multiple ligatures can be take a significant amount of time as thetensioning tool 250 may have to be removed from a surgical site each time a surgeon wishes to tension a new ligature. This especially inefficient in procedures in which a surgeon may wish to tension each ligature a little at a time rather than tensioning one ligature completely, then moving to the next ligature. -
FIG. 40 is a diagrammatic representation of another embodiment of atensioning tool 300 for tensioning a conformable ligature that overcomes the shortcomings oftensioning tool 250.Tensioning tool 300 comprises atool body 305, a threadeddrive shaft 310 and amovable carriage 315 engaged with the threads ofdrive shaft 310. The threads ofdrive shaft 310 can include any suitable thread shape including a symmetric v-thread, square thread, British acme thread, worm thread, buttress thread, metric acme thread or other suitable thread. Preferably, driveshaft 310 has a thread pitch of between 1-5 mm.Movable carriage 315 is engaged with the threads ofdrive shaft 310 and moves alongslot 320 intool body 305 whendrive shaft 310 rotates,Slot 320 can partially overlapcarriage 315 to capturecarriage 315 inslot 320. In other embodiments,carriage 315 can be held in place bydrive shaft 310.Carriage 315carries tensioning member 325 that acts as an attachment point for a conformable ligature.Tensioning tool 300 further includes a handle that provides an ergonomic user control to rotatedrive shaft 310. According to one embodiment, the handle can connect to driveshaft 310 using aquick connect 330. In other embodiments, the handle may be fixed. Preferably, all portions of tensioning tool are formed of biocompatible material such as stainless steel, titanium, a strong plastic or other material. -
Tensioning tool 300 also includes aconnector 335 shaped to interface with a ligature capturing implant (e.g., such as the connection parts shown inFIGS. 1-13 and blocking bodies shown inFIGS. 14-38 ).Connector 335 can be shaped to abut a variety of ligature capturing implants orconnector 335 can be interchangeable such that a surgeon can select the appropriate interface member based on the type(s) of ligature capturing implants used in a particular procedure. According to one embodiment,connector 335 can simply abut the ligature capturing implant (including abutting a rod if the ligature capturing implant uses a rod) or, according to other embodiments, may attach to the ligature capturing implant.Connector 330 can includetangs 340 that define anopen area 345 through which the ends of the conformable ligature can pass so that a portion of conformable ligature can be looped around tensioningmember 325. -
FIG. 41 is a diagrammatic representation of a cross section of one embodiment oftensioning tool 300showing tool body 305,drive shaft 310,carriage 315, tensioningmember 325,quick connect 330 andconnector 335. While various components such asbody 305 and driveshaft 310 are each shown as being single pieces, they may comprise multiple parts. For example, driveshaft 310 can include a threaded portion that connects to a non-threaded portion. As another example,tool body 305 may comprise multiple pieces. - As illustrated in
FIG. 41 ,carriage 315 defines a threadedpassage 355 that engages the threads ofdrive shaft 310. Asdrive shaft 310 rotates,carriage 315 will move either towards or away fromconnector 335 alongslot 320 depending on the direction of rotation ofdrive shaft 310. In the embodiment ofFIG. 41 , rotation occurs about an axis that is substantially parallel to the primary direction of movement of tensioningmember 325. The tension in a conformable ligature looped about or otherwise attached to tensioningmember 325 will increase or decrease depending on the direction of rotation. Tensioningmember 325 may includeflange 360 for preventing the conformable ligature from detaching from tensioningtool 300. -
Tensioning tool 300 further includes a handle that provides an ergonomic user control to rotatedrive shaft 310. According to one embodiment, the handle can connect to driveshaft 310 atquick connect 330. At the other end,drive shaft 310 can rest in a drive shaft seat 364 that is movable intool body 305. Aspring 365 between drive shaft seat 364 andtool body 305 allowsdrive shaft 310 to be pushed towardsconnector 335. This can dampen forces applied to the drive shaft towards connector 335 (e.g., by the surgeon inadvertently pushing on then handle). Furthermore, sincespring 365 will have a known displacement per unit force applied, a measure of displacement ofspring 365 indicates how much tension is applied to the ligature (i.e., the force from the tensioned ligature is transferred throughcarriage 315 to driveshaft 310 to compress spring 365 a known displacement). According to one embodiment,tensioning tool 300 can include features (such as extensions 366) that are coupled to the drive shaft.Extensions 366 move forward asdrive shaft 310 moves forward whenspring 365 compresses. The position ofextensions 366 can be compared to markings onbody 305 to determine the force applied to the ligature. Preferably,spring 365 is selected so thatspring 365 is fully compressed at between 500 Newtons and 1500 Newtons. - In operation, a surgeon can form a loop about one or more structures with a conformable ligature and a ligature capturing implant Examples of ligature capturing implants are shown in
FIGS. 1-28 , though any ligature capturing implant known or developed in the art can be used, Examples of a conformable ligature looped about one or more structures are shown inFIGS. 29-38 . The structures can include bones, rods and other structures in a patient's body. Initially, the surgeon can configure the ligature capturing implant to allow tightening of the ligature. Another portion of the ligature can be coupled totensioning tool 300 at tensioningmember 325. According to one embodiment, the conformable ligature is attached by creating a loop with the free ends of the ligature (e.g., such as ends 42 and 44 ofFIG. 6C ). This can be done using pins, brackets, metal attachments, sewing, a knot, a clamp or other mechanism for forming the free ends into a loop. In other embodiments, the conformable ligature may be clamped to a portion oftool 300 or otherwise attached totool 300. - Before or after attaching the ligature to tensioning
member 325, the surgeon can bringconnector 335 into contact with the ligature capturing body so thatconnector 335 pushes against the ligature capturing body as the ligature is tensioned. Rotatingdrive shaft 310 causescarriage 315 to move alongslot 320. Ascarriage 315 moves, a portion of the conformable ligature is pulled causing the loop about the various structures to tighten. When the surgeon determines that the ligature is sufficiently tightened about the structures to be fixed, the surgeon can tighten the ligature capturing implant so that the ligature does not move within the ligature capturing implant thereby securing the loop about the structures. In other embodiments, the ligature capturing implant may be configured to allow the ligature to be tightened but not loosened. Consequently, once the surgeon is satisfied with the tension in the loop, the surgeon does not have to further adjust the ligature capturing implant to prevent loosening of the loop. Preferably,tensioning tool 300 can apply a tensioning force of at least between 300 and 1500 Newtons to the conformable ligature. - When the loop about the structures is secure, the surgeon can rotate
drive shaft 310 in the opposite direction to movecarriage 315 towardsconnector 335. This will release the tension from the portion of the ligature betweentensioning member 325 and the ligature capturing implant to allow the surgeon to remove thetensioning tool 300. - The embodiment of
FIGS. 40 and 41 provides several advantages over the embodiment ofFIG. 39 . First, the movement speed and placement ofcarriage 315 can be finely controlled by controlling rotation ofdrive shaft 310. This allows the surgeon to have continuous control over the tensioning process and greater control over the final tension of the ligature when compared to the pulsed tensioning provided by the embodiment ofFIG. 39 . Furthermore, the surgeon can easily reduce the tension in the ligature by small, controllable amounts simply by rotatingdrive shaft 310 in the opposite direction. Consequently, if the surgeon deems that the ligature is too tight, the surgeon can rotatedrive shaft 310 in the appropriate direction until the ligature is at the appropriate lower tension. This is a simpler process than having to release a relatively large amount of tension and then retention the ligature to the desired tension. - Another advantage is provided in procedures in which multiple ligatures are being installed. In some cases, surgeons find it desirable or necessary to use multiple ligatures. In such procedures, the surgeon will often want to tension each ligature a little at a time. For example, if there are three ligatures, the surgeon will tension the first ligature a small amount, then tension the second ligature a small amount, then tension the third ligature a small amount, then return to the first ligature and tension it some more and so on until all the ligatures are tensioned the appropriate amount. The embodiments of
FIGS. 40 and 41 provide an advantage for this type of procedure because they are less bulky. This allows tensioningtool 300 to be left in place during a procedure so that the surgeon can tension other ligatures with other similar tensioning tools without removingtensioning tool 300. Consequently, multiple tensioning tools can be during a procedure to progressively tension a number of ligatures. Thus, efforts can be divided along the spine during a reduction procedure so that reduction is continuous. -
FIGS. 42A and 42B illustrate another embodiment of atensioning tool 300.Tensioning tool 300 comprises atool body 305 and a threadeddrive shaft 310. Amovable carriage 315 is engaged with the threads ofdrive shaft 310 and moves alongslot 320 intool body 305. Slot 320 can partially overlapcarriage 315 to capturecarriage 315 inslot 320. In other embodiments,carriage 315 can be held in place bydrive shaft 310.Carriage 315carries tensioning member 325 that acts as an attachment point for a conformable ligature.Tensioning tool 300 further includes a handle that provides an ergonomic user control to rotatedrive shaft 310. According to one embodiment, the handle can connect to driveshaft 310 using aquick connect 330. -
Tensioning tool 300 also includes aconnector 335 shaped to interface with a ligature capturing implant (e.g., such as the connection parts shown inFIGS. 1-13 and blocking bodies shown inFIGS. 14-38 ).Connector 335 can be shaped to abut a variety of ligature capturing implants orconnector 335 can be interchangeable such that a surgeon can select the appropriate interface member based on the type(s) of ligature capturing implants used in a particular procedure. According to one embodiment,connector 335 can simply abut the ligature capturing implant or, according to other embodiments, may attach to the ligature capturingimplant Connector 330 can includetangs 340 that define anopen area 345 through which the ends of the conformable ligature can pass so that a portion of conformable ligature can be looped around tensioningmember 325. -
FIGS. 42A and 42B further showextensions 366 that can move inslot 420 asdrive shaft 310 moves (e.g., due to compression ofspring 365 shown in the embodiment ofFIG. 40 ). The position ofextensions 366 can be used to determine the amount of force applied to the spring and hence the ligature. - In the embodiment of
FIG. 42A ,carriage 315 includes aportion 370 that is exterior totool body 305. This portion can allow a surgeon to more easily graspcarriage 315 with fingers or a tool to allow the surgeon to manipulatecarriage 315. This can be advantageous in embodiments such as shown inFIGS. 43A and 43B in which the orientation of the carriage can be changed to engage or disengagecarriage 315 fromdrive shaft 310. -
FIG. 42B is a diagrammatic representation oftensioning tool 300 withhandle 375 attachedHandle 375 provides an ergonomic interface for a surgeon to rotatedrive shaft 310 and may be detachable or fixed. If the handle is detachable, a kit fortensioning tool 300 can include a variety of handles to allow a surgeon to select apreferred handle 375. In other embodiments, a motor may attach to driveshaft 310 to allow for motorized rotation ofdrive shaft 310. -
FIGS. 43A and 43B are diagrammatic representations of a view ofcarriage 315 carryingtensioning member 325 in a first orientation (FIG. 43A ) and a second orientation (FIG. 43B ) relative to driveshaft 310.Carriage 315 includes adrive shaft passage 355 through which driveshaft 310. Drive shaft passage can completely or partially encircledrive shaft 310. In the embodiments ofFIGS. 43A and 43B , driveshaft passage 355 includesthread engaging portions 380 and unthreadedportions 385. Driveshaft passage 355 can be shaped and sized such thatcarriage 315 can rock slightly to selectively engage or disengagedthread engaging portions 380 with threads ondrive shaft 310. According to one embodiment, the center of mass ofcarriage 315 can be positioned so thatcarriage 325 naturally rests in the orientation ofFIG. 43A withthread engaging portions 380. In any case, when force is applied to tensioningmember 325 by a tensioned ligature,carriage 315 will tend to rotate to engagethread engaging portions 380.Carriage 315 can be rotated slightly to disengagethread engaging portions 380. This can allow a user to easily slidecarriage 315 to a desired position. For example, a user can apply force by hand or with a tool toportion 370 to rotatecarriage 315 from the position shown inFIG. 43A to the position shown inFIG. 43B to slidecarriage 315 in either direction alongdrive shaft 310. - The ability to selectively disengage
thread engaging portions 380 so that the user can slidecarriage 315 may make the various portions of the tensioning procedure more efficient. Rather than having to rotatedrive shaft 310 to movecarriage 315 to a position in which the conformable ligature begins to tension, a user can slidecarriage 315 to that position (or other desired position) and then rotatedrive shaft 310 to further tension the conformable ligature. Additionally, once the tension of the loop about the various structures in the body has been set by fully closing the ligature capturing implant to prevent loosening of the loop, the user can simply slidecarriage 315 alongdrive shaft 310 to remove tension from the portion of the conformable ligature attached to tensioningmember 325. Additionally, if for some reason a user determines that tension must be released from the conformable ligature quickly, the user can do so by slidingcarriage 315 rather than rotatingdrive shaft 310. - In the embodiment of
FIGS. 43A and 43B , driveshaft passage 355 includesthread engaging portions 380 on the top portion of one end and the bottom portion of the other end. In other embodiments, driveshaft passage 355 may include athread engaging portion 380 at just one end or at any suitable point alongdrive shaft passage 355. - In the previous embodiments, tensioning
member 325 is carried bycarriage 315 that moves alongdrive shaft 310 asdrive shaft 310 rotates. In other embodiments, the tensioning member is located at the end of a movable shaft.FIG. 44 is a diagrammatic representation of another embodiment of a tensioning tool. In the embodiment ofFIG. 44 , atensioning tool 400 can include atool body 405, a tensioningmember shaft 410 and arotatable column 415. Tensioningmember shaft 410 carries atensioning member 412 in the form of a hook. Tensioningmember shaft 410 can include threads that engage withrotatable column 415. Rotation ofcolumn 415 can causeshaft 410 to actuate to move tensioningmember 412 towards or away fromligature capturing implant 420. In the embodiment ofFIG. 44 , a user can loop a portion of theconformable ligature 418 about tensioningmember 425 and rotatecolumn 415 to actuateshaft 410 to increase or release tension in the conformable ligature. -
Tensioning tool 400 can include anend 425 that contacts ligature capturingimplant 420. According to one embodiment, the end oftensioning tool 400 can act as a tool portion to tighten a rotatable ring or other portion ofligature capturing implant 420 to capture the conformable ligature inligature capturing implant 420. As one example, end 425 can be adapted to engage withtool portions 134 of the ligature capturing implant shown inFIG. 25 . - Thus, like the embodiments of
FIGS. 40-42B , the embodiment ofFIG. 44 includes a first portion in threaded engagement with a second portion. Rotation of the portions relative to each other causes translation oftensioning member 412. The position of tensioningmember 412 can be continuously controlled, avoiding the shortcomings of pulsed tensioning. Additionally, the tension can be easily released by rotating the portions oftensioning tool 400 in an opposite direction to move tensioningmember 412 closer to ligature capturingimplant 420. - In the above embodiments, a portion of the tensioning tool is rotated to translate a tensioning member. While specific embodiments are shown, other embodiments of translating a tensioning member can be used. For example, the tensioning member can be coupled to the tool body. As a shaft advances due to rotation either of the shaft or another portion of the tensioning tool in threaded engagement with the shaft, the tool body and consequently, the tensioning member can be pushed away from the ligature capturing implant causing tension in the ligature to increase. The tension can be reduced by rotating the portions of the tensioning tool in threaded engagement in the opposite direction relative to each other.
- According to various embodiments, a surgical procedure can be performed using a tensioning tool that provides continuous control over tensioning the ligature. A user can form a loop about one or more structures in a patient's body with a conformable ligature and a ligature capturing implant. The ligature capturing implant can include ligature capturing comprising rods, compression members or other ligature capturing implant. The structures can include, for example, a bone, a bone fastener, a tendon, a bone graft, a plate, a rod or other structure in the body. For example, the loop can be placed about a portion of a vertebra. The user can attach a portion of the conformable ligature to a tensioning member of a tensioning tool that provides a continuous range of control. The tensioning tool can comprise a first portion in threaded engagement with a second portion. The user can rotate the first portion relative to the second portion to move the tensioning member to tension the loop. For example, a user can rotate a drive shaft to move a carriage carrying the tensioning member. In some embodiments, the user can disengage the carriage from the drive shaft and slide the carriage along the drive shaft to a selected position. As another example, the user can rotate a portion of a tool engaged with a threaded shaft to cause the cause the shaft to move. The first portion can also be rotated relative to the second portion in an opposite direction to release tension from the loop. The method can further comprise positioning the tensioning tool so that a connecting portion of the tensioning tool abuts the ligature capturing implant.
- According to one embodiment, a spinal reduction can be performed using tensioning tools. A method of progressive spinal reduction can comprise forming multiple loops about structures in a patient's body with multiple conformable ligatures and ligature capturing implants and partially tensioning each conformable ligature in turn with a corresponding tensioning tool until each conformable ligature is at a desired tension to perform spinal reduction procedure. Tensioning each conformable ligature may comprise attaching a portion of that conformable ligature to a tensioning member of the corresponding tensioning tool, the corresponding tensioning tool comprising a first portion in threaded engagement with a second portion and rotating the first portion relative to the second portion to move the tensioning member away from a corresponding ligature capturing implant to tension that conformable ligature about at least a portion of a vertebra. The first portion is rotated relative to the second portion about an axis that is substantially parallel to a primary direction of movement of the tensioning member.
- Another embodiment of a method comprises providing a tensioning tool comprising, a tool body defining a slot, a threaded drive shaft running through at least a portion of the tool body, a tensioning member and a carriage coupled to the tensioning member. The carriage defines a drive shaft passage having at least one thread engaging portion to engage threads on the drive shaft. The drive shaft passes through the drive shaft passage. The method further comprises forming a loop about one or more structures in a patient's body with a conformable ligature and a ligature capturing implant, coupling a portion of the conformable ligature to the tensioning member and rotating the drive shaft to move the carriage away from the ligature capturing implant to tension the conformable ligature. Embodiments can also include rotating the drive shaft the opposite direction to release tension from the loop. The structures about which the loop is formed can include, for example, a bone, a bone fastener, a tendon, a bone graft, a plate, a rod or other structure in the body. For example, the loop can be located about at least a portion of a vertebra for a spinal reduction procedure.
- According to one embodiment, the drive shaft passage of the carriage includes one or more additional unthreaded portions. The method can further comprise rotating the carriage to disengage the at least one thread engaging portion from the threaded drive shaft and sliding the carriage along the drive shaft to a desired position.
- Another embodiment of a method comprises passing a conformable ligature around one or more structures in a body, passing first and second ends of the conformable ligature through a loop passage in a ligature capturing implant to form a loop, adjusting the ligature capturing implant to increase to resistance on the movement of the conformable ligature to a selected amount that allows the conformable ligature to move through the ligature capturing implant when a force is applied to the conformable ligature, attaching a portion of the conformable ligature to a tensioning member of a tensioning tool, rotating a threaded drive shaft of the tensioning tool to move the tensioning member to apply tension to the conformable ligature and adjusting the ligature tensioning implant to prevent the loop from loosening. According to one embodiment, rotating a threaded drive shaft of the tensioning tool to move the tensioning member comprises rotating the threaded drive shaft to move a carriage coupled to the tensioning member. The carriage can define a drive shaft passage having at least one thread engaging portion to engage threads on the drive shaft and wherein the drive shaft passes through the drive shaft passage. The method can further comprise positioning the tensioning tool so that a connecting portion of the tensioning tool abuts the ligature capturing implant. According to one embodiment the drive shaft can be rotated in an opposite direction to release tension from the conformable ligature.
- According to one embodiment a drive shaft passage can include one or more additional unthreaded portions. The method can further include rotating the carriage to disengage the at least one thread engaging portion from the threaded drive shaft and sliding the carriage along the drive shaft to a desired position.
- Another embodiment comprises a tensioning tool providing continuous control of conformable ligature tension, comprising a tool body defining a slot, a connection portion shaped to at least abut a ligature capturing implant, a threaded drive shaft running through at least a portion of the tool body, a tensioning member and a carriage coupled to the tensioning member, the carriage defining a drive shaft passage having at least one thread engaging portion to engage threads on the drive shaft and wherein the drive shaft passes through the drive shaft passage, wherein rotation of the drive shaft causes the carriage to move towards or away from the connection portion. According to one embodiment, the carriage is configured to be rotated from a first position in which the at least one thread engaging portions are engaged with threads on the drive shaft to a second, slidable position, in which the at least one thread engaging portions are not engaged with the threads of the drive shaft. The tensioning tool can further comprise a drive shaft seat in which a first end of the drive shaft is seated, a spring that compresses between the drive shaft seat of and the tool body, and a removable handle connected to a second end of the drive shaft distal from the first end.
- The foregoing specification and accompanying figures are for the purpose of teaching those skilled in the art the manner of carrying out the disclosure and should be regarded in an illustrative rather than a restrictive sense. As one skilled in the art can appreciate, embodiments disclosed herein can be modified or otherwise implemented in many ways without departing from the spirit and scope of the disclosure and all such modifications and implementations are intended to be included within the scope of the disclosure as set forth in the claims below.
Claims (19)
1. A tensioning tool providing continuous control of conformable ligature tension, comprising:
a tool body defining a slot;
a connection portion shaped to at least abut a ligature capturing element;
a threaded drive shaft running through at least a portion of the tool body;
a carriage movable along the slot, the carriage defining a drive shaft passage having at least one thread engaging portion to engage threads on the drive shaft and wherein the drive shaft passes through the drive shaft passage; and
a tensioning member coupled to the carriage;
wherein the carriage is configured to be rotated from a first position in which the at least one thread engaging portion is engaged with threads on the drive shaft to a second, slidable position, in which the at least one thread engaging portion is not engaged with the threads of the drive shaft;
wherein rotation of the drive shaft causes the carriage to move towards or away from the connection portion.
2. The tensioning tool of claim 1 , further comprising:
a drive shaft seat in which a first end of the drive shaft is seated;
a spring that compresses between the drive shaft seat and the tool body, wherein the first end is an end proximate the connection portion.
3. The tensioning tool of claim 2 , further comprising:
one or more markings on the tool body that indicate an amount of compression of the spring.
4. The tensioning tool of claim 1 , further comprising:
a detachable handle connected to the drive shaft proximate to a second end that is distal from the first end.
5. The tensioning tool of claim 1 , wherein the drive shaft passage includes a first thread engaging portion at a first end of the drive shaft passage, a second thread engaging portion at a second end of the drive shaft passage, and a non-threaded portion positioned between the first thread engaging portion and the second thread engaging portion.
6. The tensioning tool of claim 5 , wherein the first thread engaging portion and the second thread engaging portion are located on opposing sides of the drive shaft passage.
7. The tensioning tool of claim 1 , wherein the tensioning member is a post extending from the carriage.
8. The tensioning tool of claim 7 , wherein the post is configured to receive a loop of a conformable ligature therearound.
9. The tensioning tool of claim 1 , wherein the tool body extends through the carriage with a portion of the carriage including the drive shaft passage extending into the slot for receiving the drive shaft therethrough.
10. A tensioning tool for applying tension to a conformable ligature of a bone fixing system, the tension tool comprising:
an elongate tool body having a first end and a second end;
a threaded drive shaft extending along at least a portion of the tool body;
a connection portion positioned at the second end of the elongate tool body shaped to engage a ligature capturing element of the bone fixing system; and
a carriage movable along the elongate tool body to selectively apply tension to the conformable ligature via movement of the carriage;
the carriage defining a drive shaft passage through which the drive shaft extends through, the drive shaft passage having at least one thread engaging portion configured to engage threads on the drive shaft;
wherein the carriage is configured to be actuated between a first position and a second position; and
wherein in the first position the at least one thread engaging portion is engaged with threads on the drive shaft such that rotation of the drive shaft causes the carriage to move along the elongate tool body, and in the second position the at least one thread engaging portion is not engaged with the threads of the drive shaft such that the carriage is freely movable along the elongate tool body without rotation of drive shaft.
11. The tensioning tool of claim 10 , wherein the drive shaft passage includes a first thread engaging portion at a first end of the drive shaft passage, a second thread engaging portion at a second end of the drive shaft passage, and a non-threaded portion positioned between the first thread engaging portion and the second thread engaging portion.
12. The tensioning tool of claim 11 , wherein the first thread engaging portion and the second thread engaging portion are located on opposing sides of the drive shaft passage.
13. The tensioning tool of claim 10 , further comprising a tensioning member extending from the carriage configured to receive a loop of a conformable ligature therearound.
14. The tensioning tool of claim 10 , wherein the carriage is actuated between the first position and the second position by rotating the carriage about an axis generally perpendicular to a longitudinal axis of the drive shaft.
15. The tensioning tool of claim 14 , wherein the at least one thread engaging portion is moved into engagement with threads of the drive shaft as the carriage is rotated to the first position.
16. The tensioning tool of claim 15 , wherein the at least one thread engaging portion is moved out of engagement with threads of the drive shaft as the carriage is rotated to the second position.
17. The tensioning tool of claim 10 , wherein the drive shaft extends through at least a portion of the elongate tool body.
18. The tensioning tool of claim 17 , wherein the elongate tool body includes an elongate slot along which the carriage travels.
19. The tensioning tool of claim 18 , wherein the elongate tool body extends through the carriage with a portion of the carriage including the drive shaft passage extending into the slot for receiving the drive shaft therethrough.
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US14/918,198 US20160038194A1 (en) | 2007-10-23 | 2015-10-20 | Bone fixation tensioning tool and method |
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Cited By (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20120157998A1 (en) * | 2007-10-11 | 2012-06-21 | Zimmer Spine | Bone fixing system and method of use |
CN107530111A (en) * | 2015-04-17 | 2018-01-02 | 因普拉耐特公司 | Vertebrae is fixed to the device and system on bar |
US10307186B2 (en) | 2016-12-02 | 2019-06-04 | Nuvasive, Inc. | Surgical band clamp system |
US10595904B2 (en) | 2011-09-14 | 2020-03-24 | Band-Lok, Llc | Tensioning instrument and band clamp tensioning system |
US11026722B2 (en) | 2011-09-14 | 2021-06-08 | Orthopediatrics Corp. | Orthopedic tethered implants and system |
US11819255B2 (en) | 2019-10-07 | 2023-11-21 | Ortho Development Corporation | Tether tensioning instrumentation and related methods |
Families Citing this family (43)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP2052689B1 (en) * | 2007-10-23 | 2011-12-14 | Zimmer Spine | Fixing devices and stabilization systems using said fixing devices |
EP2296567B1 (en) * | 2008-06-06 | 2014-03-12 | Simpirica Spine, Inc. | Apparatus for locking a band |
EP2279707A1 (en) | 2009-07-31 | 2011-02-02 | Zimmer Spine | Bone fixing system |
EP2316363A1 (en) | 2009-10-27 | 2011-05-04 | Zimmer Spine | Bone holding device |
FR2954905B1 (en) | 2010-01-06 | 2012-12-28 | Implanet | DEVICE FOR FIXING VERTEBRAL |
US8936611B2 (en) | 2010-05-27 | 2015-01-20 | Raptor Surgical, LLC | Apparatus and methods for achilles tendon repair |
BRPI1002494B1 (en) * | 2010-07-12 | 2015-08-18 | João Bosco De Oliveira | Shear with tensioning device |
EP2422728B1 (en) | 2010-08-25 | 2013-01-30 | Zimmer Spine | Anchor for attachment to a bony structure |
EP2460482A1 (en) * | 2010-12-03 | 2012-06-06 | Zimmer Spine | Rod holding device |
FR2968739B1 (en) | 2010-12-08 | 2012-12-28 | Implanet | DEVICE FOR TENSIONING A FLEXIBLE STRIP |
FR2977138B1 (en) * | 2011-06-30 | 2014-02-28 | Implanet | DEVICE FOR FIXING VERTEBRAL |
US9358047B2 (en) | 2011-07-15 | 2016-06-07 | Globus Medical, Inc. | Orthopedic fixation devices and methods of installation thereof |
US9198694B2 (en) | 2011-07-15 | 2015-12-01 | Globus Medical, Inc. | Orthopedic fixation devices and methods of installation thereof |
US11103286B2 (en) | 2011-07-15 | 2021-08-31 | Globus Medical, Inc. | Orthopedic fixation devices and methods of installation thereof |
EP2734135B1 (en) | 2011-07-21 | 2018-03-21 | Zimmer Spine | Spinal rod fixing device |
US8636770B2 (en) | 2011-08-08 | 2014-01-28 | Zimmer Spine, Inc. | Bone anchoring device |
ES2558083T3 (en) * | 2011-09-30 | 2016-02-01 | Biedermann Technologies Gmbh & Co. Kg | Bone anchoring device and tool that cooperates with said bone anchoring device |
FR2981841B1 (en) * | 2011-10-28 | 2013-12-20 | Implanet | DEVICE FOR TENSIONING A SOFT BAND AND COMPRISING ASSEMBLY SUCH DEVICE WITH FLEXIBLE BAND |
FR2988992B1 (en) * | 2012-04-04 | 2015-03-20 | Medicrea International | MATERIAL OF VERTEBRAL OSTEOSYNTHESIS |
US9757160B2 (en) * | 2012-09-28 | 2017-09-12 | Globus Medical, Inc. | Device and method for treatment of spinal deformity |
GB201220042D0 (en) * | 2012-11-07 | 2012-12-19 | Murray David W | Adjusting spinal curvature |
US20140148854A1 (en) * | 2012-11-28 | 2014-05-29 | Zimmer Spine, Inc. | Vertebral fixation system |
US9173654B2 (en) | 2012-12-11 | 2015-11-03 | Raptor Surgical, LLC | System for tissue repair |
US9289205B2 (en) | 2012-12-11 | 2016-03-22 | Raptor Surgical, LLC | Systems for soft tissue repair |
EP2762095B1 (en) | 2013-01-31 | 2016-05-25 | Zimmer Spine | Device for fixing a bony structure to a support member |
US10548644B2 (en) * | 2013-03-05 | 2020-02-04 | Globus Medical, Inc. | Elastic member clamps |
US9433441B2 (en) * | 2013-03-05 | 2016-09-06 | Globus Medical, Inc. | Elastic member clamps |
US10034692B2 (en) | 2013-03-05 | 2018-07-31 | Globus Medical, Inc. | Elastic member clamps |
FR3012032B1 (en) | 2013-10-18 | 2015-12-11 | Implanet | DEVICE AND SYSTEM FOR VERTICAL FASTENING FOR HOLDING A VERTEBRA ON A ROD, METHOD OF BLOCKING A LOOP WITH SUCH A DEVICE. |
FR3026636B1 (en) * | 2014-10-01 | 2017-09-15 | Cousin Biotech | ANCHORAGE FOR TENSIONING A LONGILINE ELEMENT FOR ATTACHING AN IMPLANT TO A BONE MEMBER |
US9931138B2 (en) | 2014-10-15 | 2018-04-03 | Globus Medical, Inc. | Orthopedic extendable rods |
US9924976B2 (en) * | 2015-09-24 | 2018-03-27 | Warsaw Orthopedic, Inc. | Spinal implant system and method |
EP3278750B1 (en) | 2016-08-04 | 2018-12-12 | Biedermann Technologies GmbH & Co. KG | Polyaxial bone anchoring device and system of an instrument and a polyaxial bone anchoring device |
EP3287089B1 (en) | 2016-08-24 | 2019-07-24 | Biedermann Technologies GmbH & Co. KG | Polyaxial bone anchoring device and system of an instrument and a polyaxial bone anchoring device |
US10603078B2 (en) * | 2016-10-26 | 2020-03-31 | Warsaw Orthopedic, Inc. | Surgical instrument and method |
IT201700041980A1 (en) * | 2017-04-14 | 2018-10-14 | Medical Microinstruments Spa | ROBOTIC ASSEMBLY FOR MICROSURGERY |
EP3476340B1 (en) | 2017-10-25 | 2021-06-02 | Biedermann Technologies GmbH & Co. KG | Polyaxial bone anchoring device |
US11344337B2 (en) * | 2018-02-19 | 2022-05-31 | Zimmer Biomet Spine, Inc. | Systems for attenuation of increased spinal flexion loads post-fusion and associated methods |
EP3536271B1 (en) | 2018-03-06 | 2022-05-04 | Biedermann Technologies GmbH & Co. KG | Polyaxial bone anchoring device and system of an instrument and a polyaxial bone anchoring device |
US20210077091A1 (en) * | 2018-05-29 | 2021-03-18 | Smith & Nephew, Inc. | Suture passer with locking actuator |
US11284879B2 (en) | 2018-12-13 | 2022-03-29 | Howmedica Osteonics Corp. | Systems for soft tissue repair |
US11771472B2 (en) * | 2019-10-29 | 2023-10-03 | Globus Medical, Inc. | Sublaminar band clamp |
US11771475B2 (en) | 2020-10-07 | 2023-10-03 | Globus Medical, Inc. | Systems and methods for surgical procedures using band clamp implants and tensioning instruments |
Citations (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6482208B1 (en) * | 1998-11-25 | 2002-11-19 | Alliance Orthopedic, Inc. | Fracture reduction clamp |
US6689140B2 (en) * | 2000-10-02 | 2004-02-10 | Howmedica Osteonics Corp. | System and method for spinal reconstruction |
US8172847B2 (en) * | 2007-03-29 | 2012-05-08 | Depuy Spine, Inc. | In-line rod reduction device and methods |
Family Cites Families (108)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US570751A (en) | 1896-11-03 | Jto-litho | ||
US902040A (en) * | 1906-03-12 | 1908-10-27 | Homer W Wyckoff | Wire-connector. |
US1346940A (en) * | 1919-10-28 | 1920-07-20 | Asa W Collins | Apparatus for binding fractured bones |
FR522040A (en) | 1920-08-07 | 1921-07-24 | Auguste Henri Contassot | Ligating device |
FR26156E (en) | 1922-03-30 | 1923-09-05 | Ligating device | |
US2049361A (en) * | 1934-10-27 | 1936-07-28 | Ericsson Ernst Axel Johan | Wire or ribbon tightening apparatus |
DE3325650A1 (en) * | 1983-07-15 | 1985-01-24 | Eckart Dr.med. 8000 München Frimberger | STiffening probe and tensioning device for this |
US4570618A (en) | 1983-11-23 | 1986-02-18 | Henry Ford Hospital | Intervertebral body wire stabilization |
USRE36221E (en) | 1989-02-03 | 1999-06-01 | Breard; Francis Henri | Flexible inter-vertebral stabilizer as well as process and apparatus for determining or verifying its tension before installation on the spinal column |
US5030220A (en) * | 1990-03-29 | 1991-07-09 | Advanced Spine Fixation Systems Incorporated | Spine fixation system |
US5190545A (en) * | 1991-08-27 | 1993-03-02 | Pfizer Hospital Products Group, Inc. | Cerclage wire positioning insert |
US5304178A (en) * | 1992-05-29 | 1994-04-19 | Acromed Corporation | Sublaminar wire |
FR2693364B1 (en) * | 1992-07-07 | 1995-06-30 | Erpios Snc | INTERVERTEBRAL PROSTHESIS FOR STABILIZING ROTATORY AND FLEXIBLE-EXTENSION CONSTRAINTS. |
GB9217578D0 (en) | 1992-08-19 | 1992-09-30 | Surgicarft Ltd | Surgical implants,etc |
US5356412A (en) * | 1992-10-09 | 1994-10-18 | United States Surgical Corporation | Sternum buckle with rotational engagement and method of closure |
JPH07505078A (en) | 1993-01-19 | 1995-06-08 | ジベエス ソシエテ アノニム | Variable implant for vertebral osteosynthesis with costotransverse bilaterally supported monoblock hooks |
US5413576A (en) * | 1993-02-10 | 1995-05-09 | Rivard; Charles-Hilaire | Apparatus for treating spinal disorder |
US5449361A (en) * | 1993-04-21 | 1995-09-12 | Amei Technologies Inc. | Orthopedic cable tensioner |
FR2704745B1 (en) | 1993-05-07 | 1995-11-24 | Erpios | Device for connecting the ends of a ligament for osteosynthesis, in particular for vertebral osteosynthesis. |
WO1995022294A1 (en) | 1994-02-17 | 1995-08-24 | Surgical Accessories, Inc. | Fastener and tensioner for bone securing cable |
CA2141911C (en) * | 1994-02-24 | 2002-04-23 | Jude S. Sauer | Surgical crimping device and method of use |
FR2722088B1 (en) | 1994-07-08 | 1998-01-23 | Cahlik Marc Andre | SURGICAL IMPLANT FOR STABILIZING THE INTERVERTEBRAL SPACE |
FR2731344B1 (en) * | 1995-03-06 | 1997-08-22 | Dimso Sa | SPINAL INSTRUMENTATION ESPECIALLY FOR A ROD |
US6447518B1 (en) * | 1995-07-18 | 2002-09-10 | William R. Krause | Flexible shaft components |
FR2742649B1 (en) | 1995-12-22 | 1998-04-10 | Robert Louis Boutet | STRAPPING LINK FOR MEDICAL USE AND METHOD OF LAYING THE SAME |
US5667508A (en) * | 1996-05-01 | 1997-09-16 | Fastenetix, Llc | Unitary locking cap for use with a pedicle screw |
US5702399A (en) * | 1996-05-16 | 1997-12-30 | Pioneer Laboratories, Inc. | Surgical cable screw connector |
US5782831A (en) * | 1996-11-06 | 1998-07-21 | Sdgi Holdings, Inc. | Method an device for spinal deformity reduction using a cable and a cable tensioning system |
US5720751A (en) * | 1996-11-27 | 1998-02-24 | Jackson; Roger P. | Tools for use in seating spinal rods in open ended implants |
US5713897A (en) * | 1997-03-06 | 1998-02-03 | Goble; E. Marlowe | Anterior cruciate ligament tensioning device and method for its use |
GB2323036B (en) * | 1997-03-14 | 2001-04-11 | Finsbury | Prosthetic implant and surgical tool |
FR2761590B1 (en) * | 1997-04-04 | 1999-08-20 | Stryker France Sa | DEVICE FOR OSTEOSYNTHESIS OF THE RACHIS WITH ATTACHMENT OF DEAXED INTERVERTEBRAL ROD |
DE19716504A1 (en) | 1997-04-19 | 1998-12-03 | Hinze Manfred Dr Med Habil | Compression hoop for applying metal band around bone |
US5964769A (en) * | 1997-08-26 | 1999-10-12 | Spinal Concepts, Inc. | Surgical cable system and method |
US6053921A (en) * | 1997-08-26 | 2000-04-25 | Spinal Concepts, Inc. | Surgical cable system and method |
US6179838B1 (en) * | 1998-02-24 | 2001-01-30 | Daniel Fiz | Bone fixation arrangements and method |
US6241740B1 (en) * | 1998-04-09 | 2001-06-05 | Origin Medsystems, Inc. | System and method of use for ligating and cutting tissue |
DE69905707T2 (en) * | 1998-04-29 | 2003-11-06 | Dimso Sa | SPINE OSTEOSYNTHESIS SYSTEM WITH TENSIONING DEVICE, ESPECIALLY FOR FRONT FIXING |
US6099527A (en) * | 1998-04-30 | 2000-08-08 | Spinal Concepts, Inc. | Bone protector and method |
US6086590A (en) * | 1999-02-02 | 2000-07-11 | Pioneer Laboratories, Inc. | Cable connector for orthopaedic rod |
US6146386A (en) * | 1999-02-04 | 2000-11-14 | Sdgi Holdings, Inc. | Cable operated bone anchor compressor |
US6228096B1 (en) * | 1999-03-31 | 2001-05-08 | Sam R. Marchand | Instrument and method for manipulating an operating member coupled to suture material while maintaining tension on the suture material |
US6299613B1 (en) | 1999-04-23 | 2001-10-09 | Sdgi Holdings, Inc. | Method for the correction of spinal deformities through vertebral body tethering without fusion |
US6419702B1 (en) * | 1999-08-13 | 2002-07-16 | Bret A. Ferree | Treating degenerative disc disease through transplantation of the nucleus pulposis |
US6352557B1 (en) * | 1999-08-13 | 2002-03-05 | Bret A. Ferree | Treating degenerative disc disease through transplantion of extracellular nucleus pulposus matrix and autograft nucleus pulposus cells |
DE19950252C2 (en) * | 1999-10-18 | 2002-01-17 | Schaefer Micomed Gmbh | bone plate |
FR2799948B1 (en) | 1999-10-22 | 2002-03-29 | Transco Esquisse | CONNECTION BAR FOR ANCHORING AN INTER-THINNING PROSTHESIS |
SE0000327D0 (en) | 2000-01-31 | 2000-01-31 | Sven Olerud | Device for locking metal wire against metal bar and method for locking the same to be used in spinal surgery |
US6569171B2 (en) * | 2001-02-28 | 2003-05-27 | Microline, Inc. | Safety locking mechanism for a medical clip device |
US6514255B1 (en) * | 2000-02-25 | 2003-02-04 | Bret Ferree | Sublaminar spinal fixation apparatus |
US6723335B1 (en) * | 2000-04-07 | 2004-04-20 | Jeffrey William Moehlenbruck | Methods and compositions for treating intervertebral disc degeneration |
US6547770B2 (en) * | 2000-04-14 | 2003-04-15 | Aiolos Systems Aktiebolag (Ab) | Ophthalmic dispensing device |
JP2001299770A (en) | 2000-04-20 | 2001-10-30 | Azwell Inc | Clip for bone fixing string |
US6605091B1 (en) | 2000-06-30 | 2003-08-12 | Pioneer Laboratories, Inc. | Surgical cable assembly and method |
FR2812186B1 (en) | 2000-07-25 | 2003-02-28 | Spine Next Sa | FLEXIBLE CONNECTION PIECE FOR SPINAL STABILIZATION |
FR2812185B1 (en) | 2000-07-25 | 2003-02-28 | Spine Next Sa | SEMI-RIGID CONNECTION PIECE FOR RACHIS STABILIZATION |
GB0018826D0 (en) | 2000-08-02 | 2000-09-20 | Depuy Int Ltd | Improvements in and relating to fixings |
US6524315B1 (en) * | 2000-08-08 | 2003-02-25 | Depuy Acromed, Inc. | Orthopaedic rod/plate locking mechanism |
US6554831B1 (en) | 2000-09-01 | 2003-04-29 | Hopital Sainte-Justine | Mobile dynamic system for treating spinal disorder |
US6277120B1 (en) * | 2000-09-20 | 2001-08-21 | Kevin Jon Lawson | Cable-anchor system for spinal fixation |
US6773438B1 (en) * | 2000-10-19 | 2004-08-10 | Ethicon Endo-Surgery | Surgical instrument having a rotary lockout mechanism |
EP1502552A3 (en) * | 2000-10-24 | 2005-03-16 | The Spineology Group, LLC | Tension band clip |
US6716226B2 (en) * | 2001-06-25 | 2004-04-06 | Inscope Development, Llc | Surgical clip |
FR2817929B1 (en) | 2000-12-07 | 2003-03-21 | Spine Next Sa | DEVICE FOR FIXING A ROD AND A SPHERICAL SYMMETRY SCREW HEAD |
FR2818530B1 (en) | 2000-12-22 | 2003-10-31 | Spine Next Sa | INTERVERTEBRAL IMPLANT WITH DEFORMABLE SHIM |
FR2822051B1 (en) | 2001-03-13 | 2004-02-27 | Spine Next Sa | INTERVERTEBRAL IMPLANT WITH SELF-LOCKING ATTACHMENT |
US6478798B1 (en) * | 2001-05-17 | 2002-11-12 | Robert S. Howland | Spinal fixation apparatus and methods for use |
JP2004537354A (en) | 2001-07-20 | 2004-12-16 | スパイナル・コンセプツ・インコーポレーテッド | Spinal stabilization system and method |
US6796977B2 (en) * | 2001-09-28 | 2004-09-28 | Depuy Mitek, Inc. | Variable graft tensioner |
US6695852B2 (en) | 2001-10-31 | 2004-02-24 | Spineology, Inc. | Tension tools for tension band clip |
FR2836368B1 (en) * | 2002-02-25 | 2005-01-14 | Spine Next Sa | SEQUENTIAL LINK DEVICE |
EP1487352A4 (en) * | 2002-03-25 | 2006-07-12 | Dvl Acquisition Sub Inc | Surgical suturing instrument and method of use |
GB0212948D0 (en) | 2002-06-06 | 2002-07-17 | Grampian Univ Hospitals | Manipulator |
FR2842724B1 (en) * | 2002-07-23 | 2005-05-27 | Spine Next Sa | VERTEBRAL FASTENING SYSTEM |
US7250054B2 (en) * | 2002-08-28 | 2007-07-31 | Smith & Nephew, Inc. | Systems, methods, and apparatuses for clamping and reclamping an orthopedic surgical cable |
US20060064165A1 (en) | 2004-09-23 | 2006-03-23 | St. Francis Medical Technologies, Inc. | Interspinous process implant including a binder and method of implantation |
US7094240B2 (en) * | 2003-01-10 | 2006-08-22 | Sdgi Holdings, Inc. | Flexible member tensioning instruments and methods |
DE602004010125T2 (en) | 2003-07-08 | 2008-07-31 | Osiris Technology B.V. | INK JET PRINTER AND INK PRESSURE CONTROL |
FR2858929B1 (en) | 2003-08-21 | 2005-09-30 | Spine Next Sa | "INTERVERTEBRAL IMPLANT FOR LOMBO-SACRED JOINT" |
US7364061B2 (en) * | 2003-09-29 | 2008-04-29 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument incorporating a multistroke firing position indicator and retraction mechanism |
DE10348329B3 (en) * | 2003-10-17 | 2005-02-17 | Biedermann Motech Gmbh | Rod-shaped element used in spinal column and accident surgery for connecting two bone-anchoring elements comprises a rigid section and an elastic section that are made in one piece |
US7211093B2 (en) * | 2004-01-14 | 2007-05-01 | Lsi Solutions, Inc. | Sew-right running stitch instrument |
FR2867057B1 (en) | 2004-03-02 | 2007-06-01 | Spinevision | DYNAMIC BONDING ELEMENT FOR A SPINAL FIXING SYSTEM AND FIXING SYSTEM COMPRISING SUCH A CONNECTING MEMBER |
FR2870107B1 (en) | 2004-05-11 | 2007-07-27 | Spine Next Sa | SELF-LOCKING DEVICE FOR FIXING AN INTERVERTEBRAL IMPLANT |
FR2870109B1 (en) * | 2004-05-17 | 2007-04-13 | Spine Next Sa | INTERVERTEBRAL BLADE FOR CERVICAL VERTEBRATES |
FR2870718B1 (en) | 2004-05-25 | 2006-09-22 | Spine Next Sa | TREATMENT ASSEMBLY FOR THE DEGENERATION OF AN INTERVERTEBRAL DISC |
DK1781961T3 (en) * | 2004-06-09 | 2013-08-26 | Kinamed Inc | High voltage surgical cable locking device |
US20070088359A1 (en) * | 2005-02-07 | 2007-04-19 | Woods Richard W | Universal dynamic spine stabilization device and method of use |
US8696707B2 (en) * | 2005-03-08 | 2014-04-15 | Zyga Technology, Inc. | Facet joint stabilization |
FR2884135B1 (en) | 2005-04-07 | 2007-06-22 | Abbott Spine Sa | INTERVERTEBRAL IMPLANT FOR LOMBO-SACRED JOINT |
FR2884136B1 (en) | 2005-04-08 | 2008-02-22 | Spinevision Sa | INTERVERTEBRAL SURGICAL IMPLANT FORMING BALL |
US7789898B2 (en) * | 2005-04-15 | 2010-09-07 | Warsaw Orthopedic, Inc. | Transverse process/laminar spacer |
US20060276896A1 (en) * | 2005-06-02 | 2006-12-07 | Medicinelodge, Inc. | Bone implants with integrated line locks |
FR2889937B1 (en) | 2005-08-26 | 2007-11-09 | Abbott Spine Sa | INTERVERTEBRAL IMPLANT FOR LOMBO-SACRED JOINT |
FR2890850B1 (en) | 2005-09-20 | 2009-04-17 | Abbott Spine Sa | VERTEBRAL FASTENING SYSTEM |
FR2890851B1 (en) * | 2005-09-21 | 2008-06-20 | Abbott Spine Sa | ANCILLARY TO TENSION A FLEXIBLE LINK. |
DE502006004368D1 (en) | 2006-02-03 | 2009-09-10 | Spinelab Ag | spinal implant |
FR2897771B1 (en) | 2006-02-28 | 2008-06-06 | Abbott Spine Sa | INTERVERTEBRAL IMPLANT |
US7699874B2 (en) * | 2006-03-01 | 2010-04-20 | Warsaw Orthopedic, Inc. | Low profile spinal rod connector system |
US20070299445A1 (en) * | 2006-06-22 | 2007-12-27 | Shadduck John H | Spine treatment devices and methods |
EP2047813A1 (en) | 2007-10-11 | 2009-04-15 | Abbott Spine | Bone fixing system and method of use |
US8740941B2 (en) * | 2006-11-10 | 2014-06-03 | Lanx, Inc. | Pedicle based spinal stabilization with adjacent vertebral body support |
US8109978B2 (en) * | 2006-11-28 | 2012-02-07 | Anova Corporation | Methods of posterior fixation and stabilization of a spinal segment |
US7824430B2 (en) * | 2006-12-08 | 2010-11-02 | Warsaw Orthopedic, Inc. | Methods and devices for treating a multi-level spinal deformity |
US8323294B2 (en) * | 2007-08-21 | 2012-12-04 | Depuy Spine, Inc. | Tether tensioning instrument |
ATE515239T1 (en) | 2008-04-24 | 2011-07-15 | Zimmer Spine | SYSTEM FOR STABILIZING AT LEAST ONE SECTION OF THE SPINE |
ES2378142T3 (en) | 2008-05-20 | 2012-04-09 | Zimmer Spine | System to stabilize at least three vertebrae |
FR2931654B1 (en) | 2008-05-27 | 2011-12-16 | Medicrea International | MATERIAL OF VERTEBRAL OSTEOSYNTHESIS |
-
2007
- 2007-10-23 US US11/877,160 patent/US8128635B2/en not_active Expired - Fee Related
-
2012
- 2012-02-09 US US13/369,824 patent/US20120143207A1/en not_active Abandoned
- 2012-06-01 US US13/486,283 patent/US9204902B2/en not_active Expired - Fee Related
- 2012-06-01 US US13/486,312 patent/US9204903B2/en not_active Expired - Fee Related
-
2015
- 2015-10-20 US US14/918,198 patent/US20160038194A1/en not_active Abandoned
Patent Citations (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6482208B1 (en) * | 1998-11-25 | 2002-11-19 | Alliance Orthopedic, Inc. | Fracture reduction clamp |
US6689140B2 (en) * | 2000-10-02 | 2004-02-10 | Howmedica Osteonics Corp. | System and method for spinal reconstruction |
US8172847B2 (en) * | 2007-03-29 | 2012-05-08 | Depuy Spine, Inc. | In-line rod reduction device and methods |
Cited By (8)
Publication number | Priority date | Publication date | Assignee | Title |
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US20120157998A1 (en) * | 2007-10-11 | 2012-06-21 | Zimmer Spine | Bone fixing system and method of use |
US9101406B2 (en) * | 2007-10-11 | 2015-08-11 | Zimmer Spine | Bone fixing system and method of use |
US10595904B2 (en) | 2011-09-14 | 2020-03-24 | Band-Lok, Llc | Tensioning instrument and band clamp tensioning system |
US11026722B2 (en) | 2011-09-14 | 2021-06-08 | Orthopediatrics Corp. | Orthopedic tethered implants and system |
CN107530111A (en) * | 2015-04-17 | 2018-01-02 | 因普拉耐特公司 | Vertebrae is fixed to the device and system on bar |
US10307186B2 (en) | 2016-12-02 | 2019-06-04 | Nuvasive, Inc. | Surgical band clamp system |
US10945770B2 (en) | 2016-12-02 | 2021-03-16 | Nuvasive, Inc. | Surgical band clamp system |
US11819255B2 (en) | 2019-10-07 | 2023-11-21 | Ortho Development Corporation | Tether tensioning instrumentation and related methods |
Also Published As
Publication number | Publication date |
---|---|
US20160038194A1 (en) | 2016-02-11 |
US8128635B2 (en) | 2012-03-06 |
US20120239054A1 (en) | 2012-09-20 |
US20120239053A1 (en) | 2012-09-20 |
US9204903B2 (en) | 2015-12-08 |
US9204902B2 (en) | 2015-12-08 |
US20090105715A1 (en) | 2009-04-23 |
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Owner name: ZIMMER SPINE S.A.S., FRANCE Free format text: CHANGE OF NAME;ASSIGNOR:ABBOTT SPINE;REEL/FRAME:066861/0185 Effective date: 20090612 Owner name: ABBOTT SPINE, FRANCE Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:BELLIARD, KARL PIERRE;LARROQUE-LAHITETTE, GILLES;DELCLAUD, MARION JEANNE SOPHIE;AND OTHERS;SIGNING DATES FROM 20080422 TO 20080513;REEL/FRAME:066861/0018 |