Surgical screw delivery system and method

The human spine is a flexible or pliable weight bearing column of several vertebrae as designated bone is. There are 33 vertebrae that based on the of five Areas have been designated, in which they are located (cervical vertebrae, Vertebra, Lumbar, sacral vertebrae and coccyx vertebrae). When the spine of is considered top to bottom, there are generally seven cervical vertebrae, twelve vertebrae, five lumbar vertebrae, five sacral vertebrae and four coccygeal vertebrae. The vertebrae of the neck region, the back region and the lumbar region the spine are while a person's life, separated, the vertebrae in the sacrum area and in the coccyx area are in an adult, however, to form two bones joined together, the five sacral vertebrae of the Formation pass sacrum and five coccygeal vertebrae pass into the tailbone. In general, contains each vertebra a front solid segment or a front fixed body and a rear segment or arc. The arch is generally two handles and two laminae, the seven projections, namely four Joint projections, two transverse projections and a spinous Tab, enter. There are exceptions to these general characteristics vortices. For example, the first cervical vertebra (Atlas vertebra) neither a body still a spinous Head Start. Further, the second cervical vertebra (axis vertebra) a Odontoid Tab, which is a strong, out standing protrusion like teeth is shaped and extend perpendicularly from the upper surface of the body of the axis vertebra rises. Further details on the structure of the spine are Those of ordinary skill known and can be spread in such a Reference texts, such as Gray's Anatomy, Crown Publishers, Inc., 1977, p 33-54, are found.

In the last two decades has the use of implants for the stabilization of fractures and / or joining various portions of the spine increased greatly. These Implant devices comprise a plurality of longitudinal elements, such as rods or plates, on which span two or more vertebrae and by different fastening elements, such as wires, staples, and screws (Often introduced by the swirling stalks be), be attached to the vertebrae. These systems may be either the rear or the front side of the spine to be fixed. In many make are these implant systems from beneath the skin and have a higher Profile as a simpler fastening devices. Such simpler Fastening device relates to the stable rear joining the Atlas vertebra and the axis vertebra by Transarticular Screw using the technique of Magerl and others, which in Stable Posterior Fusion of the Atlas and Axis by Transarticular Screw fixation, F. Magerl, PS. Seeman, Cervical Spine, Volume 1, Springer-Verlag, copyright 1987, pp 322-327, in Primary Posterior Fusion 1-2 in Odontoid Factors; Indications, Technique, and Results of Transarticular Screw Fixation, B. Jeanneret and F. Magerl, Journal of Spinal Disorders, Volume 5, No. 4, pp. 464-475, 1992, Raven Press, Ltd., New York (see also atlanto-axial fusion With Transarticular Screw Fixation, D. Grob, B. Jeanneret, M. Aebi and TM Mark Walder, The Journal of Bone and Joint Surgery, Vol 73-B, no. 6, 1991, pp 972-976) discloses is.

The use of a screw fastening transarticular both in assembly procedures as well as stabilization procedures for fractures has been increasing constantly. Due to the small entry angle of the screw in relation to the back of a were on the operating table on her stomach lying patient in procedures involving the use of a screw fastening Transarticular is very long and wide midline incisions needed to be placed around the screw, as in various procedures both in the cervical spine and in the lumbar region is required. These large cause cuts to an extended Operation time with a resulting increase in blood loss and a Increase in the size of the Patients remaining scar. It is to be understood that although the reduction of pain and getting the range of motion the surgical target are, the size of the incision and the Scar that remains here, frequently the only visible measure are, which a patient has, the quality of the work of a surgeon to judge. It is therefore preferable if the incision in a Manner takes place, which serves not only to the contour of the skin to preserve, but that he a minimum length and has size, to increase patient satisfaction.

In document US-A-4,872,451 is an Systemset or -Kit for inserting screws disclosed an outer cannula, a Trocar, a guide and having a drill tip. This instrument is to repair big bone, as the shoulder joint, associated bands used. The effects the excessive drilling are relatively unimportant in these applications.

The present invention provides a Systemset (system set) or kit for inserting screws before which a minimally invasive portal with a small entry angle to a surgical site and provides an outer cannula, a Trocar, a guide and having a bone drill bit. The outer cannula has a first exterior surface and a first inner surface, the defining a bore. The first inner surface has a first inner diameter, and has the first outer surface a first outer<?page 3?>knife. The surfaces extending along a first length on a first axis between a first proximal end with a first stop and a first distal end. The trocar has a second exterior surface with a second outer diameter. extends the second outer surface along a second length on a second axis between a second proximal end with a second formed thereon stop and a second distal End forming a blunt tip. The guide includes a holder and a pipe on. The tube has a third exterior surface and a third inner Surface, which forms a passage. The third interior surface has a third inner diameter and the third exterior surface has a third outer diameter. The third inner surface extending between a proximal end and a third third distal end. The third outer surface extends along a third length on a third axis between a third stop on the third proximal end and the distal end of the third. The holder is under an angle to the third axis connected to the tube. The bone drill bit has a fourth outer surface with a fourth outside diameter, extending along a fourth length on a fourth axis between a fourth stop, which near a fourth proximal end is located, and a plurality of Drill grooves, which are formed on a distal end of the fourth, extends.

Preferred embodiments will now be described by way of example with reference to the drawing.

<figref idrefs="S31">1</figref> is a side view of the outermost needle of System for the insertion of screws according to the present invention.

<figref idrefs="S31">2</figref> is a trocar for use with the outer cannula from <figref idrefs="S31">1</figref> for initially introducing the System for the insertion of screws into the patient.

<figref idrefs="S31">3</figref> is a side view of a guide for Introduce in the outer cannula from <figref idrefs="S31">1</figref> to more accurately align bone drill bits and taps from the <figref idrefs="S32">4</figref>-<figref idrefs="S33">6</figref>,

<figref idrefs="S32">4A</figref> is a standard bone drill bit for use in a system for insertion of screws according to the present Invention.

<figref idrefs="S32">4B</figref> is an enlarged portion the bone drill tip <figref idrefs="S32">4A</figref>,

<figref idrefs="S32">5A</figref> is a side view of an improved bone drill bit for use with the system for the insertion of screws according to the present invention.

<figref idrefs="S32">5B</figref> is an enlarged view the tip of the bone drill <figref idrefs="S32">5A</figref>,

<figref idrefs="S33">6</figref> is a side view of a bone tap for use with of the present invention.

<figref idrefs="S33">7</figref> is a side view of a cutter for adjusting the length of the adjustable length stop out <figref idrefs="S33">8th</figref>,

<figref idrefs="S33">8th</figref> is a side view of one embodiment an adjustable length stop according to the present Invention.

<figref idrefs="S33">9</figref> is a side view of a screwdriver for use in the system for insertion of screws according to the present Invention.

<figref idrefs="S34">10</figref> is a plan view of the back of the prone patient, wherein the size of the Neck and in the lumbar region of the Transarticular Screw sipe formed from the prior art is shown.

<figref idrefs="S35">11</figref> is an illustration of the insertion of the pistol spherical trocar from <figref idrefs="S31">2</figref> through the outer cannula <figref idrefs="S31">1</figref>Whereby distally in the back from a surgical point lumbar percutaneous portal is formed.

<figref idrefs="S36">12</figref> is a plan view of the use of the system for the insertion of screws according to the present Invention to a patient lying on his stomach, with the surgical site is in the neck area.

for a better understanding the principles of the invention will now be illustrated on the drawing in the embodiment Referring, and there is a specific language for describing of these uses. The specific description is only an example given.

In <figref idrefs="S31">1</figref> is an outer cannula <figref>100</figref> shown, extending along a longitudinal axis <figref>101</figref> extends. The outer cannula <figref>100</figref> forms the primary passage for the Screw insertion into a surgical site through a percutaneous Portal (as discussed below is) away from the surgical site. Many spinal surgeries, for the the system for the insertion of screws according to the present invention usable, have very small entry angle of the screw with respect to the spine of the prone patient. The outer cannula<figref>100</figref> has a bore <figref>101a</figref> on extending between the proximal end <figref>102</figref> and the distal end <figref>104</figref> the outer cannula <figref>100</figref> extends. The outer cannula <figref>100</figref> has an outer surface <figref>106</figref> and an inner surface <figref>108</figref> , wherein the inner surface <figref>108</figref> a drilling <figref>101a</figref> defined. The distal end<figref>104</figref> the outer cannula <figref>100</figref> ends in a tip <figref>110</figref>, The summit<figref>110</figref> has such illustrated sawtooth cuts with a half-moon shape to contact with the surgical site (Ie the bone of a vertebra) to facilitate. However, it is to understood that the tip <figref>110</figref> may take a variety of forms and shapes, the crescent illustrated by the representation.

The proximal end <figref>102</figref> the outer cannula <figref>100</figref> has an annular Flange or stop <figref>112</figref> on. bore<figref>101a</figref> extends Also by the &lt;?page 4?&gt;annular flange <figref>112</figref>, The stop<figref>112</figref> prevented in combination with the stops other through the bore <figref>101a</figref> the outer cannula introduced devices to the wide introduction the various bone drill bits, taps and other Probes and interventional devices, and it prevents possible damage to the surgical site due to an excessively wide introduction. It is to be understood that the stop <figref>112</figref> not to have the shape of an annular flange needs but that he may be given by a number of projections just that from the outer surface <figref>108</figref> the outer cannula <figref>100</figref> out extend. It is further understood that the stop<figref>112</figref> the outer cannula <figref>100</figref> also simply the circumference of the outer surface <figref>108</figref> the outer cannula <figref>100</figref> at the near end <figref>102</figref> can be. This is because that the stops of the other probes or engagement devices (for example, bone drill bits, Bone Taps, guides) the circumference of the proximal end <figref>102</figref> the outer surface <figref>106</figref> the outer cannula <figref>100</figref> touch. It is also to be understood that according to the preferred embodiment the outer cannula <figref>100</figref> a annular flange <figref>112</figref> having. The outer cannula<figref>100</figref> has for drilling <figref>101a</figref> a Inner diameter Dl and an outer diameter D2, such as in <figref idrefs="S31">1</figref> is shown.

As in <figref idrefs="S31">2</figref> illustrated is a trocar extending <figref>120</figref> along a longitudinal axis <figref>121</figref> between a proximal end <figref>122</figref> and a distal end <figref>124</figref>, The trocar <figref>120</figref> is preferably, but not necessarily, a solid shaft having an outer surface <figref>126</figref> in between the proximal end <figref>122</figref> and the distal end <figref>124</figref>, The distal end <figref>124</figref> the trocar <figref>120</figref> has a pistol spherical head <figref>130</figref> With a blunt tip <figref>131</figref> on to the trauma of the tissue to minimize, if the combination of the trocar <figref>120</figref> and the outer cannula <figref>100</figref> as a penetrating means for soft Tissue or an introducer for soft Tissue from a distal incision <figref>50</figref> on the back of surgical site <figref>55</figref> used the vortex (see <figref idrefs="S35">11</figref>). The trocar<figref>120</figref> has on proximal end <figref>122</figref> an annular flange or stop <figref>132</figref> on. The outer surface <figref>126</figref> of trocar <figref>120</figref> has an outer diameter D3. Of the outer diameter D3 of the trocar <figref>120</figref> is smaller than the inner diameter D1 of the outer cannula <figref>100</figref>. which in turn is smaller than the outer diameter D2 of the outer cannula <figref>100</figref>, Because the outer diameter D3 is smaller than the inner diameter Dl, outer surface can <figref>126</figref> of trocar <figref>120</figref> through the bore <figref>101a</figref> the outer cannula <figref>100</figref> be introduced. It is to be understood that the trocar <figref>120</figref>So that he as a penetrating means for soft can act tissue, only an uninterrupted surface on gun spherical head <figref>130</figref> and at any other portion extending through the distal end <figref>104</figref> the outer cannula <figref>100</figref> out extends to have needs. Although in<figref idrefs="S31">2</figref> Accordingly, the trocar <figref>120</figref> as a massive shaft is shown, it is provided that amendments the one skilled in the art for the connection between the distal end <figref>124</figref> and the proximal end <figref>122</figref> of trocar <figref>120</figref> may occur, are within the scope of the claims.

The trocar <figref>120</figref> has a such length On that, as it passes through the bore <figref>101a</figref> the outer cannula <figref>100</figref> is introduced, the pistol spherical head <figref>130</figref> about the summit <figref>110</figref> the outer cannula <figref>100</figref> out extends. When the trocar<figref>120</figref> as far as possible by the bore <figref>101a</figref> the outer cannula <figref>100</figref> is introduced, touched the front face <figref>132a</figref> of annular flange <figref>132</figref> the rear face <figref>112b</figref> the stopper <figref>112</figref> the outer cannula <figref>100</figref> (please refer <figref idrefs="S35">11</figref>). At or near this Point extending the pistol spherical head <figref>130</figref> about the tip <figref>110</figref> the outer cannula <figref>100</figref> addition, allowing is that the trocar <figref>120</figref> and the outer cannula <figref>100</figref> by an incision <figref>50</figref> distal to the surgical site <figref>55</figref> percutaneously imported will. Accordingly, despite the fact that the desired Entry angle for the transarticular Screw is very small, the large midline incision current Techniques unnecessary. Only a small midline incision directly over the surgical site is required because of the of the bore <figref>101a</figref> the outer cannula <figref>100</figref> of Systems for inserting screws provided through the Introduce all tools, implants and Eingriffsvorrichtingen enables which to stabilize the spine transarticular using screw fastenings required are. It should be noted that although the representation out <figref idrefs="S35">11</figref> the applicability the piercing device for soft tissue as a combination of the trocar <figref>120</figref> with the outer cannula 100 in Lumbar spine shows the system for the insertion of screws according to the present invention equally is adapted to the need of a large midline incision to avoid when a surgical site, for example, located in a cervical vertebra, as the at a transarticular Screw on Atlantoaxial the case (see <figref idrefs="S36">12</figref>).

The through hole <figref>101a</figref> the outer cannula <figref>100</figref> at various embodiments of the devices used in the present invention are <figref idrefs="S31">3</figref>-<figref idrefs="S33">9</figref> illustrated and below in greater Details discussed. After the details of the individual components of different embodiments of the present invention have been set forth, the method is to their use in more Details discussed. In <figref idrefs="S31">3</figref> is an embodiment a device for precise straightening with various embodiments bone drill bits and bone taps to the appropriate lengths shown. &lt;?page 5?&gt;The leadership <figref>140</figref> generally proceeds along a longitudinal axis <figref>141</figref> (With Exception of the holder <figref>158</figref>). The leadership<figref>140</figref> has a drilling <figref>141a</figref> , which by an inner surface <figref>148</figref> defined is extending between the proximal end <figref>142</figref> and the distal end <figref>144</figref> extends. The leadership<figref>140</figref> has a between the proximal end <figref>142</figref> and the distal end <figref>144</figref>. which in a tip <figref>150</figref> ends, formed outer surface <figref>146</figref> on. The proximal end <figref>142</figref> the leadership <figref>140</figref> has a annular Flange or stop <figref>152</figref> with a front end face <figref>156</figref> and a rear end face <figref>157</figref>, The outer surface <figref>146</figref> Has an outer diameter D5, and the inner surface <figref>148</figref> has a Inner diameter D4.

The leadership <figref>140</figref> has a Holder or handle <figref>158</figref> on, at an angle with the stop <figref>152</figref> connected is. However, it should be understood given that the holder <figref>158</figref> arranged / connected at a plurality of locations can be. The holder<figref>158</figref> is transversely at an angle to the longitudinal axis <figref>141</figref>, The angle of the holder is many applications with small entrance angles relevant because he not perpendicular to the longitudinal axis <figref>141</figref> to stand should. It is also to be understood that the angle which the holder<figref>158</figref> in With respect to the longitudinal axis <figref>141</figref> forms, is preferably less than 60 degrees. The outer diameter D5 is greater than the inner diameter D4, but is less than the inner diameter D1 of the outer cannula <figref>100</figref>, Accordingly, the outer surface <figref>146</figref> by the bore <figref>101a</figref> the outer cannula <figref>100</figref> be introduced, to the front face <figref>156</figref> of the guide <figref>140</figref> the rear face <figref>112</figref> of stopper <figref>112</figref> the outer cannula <figref>100</figref> touched. As below discussed further is, when the front end face <figref>156</figref> the rear face <figref>112</figref> one stopper <figref>112</figref> the outer cannula <figref>100</figref> touched, different other instruments through the bore <figref>141a</figref> and the bore <figref>101a</figref> in the type of bone drill bits <figref>160</figref>. <figref>180</figref> and of the tap <figref>200</figref>Introduced, as discussed below.

<figref idrefs="S32">4</figref> shows a side view of a standard bone drill bit <figref>160</figref>, the extending between a proximal end <figref>162</figref> and a drilling <figref>164</figref> along an axis <figref>161</figref> extends. The proximal end<figref>162</figref> has a surface , which for applying a force to rotate the bone drill bit <figref>160</figref> designed is. According to a in <figref idrefs="S32">4A</figref> illustrated embodiment includes the standard bone drill bit <figref>160</figref> a half full cylinder <figref>163a</figref> and a flattened portion <figref>163</figref> at the proximal end <figref>162</figref> on to the rotation of the standard bone drill bit <figref>160</figref> to enable. With reference to the <figref idrefs="S32">4A</figref> and <figref idrefs="S32">4B</figref> Note that the drilling <figref>164</figref> a Number of grooves <figref>165</figref> and a standard drill bit <figref>170</figref> having. The standard bone drill bit <figref>160</figref> has an outer surface <figref>166</figref> on, extending between the front face <figref>172a</figref> of the annular flange or stop <figref>172</figref> and the top of the drill bit grooves <figref>165</figref> extends, thereby the drilling <figref>164</figref> the standard bone drill <figref>160</figref> educated is. The outer surface<figref>166</figref> of the Standard bone drill bit <figref>160</figref> has an outside diameter D6. additionally , the portion of the outer surface <figref>166</figref> in nearby the annular Flange or stopper <figref>172</figref> preferably a plurality of longitudinal marks <figref>167</figref> on.

In the <figref idrefs="S32">5A</figref> and <figref idrefs="S32">5B</figref> is the preferred embodiment a bone drill bit <figref>190</figref> for use in the system for insertion of screws according to the present Invention. It is given to understand that as a result the small entry angle between the bone and drill bit the bones in the spine and in vertebral surgical site a standard bone drill bit <figref>160</figref> on having blunt end, which can be difficult to set in motion. The tip <figref>170</figref> bone drill bit <figref>160</figref> has a Tendency along the surface to wander, allowing accurate assembly is difficult. Accordingly, the preferred embodiment a bone drill bit <figref>180</figref>Extending along an axis <figref>181</figref> in between a proximal end <figref>182</figref> and a drilling <figref>184</figref> extends. Similarly, the Standard bone drill bit, the preferred bone drill <figref>180</figref> a semi-solid cylinder <figref>183a</figref> and a flattened portion <figref>183b</figref> at the proximal end <figref>182</figref> for use in rotating the bone drill bit <figref>180</figref> on. The drilling <figref>184</figref> bone drill bit <figref>180</figref> has a number of grooves <figref>185</figref> on. The bone drill bit<figref>180</figref> Has an outer surface <figref>186</figref>. extending between the front face <figref>192a</figref> of the annular flange or stop <figref>192</figref> and the beginning of the number of grooves <figref>185</figref> of drilling <figref>184</figref> extends. The bone drill bit<figref>180</figref> has a sharply angled drill bit <figref>190</figref> at the end of the drill <figref>184</figref>. which for the more detail below discussed A method for use of the system for the insertion of screws even at the small entry angles preferably less than 45 ° (not perpendicular to the bone) allows easy insertion, when the drilling is started. The outer surface<figref>186</figref> of the Bone drill bit <figref>180</figref> has an outer diameter D7. Both the outer diameter D7 and the outer diameter D6 are less than the inner diameter D4 of the guide <figref>140</figref>, According to a preferred embodiment, took the lead <figref>140</figref> a Inner diameter D4 which is only slightly larger than the outer diameter D6 or outer diameter D7 of the bone drill <figref>160</figref> or. <figref>180</figref>, This allows a accurate positioning of the drill bits <figref>170</figref>. <figref>190</figref> and minimizes deviations from side to side of the axis <figref>161</figref> or. <figref>181</figref>. when drilling.

<figref idrefs="S33">6</figref> shows a side view of a bone screw tap <figref>200</figref> to Use with a system for insertion of screws according to the present Invention. Bone Taps<figref>200</figref> extends along the axis <figref>201</figref> between the proximal end <figref>202</figref> and the Gewindebohre&lt;?page 6?&gt;Rende <figref>204</figref>, Similarly, the bone drill bits<figref>160</figref>. <figref>180</figref> Has the proximal end <figref>202</figref> of the tap <figref>200</figref> a massive half-cylinder <figref>203a</figref> and a flattened portion <figref>203b</figref> to the enabling Rotation of the bone screw tap <figref>200</figref>, As those of ordinary skill will understand, the Taps end <figref>204</figref> the bone screw tap <figref>200</figref> Threading <figref>205</figref> and a tip 210 for producing a thread in the bone by a drill bit <figref>160</figref>. <figref>180</figref> Opening or produced Bore in the bone. Bone Taps<figref>200</figref> Has an outer surface <figref>206</figref>. extending between the front surface <figref>212a</figref> of the annular flange or stop <figref>212</figref> and the beginning of the threading <figref>205</figref> at the Taps end <figref>204</figref> extends. The outer surface<figref>206</figref> has a outer diameter D8 which is smaller than the inner diameter D4 of the guide <figref>140</figref> is, to allow that the Bone Taps <figref>200</figref> through the bore <figref>141a</figref> of the guide <figref>140</figref> are introduced can. As with the bone drill bits<figref>160</figref>. <figref>180</figref> Has the outer surface <figref>206</figref> of Bone tap <figref>200</figref> preferably on the portion the outer surface <figref>206</figref> next to the annular Flange or stop <figref>212</figref> a number of length markings <figref>207</figref>,

The <figref idrefs="S33">7</figref> and <figref idrefs="S33">8th</figref> show side views for the Cutter (<figref idrefs="S33">7</figref>) and the adjustable length stop (<figref idrefs="S33">8th</figref>). As especially in <figref idrefs="S33">7</figref> is shown has the Schneider <figref>220</figref> holder <figref>222</figref>. <figref>223</figref> on, which a joint <figref>224</figref> are pivotally connected. The tapping <figref>226</figref> the tailor <figref>220</figref> consists of a first cutting element <figref>230</figref> and a second cutting element <figref>235</figref>, The first cutting element <figref>230</figref> has a first sharp edge <figref>231</figref> Next a circular depression <figref>232</figref>That their own cutting edge <figref>233</figref> having. In a similar way has the second cutting element <figref>235</figref> a second sharp Ka nte<figref>236</figref> Next another circular depression <figref>237</figref>That their own cutting edge <figref>238</figref> having. It is to be understood that the cutter <figref>220</figref> for use on adjustable length stop <figref>240</figref> scheduled , as in <figref idrefs="S33">8th</figref> is shown.

The adjustable length stop <figref>240</figref> has integrally connected single cylindrical elements <figref>242</figref> with a length L and an inner diameter D9 and an outer diameter D10. The single ones cylindrical members <figref>242</figref> the adjustable length stop <figref>240</figref> run along a longitudinal axis <figref>241</figref>, The individual cylindrical elements <figref>242</figref> the adjustable length stop <figref>240</figref> define a bore <figref>248</figref>Extending along the axis <figref>241</figref> extends. According to a embodiment corresponds the length L of the individual cylindrical elements <figref>242</figref> the distance between the length markings in the type of length markings <figref>207</figref> at the Bone Taps <figref>200</figref>, The length markings <figref>187</figref> at bone drill bit <figref>180</figref> and / or the length of marks <figref>167</figref> at bone drill bit <figref>160</figref>, However, it will be within the Scope of the claims lying viewed that the length of individual cylindrical elements from those of the markers different to the respective bone drill bits and taps may be, and that the Length of each individual cylindrical member at a single adjustable length stop <figref>240</figref> vary can. It is to be understood that the Inner diameter D9 of the bore <figref>248</figref> the adjustable length stop <figref>240</figref> to be taller should than the diameters D8, D7, D6, but is less than D5, which in turn is less than D1, smaller than D2. It is also to be understood that the outer diameter D10 should be greater than the outside diameter D5 of the guide <figref>140</figref> or at least should have a sufficient value so that the adjustable length stop <figref>240</figref> as a contact mechanism for preventing further insertion of the Bone drills or bone taps acts when the rear face <figref>157</figref> of annular Flange or stopper <figref>152</figref> the leadership <figref>140</figref> is touched. Similarly Way should in the embodiments of the device, in which a guide <figref>140</figref> not used will, but only the outer cannula <figref>100</figref> used is the outer diameter D10 having a value such that the adjustable length stop <figref>240</figref> the rear surface <figref>112b</figref> of annular Flange or stopper <figref>102</figref> the outer cannula <figref>110</figref> touched.

In <figref idrefs="S33">9</figref> is a side view of Implantateinbringers or Mitnehmereinsatzes (Implant driver) in the form of a screwdriver <figref>260</figref> to Use with the system for the insertion of screws according to the present Invention. The screwdriver<figref>260</figref> extends substantially along an axis <figref>261</figref> between a proximal end <figref>262</figref> and a distal end <figref>264</figref>, The screwdriver <figref>260</figref> comprises a holder <figref>278</figref> on, of a front face <figref>276</figref> Has. The front face <figref>276</figref> of holder <figref>278</figref> could act as a stop, in general, the length of the screwdriver <figref>260</figref> however made intentionally long so that each just screw used can be screwed as deep as is considered necessary. The screwdriver<figref>260</figref> Has an outer surface <figref>266</figref> With an outer diameter D11, extending between the front face <figref>276</figref> the holder <figref>278</figref> and the top <figref>270</figref> at the distal end <figref>264</figref> extends. The summit <figref>270</figref> the screwdriver <figref>260</figref> it's so configured to in the screw head of the screw fastening and transarticular for others Surgeries that provided within the scope of the invention are used screw fits. Generally defines the top <figref>270</figref> the screwdriver <figref>260</figref> a polygonal shape to a polygonal base with the same Shape in the screw head of the screw used does. To the simple terms, the relationship between the diameters of various &lt;?page 7?&gt;ingredients summarized below: D₃ &lt;D₁ D_8th D₇ &lt;D₄ &lt;D₅ &lt;D₁ &lt;D₂ D₆ D_8th D₇ &lt;D₉ &lt;D₁₀ D₆ D₁₁ &lt;D₂

Now that the individual elements of the system have been described for the insertion of screws, is now be described in the general method for its use. The System for inserting screws in accordance with the present invention is for three primary surgical indications particularly useful. The first indication is the use in the repair of a odontoiden breakage. The second Indication is the Transarticular Screw on the first and second cervical vertebrae. The third indication is the Transarticular Screw on Lumbar joint side. All these indications are below in more detail discussed. In the all-common Procedure is the joint between the vertebrae, but substantially collected and immobilized until either the fracture heals (as in the first Indication) or until fusion occurs (as in the second or the third indication). It should be noted that the first indication a anterior procedure, while the second and the third indication posterior procedures are.

When using general procedure the piercing device for soft tissue or the insertion into soft tissue in the form of the outer cannula <figref>100</figref> With the trocar <figref>120</figref> with a pistol spherical head <figref>130</figref> by an incision <figref>50</figref> inserted into the skin on the back and the surgical site (in <figref idrefs="S35">11</figref> lies the surgical site via Lumbar vertebrae) guided as by nick <figref>55</figref> considered becomes. The summit<figref>110</figref> the outer cannula <figref>100</figref> is under the appropriate angle for the introduction the screw for fastening to the section of bone or Vertebra set. The pistol spherical head<figref>130</figref> and indeed the whole trocar <figref>120</figref> then from the outer cannula <figref>100</figref> away. Thereupon, the distal end <figref>144</figref> the drill guide <figref>140</figref> by the near end <figref>102</figref> the outer cannula <figref>100</figref> introduced until the front face <figref>156</figref> of stopper <figref>152</figref> the leadership <figref>140</figref> the rear face <figref>112b</figref> of annular Flange or stopper <figref>112</figref> the outer cannula <figref>100</figref> touched. As next is the drilling <figref>184</figref> bone drill bit <figref>180</figref> by the bore <figref>141a</figref> the leadership <figref>140</figref> Behind the distal end <figref>144</figref> and then into the bore <figref>101a</figref> the outer cannula <figref>100</figref> introduced. It is to be understood that the Surgeon a high-speed router to mark the launch point the screw could use, However, this does generally due to the loss of cortical bone on the outer surface of the Vortex strength of the screw fixation weakened. It is instead preferably, as mentioned above, the improved drill bit <figref>180</figref> according to the present to use the invention, a sharply angled drill bit <figref>190</figref> having, which in spite of the very small entry angle, the usual the transarticular Screw on vertebral joints is found at the beginning of the drilling process allows an easier insertion.

As mentioned above, has the bone drill bit <figref>180</figref> multiple length markings <figref>187</figref> Next the annular Flange or stop <figref>192</figref> on. The length markings<figref>187</figref> enable the surgeon, by examining the length markings <figref>187</figref> of the Bone drill bit <figref>180</figref> at a glance the route to know, which has been drilled into the bone the drill. To be used Screws (not shown) have a fixed length, which can be measured. On the basis of these fixed length an adjustable length stop <figref>240</figref> after Need either the bone drill bit <figref>180</figref> or screw tap <figref>200</figref> introduced. The outer surface<figref>186</figref>. <figref>206</figref> of the Bone drill bit <figref>180</figref> or of the tap <figref>200</figref> becomes through the bore <figref>248</figref> the adjustable length stop <figref>240</figref> introduced. In general both the bone taps <figref>200</figref> and the Bone drill bit <figref>180</figref> with 30-mil-projections in marked increments of 5 mm. Similarly, like the length L the individual cylindrical members <figref>142</figref> the adjustable length stop <figref>140</figref> in the Generally those of 5-mm increments of length markings <figref>207</figref> and <figref>187</figref>, The adjustable length stop <figref>240</figref> is simple and changes not the lengths the leadership <figref>140</figref>. whereby the use of a standard guide <figref>140</figref> and from Bone drill bits <figref>180</figref> and bone taps <figref>200</figref> With a standard length allows becomes. The variable is the adjustable length stop<figref>240</figref>. the generally consists of plastic, allowing the use of a cutter 220 for trimming the total length of the adjustable length stop <figref>240</figref> is made possible, whereby the desired insertion length of Bone drill bit <figref>180</figref> and the bone screw tap <figref>200</figref> is made possible. The tailor <figref>220</figref> Either individual cylindrical elements <figref>242</figref> cut off, the length L of the adjustable length stop <figref>240</figref> modify or it can be even used to cylindrical by a single element <figref>242</figref> to cut. It is to be understood that in the is generally preferred if the Schneider <figref>220</figref> to cut the adjustable length stop <figref>240</figref> on the total length by severing the weakened Section between the cylindrical elements of the Cancel is provided, is used.

After cutting of the adjustable length stop <figref>240</figref> on the desired total length the bone drill bit <figref>180</figref> by the &lt;?page 8?&gt;drilling <figref>141a</figref> of the guide <figref>140</figref> and the bore <figref>101a</figref> the concentric outer cannula <figref>100</figref> introduced, and the drill bit is rotated, and it is by advancing the bone drill bit <figref>180</figref> along the axis <figref>181</figref>Until the adjustable length stop <figref>240</figref> the rear face <figref>157</figref> of stopper <figref>152</figref> the leadership <figref>140</figref> touched, thereby Another advancement of bone drill bit <figref>180</figref> in an opening in the bone will prevent the bone generated. The bone drill bit <figref>180</figref> then both of the guide <figref>140</figref> as also from the outer cannula <figref>100</figref> away. Next is the bone taps <figref>200</figref> through the holes <figref>141a</figref> and <figref>101a</figref> introduced. Of the Bone Taps <figref>200</figref> has an adjustable length stop <figref>240</figref> on the the same total length has as one who at the guide <figref>140</figref> used becomes. The through the bone drill bit<figref>180</figref> produced opening in the bone is then by rotating and advancing the bone tap <figref>200</figref> With provided a thread until the adjustable length stop <figref>240</figref> at the Bone Taps <figref>200</figref> the rear face <figref>157</figref> of stopper <figref>152</figref> on the guide <figref>140</figref> touched.

Once the opening in the bone portion drilled and has been provided with a thread, the entire inner sleeve in the form of bone tap <figref>200</figref> and the guide <figref>140</figref> out the outer cannula <figref>100</figref> away. Next be a screw and a drive bushing or Implantateinbringer by the near end <figref>102</figref> the outer cannula <figref>100</figref> introduced. Of the Drive bushing is generally a standard screwdriver <figref>260</figref> With a peak <figref>270</figref> with a polygonal head of a identically shaped polygonal socket in the head of the screw (not shown) fits, the to be driven into the bone. The screw and screwdriver<figref>260</figref> will through the bore <figref>101a</figref> the outer cannula <figref>100</figref> introduced until they store the have reached that extend beyond the tip <figref>110</figref> the remote end <figref>104</figref> the outer cannula <figref>100</figref> is. The place of this opening depends on the indication from, as described below.

As mentioned above, is the first indication of a specific use for the system and the method for inserting screws according to the present Invention in a use in connection with a Odontoid fracture. A Odontoid Break is a special break in a C2 vertebrae (second Cervical vertebra) or an axis vertebra. As in the background section mentioned was the Odontoid is a tooth-shaped projection of the axis vertebra Atlas vertebrae vertically projecting upward. In the past were Odontoid breaks treated using a halo. The alternative treatment mechanism is therein, a screw on insert the breaking point. Here is an anterior procedure through the neck, so that the Operate through the bore <figref>101a</figref> the outer cannula <figref>100</figref> helps protect important structures in the neck, and generally a minimally invasive provide procedure.

The Odontoid-screw fixing is a technically demanding procedure that careful Voroperationsplanung and requires an adequate surgical training. The entry point is critical to the anterior edge of the lower end plate. If further cephalad is started, the inclination angle of the fracture fixing can are not achieved, and anterior gapping of the fracture a common Result. Furthermore, a poor proximal fragment attack point occur with a subsequent screw neck. It is important, intervene in the far cortex of Odontoid tip to a To ensure adequate engagement point, and it is necessary, the fracture fragments by either screws or construction restrain by generating a slide hole by the antibody fragment. An AP and lateral fluoroscopy are for constant monitoring while all stages of this procedure significantly.

The Odontoid bolt fastening under Use of the system for the insertion of screws according to the present Invention is a combination of percutaneous and open Technology to achieve a minimally invasive procedure. Of the Surgeon views fact the entry point of the screw and placed through a separate incision the system for the insertion of screws, while observing where the distal end <figref>104</figref> the outer cannula <figref>100</figref> docks. The technique is generally carried out using a biplanar fluoroscopy, which enables to consider the break on television screens during the drill, the tap or the screw during the procedure through him out becomes. The total of the drilling, threading and screw insertion via the working sleeve in the form of the outer cannula <figref>100</figref> and the drill guide <figref>140</figref>. as discussed above has been.

The peculiarities of the screw entry angle and the arrangement for the second indication that Transarticular Screw the C1- and the C2 vertebra (Atlas and axis vertebra) are in the above described cited articles and are not here in details discussed. It is sufficient to say that the desired Result joining is C1 and C2 using a posterior procedure, said screw over the C1 / C2 joint in his back goes. for the use of standard technology is generally a very long Incision required to obtain the proper path. Of the Nick would have to are formed entirely in the thoracic region of the spine to the to obtain correct angle of entry, because it is hard to provide steep puncture for the drill, the taps or the screw is. Indeed recommend Articles, the standard technique &lt;?page 9?&gt;describe the formation of a Incision of C1 to C7 (see the incision <figref>65a</figref> out <figref idrefs="S34">10</figref>). By contrast, requires the Using the system and method for the insertion of screws according to the present Invention only a small midline incision <figref>65</figref> (please refer <figref idrefs="S36">12</figref>) In C1 / C2 region and Two percutaneous incisions <figref>60a</figref> and <figref>60b</figref> (please refer <figref idrefs="S36">12</figref>) Around the upper thoracic Area through which the system for the insertion of screws according to the present introduced invention is directed and the surgical site at the joint between C1 and C2 becomes. This surgical site is directly formed by the small midline incision <figref>65</figref> considered.

The third indication, which, as above mentioned has particular advantages through the use of the system for inserting of screws according to the present Invention receives, is a screw via to arrange a lumbar joint side, around the joint between two Lumbar assemble. This can against the Insertion of pedicle screws and the subsequent attachment of the anchor (The pedicle screws) to a rod, a plate or another Longitudinal member, the intervertebral disc or the remaining space after an actuator spanning from her done. Instead, the surgeon places at This procedure just two screws in the form of X (when viewed from above a patient lying on the stomach) on the Lumbar joint side. This is usually done in combination with a anterior interbody fusion, the lately with the use of known as cages devices a gain popularity has experienced. The advantages of the simple insertion of screws on the Lumbar joint side are due to are the more complex device, inserted in the pedicle screws and longitudinal members are attached to the anchors, the fact that this Placing screws on the Lumbar joint side to an implant with a very low profile leads.

Again, this third indication a minimally invasive procedure that is a combination of percutaneous and open techniques. As with the second indication in the Zervikalfusion described is a small midline incision <figref>55</figref> (please refer <figref idrefs="S35">11</figref>) On the two vertebrae to be joined together formed, which extends down into the hinge side. Each screw extends through the Lamina from the rear spinous process and is driven via the hinge side, laterally and downstream is protruding. The entry point for the drill bit (and Taps and the screw) is in turn laterally outward, the top of the cross. The joint between the lumbar vertebrae is is rather low, and the exit point of the bit and the screw be fixed deep in the joint. The entry point of the screw is the posterior spinous process on the contralateral side. The extending screw between the front and the rear cortices of the laminae and penetrates the inferior articular processes. The screw then crosses the joint side, where it penetrates the upper articular process and then at the base of the transverse process and the pars interarticularis exits.

The system for the insertion of screws according to the present Invention both the three above-mentioned indications known as well as other ordinary skill procedures advantageous. The system for the insertion of screws according to the present invention allows forming one or more small percutaneous portals, through which the implant and interventional devices may be introduced. After this at the centerline of an incision has been formed or in another Way viewing the surgical site was made possible, is the docking of several pods containing device of the system for the insertion of screws according to the present invention introduced and is directly adjacent to the surgical site, as is desired. Thereafter, a surgeon by the system for inserting Screws according to the present Drill invention provided percutaneous portal, cut a thread and insert the screw.