Anterior cervical plating system

Background of the Invention 1. Related Applications This application claims the priority of Application No. 60 / 037,139, which was filed on February 11, 1997, which is incorporated herein by reference. .. Application No. 08 /, in the name of the invention "Skeletal Plating System" filed on February 11, 1998. (Agent Case No. P-13408) is incorporated herein by reference. 2. Fields of Invention The present invention generally relates to implants, methods and means for anteriorly immobilizing the human cervical vertebrae, in particular the adjacent cervical vertebrae in the space selected during spinal fusion of those cervical vertebrae. Concers about plate systems for aligning and maintaining relationships. 3. Description of Related Techniques It is now customary to use a cervical plating system for such purposes in the art. Such a system essentially consists of plates and screws for aligning and holding the vertebrae in desired positions with each other. The earliest such devices consist of stainless steel plates and screws, which are threaded completely through the vertebrae into the spinal canal to engage the tough bone tissue of the vertebral body (posterior cortex). Was necessary. This requires that this area can be observed or visualized by radiography, especially in the lower cervical spine where the vertebrae can be hidden in the shoulder during radiography. It is not always possible. A drilling operation is performed to form a hole in the vertebral body for inserting each screw, and then a screwing operation is performed. Each of these operations involved passing the instrument completely through the relevant vertebral body and into the spinal canal. Therefore, these instruments will be in close proximity to the spinal cord and dura in the vicinity of the dorsal surface of the vertebral body. Any operation that introduces an object into the spinal canal poses a serious risk to the surgeon. The conventional technique of forming a bone screw receiving hole in the vertebral body by perforation has some serious drawbacks. For example, perforation removes bone material, leaving voids and loss of bone material. The perforation also causes fine grinding of the bone at the interface between the drill bit and the bone, and the resulting fracture line tends to propagate in the direction perpendicular to the wall of the hole. More specifically, the bone material is essentially a type of ceramic that exhibits a brittle pattern in which fractures are formed and propagated in response to perforations. In addition, perforation creates heat at the interface between the bone and the subsequently attached screws that can cause thermal necrosis of the bone material. This necrosis is quite harmful. Any bone that undergoes necrosis is then absorbed by the body as part of the bone repair process, which can result in loosening of the screws. Another problem with drilling is that it is difficult to control the course of the drill and that the drill bit is driven by rotation, so the drill bit is near the associated plate. It means that it may involve soft tissues. In addition, if not very careful, the drill bit can travel significantly past the posterior cortex, causing irreparable damage within the spinal canal. Eventually, the drill bit can become stuck in the vertebral body and break, and the still rotating part of the drill bit can get into the wound and cause serious injury, while a broken drill. Part of the tip of the bit may dangerously protrude from the vertebral body, or it may break on the same surface as the upper surface of the vertebral body and be irretrievably embedded there. In any event, the steps that must be taken to recover the broken part of the drill bit inevitably prolong and complicate the surgical procedure. Known plating systems have problems with loosening and breakage of equipment, breakage of screws and plates, and retrograde screw to the patient's throat. These events generally require additional surgical intervention to replace the damaged area or the entire plate and screw and repair any damage that may have been caused. Other problems encountered by known systems are due to the inability of the screws to be fully embedded in the bone and the wear of the screws. Also, using a known plating system, the lordosis of the spine, which is the normal curvature of the cervical spine when viewed from the side, can also be eliminated. Known plating systems also include "creeping". Experience the problems associated with placing bone grafts between vertebral bodies to obtain interbody fixation that is restored by a process called "substitution." In this process, the bone at the interface between the graft and the vertebra is an organism with the production of potent acids and enzymes as a precursor to the infiltration of the interface by living tissue and the deposition or growth of new bone. Removed by a scientific process. The plate provides proper alignment and firm fixation of the vertebrae, but at the same time unfortunately the vertebrae are held apart and the resorption step of the creeping replacement process creates a groove in the bone at the fixation site. The result may be that the desired fixation is not obtained. Such failures are known as nonunions. When such a failure occurs, the equipment itself is usually damaged or loosened from the spinal column, requiring additional surgery to remove the damaged part and another surgical procedure to attempt re-fixation. .. In response to the above issues, second generation plating systems have been developed and / or proposed. Such systems include Lowery's US Pat. No. 5,364,399 and Morscher's US Pat. No. 5,423, Included are the systems disclosed in No. 826, as well as the cervical fusion plating system presented by the SYNTHES Spine, DANEK ORION plate, CODMAN SHURTLEFF plate, and SMITH NEPHEW RICHARDS plate in particular. The members that make up this second generation system have some common characteristics. They are all made from titanium alloys or pure titanium rather than stainless steel to minimize harmful tissue reactions, which is not the case with stainless steel but is MRI compatible. The screws and plates have been increased in thickness to increase their strength. The screws have a larger diameter to improve their leverage without requiring them to engage the posterior cortex of the vertebral body. The gentle longitudinal contour of the plate is used to impart some lordosis, and / or the limited lateral contour is effectively used to effectively anteriorly curved surfaces of the vertebral body. I'm tracing. Mechanisms are used to secure the vertebral screws to their associated plates in a manner that prevents the screws from reversing. This second-generation plating system was significantly improved over the earlier system, but at the same time some problems remained and new ones arose. For example, since the screw no longer reaches the posterior cortex, it is common for the screw thread in the screw hole to wear down and the screw to not have a proper lever action. In addition, screw breakage continues, most commonly occurring at screw joints to the back surface of the plate. SYNTHES system and SMITH NEPHEW The screws used in the RICHARDS system are particularly vulnerable to this problem. This is because those screws are hollow at the level where they attach to the plate that houses the fixing screws. In an attempt to prevent breakage of the plate joint of the screw, more recent designs of the screw gradually increase the valley diameter from the tip to the head. In the past, the threads near the screw heads were short, thick, and almost useless, with little holding power, and a surgeon to signal that the screws were tightened before they were worn down in the bone. There was almost no tactile feedback to. Based on empirical studies testing these conventional screws, it has been found that the use of spare screw holes rather than tapping screws is preferred for pull-out strength. Therefore, since these screws are not self-tap type, the screw holes must be pre-screwed. Since the threaded portion of the tap is inevitably sharp and rotates, there is a serious risk of damaging the surrounding soft tissue when using the tap. This is because the plates used in these systems do not have long enough axial contours to fully allow for lordosis of the spine, prevent plate vibration around its vertical axis, and anterior to the vertebral body. These plates do not prevent soft tissue creeping from the sides and below the screw holes, thus complicating these tissues, as they are complicated by the fact that they do not have sufficient lateral contours to fit the shape. You will be exposed to damage from drills and taps. Although it is possible to change the contours of these plates somewhat during surgery, this is generally limited to the contours of the vertical axis and, quite often, of the plates in a manner that adversely affects screw-plate interlocking. Bone screw holes and screw holes-causes strain on plate joints. The lack of proper contour prevents these plates from having an optimally low profile for the cervical spine. In some second generation cervical plating systems, these plates secure all of the screws. Since it could not be designed as such, the retrograde motion of the screw continues to occur. Specifically, the designers of these plates recognized the importance of fixing bone screws to the plate, but could not fix all of the screws, leaving some of the screws unfixed. I had to settle for it. In addition, some of these second-generation systems utilize small, precise "watchmaker" components to obtain interfixing. These parts are characterized by the need to engage them with a particularly precise small end screwdriver. These interfixing elements are easily inefficient due to the effort required to change the contour of the plate during surgery. Although these second-generation plating systems have been improved compared to the first problem, the most important problem of nonunion, especially "distraction nonunion", still remains. These 2nd generation plates clearly increased the fixation rate, but when fixation failure occurs, it is generally accompanied by bone resorption along the graft-vertebral junction line, which is also radiographed. Can be observed. For soft first-generation plates and screws, the plates hold the vertebrae separately and can interfere with fixation, but reduce elongation until the equipment is damaged, and then result in fixation. The plate's second generation system is too strong to cause this and therefore requires additional surgical procedures to correct the nonunion. Compression plates are well known and are widely used in orthopedic surgery to stabilize tubular and sometimes flat bones. Such plates can depend on some external compression means or can be self-compressible, which means that the tightening of the bone screw through the plate causes a linear motion perpendicular to the screw axis. It depends on the sliding ability of the screw head in the sloping groove as it is imparted. U.S. Pat. No. 5,180, No. 381 discloses an attempt to use such a mechanism in connection with anterior neck fixation. However, all presented self-compressible plating systems have in common a style that moves the plate relative to the screw when tightened, rather than causing the plate to drag the screw off axis. It was found that the screw had the need to engage both the proximal and distal cortex (a bone casing of very dense bone material) so that it would be secured to the tip of the screw. However, as already mentioned earlier in this specification, if the screw will engage the posterior cortex of the vertebral body, the drill and tap that form the screw hole, as well as the screw tip itself, are all inserted into the spinal canal. It is necessary that this causes damage to the spinal cord. The system disclosed in U.S. Pat. No. 5,180,381 avoids such danger by engaging the vertebral body terminal plate instead of the posterior vertebral cortex, but the thread path is necessarily quite short, Therefore, the threads have little chance of gaining additional leverage in the vertebral body. Therefore, U.S. Pat. No. 5,180, Since the device disclosed in No. 380 clearly pulls the anterior part of the spine more than the back to the extent that it can achieve its stated purpose, it does not appear to compress the back of the vertebral body at all. It causes an unwanted loss of iatrogenicity in normal cervical lordosis. Such a condition interferes with the normal biomechanics of the cervical spine and is potentially quite harmful. The generation of compression between adjacent vertebrae reduces extended nonunion, increases the contact surface area between the graft and the vertebrae (due to the slightly incompatible surface being forced), and increases bone formation stimulation (compression load is bone). (By stimulating production), and provides several benefits such as increased stability of fixed grafts and vertebral parts. Among the new problems created by these second-generation systems, the small "watchmaker" parts used to secure the bone screws to the plate will drop the screwdriver used to attach those parts. Tend to be. In addition, these small parts are fairly fragile and require specialized additional equipment to insert and / or operate them. In addition, improper placement of the bone screw with respect to the shaft of the plate hole will render the screw fixing mechanism useless and the fixing screw will come into contact with the improperly installed bone screw, resulting in sharp jagged titanium. Shavings can be generated. Bone Screws-The means for establishing the arrangement and fabrication of plate holes are totally unreliable. Moreover, most of these second generation systems lack reliable and effective means for placing and holding plates during installation. The features of various conventional systems are summarized below. U.S. Pat. Nos. 5,364,399 and 5,423, cited earlier herein, The system disclosed in No. 826 includes a thin stainless steel plate in which bicortical screws are mounted in parallel or diagonally, which plate has a combination of screw holes and grooves. The "acromed" system includes titanium plates and screws that require bicortical screw attachment. This system does not include any fixing means for bone screws. The system disclosed in U.S. Pat. No. 5,180,381 has an "H" type that has a combination of sloping grooves and holes and requires the mounting of both cortical screws with an angle of 45 degrees to the surface of the plate. Includes plate. The patent discloses that the positioning that forms this corner is for the purpose of producing compression. The SYNTHES Morscher plate system uses a hollow grooved screw head. The screws are unicortically arranged so that the heads remain in the upper portion of the plate hole when properly aligned. The upper portion of each screw is internally threaded to receive the small screw attached to the bone screw head to increase the tightening between the bone screw head and the wall of the associated plate hole. .. U.S. Pat. Nos. 5,364,399 and 5,423, The system disclosed in No. 826 uses a pair of monocortical bone screws that can be fixed in place at both ends of the associated plate by fixing screws with a small diameter shaft and a large head. At each end of the plate, two bone screws can be fixed in place by one fixing screw located between the bone screws. Generally, the plate is provided with one diagonal groove or multiple grooves between its two ends to receive one or more additional screws, each additional screw. It can be fixed to a bone graft spread over a plate or to each vertebra. There are no fixing screws associated with these intermediate cuneiform screws to secure the bone screws to the plate. The Codman Shurtleff plating system utilizes the sides of a pre-mounted rivet with a rotatable head to press against the head side of the bone screw to secure it to the plate. The plates of this system are also provided with holes for accommodating intermediate screws, but these screws are not associated with any fixing means. The designers of the system mentioned at the end recognized that it was important to fix the bone screws in place on those related plates, but did not provide the fixing of the intermediate bone screws in those related holes. It was. In early versions of the Codman Shurtleff system, the fixation mechanism was a lever that was pivotable around a shaft that completely penetrated the plate, and was flared to hold the shaft within the plate. This lever is rotated after the bone screw is inserted so as to engage the head of the bone screw, thus fixing the bone screw to the plate. Taking into account all the features of known cervical plating systems, it is clear that there remains a demand for improved systems with a combination of the following features: It should be securely attached to the driver to prevent it from loosening in, and 13) the system should have the ability to maintain and / or restore spinal lordosis and at the same time compress the vertebral part to be fixed. is there. Objectives of the Invention An object of the present invention is to provide an anterior neck plating system, attachment means, and attachment method that have the above characteristics and avoid many of the drawbacks of conventionally known systems. One object of the present invention is to provide a locking mechanism that allows a plurality of bone screws used to attach a plate to a vertebra to be easily and reliably fixed in place at the same time by a single operation. Another object of the present invention is that a locking mechanism for locking the bone screw can be pre-installed by the manufacturer prior to the insertion of the bone screw by the physician, thus allowing the physician to pre-install during surgery. As a separate operation, it is to provide a vertebral plate that does not require a fixation mechanism to be attached to the plate. Another object of the invention is to allow interspinal compression of the neck in lordosis (compression of fixed grafts in the intervertebral space between adjacent vertebrae), as well as optionally multisegmental compression. To provide an anterior neck plating system. A further object of the present invention is to provide a bone screw that provides the surgeon with tactile feedback to ensure sufficient tightening of the screw while avoiding wear and tear, which is less likely to fail due to breakage or loosening. That is. Another object of the present invention is to provide a bone screw that provides an intraosseous purchase without the need for penetration into the posterior cortex of the vertebra. A further object of the present invention is to provide a plate that has been textured or otherwise processed to promote bone growth from the vertebrae to the vertebrae below the plate. Another object of the present invention is a plate constructed to securely engage an instrument for forming all of the bone screw holes coaxial with the holes formed in the plate, wherein the instrument is the posterior vertebral wall. Danger of perforation or invasion of the spinal canal The plate is provided with an integrated depth limiting means that completely eliminates the above. Yet another object of the present invention is to provide a system in which the bone screw and fixation mechanism have low sides when fully mounted. Another object of the present invention is to provide an anterior cervical plating system that is at least partially bioabsorbable. Another object of the present invention is to provide an anterior cervical plating system that includes, at least in part, an internal bone growth material and surface. Another object of the present invention is to provide an anterior cervical plating system that contains, at least in part, a bone growth promoter. Another object of the present invention is to provide an instrument for reliably and easily mounting the plate of the present invention. Yet another object of the present invention is to provide an improved method for mounting the plate of the present invention. The above and other objectives and features of the invention will be more readily apparent from the following description of preferred embodiments of the invention provided with respect to the accompanying drawings. Here, this preferred embodiment merely describes the embodiment of the present invention by means of non-limiting embodiments. Description of the Invention The plating system of the first preferred embodiment of the present invention comprises a plate that extends into the intervertebral space and is long enough to at least partially overlap at least two adjacent cervical vertebrae. A significant portion of the lower surface of the plate is preferably concave, i.e., a significant portion of the vertical axis of the plate is concavely curved and a significant portion of the horizontal axis of the plate is concavely curved. Also, the lower surface of the plate can be woven and / or processed to induce bone growth along the lower surface of the plate in contact with the cervical spine. The plate comprises a plurality of bone screw receiving holes extending through the plate from the upper surface to the lower surface of the plate, and at least one fixing element is connected to the bone screw receiving holes. Plates and their components can be manufactured from any implant quality material suitable for use in the human body, plates and related parts. Can be made from biodegradable (bioabsorbable) materials. Each bone screw can be inserted into its own bone screw receiving hole for attaching the plate to the vertebra. The fixing element is engageable with the fixing element accommodating recess and has a head formed to secure the bone screw to the plate. In a preferred embodiment, one fixing element secures several different bone screws of the plate in place. The fixation element is pre-installed in a manner that does not interfere with the installation of the bone screw prior to use by the surgeon. As a result, it includes problems that have existed before with respect to the type of locking screw applied after the insertion of the bone screw, such as the means for positioning and feeding the fixing means to the plate, and also "watches". Eliminates problems such as dropouts, breakage, wear and tear and incorrect threading associated with more precise fixing screws of the prior art similar to "manufacturer parts". In another embodiment of the invention, the fixing element fits snugly into each bone screw receiving hole for fixing one bone screw in place. According to a second embodiment of the present invention, each bone screw is secured to the plate by individual fixing screws that compress at least a portion of the bone screw. The plate remains quite sturdy as no other holes need to be formed in the plate to attach the fixation to the plate. The fixing element can be in many shapes, such as, but not limited to, screws, threaded caps, rivets, set screws, overhangs, etc. to achieve their intended purpose. Also, new bone screws are disclosed to prevent the bone screws from being pulled out during use. This is achieved by a design that includes a screw in which the outer or top diameter of the thread is kept substantially constant along the overall length of the shaft of the bone thread from the bottom of the head to the top of the tip. Yes, smaller outer diameter threads are easier to insert. Since the tip of the screw is a tapping type, a groove is provided at the end. The threads also have extremely thin and sharp sides to cut into and protect the integrity of the vertebral material (stock). The plating system is the head of the bone screw The part does not have to be hollow and there is no need to install additional holes through the plate in addition to the holes for the bone screws. It will be recognized that bone screws become fragile if their heads are hollow and the plate becomes fragile if the plate has additional holes. In addition, the plates of the disclosed system are such that the holes for bone threads in the plate are properly aligned and the plate is easily applied to the vertebrae in compression. The plate includes suitable grooves for applying compressive forces in a reliable and easy manner between adjacent vertebrae to which the plate is attached and engaging means for engaging the compressive means, as described in detail below. An improved fixing screwdriver is provided. The screwdriver provides a wedge-shaped clamp with a groove in the head of the bone screw and the head of the fixing element. The same screwdriver can be used for both the bone screw and the fixing element. The driver ensures that the fixing element does not cause the driver to fall off and be lost in the wound. The screwdriver has a tapered end to facilitate insertion into the complementary groove at the head of the screw and is used to engage and lift the fixing element. Also, the containment socket can be tapered for the same purpose. In addition, a combination of a bone screw and a fixing screw driver is disclosed. Here, the bone screw driver is placed vertically in the fixing screw driver so that the bone screw and the fixing screw are installed prior to the insertion of the bone screw and both can be tightened with one instrument without removing it from place. Pass through the opening of. There are also instruments for forming pilot holes to help with the ease and accuracy of bone screw installation, and instruments for creating compressive forces between adjacent vertebrae during plate installation and holding the plate during installation. Provided. Will be. In addition, the plates of the disclosed system are such that the holes for bone threads in the plate are properly aligned and the plate is easily applied to the vertebrae in compression. The plate includes suitable grooves for applying compressive forces in a reliable and easy manner between adjacent vertebrae to which the plate is attached and engaging means for engaging the compressive means, as described in detail below. An improved fixing screwdriver is provided. The screwdriver provides a wedge-shaped clamp with a groove in the head of the bone screw and the head of the fixing element. The same screwdriver can be used for both the bone screw and the fixing element. The driver ensures that the fixing element does not cause the driver to fall off and be lost in the wound. The screwdriver has a tapered end to facilitate insertion into the complementary groove at the head of the screw and is used to engage and lift the fixing element. Also, the containment socket can be tapered for the same purpose. In addition, a combination of a bone screw and a fixing screw driver is disclosed. Here, the bone screw driver is placed vertically in the fixing screw driver so that the bone screw and the fixing screw are installed prior to the insertion of the bone screw and both can be tightened with one instrument without removing it from place. Pass through the opening of. There are also instruments for forming pilot holes to help with the ease and accuracy of bone screw installation, and instruments for creating compressive forces between adjacent vertebrae during plate installation and holding the plate during installation. Provided. Will be. In addition, the plates of the disclosed system are such that the holes for bone threads in the plate are properly aligned and the plate is easily applied to the vertebrae in compression. The plate includes suitable grooves for applying compressive forces in a reliable and easy manner between adjacent vertebrae to which the plate is attached and engaging means for engaging the compressive means, as described in detail below. An improved fixing screwdriver is provided. The screwdriver provides a wedge-shaped clamp with a groove in the head of the bone screw and the head of the fixing element. The same screwdriver can be used for both the bone screw and the fixing element. The driver ensures that the fixing element does not cause the driver to fall off and be lost in the wound. The screwdriver has a tapered end to facilitate insertion into the complementary groove at the head of the screw and is used to engage and lift the fixing element. Also, the containment socket can be tapered for the same purpose. In addition, a combination of a bone screw and a fixing screw driver is disclosed. Here, the bone screw driver is placed vertically in the fixing screw driver so that the bone screw and the fixing screw are installed prior to the insertion of the bone screw and both can be tightened with one instrument without removing it from place. Pass through the opening of. There are also instruments for forming pilot holes to help with the ease and accuracy of bone screw installation, and instruments for creating compressive forces between adjacent vertebrae during plate installation and holding the plate during installation. Provided. Provides a wedge-shaped clasp. The same screwdriver can be used for both the bone screw and the fixing element. The driver ensures that the fixing element does not cause the driver to fall off and be lost in the wound. The screwdriver has a tapered end to facilitate insertion into the complementary groove at the head of the screw and is used to engage and lift the fixing element. Also, the containment socket can be tapered for the same purpose. In addition, a combination of a bone screw and a fixing screw driver is disclosed. Here, the bone screw driver is placed vertically in the fixing screw driver so that the bone screw and the fixing screw are installed prior to the insertion of the bone screw and both can be tightened with one instrument without removing it from place. Pass through the opening of. There are also instruments for forming pilot holes to help with the ease and accuracy of bone screw installation, and instruments for creating compressive forces between adjacent vertebrae during plate installation and holding the plate during installation. Provided. Provides a wedge-shaped clasp. The same screwdriver can be used for both the bone screw and the fixing element. The driver ensures that the fixing element does not cause the driver to fall off and be lost in the wound. The screwdriver has a tapered end to facilitate insertion into the complementary groove at the head of the screw and is used to engage and lift the fixing element. Also, the containment socket can be tapered for the same purpose. In addition, a combination of a bone screw and a fixing screw driver is disclosed. Here, the bone screw driver is placed vertically in the fixing screw driver so that the bone screw and the fixing screw are installed prior to the insertion of the bone screw and both can be tightened with one instrument without removing it from place. Pass through the opening of. There are also instruments for forming pilot holes to help with the ease and accuracy of bone screw installation, and instruments for creating compressive forces between adjacent vertebrae during plate installation and holding the plate during installation. Provided.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is an upper perspective view of a first embodiment of a composite fixation plate of the cervical spine. FIG. 2 is a plan view of the composite fixation plate of the cervical spine shown in FIG. FIG. 3 is a side view of the composite fixation plate of the cervical spine shown in FIG. FIG. 4 is a view of the end of the composite fixation plate of the cervical spine shown in FIG. FIG. 5 is a bottom view of the composite fixation plate of the cervical spine shown in FIG. FIG. 6 is a plan view of the composite fixation plate of the cervical spine shown in FIG. 1-5, showing the fixation element in the open state. FIG. 7 is a plan view of a modified example of the plate of FIG. 1-6, which has four bone screw fixing elements in place. FIG. 8 is a plan view of a further embodiment of the cervical fixation plate of FIG. 1 with a rectangular central groove for increased compression capacity. FIG. 9 is a plan view of the fixing element used with the plate of FIG. 1-6. FIG. 10 is a plan view of the fixing element used for the central opening of the plates of FIGS. 7 and 22. Figure 11 shows Figures 1, 6, It is a top view of the fixing cap used for the end opening part shown in 7. FIG. 12 is a side view of the fixed element of FIG. FIG. 13 is a side view of another embodiment of the fixed element of FIG. FIG. 14 is an upper perspective view of a composite fixation plate of the cervical spine used with a fixation rivet. FIG. 15 is a bottom view of the composite fixation plate of the cervical spine of FIG. FIG. 16 is a plan view of the two bone screw fixing elements. FIG. 17 is a plan view of another embodiment of the four bone screw fixing elements having a head slit for increased flexibility of the fixing tab. FIG. 18 is a bottom view of a rivet-type fixing element used in the central opening of the plate of FIG. FIG. 19 is a side view of the rivet fixing element. FIG. 20 is an upper perspective view of the bottom portion of the head of the rivet of FIG. 19 as seen along lines 20-20. FIG. 21 is an upper perspective view of the head of the three-bone screw fixing element. FIG. 22 is an upper perspective view of a third embodiment of a composite fixation plate of the cervical spine utilizing a fixing element in the form of a screw cap. FIG. 23 is a side view of the fixing element used for the plate of FIG. FIG. 24A is a side elevation view of the bone screw according to the present invention. FIG. 24B is an enlarged side view of the bone screw of FIG. 24A. FIG. 25 is a side view of another embodiment of the bone screw according to the present invention. FIG. 26 is a bottom view of the bone screw shown in FIG. 24A. FIG. 27 is a plan view of the bone screw shown in FIG. 24A. FIG. 28 is an upper perspective view of the composite fixation plate of the cervical spine in the fourth embodiment. FIG. 29 is an upper perspective view of the fixing element used for the plate of FIG. 28. FIG. 30 is a partial side sectional view of the plate of FIG. 28 along lines 30-30 with the bone screw placed. FIG. 31 is an upper perspective view of the plate, plate holder, and means for forming bone screw receiving holes in the vertebral body, which are located relative to the anterior surface of three consecutive vertebral bodies in the cervical spine. FIG. 32 is a cross-sectional view of the portion of the bone forming apparatus shown in FIG. 31 as viewed along lines 32-32. FIG. 33 is a side view including a partial cross section illustrating a compression post tool engaged to it for insertion into the vertebral body, and a compression post. .. FIG. 34 is a side view including a partial cross section of a compression post tool engaged for removing the compression post from the vertebral body. FIG. 35 is a bottom view of the compression post tool of FIG. FIG. 36 is a side view of the plate engaging hook used in the compressor shown in FIG. 38. FIG. 37 is a cross-sectional view through the plate of another embodiment of the drill guide and drill-shaped hole forming means used during the plate mounting process. FIG. 38 is a side view showing compression between the spine and compression device compartments. FIG. 39 is a similar view of that of FIG. 38 showing the compressor at a further stage of the plate mounting process. FIG. 40 is an upper perspective view showing the fixation of the bone screw to the plate. FIG. 41 is a partial side sectional view of the fixing element attached to the driver means. FIG. 42 is a partial side sectional view of another embodiment of the fixing element attached to the driver means. FIG. 43 is a partial cross-sectional view showing the neck plate, fixing element, and bone screw along lines 43-43 of FIG. 40. FIG. 44 is a detailed enlarged portion along line 44 of FIG. 43. FIG. 45 is a side view including a partial cross section of a plate holder attached to the plate. FIG. 46 is a side view including a partial cross section of another embodiment of the plate holder attached to the plate. FIG. 47 is an upper perspective view of the first embodiment of a single fixed plate. FIG. 48 is a plan view of the plate shown in FIG. 47. FIG. 49 is a side view of the plate shown in FIG. 47. FIG. 50 is a view of the end of the plate shown in FIG. 47. FIG. 51 is a bottom view of the plate shown in FIG. 47. FIG. 52 is a plan view of the top of the plate in which the fixing elements shown in FIG. 47 are arranged. FIG. 53 is a side view of a bone screw used with the plate shown in FIG. 47. FIG. 54 is a plan view of the bone screw shown in FIG. 53. FIG. 55 is a bottom view of the bone screw of FIG. 53. FIG. 56 is a plan view of the single fixing plate of FIG. 47 and the fixing cap used. FIG. 57 is a side view of the fixing cap shown in FIG. 56. Figure 58 shows Figure 56 and It is the bottom view of the fixing cap shown in 57. FIG. 59 is a bottom perspective view of the fixing cap of FIGS. 56-58. FIG. 60 shows a single fixation of FIG. 47, which is held by a plate holder for three vertebral bodies, with hole shaping means, punching a pilot hole into the vertebral body that houses the bone screw. It is an upper perspective view of a plate. FIG. 61 is a side view including a partial cross section of the hole forming means screwed into the bone screw receiving hole. FIG. 62 is a cross-sectional perspective view of a drill and a drill guide that is drilled for insertion of a bone screw and screwed into a plate. FIG. 63 is an upper perspective view of a single fixing plate mounted along a segment of the spine, with two fixing caps attached to two bone screw receiving holes. FIG. 64 is a side view including a partial cross section of the fixing cap engaged with a driver to attach the fixing cap. FIG. 65 is a partial cross-sectional view of the plate, bone screw and fixing cap along lines 65-65 of FIG. FIG. 66 is an enlarged fragmentary view of region 66 of FIG. 65. FIG. 67 is a perspective view of a cervical fixing plate held by another plate holder means. FIG. 68 is an end sectional view of the plate holder of FIG. 67 that is engaged with the plate. FIG. 69A is an end sectional view of another embodiment of the plate holder. FIG. 69B is an end sectional view of another embodiment of the plate holder. FIG. 70 is a plate holder means with offset and removable handles. FIG. 71 is an upper perspective view of a second embodiment of a single cervical fixation plate having a separate fixing element for fixing each bone screw. FIG. 72 is an upper perspective view of the threaded fixing element used for the single fixing plate of the neck of FIG. 71. FIG. 73 is a partial side cross section of the plate of FIG. 71 as viewed along lines 73-73, with the fixing elements of FIG. 72, in place to hold the bone screw, but not fully tightened. It is a figure. FIG. 74 is an upper perspective view of another fixing element used in the first variant of the single neck fixing plate of FIG. 71. Figure 75 Is a side sectional view of a first modification of the plate of FIG. 74 with the fixing element of FIG. 71. FIG. 76 is a perspective view of the first modification of the plate of FIG. 71 and other fixing elements used. FIG. 77 is a partial side sectional view of a first modification of the plate of FIG. 71 with the fixing elements of FIG. 76 in place. FIG. 78 is an upper perspective view of another fixed element, which is the shape of the rivet used with the second modification of the fixed element of FIG. 71. FIG. 79 is a partial side cross-sectional detail view of the plate of FIG. 71 modified to use the fixed elements of FIG. 78 shown in place. FIG. 80 is a partial cross-sectional view of a plate and bone screw with the end of the tool shown used when inserting both the bone screw and the fixing cap. FIG. 81 is a side view of another embodiment of the tool of FIG. 80. FIG. 82 is a diagram showing an embodiment of a fixed plate of the cervical spine. FIG. 83 is a further embodiment of the cervical spine composite fixation plate used to stabilize the spine composite compartment. Figures 84A-84E are various embodiments of a composite fixation plate of the cervical spine used to stabilize a single section of the spine. Detailed Description of Drawings The present invention is first described in connection with a preferred embodiment of a plate system in which a plurality of bone screws are fixed (locked) in place with one fixing element (locking element). This is called a composite fixed plate system. A composite fixing plate (composite locking plate) is described, followed by a fixing element that secures the bone screw to the plate, then the bone screw associated with the composite fixing plate, and finally the means and method of mounting the composite fixing plate. .. A plate system is then described in which a single fixing element secures a single bone screw. This is called a single fixed plate system. Then, mounting fixing elements, bone screws, means and methods associated with a single fixing plate are discussed. 1. Composite Fixation Plate System A preferred embodiment of the composite fixation anterior neck fixation plate 2 according to the present invention is shown in FIG. 1-5 (shown here in an example used for two levels of fixation (three adjacent vertebrae). ). The plate 2 generally has an elongated shape, the contour of which is generally far from the rectangle due to the lobe or lateral protrusion 4 being located at the corner and in the lateral center of the plate 2. Each lobe 4 has a rounded contour and each contains a circular bone screw receiving hole 6. Two additional intermediate circular bone screw receiving holes 8 are located inside the sides of the plate 2 and have a center on the vertical axis centerline of the plate 2. The lobe 4 provides the plate 2 with additional strength in the area surrounding each bone thread receiving hole 6. It is recognized that other shapes for plate 2 may be used. The intermediate paired bone thread receiving holes 8 are used for 2 level (3 vertebrae) fixation. The intermediate cuneiform socket 8 may be removed for single level (two vertebrae) fixation, or if additional levels will be fixed, additional intermediate cuneiform sockets Hole 8 may be added. The plate 2 further comprises three locking holes 12, each of which is internally threaded 3 in a preferred embodiment, each of which is surrounded by a shallow countersunk area 14. In a preferred embodiment, the bone screw is inserted into the bone screw receiving hole and a single pre-mounted fixing element associated with each locking hole 12 is inserted into many bones at once, as described in detail below. Fix the screw 30 in place. The number of paired bone screw holes generally corresponds to the number of fixed vertebrae. One level fixation plates will have a single locking hole 12, while plates for fixing two or more levels (three vertebrae) accommodate additional paired bone screw holes. It is possible to have an additional intermediate locking hole 12. In the embodiment illustrated in Figure 1-6, each fixing element 20 at the end secures three bone screws 30 in place. On the other hand, the fixing screw 21 of the center fixing hole 12 fixes two bone screws 30 in place. Determine. As shown in FIG. 7, the central fixing element 25 can also be formed to fasten four bone screws 30 at the same time. In particular, as shown in FIGS. 3, 4 and 5, the plate 2 has its bottom surface 27 (the surface in contact with the vertebral body) in the vertical plane (corresponding to its length) and in the horizontal plane corresponding to its width. The shaft has both concave curves, both of which are concave. The concave curvature in the vertical plane corresponds to the proper shape of the anterior surface of the spine with aligned vertebrae in the proper lordosis. Its vertical curve is 15.0 cm to 30.0 cm in the radial direction, more preferably 20.0-25.0 cm.It is an arc along the circumference of the circle (referred to here as the "radius of curvature"). As can be seen on the edges of FIG. 4, the plate 2 has a radius of curvature of a circle of 15-25 mm, preferably 19-21 mm in the radial direction. The plate 2 may have a thickness of 2 to 3 mm, preferably a thickness of 2.25 to 2.5 mm. Contouring the bottom surface 27 of plate 2 so that it is at the same height with respect to the associated vertebral body has a larger radius of curvature that contacts the vertebral body only along the vertical centerline of the plate. In contrast to conventional plates, which allow lateral vibration of the plate with respect to the vertebral body. The contour of the plate of the present invention provides effective resistance to vibration of the plate 2 against the vertebral body around the vertical centerline of the plate, thereby reducing stress on the plate 2 and the bone screw 30 and soft tissue under the plate. Prevents being engaged in. Another advantage caused by the above curvature is that the plate 2 fits more closely to the facing bone surface; the plate 2 protrudes less from the spine; where it can be damaged. And the soft tissue prevents slipping beneath the edge of plate 2; And the angle of the bone screw 30 perpendicular to the plate when mounted is substantially the convergence angle, capturing the bones of the spine between the bone screws 30 and thus the plate is more firmly fixed to the spine. To be. As shown in FIG. 5, the bottom surface 27 of the plate 2 is preferably porous, has a roughened or embossed surface layer, and also has a fixation (fusion) promoter (bone-like, morphology). It may be covered, impregnated or contained (forming protein), thus promoting bone growth along the underside of plate 2 from vertebra to vertebra. The embossed bottom surface 27 is further provided with a medium that retains the fixation promoter, and the bottom surface 27 layers can be impregnated prior to attachment. The bottom surface 27 of the plate 2 may be provided with the desired porous embossed form by rough spraying or other conventional techniques such as etching, plasma spraying, sintering, or casting. In the case of porosity, the bottom surface 27 is formed to be 50-500 microns, preferably 100-300 microns, with porosity or pore size. Immobilization promoters that can be impregnated with the porous embossed bottom 27 include, but are not limited to, bone morphogenetic proteins, hydroxyapatite or hydroxyapatite tricalcium phosphate. Plate 2 may contain at least partially resorbable material, which can be further impregnated with bone growth (growth) material, so that plate 2 is absorbed by the patient's body and bone growth. It releases the material and, as a result, acts as a periodic release mechanism. Since Plate 2 is made from a material containing resorbable bone growth material, the plate gradually becomes less resistant to loads, thus avoiding slow stress protection of the spine, a more natural way. The vertebrae are fixed at. As further shown in FIGS. 4 and 5, at least one end of the plate 2 has a recess 18 that is capable of cooperating with the compressor. It will be described in detail later with reference to FIGS. 36 and 38. FIG. 6 is a plan view of the plate 2 of FIG. 1 and is a fixing element inserted into the fixing receiving hole. It has 20 and 21. In a preferred embodiment, the fixing elements 20, 21 are in the form of screws and cooperate with the threaded interior 3 of the fixing hole 12. Each of the fixing elements 20 and 21 is shown in its initial open direction, where the direction of the notch 22 in the head 23 of each fixing element 20 and 21 is that of the fixing elements 20 and 21. It is configured to allow the bone screw 30 to enter the adjacent bone screw receiving holes 6 and 8 without being obstructed by the head 23. Understand that it is possible to arrange the head 23 in another position as long as the structure allows the bone screw to be inserted into the adjacent bone screw receiving hole without being disturbed by the head 23. I want to be. FIG. 8 is a plan view of another embodiment of plate 2 of FIG. 1-5, commonly referred to as plate 120. The plate 120 comprises a vertically extending rectangular groove 122 along the vertical axis that is superimposed on the central fixing hole 12. The rectangular groove 122 allows for additional relative movement between the plate 120 and the compression post 54 that are coupled to the compression tool during the compression process, as described below. With reference to FIGS. 14 and 15, other embodiments of the composite fixation plate referred to by reference numeral 70 are shown. Rather than the threaded fixing holes 12, the plate 70 provides a central opening 200 for accommodating the removable rivet 202 of the type shown in FIGS. 17-20. FIG. 15 is a bottom view of the plate 70 shown in FIG. The contour of plate 70 is the same as that of plate 2 shown in Figure 1-5. The rivet 202 is removable and is fitted in the screwless opening 200, which is equivalent to the fixing holes 12 and grooves 122 described above. In other embodiments, rivets manufactured as part of the plate 70 may be used rather than removable configurations, as used in the end fixing holes 19 of FIGS. 14 and 15. As described in FIG. 22, another embodiment of the composite fixation plate is shown and is commonly referred to by reference numeral 230. The plate 230 is for a fixing element, eg, of the cap 300 shown in FIGS. 9 and 23. Such as a screw cap, or one with a notch having a plan view appearance, such as the fixing element of FIG. 10-11. The central fixing hole 602 has an elongated groove 234 to provide increased compression capacity, which is further discussed herein. As shown in FIG. 10-13, first embodiments of fixing elements 20, 21, 25 in the form of fixing screws of the present invention used with the plate 2 are shown. FIG. 10 is a top view illustrating the head 23 of the central fixing element 25 shown in FIG. 7. The shaft 46 of the fixing element 25 is threaded and engages the threaded 3 in the fixing hole 12 associated with the plate 2. As shown in FIG. 21, each section 49 on each side surface of the notch 22 of the fixing element 21 has a seating surface 48 formed on the lower surface of the fixing element head 23. As shown in FIG. 16, the fixing element head 23 may be provided with two grooves 42 for imparting flexibility to the fixing element head 23, which grooves 42 when the fixing element rotates. In addition, it helps to place the fixing element on the top of the bone screw head 32 while acting as a bearing. Alternatively, it will be appreciated that the seating surface can be camped, tilted, or wedge-shaped. The cammed, slanted, or wedge-shaped features can also be used for the other fixing elements described herein. As described in FIGS. 6 and 10-13, when the fixing elements 20 and 21 are rotated in the clockwise direction with respect to the figure of FIG. 6, each seat surface 48 is a curved surface of each bone screw head 32. It will be understood that riding on 39 and securely fixing the bone screw 30 and fixing elements 20 and 21 associated in place. Alternatively, instead of the seat surface 44 as shown in FIG. 21, a sloped or wedge-shaped surface 44 may be used to increase the force applied to the bone screw head 32. When fixing, the tip of the inclined part of the fixing element is lower than the protrusion of the bone screw head 32, so loosen the fixing element more than the force required to tighten and fix the fixing element. Unconcluded Greater force is sometimes required. However, the fixation element head 23 does not need to have a groove, need to be cammed, or have a beveled surface to achieve fixation of the bone screw 30 in place. Other engaging means may be used that can prevent the fitting or fixing element from moving from its fixing position due to pressure, frictional force, interference. The rivet 202 shown in Figure 17-20 is shown in Figure 14, It is used in connection with the plate 70 shown in 15, and is shown in detail in the cross-sectional views of FIGS. 19 and 20. The rivet 202 has an elongated bottom compartment 208 for fitting within the corresponding opening 200 of the head 204, shaft 206 and plate 70. The lower surface 210 of the head 204 of the rivet 202 has an irregular surface that may be cammed on the lower surfaces of the fixing elements 20, 21 to engage the surface 39 of the bone screw head 32. Due to the end fixing hole 19, the upper surface of the elongated bottom compartment 208 is not the bottom of the plate 70 to hold the rivet 202 in the fixed position against the bone screw head 32, as shown in FIG. It may have an irregular surface that cooperates with a regular surface. Although the rivets in FIG. 18 are separate, removable components from the plate, even though they are formed as part of the plate, especially as end fixing holes, during the plate manufacturing process. Also, the rivet may be configured to be non-detachable. Each of the above embodiments results in a firm attachment of the fixation element to the bone screw 30 and the associated plate. In another embodiment of the composite fixing plate 23 shown in FIG. 22, the fixing element may be in the shape of the threaded fixing cap 300 shown in FIG. The threaded fixing cap 300 has a thread 302 on an outer circumference that matches the thread 303 on the inner circumference of the recess 304 for the fixing element in the upper part of the plate 230 shown in FIG. The fixed cap 300 is relatively thin, especially when compared to its width. The upper portion 305 of the fixing cap 300 includes a non-circular through hole 306 for accommodating a similarly configured drive tool. As described in FIGS. 28, 29 and 30, another embodiment of the composite fixing plate commonly referred to by reference numeral 400 and a fixing element in the form of a thin fixing element 412 are shown. The plate 400 is located on its surface opening for insertion of the thin fixing element 412, the recess 402 associated with each of the bone thread receiving holes 408, and the side wall of the bone thread receiving hole 408. It has a groove 410 and has a series of thin protrusions or blades 414, which gives the fixing element 412, which is thinner than the groove 410, an appearance similar to that of a propeller. The thin fixing element 412 is rotatable within the plate so as not to cover the bone screw hole, which allows the thin fixing element 412 to be pre-installed by the surgeon prior to the installation of the bone screw. The limited rotation of the thin fixing element 412 allows the blade 414 to protrude into the groove 410 and cover part of the top of the associated bone screw 30. The blade 414 of the thin fixing element 412 is flexible and slides over the entire surface 39 of the bone screw head 32 to secure the bone screw 30 in place when rotating. As with the other embodiments discussed, each of the fixation element embodiments can secure a plurality of bone screws 30. A variety of composite fixing plates and fixing element combinations can quickly fix as many as four bone screws, but if they themselves are fixed to the plate, they can be fixed with a smaller number or nothing. Will be understood to be equally effective. One feature of each of the above fixed element embodiments is a recess in the bone screw 30 so that the driver engaging means, eg, in these cases, the same tool can be used to turn the bone screw 30 and the fixing element. Note that it has a recess 24 that is the same size as 34. Also, the fixing element is strong enough and has sufficient mass to be able to withstand being fixed without breakage. All of the shown examples of composite fixation elements with many notches have an arc with a larger radius than that of the bone screw head. In addition, the head 23 of each of the fixing elements 20, 21 has a non-circular recess 24, shown in FIG. 9, such that it can be fitted, for example, by a corresponding operating tool, such as that shown in FIGS. 40-42. Prepare for the center. In the embodiment of head 23 shown in FIG. 9, the relevant tool has a hexagonal head, but even if other shapes of recesses within head 23 are used, as discussed with respect to FIGS. 80 and 81. Good. Each fixing hole 12 and fixing element 20, The 21 threads have close tolerances, so they hold their orientation securely so that they can be inserted into the bone screw receiving holes 6 and 8 without the need to tighten the bone screw 30. .. It will be appreciated that various forms of fixation elements will be disclosed and, in view of the teachings, other equivalent means may be used to secure the bone screw 30 in place. In FIG. 83, an alternative composite fixing plate 990 is shown, which has an additional intermediate bone screw receiving hole 980 and an associated fixing element 960 for fixing the bone screw 30 in place. Plate 990 allows closer spacing and more pairs of bone screw holes to engage than the number of vertebrae. In Figures 84A-84E, a variety of plates 700a-g used for single level fixation are shown. Each of these plates 700a-g spans one spinal compartment consisting of one intervertebral space and two adjacent vertebrae (including bone grafts) and is linked to two adjacent vertebrae. It is designed so that the bone screw is inserted into the end of the vertebra through the bone screw receiving hole 6 and is fixed in place. As shown in Figures 84A-84E, one fixing element 710 or two fixing elements can be used to secure the four bone screws in place. In Figures 84A-84E, each plate 700a-e, before rotating and fixing the bone screw, is shown along with the fixing elements in their open direction. Each of the above-mentioned plates may have substantially similar contours of both concave surfaces, as described above, so as to coincide with the anterior surface of the spinal column. 24A and 24B provide side views of one embodiment of the bone screw 30 of the present invention. FIG. 27 is a plan view of the bone screw 30. As the recesses 24 of the fixing elements 20 and 21, there is a recess 34 in the center of the bone screw head 32 having a shape that may have the same shape. In this case, the fixing elements 20 and 21 are rotated. It may be rotated with the same tool used for. It will be appreciated that the driver engagement portion of the bone screw 30 may be grooved, which can be male or female (as shown). Shown in Figures 24A and 24B In the embodiment of the bone screw 30, the bone screw head 32 is provided with a stepped portion, which is adjacent to the screw shaft portion 33 and has a diameter smaller than the upper part of the bone screw head 32. Has 35. When this embodiment of the bone screw 30 is adopted, each of the bone screw receiving holes 6 and 8 of the plate 2 is provided with a countersunk hole that fits the diameter of the upper part of the bone screw head 32 and has a tightening size. It has the area 14 that has been removed. The lower portion 35 of the bone screw head 32 is sized to form a tightening fit at its associated parts of the bone screw receiving holes 6, 8. The larger diameter upper part of the bone screw head 32 ensures that the bone screw 30 does not travel completely through the bone screw receiving holes 6 and 8 of the plate 2. The bone screw 30 passes through the top surface of the plate 2 completely without engaging the top surface in any shape. As shown in FIG. 44, the head 32 of the screw 30 is until the lower surface of the enlarged screw head 32 engages the upper surface of the bone screw containment portion that narrows with an intermediate material or under the intermediate material of the plate. , Passing through the top surface of the plate without any obstacles. This is considered to be an optimization that provides maximum stability of the screw to the plate, even when not fixed, for all other forces that reverse the insertion path, while the bone screw head 23 It also provides the highest plate strength on the underside. That is, since the plate is only about 2-3 mm thick, if the heads are formed in the same way and there is little tolerance (interference) between them, the vertical circumferential wall will have the most screw movement. It becomes possible to limit. Placing the head supports near the thickness of the center of the plate is preferred because the recesses for the driver can be adapted without weakening them so that the head remains large. On the other hand, placing the head support away from the top surface of the plate allows the screw head to be inserted deep into the plate. Placing the head support approximately in the center of the plate thickness ensures a large amount of plate material under the supporting head, while providing adequate head length above and below the contact point. And the contact point is inevitable Providing an appropriate lever arm to prevent necessary movement will prevent it from acting as a fulcrum. As shown in FIG. 25, in another embodiment of the bone screw 30', the bone screw head 32' is tapered from its top towards the screw tip 36'. On the other hand, the bone screw head 32'is associated with the bone screw receiving hole 6, when the bone screw 30' is fully installed. The dimensions are set so that the tightening fit is performed at 8. When this embodiment of the bone screw 30'is used, the bone screw receiving holes 6 and 8 need not have a countersunk area 4. In each of the above embodiments of the bone screw, the bone screws 30 and 30'present a unique combination of a tapered screw shaft 33 and a spiral thread 31. The diameter of the screw shaft 33 increases approximately from the end of the shaft near the screw tip 36 towards the portion near the base of the shaft near the screw head 32. In a preferred embodiment, the rate of increase in diameter is greater even near the bone screw head 32. This type of shape avoids stress sources and provides increased strength where it is most needed in screw-plate joints. To taper the screw shaft 33, it may have a concave shape or may be linear, as shown in FIG. 24A. The end portion of the screw shaft 33 may have a constant diameter. On the other hand, as shown in FIGS. 24A and 24B, the thread 31 of the bone screw 30 is from the portion near the base of the shaft under the bone screw head 32 to the end of the shaft near the tip 36 of the bone screw. Has a substantially constant outer or top diameter "d". At the thread tip 36, the top diameter of the thread 31 may be reduced by one to two revolutions, preferably to facilitate insertion and penetration of the bone screw 30 into the bone. In a preferred embodiment, the thread 31 of each bone thread 30 has an outer diameter slightly smaller than the diameter of the lowest portion 35 of the bone thread head 32, which is the end or top of the associated thread 31. Adjacent to. In addition, the threads 31 are relatively thin in the longitudinal direction of the thread, taper outwards, and have a triangular cross section. Examples of the dimensions of a surgical bone screw for the human anterior cervical spine for insertion into the vertebra are as follows: The threaded portion of the screw is approximately 10 mm to approximately 22 mm in length (preferably 12). -18 mm) and head length of approximately 1 mm to approximately 3 mm (preferably 2-2. Has 5 mm). The threads should have a maximum outer diameter of about 3.6 mm to about 5.2 mm (preferably 3.8-4.5 mm) and the head should have a diameter of about 3.8 mm to about 6 mm (preferably 4-5.5). mm). Thread pitches range from about 1.25 mm to about 2.5 mm (preferably 1.5-2.0 mm) and have sharp, thin threaded sides. The vertices of the two surfaces of the thread have an angle of less than approximately 21 degrees (preferably 15 degrees), and the base of the thread is approximately 0.60 mm thick (preferably 0.25 mm-0.). It is less than 35 mm). The screw has a valley diameter that increases from the upper vicinity of the end portion of the shaft portion toward the lower vicinity of the screw head portion along the vertical axis. Preferably, the tip of the screw end is grooved by at least one notched section, which makes the screw self-tap. Even though the thread 31 of the bone screw 30 has a thin side, the thread is nevertheless stronger than the bone and there so that this thread efficiently cuts a thin spiral groove into the bone tissue. Will be inserted. The amount of bone moved by the thickness of the thread is minimized by the thin shape of the thread, but the effective apex diameter of the thread maximizes the surface area of the thread in contact with the bone. Increasing the diameter of the screw shaft 33 near the bone screw head 32 increases the strength required there. On the other hand, if this type of strength is not required, reducing the diameter of the screw shaft 33 away from the bone screw head 32 can ensure the maximum area for engaging the thread 31 with the bone. It becomes. In a preferred embodiment, as shown in FIGS. 24A and 26, the bone screw tip 36 is grooved 38 so that the bone screw 30 can self-tap. Unlike conventional bone screws used in conventional anterior cervical spine surgery, which cannot be self-tapped, the threaded form of the screw of the present invention is very sharp and grooved. The shape is closer to a tap than a conventional screw. An additional embodiment of the bone screw 30 is shown in FIGS. 53-55. As an example, a plate for fixing three adjacent vertebrae (between two or a division of two vertebrae) is shown. Each pair of bone screw receiving holes associated with the vertebrae is considered to be a plate compartment, for example shown as the three compartments in FIG. 1, upper, middle and lower compartments. The discussion so far has been about the plates used to join the three vertebrae that sandwich the two gaps, but with the appropriate number and position of bone screw receiving holes for the number of vertebrae to join. It can form long or short plates. For example, the division along line 9 in Figure 1 or shown in Figure 82-84F. It must be understood that it can take the form of plates shown as fewer or more intermediate segments, such as intermediate segments of plates. With reference to FIGS. 31-42, an outline of the steps of the method of mounting the plate of the present invention will be described below. A detailed description of the means and methods for attaching the plates of the present invention follows the overview. Step 1 Complete the interbody fusion and the surgeon removes any bone spool or local irregularities along the anterior surface of the spinal column in the area to be fixed. Step 2 A plate of the correct length is selected by the surgeon by measuring the distance on the spinal column with a diameter gauge, ruler, template, etc. The plate is long enough to measure the distance of the spinal column to be fixed and to partially cover each part of the vertebrae at each end to be fixed. Step 3 Utilizing a plate holder, the plate is placed at the site of injury to determine the position, length, and screw hole arrangement associated with the part of the spinal column to be fixed. Step 4 For plates thus placed and held firmly, as shown in FIG. 31, the plate is attached to any vertebra that is fixed (illustrated only, but shown as the main vertebra). You may. Substep 4A Pilot (guide) hole punch 60 is attached to plate 2 as shown in FIG. Alternatively, a drill guide may be used instead, although not preferred, as shown in FIG. 37. In any case, the pilot hole forming means is reliably positioned and captured by the plate bone screw receiving hole wall. Substep 4B pilot holes are then formed by punching with the pilot hole punch of FIG. 32 or drilling with the drill of FIG. 37. Although not preferred, as an option, the formation of the pilot hole may be treated as a whole, and the correct screw chosen to have a length shorter than the distance to the posterior vertebral cortex along its path is inserted directly. May be done. The applicable screw length can be determined by X-ray photography and MRI. It is made by measuring from or by CT scan or by template, or it is determined directly by measuring the depth of the intervertebral space. Step 5 A properly selected screw is attached to the screw driver regardless of the specific shape of the screw driver engaging means. The screw is also designed to have a tightening fit so that it is firmly secured to the driver during insertion into the insertion site. Figures 41, 42, 63, 64, 80 and 81 show various ways to achieve this type of fitting of drivers and screws. In addition to wedges at the screw and driver interface, clips, springs, and other means are known to temporarily and reversibly secure the screw to the driver, as shown in FIG. Here, the grooved inwardly bounced sleeve remains screwed into the plate and holds the screw cap until it is automatically recessed and pushed back. Once the first bone screw is completely inserted into the vertebrae through the plate, it is preferable to insert the other of the horizontal sets in the method shown in FIG. 33 and already described. In a similar manner, at the surgeon's option, it is possible, or additionally, to insert the remaining bone screw into each vertebra contained within the fixed vertebra, just at the end of the fixed structure. , Screws can be inserted into the fixed implant. However, as shown in FIGS. 33, 34, 38 and 39, in the present invention, the surgeon's option is to place some or all of the fixed structure under pressure and, if multi-segmented, segment. It is possible to do so in between or throughout the fixed structure. It will be appreciated that the same procedure may generally be used in any of the plate systems of the present invention. As shown in FIG. 31, in the intervertebral space of the spine between adjacent vertebrae 50 forming a fixed bone graft structure, the pre-attached fixed implant blocks 51 allow the vertebrae 50a-c to come from each other. Be separated. Plate 2 simplifies the figure It is shown in FIG. 31 regarding fixing the elements 20, 21 that are removed in order to do so. In a preferred embodiment, the fixation elements 20, 21 may and preferably are pre-attached to the positions shown in FIG. 6 prior to placing the plate 2 on the vertebral body of the vertebral bone 50, thereby performing surgery. Excludes time and problems. Plate 2 is provided by any known plate holding means, but preferably by the holding tool shown in FIG. 45, 46 or 70 by a notch 142 on the side of the compression arm 104, 130 of the spinal compression tool 100 shown in FIG. Alternatively, as a further option, it may be held in place by a single plate holder similar to the design in Figure 70. Plate holder a hollow tubular housing 872 with a central rod 874 with threads 878 at one end for engaging one of the threaded fixing holes 12 of the plate 2, as shown in FIG. 45. 870 has. The bottom edge of the housing 872 is a protrusion 880, which extends outward and downward to fit into the bone thread receiving hole of the plate 2 that prevents the housing 872 from rotating. Has 882. The central rod 874 is located in the housing 872 so that it can be rotated by rotating a handle (not shown) that secures it to the central rod 874 at its upper end. FIG. 46 shows another embodiment of the plate holder 890. The single solid member 890 has a threaded protrusion 894 at its bottom end for attachment to the threaded fixing hole 12 in the center of the plate. The bottom surface of the holder 890 of this embodiment is contoured to match the contour of the surface of the plate adjacent to the fixing hole 12, shown as the recess 14. As described in FIGS. 67-68, embodiments of plate holders that are located in the vertebrae while holding any of the plates are generally indicated by reference numeral 800. The plate holder 800 comprises a hollow tubular housing 802 with a handle 806 at one end and a central rod 804 with a thread 808 at the other end for engaging one of the threaded fixing holes 12 of the plate 600. Have. The bottom end of the housing 802 is outer and then downward 814, to fit along the side edge of the plate 2 between the end and the intermediate lobe, which prevents the housing 802 from rotating. It has protrusions 810 and 812 extending to 816. The central rod 804 is located in the housing 802 so that it can be rotated by rotating a handle 806 that is secured to the central rod 804 at its upper end. This central rod 804 has a central rod 804 by a number of conventional methods, eg, an annular recess having a length of approximately 3-5 mm and a set screw protruding inward from the housing that engages the central rod 804. It may be attached to the housing 802 so that it can move up and down somewhat. Once the plate 600 is in place and the plate is attached to one of the vertebrae by the bone screw 30, the central rod 804 is detached from the opening in the plate 600 and the holder 800 is removed. FIG. 69A is another embodiment of the plate holder 850. The single solid member 852 has, at its bottom end, a threaded protrusion 854 for attachment to the central threaded fixing hole 12 of the plate 12. The solid member 852 may also be threaded into the bone thread receiving hole 6. The bottom surface of the holder 850 of this embodiment is contoured to match the contour of the surface of the plate adjacent to the fixing hole 12, indicated as the recess 14. FIG. 69B is another embodiment of the plate holder 850'. A housing 851'with an end 853' formed to engage the bone thread receiving hole 6 includes a rod 855'having an uneven diameter and threaded portion 857'. Since the rod 855'is rotated by a handle similar to the handle 806 shown in FIG. 68, the rod 855'move down into the housing 851' and into the matching thread 858'. As the end of the rod 855'is driven downwards, the wedged portions 859a'and 859b' (859c'859d' (not shown)) of the plate holder 850 are extended to hold the bone screw of the plate. Plate holder 850'is most often used for unscrewed bone screw receiving holes However, it works effectively for all types of bone screw receiving holes. As described in FIG. 70, another embodiment of the plate holder referenced by reference numeral 800'is shown. Here, during a mounting procedure that reduces the tightness of the plate holder 800 by surgical procedure, first to mount the plate holder 800 on the plate by rotating the shaft 804, and then by extension 864. There is a removable handle 860 used to hold the plate holder 800'away from the side. The compression tool 100 described in FIG. 38 is shown with a gear bar 102 having a first compression arm 104 fixed to its free end. The compression arm 104 detachably holds the plate engaging element 108 shown in FIG. 36 or the notch 18 in the end of the plate 2 having a hook 110 at one end to engage the recess, or FIG. 33-. It has a hole 106 at its end for detachably holding the compression post 54 shown in 34. As shown in FIG. 36, the plate engaging element 108 is used to limit the insertion depth of the plate engaging element 108 to the shaft 112 inserted into the corresponding hole 106 of the compression arm 104 and to the hole 106 exactly. Includes a flange 115 that rests on the bottom surface of the hole 106. A ring spring 128, preferably metal, is located in the annular recess of the shaft 112 to hold the plate engaging element 108 in the hole 106. The compression tool 100, described in FIGS. 38-39, includes a second movable compression arm 130 that can move parallel to the first compression arm 104 along the toothed bar 102. The end of the second compression arm 130 also has the same hole 132 as the hole 106 that can accommodate the removable post 134. These holes 106 and 132 are the same so that both compression arms 104 and 130 can be used to hold the removable post 134 and the compression tool 100 can be used in any direction. It is said that. Can be operated even when there is an angle to the plate The ability to rotate and slide in holes 106, 132 of 130 allows the device to be easily attached to the spinal column via compression posts 54 and plates. The compression arm 130 has a drive assembly consisting of a toothed wheel (invisible), the toothed wheel is engaged with the tooth gear 138 of the bar gear 102, and the compression arm 130 is along the gear bar 102. It is connected to a compression arm 130 so that it can be moved by rotation of the handle 140, and the handle is engaged with a toothed wheel. When the handle 140 is turned in the direction of the arrow shown in FIG. 38, the compression arm 130 moves towards the compression arm 104. The drive assembly has a self-fixing release mechanism that prevents the movement of the two compression arms 104, 130 away from each other without release activation. On opposite sides on the inner end of each compression arm, as shown in FIG. 37, along its side between the central lobe 4 and the end lobe 4, a notch 142 or a notch 142 to hold the plate 2. There is a recess. The gear bars 102 and compression arms 104, 130 are described linearly, but if necessary, the gear bars 102 and compression arms 104, 130 are arcuate or arcuate to induce lordosis within the vertebrae. It is possible that it may otherwise be shaped. The compression tool 100 is used to hold the plate 2 as shown in FIG. As a result, when the plate 2 is properly placed, the ends 144 of the compression arms 104, 130 are aligned with the fixed implant structure 51 placed in the intervertebral space. The gap lies between the plate 2 and each fixed implant structure 51, and if space is provided to accommodate the free ends of the arms 104, 130, they are formed beyond the bottom surface of the plate 2. As described below, a similar compression tool 100 may be used to compress multiple cervical vertebral bodies with bone implants placed during attachment of the plate 2 to the vertebral bone 50. With reference to FIG. 31, plate 2 is held by a suitable holder. Although held, in this case the boulders are shown as compression arms 104 and 130. A plate 2 of the appropriate length is properly placed so that the bone screw receiving holes 6 are aligned with each of the respective vertebrae 50a-c to which the bone screw receiving holes 6 are fixed. As a next step, a bone screw receiving hole 6 is formed in the vertebra 50a before the bone screw 30 itself is attached. The procedure is described first to attach the plate 2 to the upper vertebra 50a, but the plate 2 may be attached to any vertebra in any order. As mentioned above, differently sized plates are available, so doctors are advised that bone screw receiving holes 6, 8 are suitable for placement in three adjacent vertebrae 50a, 50b and 50c. Choose a size plate. The pilot hole is formed by the pilot hole forming device 60 shown in FIGS. 31 and 32. Unlike those according to known prior art and screw plating systems, the bone screw 30 may be inserted without the traditional formation of screw holes formed in the vertebrae. This is because the bone threads 30 are preferably sharply pointed, tapped (male threaded), and have a tapered outer diameter at their tips to assist in screw insertion and removal into the bone. is there. However, while holes in the bone of the vertebra may be formed prior to screw insertion, however, the holes are smaller in diameter than the root diameter of the screw and for purposes different from the prior art. In the prior art, since the screw was not a tap, the hole to be drilled had to be the same diameter as the root diameter (smaller diameter) of the screw, but preferably larger. Here, it is desirable to prevent damage to the vertebrae during the insertion of the bone screw 30 by making a pilot hole and ensuring a suitable path for the bone screw 30. In addition, the pilot hole forming device 60 makes the vertebral mass required to receive the tap bone screw 30 used for this insertion more compact. As shown in FIGS. 31 and 32, the pilot hole forming apparatus 60 includes a hollow cylindrical housing 62 having a bottom with through holes 63. Ha The uging 62 includes a central shaft 64 extending through a through hole 63 at the bottom of the housing 62. The tip 66 of the shaft 64 gradually tapers towards the sharp tip 65. The shaft 64 includes a ring member 73 having a diameter that closely corresponds to the inner diameter of the housing 62 to guide the movement of the shaft 64 within the housing 62. The compression spring 67 is arranged between the ring member 73 and the bottom of the housing 62. The compression spring 67 provides a bias force that normally propels a sharp tip 65 into a position housed within the housing 62. The upper end of the shaft 64 has an enlarged head 68 extending outward of the housing 62 intended to be manually pushed down or struck by an impact device, from the housing 62 and from the vertebral body 50a. Drives a sharp tip 65. The shaft 64 is given a length, taking into account the length when the spring 67 is fully compressed, thus determining the maximum depth of the pilot hole formed in the vertebral body. The depth is chosen to ensure that the pilot hole does not reach the posterior cortex of the vertebral body, which is adjacent to the spinal canal. Certain structural features of the hole forming apparatus 60 are shown in more detail in FIG. In particular, it can be seen that the bottom end of the housing 62 has a protruding portion 69 that is sized exactly as required to fit in the bone screw receiving holes 6 or 8 of the plate 2. The bottom 71 of the protrusion 69 is flat in a plane perpendicular to the axis of the housing 62. The protruding portion 69 of the housing 62 is snugly inserted into the bone screw receiving holes 6 and 8. The flat bottom 71 is then pressed against the upper surface of the plate 2 to ensure that the tip 66 of the shaft 64 forms a vertebral pilot hole with an axis perpendicular to the portion that engages the plate 2. This also ensures that the bone screw 30 is subsequently attached because the shaft is formed perpendicular to a plane parallel to the upper and lower surfaces of the portion that engages the plate 2. Pilot hole forming device when plates with threaded bone screw receiving holes are used The lower end of 60 is threaded to engage the threads in the bone thread receiving holes 6 and 8, thereby fixing the plate and pilot hole forming device together and between the pilot hole forming device and plate 2. Guarantee stable mating. Note that the diameter of the tip 66 of the shaft 64 is small, as it must fit in the small space left between the inner walls of the pilot hole forming device. A small diameter is sufficient, as all that is formed is a pilot hole for the tapping bone screw 30. With reference to FIG. 37, in any case, if it is desired to form a pilot hole in the vertebral body 50 by drilling rather than by utilizing the pilot hole forming device 60, it is shown in FIG. 37. A hole may be formed by the drill guide 80 with the lower end portion. The guide of the drill 80 consists of a tubular member 82 and a small diameter lower end 84 sized to form an accurate fit (interference) in the associated bone thread receiving holes 6 and 8 of the plate 2. Since the drill guide 80 includes an end surface that forms a plane perpendicular to the vertical axis of the drill guide 80 along the small diameter lower end portion 84, the small diameter portion 84 is fitted into the bone screw receiving hole 6. And when the surface surrounding the small diameter portion 84 comes into direct contact so as to form a plane with the upper surface of the plate 2, the axis of the drill guide hole 86 of the drill guide 80 is exactly relative to the upper and lower surfaces of the plate 2. Is vertical. As in the case described above, the bottom end of the drill guide 80 may be threaded and thus screwed into the threaded opening of the plate 2. Through the two bone screw fixing holes 6 on the top of the plate 2, either the hole forming device 60 or the drill guide 80, the bone screw receiving hole 6, After the 8 is formed in the vertebral body 50a, the bone screw 30 is screwed into the vertebral bone 50, with the plate 2 firmly held against the vertebral bone 50 by the compression tool 100 or the plate holder 800. In this way, the plate is fixed to the vertebra 50a. It is also possible, if desired, to press-fit a fixed implant into the next adjacent vertebra 50b before attaching the bone screw 30 to the adjacent vertebra 50b through the central bone screw receiving hole of the plate 2. Once the first bone screw is in place on the vertebra 50a, the plate holder 100 or 800 may be removed from the plate 2. Press-fitting of a fixed implant structure between two adjacent vertebrae 50a and 50b is performed as follows: The compression post 54 is driven into the vertebrae of vertebrae 50b through the central fixation hole 12 of plate 2 by the insertion tool 90, shown in FIGS. 33, 34 and 35, and the compressive force between the vertebrae 50a and 50b in the next step. Is used to add. The compression post 54 includes a shaft 56 having a sharp tip 57 at its lower end, a collar 58 extending outward from the center that acts as a tool for controlling the depth of the hole, and an enlarged head 55 near the upper end thereof. Consists of a peripheral groove 59 that defines. The compression post insertion tool 90 consists of a shaft 92 with a closed hollow portion 94 at its lower end 96 for receiving the compression post 54, and an enlarged percussion cap 98 at the other end. The compression post insertion tool 90 also has a second opening 95 at its lower end 96 that has a recess 99 in its inner wall to allow the enlarged head 55 on the compression post 54 to engage in the recess 97. Consists of including. As shown in FIG. 35, the second opening 95 communicates with the hollow portion 94 of the insertion tool 90. With reference to FIG. 38, the hole 132 in the second compression arm 130 of the compression tool 100 is then used in the compression post 54 inserted into the vertebra 50b, and the plate engaging element 108 is It is inserted into the hole 106 of the first compression arm 104 of the compression tool 100. The hook 110 of the plate engaging element 108 shown in FIG. 36 fits into the notch 18 at the end of the plate 2 and is thereby secured by a bone screw 30 inserted into the vertebra 50a, as shown in FIG. 38. However, as mentioned above, the compression tool 100 is rotatable so that the first compression arm 104 is currently located at the bottom but can be fitted over the compression post 54 within the vertebra 50c. .. The plate is attached to the vertebra 50a by the bone screw 30 and secures the compression post 64 to the vertebra 50b adjacent to the 50b, so that the rotation of the handle 140 causes the first and second compression arms 104 and 130 in the direction of the vertebra 50a. Movement, bone transfer between adjacent vertebrae 50a and 50b Debris structure 51 results in compression. A distance of a few millimeters is sufficient for press-fitting the bone graft structure 51. Once the desired press fit is obtained, the bone screw pilot hole for insertion of the bone screw 30 into the bone screw receiving hole 8 of the bone plate 2 is formed by the pilot hole forming device 60 in the vertebral body 50b, as described above. The plate 2 is fixed to the adjacent vertebra 50b. The compression tool 100 may then be removed by launching the release. FIG. 39 illustrates the use of a compression tool 100 to induce compression between the lower two vertebral bodies 50b and 50c after attaching the bone screw 30 to the intermediate vertebral body 50b, just as described. As shown in FIG. 39, the compression post 54 is left in place on the intermediate vertebral body 50b, and an additional compression post 54 is a pilot hole forming tool far from the plate itself in the recess between the end processes 4. The 60 drives into the lower vertebral body 50c, allowing the lower compression post 64 to move in the direction of the vertebral bone 50b as shown. The original compression post 64 is inserted into the hole 106 in the first compression arm 104, and the additional compression post 54 is inserted into the hole 132 in the second compression arm 130 of the compression tool 100. On the other hand, as shown above, the rotation of the handle 140 is the movement of the two compression arms 104 and 130 towards each other, towards the upper compression post 54 within the vertebra 50b, the vertebra 50c. The compression post 54 inside will move, compressing the fixed implant structure 51 between the vertebrae 50b and 50c again. The upper compression post 54 in the vertebra 50b cannot move from the time the vertebra 50b is fixed to the plate by inserting the bone screw 30 in the bone screw receiving hole 8 of the plate 2. Thus, only the lower compression post 54 and the vertebra 50c may move. As described above, a pilot hole associated with the vertebra 50c is formed and the bone screw 30 is inserted into the bone screw receiving hole 6. The compression tool 100 is then removed. The compression post 54 then has a second opening 95 of the compression post insertion / removal tool 90. It is removed from the vertebra by inserting it and it engages with the enlarged head 55 at the end of the compression post 54 by the indentation 97, as shown in FIG. It is recognized that other variants may be used as long as they are within the order of compression. For example, during compression of the fixed implant structure 51 between vertebrae 50b and 50c, the hook 110 of the compression tool 100 may engage the notch 18 at the end of the plate 2 and the other compression tool 100. The compression arm may engage the compression post 54 within the third adjacent vertebra 50c. Note that plate 2 provides a concave notch between the lobes at the end of the plate for insertion of the compression post 54 within the vertebra. On the other hand, no space needs to be formed under the end of the plate 2 for the insertion of the compression post 54. Note that the above procedure is performed with bone screws 30 fully inserted into the vertebral bodies 50a, 50b and 50c and the lordosis is maintained during compression of the bone graft structure 51. .. As mentioned above, the procedure for attaching the plate 2 to the vertebrae 50a, 50b and 50c has been illustrated without the fixing screws 20, 21 in place on the plate 2. FIG. 40 is a perspective view showing plate 2 of FIG. 1-5 at the stage of the surgical procedure, where the bone screw 30 is fully inserted into the three adjacent vertebrae 50a, 50b and 50c. Then, rotate the fixing screws 20 and 21 at an angle of about 90 degrees to fix the three bone screws 30 in place; Rotate the fixing screw 20 seen on the left side at an angle of about 60 degrees to fix the three bone screws 30 in place, and rotate the center fixing screw 21 at an angle of about 90 degrees, the two others Fix the bone screw 30 in place. At this time, one of the camized surfaces 44 of the fixing screws 20 and 21 rests the screw head 32 of each bone screw 30 on the top. Installation of the fixing cap 300 is also performed with a tool 220, eg, shown in FIGS. 41 and 42, comprising a well-shaped tip 222 having a length matching the depth of the hole 306 of the fixing cap 300. May be good. The end 222 of the tool 220 closest to the end is flared so that it forms a frictional fit with the screw cap 300 for ease of operation and the screw cap 300 falls off the tool 200. It is designed not to be. FIG. 43 is a cross-sectional view of the center of the two end fixing screw holes 6 of the plate 2 with two bone screws 30 at their mounting positions and a fixing element 21 at their fixing position. FIG. 44 is an enlarged view of one of the bone screws 30 in plate 2 of FIG. 43. In a preferred embodiment, at the tip crossed by the vertical axis of the associated bone screw 30, the axis of each screw 30 is generally perpendicular to the tangent plane to the top and bottom surfaces of the plate 2. Thus, due to the curvature of the plate 2 in the plane of FIG. 18, the bone screws 30 may be oriented towards each other so as to converge at a desired angle. The axes of the two bone screws 30 shown in FIG. 18 can be crossed at an angle of approximately 45 degrees. Alternatively, the left-right curvature of the plate may be the same with respect to the anterior surface of the human adult cervical spine, or a pair of screws when optimal convergence is seen at the ends. The axis of the hole can deviate perpendicular to the plate. Once inserted, the bone screw 30 is fixed to the plate, so that each pair of bone screw 30 has a "claw" with a strong triangular frame structure. As a result, the wedge-shaped mass of the bone material is contained between the angled bone screws, so even if the screws come off ( Even with thread stripping), the vertebral bodies 50a, 50b and 50c are very stable and attached to the plate. The "claw" may be further formed by three bent bone screws in a tripod configuration or by four bone screws in a four-sided claw configuration. The plating system according to each of the above embodiments may be mounted in the same manner as described above and may use the same instruments and tools, as exemplified and described for the first embodiment. In the embodiment shown in FIG. 22, the compression operation is performed by the groove 604 instead of the center fixing screw hole 12. b.) Single Fixed Plate System A single fixed plate system is described here. FIG. 47-52 is a diagram of a first embodiment of a single fixed plate system. The contour of plate 600 is the same as plate 2 shown in Figure 1-5. The plate 600 includes a bone thread receiving hole 602 and is in the form of a fixing cap 610 shown in FIGS. 56-59, with an internal threaded 603 containing the corresponding fixing element. For example, in plate 600, the bone screw hole 602 has an outer diameter of approximately 5 mm with a preferred range of 4-6 mm; in the range of 3.5-5.8 mm for this use, approximately 4. It has an inner diameter of 8 mm with a screw. Mounting means other than threads may be used, for example it is a bayonet type mounting element. The bottom of each bone screw receiving hole 602 comprises an inwardly stepped portion of appropriately selected dimensions for holding the associated bone screw 170, as shown in FIGS. 53-55. As described in more detail below, in this embodiment, a single fixing element in the form of a fixing cap 610 comprising thread 608, shown in FIGS. 56-59, is provided in each of the bone screw storage holes 602. Related. The difference between the bone screw 170 used in a single fixation embodiment of the plate and the bone screw used in connection with the composite fixation plate is essentially that in the composite fixation plate embodiment, the fixation element In a single fixing embodiment, the fixing cap 610 is due to the fact that it fits over the head 172 of the bone screw 170, whereas it slides over a portion of the upper 39 of the screw head 32. Therefore, the head 172 of the bone screw 170 of this embodiment does not need to be smooth. Thereby, the head 172 of the bone screw 170 of this embodiment can be made thicker and stronger. FIG. 63 shows two bone screws 170 and associated threaded fixing caps 610 in their fully attached position. At these positions, the head portions 174 and 176 of each bone screw 170 form a tight fit with the corresponding portion of the associated bone screw receiving hole 602. The end 612 of each threaded fixing cap 610 forms a tight fit with the top 178 of the head of its associated bone screw 170. Since the thread 608 of each fixing cap 610 meshes with the female screw in the bone screw receiving hole 602 that is exactly associated, each threaded fixing cap 610 additionally has the bone associated with the associated head portion 178. A tightening force is applied between the screw receiving hole 602 and the female screw 603. The rounded head 614 of each threaded fixing cap 610 ensures that there are no sharp edges or protrusions on the upper surface of the assembled plating system. See Figures 80 and 81 for a single fixed device. Tools for inserting bone screws and fixing caps at rate 600 are shown. In the first embodiment of the drive tool 1000 shown in FIG. 80, the tool 1000 comprises an outer tubular housing 1002. Within the housing 1002 is a torkil or hexagonal screwdriver 1004 with a protruding end 1006 corresponding to a recess 306 in the cap 610 for engagement with the cap 610. As described above, in order to firmly hold the fixing cap 610 to the driver, the driver 1004 is shaped so that the fixing cap 610 can be securely and firmly attached. Since the hex driver 1004 is hollow, the shaft 1010 of the Phillips or torks screw driver is for engagement by its tip 1012 with the corresponding recess 180 of the bone screw 170 for engagement by the end 1006 of the driver 1004. It is possible to allow fitting by the hollow portion 1012 of. The shaft 1010 of the driver 1000 is longer than the tubular housing, and the driver 1004 has an upper end (not shown) that extends from the tip of the tubular housing 1002, so that it can be rotated by the handle. The housing 1002 has a diameter at which the fixing cap 610 can be held by frictional fitting or by the driver 1004 within the inner end of the tubular housing 1002. It will be appreciated that other methods of holding the retaining cap 610 within the ends of the tubular housing 1000 may also be used. As shown in Figure 80, the operation of the bone screw and fixing element driver 1000 is as follows: The cap 610 is inserted onto the cap driver 1004 having the end of the cap driver 1004 and then the shaft 1010 of the bone screw driver passing through the central longitudinal opening of the cap driver. As shown in the figure, the bone screw driver shaft 1010 passes through the recess 306 in the cap 610 and engages the recess 180 in the head of the bone screw 170. Bone screw 170 is shown attached in the bone screw receiving hole in the plate 600. The handle of the bone screw driver (not shown) is rotated so that the bone screw 170 is screwed in place. Since the diameter of the bone screw driver is less than the width of the recess 306 of the cap 610, the bone screw driver 1010 can rotate without rotating the cap 610. The hollow tubular housing 1002 rests on the surface of the plate 600 to help align the shaft 1010 associated with the plate. When the bone screw 170 is inserted, the cap driver 1004 is pushed down until the thread 608 on the outside of the cap 610 engages the thread 603 of the bone screw receiving hole. The cap driver 1004 is then turned until the cap 610 is firmly seated in place. FIG. 81 shows another embodiment of the combination of bone screw and fixed cap driver. No housing is used in this embodiment. Instead, the cap driver 1010 holds the cap 610 by friction and the handle 620 of the bone screw driver 1010 is rotated. The ball spring 622 assembly holds the cap driver 1002 in place until the bone screw is screwed into the bone screw receiving hole. The driver 1010 has an elongated portion, and when the bone screw is attached, the ball spring 622 is pushed down and the handle 624 associated with the cap driver can be lowered for the rotation of the cap 610. The tubular housing may be used to help align the caps 610 in the bone thread receiving holes, as described above. Figure 80 and And 81, the driver simplifies the procedure and reduces the number of instruments required during the installation procedure. This procedure is fast and reliable and ensures that the watch parts are not lost or difficult to operate. FIG. 52 is a plan view of a partially mounted plate 600 with a threaded fixing cap 600 mounted in the bone screw receiving hole 602. Figure 54-56 shows the bone screw 170 used in the single fixation plating system of the present invention. The bone screw 170 differs from the bone screw 30 described in detail above only in terms of the stepped configuration of the head 172. Preferably, the bone screw 170 includes a lower portion 174 adjacent to the screw shaft portion and having a reduced diameter equal to the maximum diameter of the shaft portion 176. The portion 178 of the head 172 is also smaller in diameter than the lower portion 174. The thread 182 has the same configuration as the bone screw 30 described above. However, either embodiment of the bone screw can be used for any of the plates. In the case of the composite fixation plating system described above, the bone screw 170 for a single fixation plating system is preferably solid, where the screw joins the lower plate surface and the screw used in the prior art plate The most fragile location, the only recess in the head is due to the engagement of the tip 222 of the drive tool 220, which recess is the important area described above. Therefore, these bone screws 170 remain tough. The screw head is not deeply grooved in the part. The fixing cap does not exert a radial outer force on the associated bone screw head so that the screw head does not spread apart due to being stressed and weakened. Referring to FIGS. 71, 73 and 75, another embodiment of the single fixed plate system of the present invention is shown and referenced by reference numeral 500. Plate 500 is associated with each of the bone screw openings 502, but has a similar contour to plate 2 shown in Figure 1-5, as shown in Figures 72 and 74 as a threaded fixed set screw or cap 506 or screw 508. Shown A threaded opening 524 that is stepped from a bone screw opening 502 for receiving the fixing elements 506, 508. It will be appreciated that other configurations of a single fixed plate can be used. FIG. 82 shows a single fixing plate 900 with a set of bone screw receiving holes 910 at its end 930 and a number of bone screw receiving holes 950 along the vertical axis of the plate 900. The additional bone screw receiving hole 950 allows a single plate to align a number of differently sized vertebral intervertebral cavities and bone fixation grafts. As described above, in the plate of the present invention shown in FIG. 1-5, the surgeon selects a plate of an appropriate size, and the bone screw receiving hole 6, It is necessary to align each pair of 8 to the appropriate vertebrae. This requires that a number of plates made in different sizes can use optimal attachment of bone screw receiving holes for each vertebra. In plate 900 of FIG. 82, the adjacent space and increasing number of central openings allows the surgeon to position at least one applicable opening to be fitted to each intermediate vertebra and / or bone graft. It will be possible. The procedure for mounting a single fixing plate is substantially similar to the details relating to the composite fixing plate herein. The central flute 670 within a single fixing plate is used for the compression procedure. The same means are used to make plate holes by either punching or drilling. Figure 60-69 shows the various steps in the procedure for mounting a single fixing plate, similar to the steps used in mounting a composite fixing plate. The fixing elements 508 and 522 have bone screws, so that the heads 507 and 526 of the fixing elements 508 and 522 have recesses 510 and 524 that match the diameters of the bone screw openings 502 and 528. It can be installed in place prior to inserting the bone screw 170 into the receiving holes 502 and 528. As the fixing elements 508 and 522 rotate, a portion of their head will secure it in place at the top of the head of the bone screw 170.<u style="single">Stretch to cover the top</u>.. Similar to the above embodiments, the bottom surfaces of the fixing screws 508 and 522 may be camped or have other configurations for engagement with the surface 39 of the associated bone screw 170. Although plate means and methods have been described for attaching the plate to the vertebrae of the spinal column, it will be appreciated that the plate can be employed in the specifications of other parts of the body. However, the dimensions of the plate, the specific contour and placement of the bone screw receiving holes must be modified. Similarly, the bone screws described herein may be used in other parts of the body and are further modified to serve their intended and purpose according to the size of the body part to which they are attached. .. Although specific embodiments of the present invention have been described with the drawings, it is obvious to those skilled in the art that modifications and modifications are made without departing from the present invention in a broader aspect, and therefore attached. The object of the claims is to cover the true spirit of the invention and all such modifications and variations that fall within the scope of the invention. Certain innovative features have been presented with respect to specific examples, but these are beyond the explicit examples as they are merely illustrations, easily alternative combinations, and thus trivial and claimed. It will be understood that various combinations of innovative features of are taught.