Expandable fusion device

Mutual Reference to Related Applications This patent application is a divisional application of U.S. Patent Application No. 12 / 875,818 filed on September 3, 2010 and now U.S. Patent No. 8,632,595, filed on December 17, 2013. A partial continuation of US Patent Application No. 14 / 109,429, a partial continuation of US14 / 014,189 filed on February 3, 2016, the entire disclosure of which is incorporated herein by reference. Is done.

A common procedure for dealing with disc-related pain that has degenerated due to various factors such as trauma or aging is the use of intervertebral fusion devices to fix one or more adjacent vertebral bodies. Generally, the disc is partially or completely removed first to fix the adjacent vertebral body. An intervertebral fusion device is then typically inserted between adjacent vertebrae to maintain normal disc spacing and restore spinal stability, thereby promoting intervertebral fusion.

There are several known conventional fusion devices and methods in the art to achieve intervertebral fusion. These include screw and rod configurations, solid bone grafts, and fixation devices including cages or other transplant mechanisms typically filled with bone and / or bone growth inducers. These devices are implanted between adjacent vertebral bodies to fix the vertebral bodies together and reduce the associated pain .

However, there are drawbacks associated with known conventional fixed devices and methods. For example, current methods for installing conventional fixation devices extend adjacent vertebral bodies to restore the affected disc cavity to its normal or healthy height prior to implantation of the fixation device. Often necessary. To maintain this height when the fixation device is inserted, the fixation device is usually dimensioned higher than the height of the initial stretch. This difference in height can make it difficult for the surgeon to place the fixation device in the stretched intervertebral space.

Therefore, a fixed device that can be placed in the disc cavity at a height that does not stretch at all from a minimum, and a fixed device that can maintain a normal distance between adjacent vertebral bodies when implanted. There is a need.

In an exemplary embodiment, the invention is expandable and can be placed in the disc cavity to maintain normal disc spacing and restore spinal stability, thereby promoting intervertebral fusion. Provide a fixed device. In one embodiment, the fixation device includes a central ramp, a first end plate, and a second end plate. The central slope may be able to move in the first direction so as to push the first and second end plates outward to form a non-expanded configuration. The expandable fixation device may be placed in the disc cavity through the endoscopic tube and then expandable to an dilated configuration.

In one exemplary embodiment, the device may be provided with a first end plate for an intervertebral implant, the first end plate having a first upper surface and a first lower surface. A plate portion may be provided, the first end plate having a first anterior inclined portion extending away from the first lower surface and a first posterior inclined portion extending away from the first lower surface. Further prepare. The device may further comprise a second end plate for the facet implant, the second end plate may comprise a second plate portion having a second upper surface and a second lower surface, the second end. The plate further comprises a second anterior sloping portion extending away from the second lower surface and a second rear sloping portion extending away from the second lower surface. The device may further comprise a body located between the first end plate and the second end plate, which body may include a rear end plate engaging slope. The device may further include a drive tilt portion located at the front end of the device, the drive tilt portion comprising a front end plate engaging tilt portion. When the device is in a non-expanded configuration, the rear end plate engaging tilt and the front end plate engaging tilt can have an tilt angle with respect to the vertical axis of the device, which is the first rear tilted portion with respect to the vertical axis. And the tilt angle with the first forward tilted portion of the first end plate is different. In the device, the movement of the drive slope in one direction moves away from the first and second end plates, and the movement of the drive slope in the second direction moves the first and second end plates to each other. It can be configured to move towards.

Further areas of applicability of the invention will become apparent from the detailed description provided later herein. The detailed description and specific examples show preferred or exemplary embodiments of the invention, but they are for illustrative purposes only and are not intended to limit the scope of the invention. Please understand that.

The present invention is more fully understood from the detailed description and accompanying drawings.<figref num="1">FIG. 3 is a side view of an embodiment of an expandable fixation device shown between adjacent vertebrae according to the present invention.</figref><figref num="2">FIG. 1 is a front perspective view of the expandable fixed device of FIG. 1 shown in a non-expandable position according to an embodiment of the invention.</figref><figref num="3">FIG. 1 is a front perspective view of the expandable fixed device of FIG. 1 shown in an extended position according to an embodiment of the invention.</figref><figref num="4">FIG. 1 is a rear perspective view of the expandable fixed device of FIG. 1 shown in a non-expanded position according to an embodiment of the invention.</figref><figref num="5">FIG. 1 is a rear perspective view of the expandable fixed device of FIG. 1 shown in an extended position according to an embodiment of the invention.</figref><figref num="6">FIG. 1 is a side view of the expandable fixed device of FIG. 1 shown in a non-expandable position according to an embodiment of the invention.</figref><figref num="7">FIG. 1 is a side view of the expandable fixed device of FIG. 1 shown in an extended position according to an embodiment of the invention.</figref><figref num="8">FIG. 1 is a perspective view of a centrally inclined portion of the expandable fixed device of FIG. 1 according to an embodiment of the present invention.</figref><figref num="9">FIG. 3 is a perspective view of a drive tilt portion of the expandable fixed device of FIG. 1 according to an embodiment of the present invention.</figref><figref num="10">FIG. 3 is a perspective view of the end plate of the expandable fixed device of FIG. 1 according to an embodiment of the present invention.</figref><figref num="11">FIG. 3 is a perspective view showing the placement of a first end plate of an embodiment of an expandable fixation device into an intervertebral disc cavity through an endoscopic tube according to an embodiment of the present invention.</figref><figref num="12">FIG. 3 is a perspective view showing the placement of a second end plate of an expandable fixation device into an intervertebral disc cavity through an endoscopic tube according to an embodiment of the invention.</figref><figref num="13">FIG. 3 is a perspective view showing the placement of a central tilted portion of an expandable fixation device into the disc cavity through an endoscopic tube according to an embodiment of the invention.</figref><figref num="14">It is a perspective view which shows the expansion of the expandable fixed device according to one Embodiment of this invention.</figref><figref num="15">FIG. 3 is a side schematic of the expandable fixed device of FIG. 1 with different end plates.</figref><figref num="16">FIG. 1 is a partial side view of an expandable fixed device showing end plate expansion in different modes.</figref><figref num="17">FIG. 3 is a side schematic of the expandable fixation device of FIG. 1 including an artificial end plate shown between adjacent vertebrae.</figref><figref num="18">FIG. 3 is a front perspective view of an alternative embodiment of an expandable fixed device shown in a non-expandable position according to an embodiment of the invention.</figref><figref num="19">FIG. 18 is a front perspective view of the expandable fixed device of FIG. 18 shown in an extended position according to an embodiment of the invention.</figref><figref num="20">FIG. 18 is a rear perspective view of the expandable fixed device of FIG. 18 shown in a non-expanded position, according to an embodiment of the invention.</figref><figref num="21">FIG. 18 is a rear perspective view of the expandable fixed device of FIG. 18 shown in an extended position according to an embodiment of the invention.</figref><figref num="22">FIG. 18 is a side view of the expandable fixed device of FIG. 18 shown in a non-expandable position according to an embodiment of the invention.</figref><figref num="23">FIG. 18 is a side view of the expandable fixed device of FIG. 18 shown in an extended position according to an embodiment of the invention.</figref><figref num="24">FIG. 18 is a perspective view of the end plate of the expandable fixed device according to an embodiment of the present invention.</figref><figref num="25">FIG. 18 is a perspective view of a centrally inclined portion of the expandable fixed device of FIG. 18 according to an embodiment of the present invention.</figref><figref num="26">FIG. 18 is a side view of the central tilt portion of the expandable fixed device of FIG. 18 according to an embodiment of the present invention.</figref><figref num="27">FIG. 18 is a top view of the central tilt portion of the expandable fixed device of FIG. 18 according to an embodiment of the present invention.</figref><figref num="28">It is a perspective view which shows the arrangement of the central inclined part of the expandable fixed device of FIG. 18 according to one Embodiment of this invention.</figref><figref num="29">It is a perspective view which shows the arrangement of the 1st end plate of the expandable fixed device of FIG. 18 according to one Embodiment of this invention.</figref><figref num="30">It is a perspective view which shows the arrangement of the 2nd end plate of the expandable fixed device of FIG. 18 according to one Embodiment of this invention.</figref><figref num="31">It is a perspective view which shows the arrangement of the actuating member of the expandable fixed device of FIG. 18 according to one Embodiment of this invention.</figref><figref num="32">It is a perspective view which shows the extension of the expandable fixed device of FIG. 18 according to one Embodiment of this invention.</figref><figref num="33">FIG. 3 is a front perspective view of an alternative embodiment of an expandable fixed device shown in a non-expandable position according to an embodiment of the invention.</figref><figref num="34">FIG. 33 is a front perspective view of the expandable fixed device of FIG. 33 shown in an extended position according to an embodiment of the invention.</figref><figref num="35">FIG. 33 is a rear perspective view of the expandable fixed device of FIG. 33 shown in a non-expanded position, according to an embodiment of the invention.</figref><figref num="36">FIG. 33 is a rear perspective view of the expandable fixed device of FIG. 33 shown in an extended position according to an embodiment of the invention.</figref><figref num="37">FIG. 33 is a side sectional view of the expandable fixed device of FIG. 33 shown in a non-expandable position according to an embodiment of the invention.</figref><figref num="38">FIG. 33 is a side sectional view of the expandable fixed device of FIG. 33 shown in an extended position according to an embodiment of the invention.</figref><figref num="39">FIG. 33 is a perspective view of an end plate of an expandable fixed device according to an embodiment of the present invention.</figref><figref num="40">FIG. 3 is a rear perspective view of an alternative embodiment of an expandable fixed device shown in a non-expandable position according to an embodiment of the invention.</figref><figref num="41">FIG. 40 is a rear perspective view of the expandable fixed device of FIG. 40 shown in a partially extended position according to an embodiment of the invention.</figref><figref num="42">FIG. 40 is a rear perspective view of the expandable fixed device of FIG. 40 shown in an extended position according to an embodiment of the invention.</figref><figref num="43">FIG. 40 is a side view of the expandable fixed device of FIG. 40 according to an embodiment of the invention.</figref><figref num="44">FIG. 40 is a side sectional view of the expandable fixed device of FIG. 40 shown in a non-expandable position according to an embodiment of the invention.</figref><figref num="45">FIG. 40 is a perspective view of an end plate of an expandable fixed device according to an embodiment of the present invention.</figref><figref num="46">FIG. 40 is a perspective view of a centrally inclined portion of the expandable fixed device of FIG. 40 according to an embodiment of the present invention.</figref><figref num="47">FIG. 40 is a perspective view of a drive tilt portion of an expandable fixed device according to an embodiment of the present invention.</figref><figref num="48">FIG. 40 is a perspective view of a drive tilt portion of an expandable fixed device according to an embodiment of the present invention.</figref><figref num="49">FIG. 40 is a perspective view of a drive tilt portion of an expandable fixed device according to an embodiment of the present invention.</figref><figref num="50">FIG. 3 is a rear perspective view of an alternative embodiment of an expandable fixed device shown in an extended position according to an embodiment of the invention.</figref><figref num="51">FIG. 50 is a side sectional view of the expandable fixed device of FIG. 50 shown in an extended position according to an embodiment of the present invention.</figref><figref num="52">FIG. 50 is an exploded view of the expandable fixed device of FIG. 50 according to an embodiment of the present invention.</figref><figref num="53">FIG. 50 is a top view of the expandable fixed device of FIG. 50 shown in a non-expandable position according to an embodiment of the invention.</figref><figref num="54">FIG. 50 is a rear end view of the expandable fixed device of FIG. 50 shown in an extended position according to an embodiment of the invention.</figref><figref num="55">FIG. 5 is a perspective view of the end plate of the expandable fixed device of FIG. 50 according to an embodiment of the present invention.</figref><figref num="56">FIG. 5 is a perspective view of the central tilt portion of the expandable fixed device of FIG. 50 according to an embodiment of the present invention.</figref><figref num="57">FIG. 5 is a perspective view of a drive tilt portion of the expandable fixed device of FIG. 50 according to an embodiment of the present invention.</figref><figref num="58">It is an exploded view of an alternative embodiment of an expandable fixed device according to an embodiment of the present invention.</figref><figref num="59">FIG. 58 is a side view of the expandable fixed device of FIG. 58 shown in partial cross section in a non-expandable configuration according to an embodiment of the invention.</figref><figref num="60">FIG. 58 is a side view of the expandable fixed device of FIG. 58 shown in a non-expandable configuration according to an embodiment of the invention.</figref><figref num="61">FIG. 58 is a perspective view of the expandable fixed device of FIG. 58 shown in a non-expandable configuration according to an embodiment of the invention.</figref><figref num="62">FIG. 58 is a side view of the expandable fixed device of FIG. 58 shown in partial cross section in a lordotic expansion configuration according to an embodiment of the invention.</figref><figref num="63">FIG. 58 is a side view of the expandable fixed device of FIG. 58 shown in a lordotic expansion configuration according to an embodiment of the invention.</figref><figref num="64">FIG. 58 is a perspective view of the expandable fixed device of FIG. 58 shown in a lordotic expansion configuration according to an embodiment of the invention.</figref><figref num="65">FIG. 58 is a side view of the expandable fixed device of FIG. 58, shown in partial cross section in a fully expanded configuration, according to an embodiment of the invention.</figref><figref num="66">FIG. 58 is a side view of the expandable fixed device of FIG. 58 shown in a fully expanded configuration according to an embodiment of the invention.</figref><figref num="67">FIG. 58 is a perspective view of the expandable fixed device of FIG. 58 shown in a fully expanded configuration according to an embodiment of the invention.</figref><figref num="68">It is an exploded view of an expandable fixed device having a ratchet mechanism according to some embodiments.</figref><figref num="69A">FIG. 68 is a side view of the expandable fixed device of FIG. 68 of the expansion process according to some embodiments.</figref><figref num="69B">FIG. 68 is a side view of the expandable fixed device of FIG. 68 of the expansion process according to some embodiments.</figref><figref num="69C">FIG. 68 is a side view of the expandable fixed device of FIG. 68 of the expansion process according to some embodiments.</figref><figref num="70A">FIG. 68 is a different view of the expandable fixed device of FIG. 68 in a contracted state, according to some embodiments.</figref><figref num="70B">FIG. 68 is a different view of the expandable fixed device of FIG. 68 in a contracted state, according to some embodiments.</figref><figref num="70C">FIG. 68 is a different view of the expandable fixed device of FIG. 68 in a contracted state, according to some embodiments.</figref><figref num="71A">FIG. 68 is a different view of the expandable fixed device of FIG. 68 in a fully unexpanded tilted state, according to some embodiments.</figref><figref num="71B">FIG. 68 is a different view of the expandable fixed device of FIG. 68 in a fully unexpanded tilted state, according to some embodiments.</figref><figref num="71C">FIG. 68 is a different view of the expandable fixed device of FIG. 68 in a fully unexpanded tilted state, according to some embodiments.</figref><figref num="72A">FIG. 68 is a different view of the expandable fixed device of FIG. 68 in a fully expanded state, according to some embodiments.</figref><figref num="72B">FIG. 68 is a different view of the expandable fixed device of FIG. 68 in a fully expanded state, according to some embodiments.</figref><figref num="72C">FIG. 68 is a different view of the expandable fixed device of FIG. 68 in a fully expanded state, according to some embodiments.</figref><figref num="73">FIG. 68 is a top view of the expandable fixed device of FIG. 68, according to some embodiments.</figref><figref num="74">FIG. 6 is a top view of the expandable fixed device of FIG. 68, according to some embodiments.</figref><figref num="75">FIG. 68 is an enlarged view of the expandable fixed device of FIG. 68, according to some embodiments.</figref><figref num="76">FIG. 68 is an enlarged view of the expandable fixed device of FIG. 68, according to some embodiments.</figref><figref num="77">FIG. 68 is a top perspective view of the expandable fixed device of FIG. 68, according to some embodiments.</figref><figref num="78A">FIG. 6 is a top perspective view of the expandable fixed device of FIG. 68 transitioning from a locking configuration to an disengaging configuration according to some embodiments.</figref><figref num="78B">FIG. 6 is a top perspective view of the expandable fixed device of FIG. 68 transitioning from a locking configuration to an disengaging configuration according to some embodiments.</figref><figref num="78C">FIG. 6 is a top perspective view of the expandable fixed device of FIG. 68 transitioning from a locking configuration to an disengaging configuration according to some embodiments.</figref><figref num="78D">FIG. 6 is a top perspective view of the expandable fixed device of FIG. 68 transitioning from a locking configuration to an disengaging configuration according to some embodiments.</figref><figref num="78E">FIG. 6 is a top perspective view of the expandable fixed device of FIG. 68 transitioning from a locking configuration to an disengaging configuration according to some embodiments.</figref><figref num="78F">FIG. 6 is a top perspective view of the expandable fixed device of FIG. 68 transitioning from a locking configuration to an disengaging configuration according to some embodiments.</figref><figref num="78G">FIG. 6 is a top perspective view of the expandable fixed device of FIG. 68 transitioning from a locking configuration to an disengaging configuration according to some embodiments.</figref>

The following description of the preferred embodiment (s) is merely exemplary in nature and is by no means intended to limit the invention, its use, or its use.

Spinal fusion is typically used to relieve pain caused by the movement of degenerated disc material. Upon successful fixation, the fixation device is permanently fixed in the disc cavity. FIG. 1 shows an exemplary embodiment of a fixation device 10 that is expandable between adjacent vertebral bodies 2 and 3. The fixation device 10 engages the end plates 4 and 5 of adjacent vertebral bodies 2 and 3 to maintain normal disc spacing and restore spinal stability in place, thereby restoring intervertebral stability. Promote fixation. The expandable fixing device 10 can be manufactured from many materials including titanium, stainless steel, titanium alloys, non-titanium metal alloys, polymer materials, plastics, plastic composites, PEEK, ceramics, and elastic materials. In one embodiment, the expandable fixation device 10 can be configured to be placed between adjacent vertebral bodies 2 and 3 through the endoscopic tube and into the disc cavity.

In one exemplary embodiment, a bone implant or similar bone growth-inducing material can be introduced around and in the fixation device 10 to further promote and promote intervertebral fusion. In one embodiment, the fixation device 10 is preferably filled with a bone implant or similar bone growth-inducing material in order to promote bone growth through and around the fixation device. Such implants may be filled between the end plates of adjacent vertebral bodies before, after, or between implants of the fixation device.

With reference to FIGS. 2-7, one embodiment of the fixed device 10 is shown. In one exemplary embodiment, the fixation device 10 includes a first end plate 14, a second end plate 16, a central tilt portion 18, and a drive tilt portion 260. In one embodiment, the expandable fixation device 10 can be configured to be placed between adjacent vertebral bodies 2 and 3 through the endoscopic tube and into the disc cavity. One or more components of the fixation device 10 may include features such as through holes that facilitate placement through the endoscope tube. In one embodiment, the components of the fixation device 10 are placed through the endoscopic tube by assembling the fixation device 10 within the disc cavity.

The following discussion relates to the second end plate 16, but in the embodiments of the present invention, the second end plate 16 is substantially the same as the first end plate 14, so that the discussion is the first. It should be understood that it applies equally to the end plate 14 of 1. Next, with reference to FIGS. 2-7, 10, in one exemplary embodiment, the second end plate 16 has a first end 39 and a second end 41. In the illustrated embodiment, the second end plate 16 has an upper surface 40 connecting the first end 39 and the second end 41 and a lower surface 42 connecting the first end 39 and the second end 41. Further prepare. In one embodiment, the second end plate 16 further comprises a through opening 44, as seen in FIG. The penetration opening 44, in an exemplary embodiment, receives a bone implant or similar bone growth-inducing material, and further fills the central opening of the central slope 18 with the bone implant or similar bone growth-inducing material. Is sized to allow for.

As best seen in FIGS. 7 and 10, in one embodiment, the bottom surface 42 comprises at least one extension 46 extending along at least a portion of the bottom surface 42. In one exemplary embodiment, the extension 46 can extend along a considerable portion of the bottom surface 42, including along the center of the bottom surface 42. In the illustrated embodiment, the extending portion 46 includes a substantially concave surface 47. For example, when the device 10 is in a non-expanded configuration, the concave surface 47 can form a through hole with the corresponding concave surface 47 (not shown) of the first end plate 14. In another exemplary embodiment, the extension 46 comprises at least one inclined surface 48. In another exemplary embodiment, there are two inclined surfaces 48, 50, the first inclined surface 48 faces the first end 39 and the second inclined surface faces the second end 41. .. In one embodiment, the first inclined surface 48 may be in close proximity to the first end 39 and the second inclined surface 50 may be in close proximity to the second end 41. It is contemplated that the slopes of the slopes 48, 50 may be equal to or different from each other. The effect of changing the slopes of the slopes 48 and 50 will be described later.

In one embodiment, the extension 46 may include a feature for fixing the end plate 16 when the expandable fixing device 10 is in the extended position. In one embodiment, the extension 46 comprises one or more protrusions 49 extending from the side 51 of the extension. In the illustrated embodiment, there are two protrusions 49 extending from each of the side 51s, and on each of the side surfaces 53, one of the protrusions 49 extends from the bottom of each end. As described in more detail later, the protrusion 49 engages the central tilt 18 to prevent and / or limit the longitudinal movement of the end plate 16 when the device 10 is in the extended position. Can be formed into.

As illustrated in FIGS. 2-5, in one embodiment, the top surface 40 of the second end plate 16 is flat and substantially planar so that the top surface 40 of the end plate 16 can engage the adjacent vertebral body 2. Is. Alternatively, as shown in FIG. 15, the top surface 40 may be curved convexly or concavely to allow a higher or lower degree of engagement with the adjacent vertebral body 2. good. Further, the upper surface 40 may be substantially flat, but it is also intended to include a substantially linear inclined surface or a curved inclined surface. The slanted surface allows engagement with adjacent vertebral bodies 2 in the lordotic fashion. Although not shown, in one exemplary embodiment, the top surface 40 includes texturing to assist in gripping adjacent vertebral bodies. Texturings can include, but are not limited to, teeth, ridges, friction-increasing elements, keels, or gripping or lever-like protrusions.

Referring now to FIGS. 2-8, in one exemplary embodiment, the central ramp 18 connects the first end 20, the second end 22, the first end 20 and the second end 22. It has a first side portion 24 and a second side portion 26 (best seen on FIG. 5) connecting the first end 20 and the second end 22 on opposite sides of the central inclined portion 12. In one exemplary embodiment, the first side portion 24 and the second side portion 26 may be curved. The central slope 18 has a lower end 28 sized to receive at least a portion of the first end plate 14 and an upper end sized to receive at least a portion of the second end plate 16. Including the end 30 and more.

The first end 20 of the central ramp 18 comprises an opening 32 in one exemplary embodiment. The opening 32 can be configured to receive the endoscopic tube according to one or more embodiments. The first end 20 of the central ramp 18 comprises, in one exemplary embodiment, at least one angled surface 33, but may include a plurality of angled surfaces. The angled surface 33 can serve to stretch adjacent vertebral bodies when the fixation device 10 is inserted into the intervertebral space.

The second end 22 of the central ramp 18 comprises an opening 36 in one exemplary embodiment. The opening 36 extends from the second end 22 of the central inclined portion 18 into the central guide portion 37 of the central inclined portion 18.

In one embodiment, the central inclined portion 18 further includes one or more inclined surfaces 33. As is best seen in FIG. 8, the one or more inclined surfaces 33 are between the first side 24 and the second side 26 and between the central guide 37 and the second end 22. To position. In one embodiment, the one or more inclined surfaces 33 face the second end 22 of the central inclined portion 18. In one embodiment, the central inclined portion 18 includes two inclined surfaces 33, one of the inclined surfaces 33 having an upward slope and the other of the inclined surfaces 33 having a downward slope. It is attached. The inclined surface 33 of the central inclined portion can be configured and dimensioned so as to engage with the inclined surface 48 of each of the first and second end plates 14 and 16.

It should be understood that the following considerations relate to the second side 26 of the central ramp 18, but in embodiments of the present invention the discussion applies equally to the first side 24. In the illustrated embodiment, the second side portion 26 comprises an internal surface 27. In one embodiment, the second side portion 26 further includes a lower guide portion 35, a central guide portion 37, and an upper guide portion 38. In the illustrated embodiment, the lower guide portion 35, the central guide portion 37, and the upper guide portion 38 exit the inner surface 27 and extend from the second end 22 to one or more inclined surfaces 31. In the illustrated embodiment, the second end 22 of the central tilt portion 18 further comprises one or more guide portions 38. The guide portion 38 can serve to induce parallel motion of the first and second end plates 14 and 16 with respect to the central inclined portion 18. For example, the protrusion 49 on the second end plate 16 may be sized to be received between the central guide 37 and the upper guide 38. The protrusion 49 of the first end plate 16 may be sized to be received between the central guide 37 and the lower guide 35. The first slot 29 may be formed close to the center of the upper guide portion 38. The second slot 31 may be formed between the end of the upper guide 38 and one or more inclined surfaces 33. The protrusion 49 may be sized to be received within the first slot 29 and / or the second slot 31 when the device 10 is in the extended position.

Next, referring to FIGS. 4 to 7 and 9, the drive inclined portion 260 has a through hole 262. In one embodiment, the drive tilt portion 260 is substantially wedge-shaped. As shown, the drive ramp 260 has a wide end 56, a narrow end 58, a first side 60 connecting the wide end 56 and the narrow end 58, and a wide end. A second side portion 62 connecting the 56 and the narrow end 58 may be provided. The drive inclined portion 260 may further include an inclined surface including an upward inclined surface 64 and an opposed downward inclined surface 66. The upward inclined surface 64 and the downward inclined surface 66 may be configured and dimensioned to engage the inclined surface 50 close to the second end 41 of the first and second end plates 14, 16. The first and second side portions 60, 62 may include, for example, a groove 68 extending in a direction parallel to the vertical axis of the through hole 262, respectively. The groove 68 may be sized to receive the central guide 37 on the inner surface 27 of each of the sides 24, 26 of the central slope 18. In this way, the groove 68, together with the central guide portion 37, can form a surface for inducing parallel motion of the drive tilt portion 260 in the central tilt portion 18.

A method of installing the expandable fixed device 10 of FIG. 1 according to an embodiment of the present invention will be discussed next. The intervertebral space is prepared prior to insertion of the fixation device 10. In one method of placement, a discectomy is performed in which the entire disc is removed. Alternatively, only part of the intervertebral disc may be removed. The end plates of adjacent vertebral bodies 2 and 3 are then cured to create an exposed end surface to promote bone growth across the intervertebral space. One or more endoscopic tubes can then be inserted into the disc cavity. The expandable fixation device 10 can then be introduced into the intervertebral space through the endoscopic tube and placed in place within the disc cavity.

After the fixation device 10 has been inserted in place within the disc cavity, the fixation device 10 can then be expanded to the dilated position. In order to expand the fixed device 10, the drive tilt portion 260 may be moved in the first direction with respect to the central tilt portion 18. The parallel motion of the drive tilt portion 260 through the central tilt portion 18 may be guided by the central guide portion 37 on each of the first and second side portions 24, 26 of the central tilt portion 18. When the drive tilted portion 260 moves, the upward tilted surface 64 pushes the tilted surface 50 close to the second end 41 of the second end plate 16, and the downward inclined surface 66 is the second of the first end plate 14. Push the slope 50 close to the end 41 of. Further, the inclined surface 33 of the central inclined portion 18 pushes the inclined surface 48 close to the first end 41 of the first and second end plates 14, 16. In this way, the first and second end plates 14 and 16 are pushed outward to form an expanded configuration. As described above, the central inclined portion 16 includes a anchoring feature portion for fixing the end plates 14 and 16.

It should also be understood that the extensions of the end plates 14, 16 may differ based on the dimensional differences between the inclined surfaces 48, 50 and the angled surfaces 62, 64. As can be best seen in FIG. 16, the end plates 14 and 16 can be extended in any of the following modes: Expansion that rises straight, switches to the lordosis expansion configuration after rising straight, or switches to the lordosis expansion configuration after rising straight in a misaligned state.

Returning to FIGS. 2-7, if the fixed device 10 needs to be relocated or modified after it has been installed and expanded, the fixed device 10 can be returned to the non-expanded configuration, retracted and relocated to obtain the desired position. It can be expanded again after it has been created. In order to contract the fixed device 10, the central tilt portion 18 is moved away from the central tilt portion 260 with respect to the central tilt portion 260. When the central inclined portion 18 moves, the inclined surface 33 of the central inclined portion 18 advances along the inclined surface 48 of the first and second end plates 14 and 16, and the end plates 14 and 16 move inward and are not expanded. Become a position.

Next, with reference to FIG. 17, the fixed device 10 is shown with an exemplary embodiment of the artificial end plate 100. The artificial end plate 100 allows the introduction of lordosis even when the end plates 14 and 16 of the fixing device 10 are substantially planar. In one embodiment, the artificial end plate 100 has an upper surface 102 and a lower surface 104. The top surface 102 of the artificial end plate 100 has at least one spike portion 106 to engage the adjacent vertebral body. The bottom surface 104 has complementary textured or engaged features on their surface to engage the textured or engaged features on the upper and lower end plates 16 of the fixation device 10. Have. In one exemplary embodiment, the top surface 102 of the artificial end plate 100 has a substantially convex cross section and the bottom surface 104 has a substantially parallel cross section so as to achieve lordosis. In another exemplary embodiment, the fixed device 10 should be used with the only artificial end plate 100 to introduce lordosis, even if the end plates 14 and 16 of the fixed device 10 are substantially planar. Can be done. The artificial end plate 100 can engage with or engage with the end plate 14 and can function in the same manner as described above for the two artificial end plates 100.

Referring to FIGS. 11-14, embodiments for placing the expandable fixation device 10 within the disc cavity are illustrated. The expandable fixation device 10 can be introduced into the intervertebral space through the endoscopic tube using a tool 70 attached to the end plate 16 and a second end plate, as seen in FIG. 16 is first placed in the disc cavity below the canal by the tool 70. As shown on FIG. 12, after the insertion of the second end plate 16, the tool 72 allows the first end plate 14 to be placed in the disc cavity through the same endoscopic tube. As shown on FIGS. 13 and 14, following the first end plate 14, the central tilt portion 12 is placed in the disc cavity through the same endoscopic tube by guiding with tools 70 and 72. be able to.

Next, with reference to FIGS. 18-23, an alternative embodiment of the expandable fixed device 10 is shown. In one exemplary embodiment, the fixation device 10 includes a first end plate 14, a second end plate 16, a central ramp 18, and an actuator assembly 200. As described in more detail later, the actuator assembly 200 drives the central tilt portion 18, which pulls the first and second end plates 14, 16 apart to extend the expandable fixed device. Put in position. One or more components of the fixation device 10 may include features such as through holes that facilitate placement through the endoscope tube. In one embodiment, the components of the fixation device 10 are placed through the endoscopic tube by assembling the fixation device 10 within the disc cavity.

The following discussion relates to the second end plate 16, but in the embodiments of the present invention, the second end plate 16 is substantially the same as the first end plate 14, so that the discussion is the first. It should be understood that it applies equally to the end plate 14 of 1. Further referring to FIG. 24, in one exemplary embodiment, the second end plate 16 has a first end 39 and a second end 41. In the illustrated embodiment, the second end plate 16 has an upper surface 40 connecting the first end 39 and the second end 41 and a lower surface 42 connecting the first end 39 and the second end 41. Further prepare. Although not shown, in one embodiment, the second end plate 16 further comprises a through opening. Penetration openings are sized to receive a bone implant or similar bone growth-inducing material in one exemplary embodiment.

In one embodiment, the top surface 40 of the second end plate 16 is flat and substantially planar so that the top surface 40 of the end plate 16 can engage the adjacent vertebral body 2. Alternatively, as shown in FIG. 15, the top surface 40 may be curved convexly or concavely to allow a higher or lower degree of engagement with the adjacent vertebral body 2. good. Further, the upper surface 40 may be substantially flat, but it is also intended to include a substantially linear inclined surface or a curved inclined surface. The slanted surface allows engagement with adjacent vertebral bodies 2 in the lordotic fashion. Although not shown, in one exemplary embodiment, the top surface 40 includes texturing to assist in gripping adjacent vertebral bodies. Texturings can include, but are not limited to, teeth, ridges, friction-increasing elements, keels, or gripping or lever-like protrusions.

In one embodiment, the second end plate 16 connects a first side portion 202 connecting the first end 39 and the second end 41, and a first end plate 39 connecting the second end 41. Further provided with 2 side portions 204. In the illustrated embodiment, the first and second side portions 202, 204 are extensions from the bottom surface 42. In one exemplary embodiment, the first and second side portions 202, 204 include inclined surfaces 206, 208, respectively. In the illustrated embodiment, the ramps 206, 208 extend from the first end 39 of the second end plate 16 to the bottoms 210, 212 of the sides 202, 204, respectively. In one embodiment, the inclined surfaces 206, 208 face forward because the inclined surfaces 206, 208 face the first end 39 of the second end plate. As discussed above, the slopes of the slopes 206, 208 may be different as desired for a particular application.

In one embodiment, the first and second side portions 202, 204 each include at least one protrusion 214. In one exemplary embodiment, the first and second side portions 202, 204 include a first projection 214, a second projection 216, and a third projection 218, respectively. In one embodiment, the protrusions 214, 216, 218 extend from the internal surface 220 of the first and second side portions 202, 204. In one exemplary embodiment, the protrusions 214, 216, 218 extend from below the inner surface 220. As is best seen in FIG. 24, the first and second protrusions 214, 216 form the first slot 222, and the second and third protrusions 216, 218 form the second slot 224. Form.

As best seen in FIG. 24, the lower surface 42 of the second end plate 16 includes, in one embodiment, a central extension 224 extending along at least a portion of the lower surface. In the illustrated embodiment, the central extension 224 extends between the first and second side portions 202 and 204. In one exemplary embodiment, the central extension 224 can extend from the second end 41 of the end plate 16 to the central portion of the end plate. In one embodiment, the central extension 224 comprises a substantially concave surface 226 configured and dimensioned to form a through hole with the corresponding concave surface 226 (not shown) of the first end plate 14. The central extension 224 can further include an inclined surface 228 in one exemplary embodiment. In the illustrated embodiment, the inclined surface 228 faces the first end 39 of the end plate 16. The ramp 228 may be at one end of the central extension 224. In one embodiment, the other end of the central extension 224 forms a stop 230. In the illustrated embodiment, the stop 230 is recessed from the second end 41 of the second end plate 16.

Referring to FIGS. 25-27, in one exemplary embodiment, the central tilt portion 18 comprises a body portion 232 having a first end 234 and a second end 236. In one embodiment, the body unit 232 includes at least a first expansion unit 238. In one exemplary embodiment, the main body 232 includes a first expansion 238 and a second expansion 240 extending from the opposite side of the main body, the first and second expansions 238. , 240 each have a substantially triangular cross section. In one embodiment, the extensions 238, 240 engage the inclined surfaces 206, 208 of the first and second end plates 14, 16 respectively, and pull the first and second end plates 14, 16 apart. Has angled surfaces 242, 244 configured and dimensioned to. In one embodiment, the engagement between the angled surfaces 242, 244 of the extensions 238, 240 and the inclined surfaces 206, 208 of the first and second end plates 14, 16 is described as a dovetail connection. can do.

The second end 236 of the central ramp 18 comprises, in one exemplary embodiment, the opposing angled faces 246. The angled surface 246 can be configured and dimensioned to engage the inclined surface 228 of the central extension 224 of each of the first and second end plates 14, 16. In other words, one of the angled surfaces 246 may be facing upwards and, in one embodiment, is configured to engage the inclined surface 228 of the central extension 224 of the second end plate 16. be able to. In one embodiment, the engagement between the angled surface 246 of the second end 236 of the central inclined portion 18 and the inclined surface 228 of the first and second end plates 14, 16 is as a dovetail connection. Can be explained.

The second end 236 may further include an extension 252 in one exemplary embodiment. In the illustrated embodiment, the extending portion 252 has a substantially cylindrical shape, and the through hole 254 extends vertically in the extending portion 252. In one embodiment, the extending portion 252 may include a chamfered end 256. Although not shown, at least a portion of the extension 252 may be threaded.

Still referring to FIGS. 25-27, the central tilt portion 18 further provides a feature portion for fixing the first and second end plates 14, 16 when the expandable fixing device 10 is in the extended position. Can include. In one embodiment, the main body portion 232 of the central inclined portion 18 includes one or more protrusions 248, 250 extending from opposite sides of the main body portion 232. As shown, the protrusions 248, 250 may be spaced along the body 232 in one embodiment. As best seen in FIGS. 19 and 21, in one exemplary embodiment, the protrusions 248, 250 correspond to the first and second end plates 14, 16 when the device 10 is in the extended position. It can be configured and dimensioned for insertion into slots 222, 224. The protrusions 248, 250 can engage the end plates 14, 16 to prevent and / or limit the movement of the end plates 14, 16 with respect to the central tilt 18 after expansion of the device 10.

Referring to FIGS. 20-23, in one exemplary embodiment, the actuator assembly 200 is configured to engage the stop 232 within the central extension 224 of the first and second end plates 14, 16. And has a flanged end 253 to be dimensioned. In one embodiment, the actuator assembly 200 further includes an extension 254 extending from the flanged end 253. In a further embodiment, the actuator assembly 200 includes a threaded hole 256 extending through the actuator assembly 200. It should be appreciated that the threaded hole 256 of the actuator assembly 200 is referred to as threaded, but the threaded hole 256 may be partially threaded according to one embodiment. In one exemplary embodiment, the threaded hole 256 is configured and dimensioned to accept the extending portion 252 of the central inclined portion 18 by screwing.

Further with reference to FIGS. 28-32, a method of installing the expandable fixed device 10 of FIGS. 18-27 according to one embodiment of the present invention will be discussed next. Prior to insertion of the fixation device, the disc cavity may be prepared as described above, and then one or more endoscopic tubes may be inserted into the disc cavity. The expandable fixation device 10 can then be inserted into the disc cavity and placed in place, as best seen in FIGS. 28-32. The expandable fixation device 10 can be introduced into the intervertebral space through an endoscopic tube (not shown), with the central tilt 18 first under the tube and in the disc cavity, as seen in FIG. 28. Placed inside. After insertion of the central tilt, the first end plate 14 can be placed through the endoscopic tube as shown on FIG. 29, followed by the second end as shown on FIG. 30. The plate 16 is inserted. As best seen in FIG. 31, after the second end plate 16, the actuator assembly 200 may then be inserted to complete the assembly of the device 10.

After the fixation device 10 has been inserted and assembled in the appropriate location within the disc cavity, the fixation device 10 can then be expanded to the expansion position. The actuator assembly 200 can be rotated to extend the fixed device 10. As described above, the actuator assembly 200 is screwed into engagement with the extension 250 of the central tilt portion 18. Therefore, when the actuator assembly 200 is rotated in the first direction, the central tilt portion 18 moves toward the flanged end 253 of the actuator assembly 200. In another exemplary embodiment, the actuator assembly 200 can be moved linearly by ratchet teeth as a means for controlling the movement of the central tilt portion 18. As the central slope 18 moves, the angled surfaces 242, 244 of the extension 238, 240 of the central slope 18 become the first and second side portions 202, of the first and second end plates 14, 16. Push the inclined surfaces 206 and 208 of 204. Further, the angled surface 246 of the second end 236 of the central inclined portion 18 also pushes the inclined surface 228 of the central extending portion 224 of each of the end plates 14 and 16. This is best seen in Figures 22-23.

Since the expansion of the fixed device 10 is operated by the rotation input, the expansion of the fixed device 10 is infinite. In other words, the end plates 14 and 16 can be expanded to an infinite height as the actuator assembly 200 rotates and advances. As described above, the central inclined portion 16 includes a anchoring feature portion for fixing the end plates 14 and 16.

If the fixed device 10 needs to be relocated or modified after it has been installed and expanded, the fixed device 10 may be returned to the non-expanded configuration, retracted, relocated, and re-expanded after the desired position is obtained. can. The actuator assembly 200 can be rotated in a second direction to retract the fixation device 10. As described above, the actuator assembly 200 is screwed into the extending portion 250 of the central tilt portion 18, so that when the actuator assembly 200 is rotated in a second direction opposite to the first direction, it is centered. The ramp 18 moves away from the flanged end 253 with respect to the actuator assembly 200 and the first and second end plates 14, 16. When the central inclined portion 18 moves, the first and second end plates are pulled inward to reach the non-expanded position.

Next, with reference to FIGS. 33-38, an alternative embodiment of the expandable fixed device 10 is shown. In the illustrated embodiment, the fixation device includes a first end plate 14, a second end plate 16, a central ramp 18, and an actuator assembly 200. The fixed device 10 of FIGS. 33-38 and its individual components are similar to the device 10 illustrated above FIGS. 18-23, with some modifications. This time, the changes to device 10 are described below.

The following discussion relates to the second end plate 16, but in the embodiments of the present invention, the second end plate 16 is substantially the same as the first end plate 14, so that the discussion is the first. It should be understood that it applies equally to the end plate 14 of 1. Further referring to FIG. 39, in one exemplary embodiment, the bottom surface 42 of the second end plate 16 has been modified. In one embodiment, the central extension 224 extending from the bottom surface 42 has been modified to include a second slope 258 rather than a stop. In one exemplary embodiment, the second inclined surface 258 faces the second end 41 of the second end plate 16. In contrast, the ramp surface 228 on the central extension 228 faces the first end 39 of the second end plate. The concave surface 228 connects the inclined surface 228 and the second inclined surface 258.

Referring to FIGS. 35-38, in one exemplary embodiment, the actuator assembly 200 is further modified to include a drive tilt 260. In the illustrated embodiment, the drive tilt portion 260 has a through hole 262 through which the extension portion 254 extends. In one embodiment, the drive tilt portion 260 is substantially wedge-shaped. As shown, the drive ramp 260 may include a blunt end 264 that engages a flanged end 253. In one exemplary embodiment, the drive sloping section 260 is configured to engage the second sloping surface 258 of each of the end plates 14, 16 and separate the first and second end plates 14, 16. It further comprises a dimensioned angled surface 266.

Next, with reference to FIGS. 40-44, an alternative embodiment of the expandable fixed device 10 is shown. In the illustrated embodiment, the fixation device 10 includes a first end plate 14, a second end plate 16, a central tilt portion 18, an actuator assembly 200, and a drive tilt portion 300. As described in more detail later, the actuator assembly 200, in one embodiment, functions to pull the central tilt portion 18 and the drive tilt portion 300 together and pull the first and second end plates 14, 16 apart. do.

The following discussion relates to the first end plate 14, but in the embodiments of the present invention, the second end plate 16 is substantially the same as the first end plate 14, so that the discussion is the first. It should be understood that it applies equally to the end plate 16 of 2. Referring to FIGS. 40-45, in one exemplary embodiment, the first end plate 14 has a first end 39 and a second end 41. In the illustrated embodiment, the first end plate 14 has an upper surface 40 connecting the first end 39 and the second end 41 and a lower surface 42 connecting the first end 39 and the second end 41. Further prepare. Although not shown, in one embodiment, the first end plate 14 may further comprise a through opening. Penetration openings are sized to receive a bone implant or similar bone growth-inducing material in one exemplary embodiment.

In one embodiment, the top surface 40 of the first end plate 14 is flat and substantially planar so that the top surface 40 of the end plate 14 can engage the adjacent vertebral body 2. Alternatively, as shown in FIG. 15, the top surface 40 may be curved convexly or concavely to allow a higher or lower degree of engagement with the adjacent vertebral body 2. good. Further, the upper surface 40 may be substantially flat, but it is also intended to include a substantially linear inclined surface or a curved inclined surface. The slanted surface allows engagement with adjacent vertebral bodies 2 in the lordotic fashion. Although not shown, in one exemplary embodiment, the top surface 40 includes texturing to assist in gripping adjacent vertebral bodies. Texturings can include, but are not limited to, teeth, ridges, friction-increasing elements, keels, or gripping or lever-like protrusions.

In one embodiment, the first end plate 14 connects a first side portion 202 connecting the first end 39 and the second end 41, and a first end plate 39 connecting the second end 41. Further provided with 2 side portions 204. In the illustrated embodiment, the first and second side portions 202, 204 are extensions from the bottom surface 42. In one embodiment, the first and second sides have an inner surface 302 and an outer surface 304, respectively. In one exemplary embodiment, the first and second side portions 202, 204 each have one or more inclined portions. In the illustrated embodiment, the first and second side portions 202, 204 include the first inclined portions 306, 308 at the first end 39 of the end plate 14 and at the second end 41 of the end plate 14. Includes second sloping portions 310, 312. The first and second side portions 202, 204 may include bridge portions 314 connecting the first inclined portions 306, 308 and the second inclined portions 310, 312, respectively. In one embodiment, the first inclined portions 306, 308 abut on the outer surface 304 of the respective side portions 202, 204, and the second inclined portions 310, 312 are the inner surfaces of the respective side portions 202, 204. Contact 302. As shown, the first inclined portions 306, 308 may include tongue-shaped portions 316, 318, the tongue-shaped portions 316, 318 extending in an oblique direction with respect to the upper surface 40 of the end plate 14. do. As further illustrated, the second inclined portions 310, 312 may include tongue-shaped portions 320, 322 extending in an oblique direction with respect to the top surface 40 of the end plate 14.

As best seen in FIG. 45, the lower surface 42 of the second end plate 16 includes, in one embodiment, a central extension 224 extending along at least a portion of the lower surface. In the illustrated embodiment, the central extension 224 extends between the first and second side portions 202 and 204. In one exemplary embodiment, the central extension 224 can extend between the first sloping portions 306, 308 and the second sloping portions 310, 312. In one embodiment, the central extension 224 comprises a substantially concave surface 226 configured and dimensioned to form a through hole with the corresponding concave surface 226 (not shown) of the second end plate 16.

Referring to FIGS. 43 and 44, the actuator assembly 200 includes a head portion 324, a rod receiving extension portion 326, and a connecting portion 328 which is a connecting portion connecting the head portion 324 and the rod receiving extending portion 326. As shown, the head portion 324 may include one or more instrument gripping features 330 that can be swiveled by a suitable instrument. Further, the head portion 324 has a larger diameter than the other components of the actuator assembly 200 so as to provide a contact surface with the drive tilt portion 300. In the illustrated embodiment, the head portion 324 includes a rim 332 that provides a surface for contact with the drive tilt portion 300. As seen in FIG. 44, in one exemplary embodiment, the rod receiving extension 326 comprises an opening that is sized and sized to receive the extension 336 of the central tilt portion 18. In one embodiment, the rod receiving extension 326 includes a thread for screwing engagement with the extension 336. In another embodiment, the rod receiving extension 326 includes ratchet teeth for engaging the extension 336. In the illustrated embodiment, the head portion 324 and the rod receiving extending portion 326 are connected by a connecting portion 328 which may have a substantially cylindrical shape.

Referring to FIGS. 43, 44, and 46, the central tilt portion 18 includes an extension portion 334 and an extension portion 336. As best seen in FIG. 46, the extension 334 may include an upper portion 338 and side portions 340, 342 extending downward from the upper portion 338. In one embodiment, each of the side portions 340, 342 comprises a double overlapping sloping portion. For example, the side portions 340 and 342 each include a first inclined portion 344 that overlaps with the second inclined portion 346. In the illustrated embodiment, the first inclined portion 344 faces the extending portion 336, while the second inclined portion 344 faces the extending portion 336. In one embodiment, angled grooves 348, 350 are formed in each of the first and second inclined portions 344, 346. In another embodiment, the angled grooves 348, 350 are sized to receive the corresponding tongue portions 316, 318, 320, 322 of the first and second end plates, and the angled grooves 348 are , The tongues 320, 322 of the second end plate 16 are received, and the angled groove 350 receives the tongues 316, 318 of the first end plate 14. The device 10 is described with the tongues 316, 318, 320, 322 on the end plates 14, 16 and the angled grooves 348, 350 on the central slope 18, where the device 10 is one of the inventions. It should be understood that, according to embodiments, it may be configured with grooves on the end plates 14, 16 and a tongue on the central slope 18.

In one exemplary embodiment, the extension 336 is sized to be received within the rod receiving extension 326 of the actuator assembly 200. In one embodiment, the extension 336 has a thread and the extension 336 is screwed into the rod receiving extension 326. In another embodiment, the extension 336 has ratchet teeth and the extension 336 is clamped within the rod receiving extension 336. In one embodiment, the extension 336 includes a nose 352 at the end of the extension 336.

Referring to FIGS. 47-49, in one exemplary embodiment, the drive slope 300 includes an upper portion 354 with a top surface 356 and a slope 358. In one embodiment, the drive tilt 300 further comprises side portions 360, 362 extending from the top 354 and connecting the top 354 to the bottom 364 of the drive tilt 300. As best seen in FIGS. 48-49, the drive tilt portion 300 further includes, in an exemplary embodiment, a hole 366 sized to receive the connection portion 328 of the actuator assembly 200. In one embodiment, the drive tilt 300 moves along the connection 328 as the actuator assembly 200 pushes the drive tilt 300. In one exemplary embodiment, the drive tilt portion 300 further comprises a contact surface 368 that engages the rim 332 of the head portion 324 of the actuator assembly 200. In the illustrated embodiment, the contact surface 368 has a substantially annular shape.

In one exemplary embodiment, the side portions 360, 362 of the drive tilt portion 300 each include an overlapping tilt portion. For example, side portions 360, 362 each include a first inclined portion 370 that overlaps with a second inclined portion 372. In the illustrated embodiment, the first inclined portion 370 faces the central inclined portion 18, while the second inclined portion 372 faces in the opposite direction. In one embodiment, angled grooves 374, 376 are formed in each of the first and second inclined portions 370, 372. FIG. 48 is a perspective view of the drive tilted portion 300 showing the upper end of the angled groove 374 of the tilted portion 370. FIG. 49 is a perspective view of the drive inclined portion 300 showing the upper end of the angled groove 376 of the inclined portion 372. In an exemplary embodiment, the angled grooves 374, 376 are sized and angled to accept the corresponding tongues 316, 318, 320, 322 of the first and second end plates 14, 16. Groove 370 receives the tongues 316, 318 of the second end plate 16, and the angled groove 372 receives the tongues 320, 322 of the first end plate 14. Device 10 is described with the tongues 316, 318, 320, 322 of the first and second end plates 14, 16 and the angled grooves 370, 372, 374, 376 on the drive ramp 300. It should be appreciated that the device 10 may be configured with a groove on the second end plate 16 and a tongue on the drive tilt 300 according to one embodiment of the invention.

Next, with reference to FIGS. 40 to 42, a method of installing the expandable fixed device 10 of FIGS. 40 to 49 according to one embodiment of the present invention will be discussed next. The disc cavity may be prepared as described above prior to insertion of the fixation device. The expandable fixation device 10 can then be inserted into the disc cavity and placed in place. The expandable fixation device 10 is then inserted into the intervertebral space and the end of the central tilt 18 with the dilation 334 is inserted. In an exemplary method, the fixation device 10 is in a non-expanded position when introduced into the intervertebral space. In an exemplary method, the intervertebral space may be stretched prior to insertion of the fixation device 10. Stretching provides several advantages by providing greater access to the surgical site, easier disc removal, and easier curettage of the end plates of vertebral bodies 2 and 3.

As best seen in FIG. 42, the fixation device 10 can be inserted into the disc cavity and installed in place, and then the fixation device can be expanded to the dilated position. An instrument is engaged with the head portion 324 of the actuator assembly 200 to extend the fixation device 10. The instrument is used to rotate the actuator assembly 200. As mentioned above, the actuator assembly 200 is screwed into the extension 336 of the central tilt portion 18, so that when the actuator assembly 200 is rotated in the first direction, the central tilt portion 18 becomes the actuator assembly. Pulled towards 200. In an exemplary embodiment, the actuator assembly 200 is linearly moved by engaging ratchet teeth as a means for controlling the movement of the actuator assembly 200 and the central tilt portion 18. When the central tilt 18 is pulled towards the actuator assembly 200, the first tilt 344 of the central tilt 18 pushes the second tilts 310, 312 of the second end plate 16 and the central tilt 18 The second inclined portion 346 of the first inclined portion 14 pushes the first inclined portion 306, 308 of the first end plate 14. In this way, the central inclined portion 18 acts to push the end plates 14 and 16 outward to the extended position. This is best seen in Figures 40-42. As the end plates 14 and 16 move outward, the tongues 316, 318, 320 and 322 of the end plates 14 and 16 enter the angled grooves 348 and 350 and the tongues 320 and 322 of the second end plate 16 Enters the angled groove 348, and the tongue portions 316, 318 of the first end plate 14 enter the angled groove 350.

As mentioned above, the actuator assembly 200 also engages the drive tilt portion 300, and thus when the actuator assembly 200 is rotated in the first direction, the actuator assembly 200 causes the drive tilt portion 300 toward the central tilt portion 18. Push in a straight line. When the drive inclined portion 300 is pushed toward the central inclined portion 18, the first inclined portion 370 of the drive inclined portion 300 pushes the first inclined portions 306 and 308 of the second end plate 16 to push the drive inclined portion 306 and 308. The second sloping portion 372 of the 300 pushes the second sloping portions 310, 312 of the first end plate 14. In this way, the drive inclined portion 300 also acts to push the end plates 14 and 16 outward to the extended position. This is best seen in Figures 40-42. As the end plates 14 and 16 move outward, the tongues 316, 318, 320 and 322 of the end plates 14 and 16 enter the angled grooves 370 and 372 and the tongues 316 and 318 of the second end plate 16 Enters the angled groove 370, and the tongue portions 320, 322 of the first end plate 14 enter the angled groove 372.

Since the expansion of the fixed device 10 is operated by the rotation input, the expansion of the fixed device 10 is infinite. In other words, the end plates 14 and 16 can be expanded to an infinite height as the actuator assembly 200 rotates and advances.

Next, with reference to FIGS. 50-54, an alternative embodiment of the expandable fixed device 10 is shown. In the illustrated embodiment, the fixation device 10 includes a first end plate 14, a second end plate 16, a central tilt portion 18, an actuator assembly 200, and a drive tilt portion 300. As described in more detail later, the actuator assembly 200, in one embodiment, functions to pull the central tilt portion 18 and the drive tilt portion 300 together and pull the first and second end plates 14, 16 apart. do. In one embodiment, the expandable fixation device may include features such as through holes that facilitate placement through the endoscope tube. In one embodiment, the assembled fixation device 10 may be placed through the endoscope tube and then expanded.

The following discussion relates to the first end plate 14, but in the embodiments of the present invention, the second end plate 16 is substantially the same as the first end plate 14, so that the discussion is the first. It should be understood that it applies equally to the end plate 16 of 2. It should be understood that in one embodiment, the first end plate 14 is configured to work with the second end plate 16. Further referring to FIG. 55, in one exemplary embodiment, the first end plate 14 has a first end 39 and a second end 41. As shown, the first end 39 may be wider than the second end 41. In the illustrated embodiment, the first end plate 14 has an upper surface 40 connecting the first end 39 and the second end 41 and a lower surface 42 connecting the first end 39 and the second end 41. Further prepare. As best seen in FIG. 54, the bottom surface 42 may be concavely curved so that the first and second end plates 14, 16 form through holes when the device 10 is in the closed position. .. In one embodiment, the first end plate 14 may include a through opening 44. The penetration opening 44 is sized to receive a bone implant or similar bone growth-inducing material in one exemplary embodiment.

In one embodiment, the top surface 40 of the first end plate 14 is flat and substantially planar so that the top surface 40 of the end plate 14 can engage the adjacent vertebral body 2. Alternatively, as shown in FIG. 15, the top surface 40 may be curved convexly or concavely to allow a higher or lower degree of engagement with the adjacent vertebral body 2. good. Further, the upper surface 40 may be substantially flat, but it is also intended to include a substantially linear inclined surface or a curved inclined surface. The slanted surface allows engagement with adjacent vertebral bodies 2 in the lordotic fashion. As illustrated, in one exemplary embodiment, the top surface 40 includes texturing to assist in gripping adjacent vertebral bodies. For example, the top surface 40 may further comprise a textured 400 for engaging with adjacent vertebral bodies. Texturings can include, but are not limited to, teeth, ridges, friction-increasing elements, keels, or gripping or lever-like protrusions.

In one embodiment, the first end plate 14 connects a first side portion 202 connecting the first end 39 and the second end 41, and a first end plate 39 connecting the second end 41. Further provided with 2 side portions 204. In the illustrated embodiment, the first and second side portions 202, 204 are extensions from the bottom surface 42. In one embodiment, the first and second side portions 202, 204 include an inner surface 302 and an outer surface 304, respectively. In one embodiment, the first end 39 of the first end plate 14 generally fits into the second end 41 of the second end plate 16 when the device 10 is in the closed position. Designed and configured. As shown, the first and second side portions 202, 204 may include a first inclined portion 306, 308, a second inclined portion 310, 312, and / or a central inclined portion 402, respectively. ..

In one embodiment, the first inclined portions 306, 308 are close to the first end 39 of the end plate 14. According to an embodiment of the present invention, the first tilted portions 306, 308 of the first end plate 14 become the second tilted portions 310, 312 of the second end plate 16 when the device 10 is in the closed position. Generally designed and configured to fit. In one exemplary embodiment, the first inclined portions 306, 308 may substantially face the first end 39 and extend, for example, in an oblique direction with respect to the top surface 40. As shown, the first inclined portions 306, 308 may include tongue-shaped portions 316, 318 extending in an oblique direction with respect to the upper surface 40 of the end plate 14.

In one embodiment, the second inclined portions 310, 312 are close to the second end 41 of the end plate 14. In one exemplary embodiment, the second inclined portions 310, 312 can extend in an oblique direction with respect to the top surface 40 and substantially face the second end 41. The first and second side portions 202, 204 may include, in one embodiment, a bridge portion 314 connecting the first inclined portions 306, 308 and the second inclined portions 310, 312, respectively. As further illustrated, the second inclined portions 310, 312 may include tongue-shaped portions 320, 322 extending in an oblique direction with respect to the top surface 40 of the end plate 14.

In one embodiment, the end plate 14 may further include a central inclined portion 402 in the vicinity of the bridge portion 314. In the illustrated embodiment, the end plate 14 includes a central inclined portion 402 in the vicinity of the bridge portion 314 of the second side portion 204. In one exemplary embodiment, the central inclined portion 402 can extend in an oblique direction with respect to the top surface 40 and faces the first end 39 of the end plate 14. As shown, the first inclined portions 306, 308 may include tongue-shaped portions 316, 318, the tongue-shaped portions 316, 318 extending in an oblique direction with respect to the upper surface 40 of the end plate 14. do.

Referring to FIGS. 50-52, 54, in one embodiment, the actuator assembly 200 includes a head portion 324, an extension portion 404, and a through hole 406 extending longitudinally through the actuator assembly 200. As shown, the head portion 324 may include one or more instrument gripping features 330 that can be swiveled by a suitable instrument. Further, the head portion 324 has a larger diameter than the other components of the actuator assembly 200 so as to provide a contact surface with the drive tilt portion 300. In the illustrated embodiment, the head portion 324 includes a rim 332 that provides a surface for contact with the drive tilt portion 300. In one embodiment, the extending portion 404 is a substantially rod-shaped extending portion. In another embodiment, the extension 404 includes ratchet teeth for engaging the extension 336.

Referring to FIGS. 51, 52, and 56, the central ramp 18 includes a first end 408 and a second end 410. In one embodiment, the central inclined portion 18 has a first expansion portion 412, a second expansion portion 414, a rod receiving extending portion 416, and a through hole 418 extending in the vertical direction through the central inclined portion 18. include. In one exemplary embodiment, the first extension 412 may be in close proximity to the first end 408 of the central slope 18. As best seen in FIG. 56, the first extension 412 may include sides 420, 422. In one embodiment, each of the side portions 420, 422 includes a double overlapping inclined portion extending diagonally with respect to the through hole 418. For example, side portions 420, 422 each include a first inclined portion 424 that overlaps with a second inclined portion 426. In the illustrated embodiment, the first tilted portion 424 faces the rod receiving extension 416, while the second tilted portion 426 points in the opposite direction. In one embodiment, angled grooves 428, 430 are formed in each of the first and second inclined portions 424, 426. In one exemplary embodiment, the angled grooves 428, 430 are sized and angled to accept the corresponding tongues 316, 318, 320, 322 of the first and second end plates 14, 16. The grooved groove 428 receives the tongues 320, 322 of the second end plate 16, and the angled groove 430 receives the tongues 316, 318 of the first end plate 14. The device 10 is described with the tongues 316, 318, 320, 322 on the end plates 14, 16 and the angled grooves 428, 430 on the central slope 18, where the device 10 is one of the inventions. It should be understood that, according to embodiments, it may be configured with grooves on the end plates 14, 16 and a tongue on the central slope 18.

In one embodiment, the second extension 414 is located on the rod receiving extension 416 between the first end 408 and the second end 410 of the central tilt portion 18. In one exemplary embodiment, the second extension 414 includes a centrally inclined portion 432. In one embodiment, the second extension 414 includes two centrally inclined portions 432 on either side of the rod receiving extension 416. In one exemplary embodiment, the central inclined portion 424 extends obliquely with respect to the through hole 418 and faces the second end 410 of the central inclined portion 18.

The rod receiving extension 416 extends from the first extension 412 and has an opening 434 at the second end of the central slope 18. In one embodiment, the rod receiving extension 416 is sized and configured to receive the extension 404 of the actuator assembly 200. In one embodiment, the rod receiving extension 416 has a thread, and the rod receiving extension 416 receives the extension 404 of the actuator assembly 200 by screwing. In another embodiment, the rod receiving extension 416 has ratchet teeth and the extension 404 is clamped within the rod receiving extension 416.

Referring to FIGS. 50-52, 57, in one exemplary embodiment, the drive slope 300 includes an upper portion 354 with a top surface 356 and a slope 358. In one embodiment, the drive tilt 300 further comprises, in one exemplary embodiment, a hole 366 sized to receive the extension 404 of the actuator assembly 200. In the illustrated embodiment, the top 354 has a hole 436 extending through the top surface 356 to the hole 366. A positioning screw 438 may be inserted through the hole 436 to secure the drive tilt 300 to the actuator assembly 200. In one embodiment, the drive tilt portion 300 further comprises a contact surface 368 that engages the rim 332 of the head portion 324 of the actuator assembly 200. In the illustrated embodiment, the contact surface 368 has a substantially annular shape.

In one embodiment, the drive tilt 300 further includes side portions 360, 362 extending from the top 354 connecting the top 354 to the bottom 364 of the drive tilt 300. In one exemplary embodiment, the side portions 360, 362 of the drive tilt portion 300 each include a tilt portion 438. In the illustrated embodiment, the inclined portion 438 faces the central inclined portion 300. In one embodiment, the tilted portion 438 is configured and dimensioned to engage the tilted portions 306, 308 at the first end 39 of the second end plate 16. In one embodiment, angled grooves 440 are formed in the inclined portions 316, 318. In one exemplary embodiment, the angled groove 440 is sized to receive the corresponding tongues 316, 318 of the second end plate 16. The device 10 is described with the tongue portions 316, 318 on the second end plate 16 and the angled groove 440 on the drive tilt portion 300, wherein the device 10 is described according to an embodiment of the present invention. It should be understood that it may be configured with a groove on the end plate 16 of 2 and a tongue on the drive ramp 300.

A method of installing the expandable fixed device 10 of FIGS. 50-57 according to one embodiment of the present invention will be discussed next. The disc cavity may be prepared as described above prior to insertion of the fixation device. The expandable fixation device 10 can then be inserted into the disc cavity and placed in place. In one embodiment, the device 10 is assembled prior to insertion. The expandable fixation device 10 can be introduced into the intervertebral space and the end with the first end 408 of the central tilt 18 is inserted. In an exemplary method, the fixation device 10 is in a non-expanded position when introduced into the intervertebral space. In an exemplary method, the intervertebral space may be stretched prior to insertion of the fixation device 10. Stretching provides several advantages by providing greater access to the surgical site, easier disc removal, and easier curettage of the end plates of vertebral bodies 2 and 3.

With the fixation device 10 inserted into the disc cavity and installed in place, the fixation device can then be expanded to the dilated position. An instrument is engaged with the head portion 324 of the actuator assembly 200 to extend the fixation device 10. The instrument is used to rotate the actuator assembly 200. As mentioned above, the actuator assembly 200 is screwed into the rod receiving extension 416 of the central tilt 18 so that when the actuator assembly 200 is rotated in the first direction, the central tilt 18 Pulled towards the actuator assembly 200. In one exemplary embodiment, the actuator assembly 200 is linearly moved by engaging ratchet teeth as a means for controlling the movement of the actuator assembly 200 and the central tilt portion 18.

When the central tilt space 18 is pulled towards the actuator assembly 200, the central tilt 18 acts to push the end plates 14, 16 outward to the extended position. As an example, the first inclined portion 424, the second inclined portion 426, and the central inclined portion 432 push the corresponding inclined portions of the first and second end plates 14, 16. The first inclined portion 424 of the first extended portion 412 of the central inclined portion 18 pushes the second inclined portions 310 and 312 of the second end plate 16 and the second inclined portion of the second end plate 16. The corresponding tongues 320, 322 of 310, 312 enter the angled groove 428 of the first tilted portion 424 of the first extension 412. The second sloping portion 426 of the first extension 412 pushes the first sloping portions 316, 318 of the first end plate 14 and corresponds to the first sloping portions 316, 318 of the first end plate 14. The tongue portions 316, 318 to be inserted into the angled groove 430 of the second inclined portion 426 of the first expansion portion 412. The centrally inclined portion 432 of the second expansion portion 414 pushes the centrally inclined portion 402 of the first and second end plates 14 and 16.

As mentioned above, the actuator assembly 200 also engages the drive tilt portion 300, and thus when the actuator assembly 200 is rotated in the first direction, the actuator assembly 200 causes the drive tilt portion 300 toward the central tilt portion 18. Push in a straight line. When the drive inclined portion 300 is pushed toward the central inclined portion 18, the drive inclined portion 300 also acts to push the end plates 14 and 16 outward to the extended position. As an example, the tilted portion 438 of the drive tilted portion 300 pushes the tilted portions 306, 308 at the first end 39 of the second end plate 16. As the end plates 14 and 16 move outward, the tongues 316 and 318 of the inclined portions 306 and 308 of the second end plate 16 enter the angled groove 440 of the inclined portion 438 of the drive inclined portion 300.

Further, the extension of the end plates 14 and 16 may be different based on the difference in the dimensions of the central inclined portion 18, the drive inclined portion 300, and the various inclined portions in the first and second end plates 14 and 16. Please also understand. As can be best seen in FIG. 16, the end plates 14 and 16 can be extended in any of the following modes: Expansion that rises straight, switches to the lordosis expansion configuration after rising straight, or switches to the lordosis expansion configuration after rising straight in a misaligned state.

Next, with reference to FIG. 58, an alternative embodiment of the expandable fixed device 10 is shown, in which the expandable fixed device 10 is extended to a lordosis expansion configuration. In the illustrated embodiment, the expandable fixation device 10 includes a first end plate 14, a second end plate 16, an actuator assembly 200, a drive tilt 300, and a body 500. As will be described in more detail later, the actuator assembly 200, in one embodiment, functions to pull the drive tilt portion 300 and the body 500 together and pull the first and second end plates 14, 16. For example, the actuator assembly 200 may be rotated to pull the drive tilt 300 towards the body 500. 62-64) and then expands in height until it is fully expanded (FIGS. When this happens, the expandable fixed device 10 first expands to a lordosis expansion configuration (Figs. 62-64) and then expands in height until fully expanded (Figs. 65-67). In an embodiment, the expandable fixed device 10 may have two stages of expansion, commonly referred to as a lordosis stage and a parallel stage. In the lordosis stage, the expandable fixed device 10 has a lordosis angle. Can be expanded at one end to achieve. The expandable fixed device 10 can then be expanded in parallel stages, and lordosis expansion is maintained at both ends of the expandable fixed device 10 and expands at a substantially constant rate. In one embodiment, the expandable fixation device 10 may include features such as through holes that facilitate placement through the endoscope tube. In one embodiment, the assembled fixation device 10 may include. , May be placed through the endoscopic tube and then expanded.

The following discussion relates to the first end plate 14, but in the embodiments of the present invention, the second end plate 16 is substantially the same as the first end plate 14, so that the discussion is the first. It should be understood that it applies equally to the end plate 16 of 2. It should be understood that in one embodiment, the first end plate 14 is configured to work with the second end plate 16. In one exemplary embodiment, the first end plate 14 has a first end 39 and a second end 41. In the illustrated embodiment, the first end plate 14 further comprises a plate portion 502 that may extend between the first end 39 and the second end 41. The plate portion 502 may include a top surface 40 and a bottom surface 42. In one embodiment, the first end plate 14 may include a through opening 44. The penetration opening 44 may, in one exemplary embodiment, be sized to receive a bone implant or similar bone growth-inducing material.

In one embodiment, the upper surface 40 of the plate portion 502 is flat and substantially planar so that the upper surface 40 of the plate portion 502 can engage the adjacent vertebral body 2. Alternatively, as shown in FIG. 15, the top surface 40 may be curved convexly or concavely to allow a higher or lower degree of engagement with the adjacent vertebral body 2. good. Further, the upper surface 40 may be substantially flat, but it is also intended to include a substantially linear inclined surface or a curved inclined surface. The slanted surface allows engagement with adjacent vertebral bodies 2 in the lordotic fashion. As illustrated, in one exemplary embodiment, the top surface 40 includes texturing to assist in gripping adjacent vertebral bodies. For example, the top surface 40 may further comprise a textured 400 for engaging with adjacent vertebral bodies. Texturings can include, but are not limited to, teeth, ridges, friction-increasing elements, keels, or gripping or lever-like protrusions.

In one embodiment, the first end plate 14 further comprises an anterior extending portion 504 extending from the plate portion 502. As shown, the anterior extension 504 may extend from either side of the plate portion 502 close to the second end 41 of the first end plate 14. The front extending portion 504 may extend to the side opposite to the upper surface 40 of the plate portion 502. In one embodiment, the first end plate 14 may further comprise a posterior extending portion 506 extending from the plate portion 502. As shown, the posterior extension 506 can extend from either side of the plate portion 502 close to the first end 39 of the first end plate 14. The posterior extending portion 506 may extend to the side opposite to the upper surface 40 of the plate portion 502. As shown, the anterior extension 504 and the posterior extension 506 can each include an inclined portion. For example, the anterior extension 504 may include an anterior inclined portion 508 and the posterior extending portion 506 may include a posterior inclined portion 510. The forward tilted portion 508 and the backward tilted portion 510 can be considered tilted when they can be tilted with respect to the vertical axis 512 of the expandable fixed device 10. In one exemplary embodiment, the anteriorly inclined portion 508 may substantially face the second end 41 and the rearwardly inclined portion 510 may substantially oppose the first end 39.

Next, an embodiment of the actuator assembly 200 will be discussed in more detail with reference to FIG. In the illustrated embodiment, the actuator assembly 200 is in the form of a drive screw. As shown, the actuator assembly 200 may include a head portion 324 and an extension portion 404. As shown, the head portion 324 may include one or more instrument gripping features 330 that can be swiveled by a suitable instrument. Further, the head portion 324 may have a larger diameter than the other components of the actuator assembly 200 so as to provide a contact surface with the body 500. In the illustrated embodiment, the ring 514 enters the groove 516 of the head portion 324. In some embodiments, the ring 514 can be a compressible ring, such as a C-ring, as shown in FIG. 58, which holds the head portion 324 within the rear through hole 536 of the body portion 500. It is configured in. In one embodiment, the extension 404 is a substantially rod-like extension, which can be threaded to engage the corresponding opening 522 in the drive slope 300. In another embodiment, the extension 404 may include ratchet teeth (not shown) for engaging with an opening 522 in the drive tilt 300.

Next, an embodiment of the drive tilt portion 300 will be discussed in more detail with reference to FIG. 58. As shown, the drive tilt portion 300 may include a tilt body portion 518 and an extension portion 520. In the illustrated embodiment, the extension 520 may extend from the tilted body portion 518 towards the first end 39 of the expandable fixed device 10. The extension 520 may include an opening 522 that may engage the extension 404 of the actuating assembly 200. In embodiments, the extension 520 may be threaded with the extension 404 of the actuating assembly 200. The rotation of the drive tilt 300 may be restricted so that the drive tilt 300 can be pulled towards the body 500 when the actuating assembly 200 can be rotated. The drive tilt 300 may be secured to the actuator assembly 200 at the front end of the expandable fixation device 10. In embodiments, the front end of the expandable fixed device 10 can be in front of the expandable fixed device 10, so that the drive tilt portion 300 can be considered as the nose portion of the expandable fixed device 10. In embodiments, the anterior end 524 of the drive tilt 300 can be angled, rounded, or otherwise tapered so that the drive tilt is when the fixation device 10 is inserted into the intervertebral space. It can serve to stretch adjacent vertebral bodies.

As shown, the drive tilt portion 300 may include a front end plate engaging tilt portion 526. The front end plate engaging slope 526 can be beveled with respect to the vertical axis 512 of the expandable fixed device 10. As shown, the pair of front end plate engaging tilts 526 that engage the second end plate 16 can be on one side of the drive tilt and another that engages the first end plate 14. A pair of front end plate engaging tilts 526 can be on the opposite side of the drive tilt 300. In operation, the front end plate engaging slope 526 may engage the front end plate 508 of the first and second end plates 14, 16. The first and second end plates 14 and 16 may allow the front end plate engaging inclined portion 526 to be pushed up when the drive inclined portion 300 is pulled toward the main body 300, and the first and second end plates 14 and 16 may be provided. Pushing 14, 16 relative apart can increase the height of the expandable fixed device 10.

Next, an embodiment of the main body 500 will be discussed in more detail with reference to FIG. 58. As shown, the body 500 may have a first body end 528 and a second body end 530. The side 532 may connect the first body end 528 and the second body end 530. In the illustrated embodiment, the body 500 may have a central opening 534 that may intersect the vertical axis 512 of the expandable fixed device and extend through the body 500. As shown, the first body end 528, the second body end 530, and the side 532 may define a central opening 534. The rear through hole 536 can be formed through the second body end 530. The rear through hole 536 is centrally located and may be substantially aligned with the vertical axis 512 of the expandable fixed device 10. As previously described, the head portion 324 of the actuator assembly 200 may be held in the rear through hole 536 using, for example, the ring 514. The washer 515 may also be held in the corresponding groove of the head portion 324. The rear through hole 506 can also be threaded, for example to facilitate engagement with the insertion device. The second body end 530 may also include a tool that engages with features such as the lateral recess 538, which is the use of the device for inserting the expandable fixation device 10 into the desired position within the patient. Can be facilitated. The first body end 528 may include a corresponding anterior through hole 540. As shown, the anterior through hole 540 is centrally located and may be approximately aligned with the vertical axis 512 of the expandable fixed device. The extension 404 of the actuator assembly 200 may extend through the front through hole 540 and engage the drive tilt 300.

As shown, the second body end 530 may include a rear end plate engaging slope 542. The rear end plate engaging slope 542 can be beveled with respect to the vertical axis 512 of the expandable fixed device 10. In operation, the rear end plate engaging tilt portion 542 may engage the rear end plate engaging portion 510 of the first and second end plates 14, 16. As shown, the pair of rear end plate engaging tilts 542 that engage the second end plate 16 can be on one side of the second body end 530, while the first end plate 14 Another pair of rear end plate engaging tilts 542 (not shown in FIG. 58) that engages with can be on the opposite side of the second body 530. The first and second end plates 14 and 16 may allow the rear end plate engaging inclined portion 542 to protrude when the drive inclined portion 300 is pulled toward the main body 300, and the first and second end plates 14 and 16 may be provided with the rear end plate engaging inclined portion 542. Pushing 14, 16 relative apart can increase the height of the expandable fixed device 10.

As described above, the expandable fixed device 10 shown in FIG. 58 may first expand to the lordosis and then expand in parallel until full expansion of the expandable fixed device 10 can be achieved. .. In order to achieve this front bay expansion, the forward inclined portion 508 and the rear inclined portion 510 of the first and second end plates 14 and 16 are the front end plate engaging inclined portion 526 of the drive inclined portion 300 and the rear of the main body 500. It can be at a different angle with respect to the vertical line 512 than the end plate engaging slope 542. This difference in angle can exist when the expandable fixed device 10 is in a non-expandable configuration. When the drive tilt portion 300 can be pulled toward the body 500, the positions of the first and second end plates 14, 16 and / or the drive tilt portion 300 and the body 500 with respect to the body 500 have a difference in angle. As the 1st and 2nd end plates 14, 16 are pushed outwards, they shrink and can potentially approach zero. As this angle is reduced, the posterior portion of the expandable fixed device can be expanded to give rise to a lordosis angle. When this angle is reduced (or reaches near zero), the first and second end plates 14, 16 can then be expanded and expandable in parallel with the first end 39 and the second end 41. Extend at approximately the same height until the fixed device 10 can reach its full height. The lordosis angle can be maintained as the first and second end plates 14, 16 expand in parallel.

FIGS. 59-61 illustrate a non-expandable, expandable fixed device 10 according to this embodiment. As can be seen in FIG. 60, the expandable fixed device 10 can have a lordosis angle ΘLA of about 0 ° when it is non-expandable. As an example, the first and second end plates 14, 16 may be substantially aligned with the vertical axis 512 of the expandable fixed device 10. According to this embodiment, the lordotic expansion of the expandable fixed device 10 can be achieved by using different tilt angles with respect to the vertical axis 512. As best seen in FIG. 59, the rear end plate engaging tilted portion 542 of the body 500 may have an angle α body, and the rear tilted portions 510 of the first and second end plates 14, 16 may have an angle α. It may have a rear end plate. The front end plate engaging tilt portion 526 of the drive tilt portion 300 may have an angle α drive tilt portion, and the front tilt portions 508 of the first and second end plates 14, 16 have an angle α front end plate. Can be. These angles may be selected, for example, to provide the desired rate of increase in height during expansion of the expandable fixed device 10. As an example, the angles can be individually selected, for example, from about 5 ° to about 85 °, and optionally from about 35 ° to about 65 °. However, as mentioned above, embodiments may provide differences in these angles, for example to drive lordosis expansion. As best seen in FIG. 59, the difference between the angle α rear end plate and the α body can be provided by the Δ rear, and the difference between the α front end plate and the α drive slope is by the Δ front. Can be provided. The rear and front of Δ may be the same or different. As an example, Δ posterior and Δ anterior can be in the range of 1 ° to about 20 °, respectively, and alternatives can be in the range of about 2 ° to about 5 °.

62 to 64 illustrate the expandable fixed device 10 in a lordotic expansion configuration according to this embodiment. The expandable fixed device 10 can be expanded to provide a lordosis angle ΘLA up to about 15 °, more specifically from about 4 ° to about 10 °. A lordosis angle ΘLA up to 12 ° may be desirable for certain applications such as the neck, while other lordosis angles ΘLA may be desired for other applications.

To extend the expandable fixed device 10, the drive tilt 300 may be moved in a first direction with respect to the body 500. As an example, the drive ramp 300 may be pulled towards the body 500. In some embodiments, the actuator assembly 200 (best seen in FIG. 58) can be rotated to pull the drive tilt 300 towards the body 500. When the drive tilt portion 300 is pulled toward the main body 500, the drive tilt portion 300 and the main body 500 may engage with the first and second end plates 14, 16. As an example, the forward inclined portion 508 of the first and second end plates 14, 16 engages with the front end plate engaging inclined portion 526 of the drive inclined portion 300, and the first and second end plates 14, 16 The rear tilted portion 510 of the main body 500 may engage with the rear end plate engaging tilted portion 542 of the main body 500. However, due to the difference in tilt angles (shown as Δback and Δfront in FIG. 59), the first and second end plates 14, 16 have anterior ends to increase the height of the expandable fixed device. The plate engaging inclined portion 526 and the rear end plate engaging inclined portion 542 may not be extended upward. Instead, in some embodiments, the first and second end plates 14, 16 rotate at the point of contact between the first and second end plates 14, 16 and the body 500 and oppose. The end plates 14 and 16 can be expanded at the side edges. As can be seen in FIGS. 62-64, this rotation can result in the extension of the first and second end plates 14, 16 to the expanded lordosis configuration. As will be appreciated, the rotation of the first and second end plates 14, 16 can change the angle α rear end plate and the angle α front end plate with respect to the vertical axis 512, and thus the tilt angle Δrear, Δ. Reduce the front difference. When the difference in tilt angle Δ backward, Δ forward approaches 0 ° (eg 0.5 °, 0.1 °, or less), the lordosis expansion can stop and the expandable fixed device 10 has its lordosis expansion. It can be a configuration.

FIGS. 65-67 illustrate the expandable fixed device 10 in a fully expanded configuration according to this embodiment. In some embodiments, it may be desirable to further extend the expandable fixed device 10 from the lordotic expansion configuration of FIGS. 62-64. As an example, continuous motion of the drive tilt 300, eg, translational motion towards the body 500, may further expand the expandable fixed device 10. This further expansion can be considered parallel expansion when both ends of the expandable fixed device 10 can be expanded in equal proportions. Expansion may continue, for example, until the expandable fixed device 10 reaches its full expansion configuration, or until the desired height of the expandable fixed device 10 is achieved. The expansion of the expandable fixed device 10 may be limited by the engagement of the drive tilt portion 300 with the body 500.

If the fixed device 10 needs to be relocated or modified after it has been installed and expanded, the fixed device 10 may be returned to the non-expanded configuration, retracted, relocated, and re-expanded after the desired position is obtained. can. An instrument can be used to rotate the actuator assembly 200 in a second direction opposite to the first direction in order to retract the fixation device 10. The opposite rotation of the actuator assembly 200 can result in a movement that separates the body 500 and the drive tilt 300 from each other. When the main body 500 and the drive inclined portion 300 move away from each other, the end plates 14 and 16 move inward to the non-expanded position.

The extended height of the expandable fixation device 10 depends on the patient and the joint to which the expandable fixation device 10 can be implanted, but can range from 7 mm to 12 mm, but as much as 5 mm. , And may be larger or smaller, including about 16 mm. The expandable fixation device 10 can be implanted within any level of the spine and can be implanted in other joints of the body, including the hands, wrists, elbows, shoulders, hips, knees, ankles, or joints of the feet. ..

So far, we have only discussed having a single fixation device 10 in the intervertebral space, but it is conceivable that more than one fixation device 10 may be inserted into the intervertebral space. Furthermore, it is also contemplated that each fixed device 10 does not need to be finally installed in a fully expanded state. Rather, depending on the position of the fixation device 10 in the disc cavity, the height of the fixation device 10 may vary from non-expanded to fully expanded. It should be noted that the fixed 10 may be permanently positioned in any state between the expanded and non-expanded states, as well as the different heights from the non-expanded state to the expanded state.

In some embodiments, expandable fixed devices may be provided in which expansion is performed via a ratchet mechanism. By providing a ratchet mechanism, this advantageously provides rapid, convenient and discontinuous expansion of fixed devices.

FIG. 68 is an exploded view of an expandable fixed device with a ratchet mechanism, according to some embodiments. The expandable fixing device 600 includes a first end plate 620, a second end plate 630, a main body 610 located between the first end plate 620 and the second end plate 630, and a stem 660. , With a related color 670 and a nose section 680. The stem 660 and associated collar 670 advantageously provide a discontinuous ratchet mechanism to the expandable fixed device, whereby the expandable fixed device is gradually incremented alternately until the desired expansion occurs. , Then you can stop.

The first end plate 620 comprises a lower end plate having a first end 622 and a second end 624. The first end 622 comprises a pair of first end tilted portions 626a, 626b. Each of these tilted portions 626a, 626b is configured to engage the corresponding lower nose tilted portions 682a, 682b on the nose portion 680 to aid in the expansion of the expandable fixed device. The second end 624 comprises a pair of second end tilted portions 628a, 628b. Each of these tilted portions 628a, 628b is configured to engage the corresponding rear lower tilted portion 616a, 616b on the body 610 to assist in the expansion of the expandable fixed device. The first side portion 623 having the central inclined portion 627a and the second side portion 625 having the central inclined portion 627b are located between the first end 622 and the second end 624 of the first end plate 620. To position. Each of the central tilts 627a, 627b is configured to engage the corresponding forward downward tilts 615a, 615b (invisible) of the base 610 to assist in the expansion of the expandable fixed device. The inclined portion of the first end plate 620 is formed along the outer periphery surrounding the central opening 629.

The second end plate 630 comprises an upper end plate having a first end 632 and a second end 634. The first end 632 comprises a pair of first end tilted portions 636a, 636b. Each of these tilted portions 636a, 636b is configured to engage the corresponding upper nose tilted portions 684a, 684b on the nose portion 680 to assist in the expansion of the expandable fixed device. The second end 634 comprises a pair of second end tilted portions 638a, 638b. Each of these tilted portions 638a, 638b is configured to engage the corresponding rear-up tilted portion 618a, 618b on the body 610 to assist in the expansion of the expandable fixed device. The first side portion 633 having the central inclined portion 637a and the second side portion 635 having the central inclined portion 637b are provided between the first end 632 and the second end 634 of the second end plate 630. To position. Each of the central tilts 637a, 637b is configured to engage the corresponding forward upward tilts 617a, 617b of the base 610 to assist in the expansion of the expandable fixed device. The inclined portion of the second end plate 630 is formed along the outer periphery surrounding the central opening 639.

The main body 610 includes a front through hole 612 and a rear through hole 614. The anterior through hole 614 comprises an opening for receiving the collar 670 and thus the stem 660 through it. The rear through hole 614 comprises an opening through which one or more tools (eg, expansion tools and disengagement tools) can pass, as shown in FIGS. 78B and 78D. In some embodiments, the rear through hole 614 is threaded to allow engagement with the insertion tool. In addition, the body 610 comprises one or more tool recesses 611 that can be engaged by an insertion tool to provide easy delivery of the implant into the surgical site. As shown and described above in FIG. 68, the body 610 has several angled surfaces configured to engage the corresponding slopes on the first end plate 620 or the second end plate 630. Alternatively, it is provided with an inclined portion. As the ramps slide relative to each other, this expands the expandable fixed device.

The stem 660 and associated collar 670 form a ratchet mechanism for expanding expandable stationary devices. The stem 660 includes a head portion 662 and a shaft 664. The stem 660 (via its head portion 662) is receptive within the nose portion 680 of the implant, thereby being rotatable. In some embodiments, rotation of the stem 660 changes the implant from a "locking" ratchet configuration to a "disengagement" non-ratchet configuration, as further discussed below. The head portion 662 of the stem 660 comprises one or more grooves or slots 668 for receiving one or more nose pins 690a, 690b extending through the nose portion 680. The shaft 664 of the stem 660 has an opening 663 through which an elongated body for receiving the expansion tool 710 (shown in FIG. 78C) is provided. The stem 660 further includes ratchet teeth 665 extending along the length of the shaft 664. In addition, the stem 660 comprises one or more flat areas 667 located adjacent to the ratchet teeth 665. In some embodiments, the stem 660 comprises a pair of flat areas 667 located 180 degrees apart from each other. In some embodiments, the stem 660 comprises a halfling portion 664 advantageously designed to collide with a fully expanded body 610 to prevent excessive expansion of the device.

The stem 660 can be configured in two ways. In the first "locking" configuration (shown in Figure 78D), the ratchet teeth 665 of the stem 660 are engaged with the corresponding ratchet recess 675 of the collar 670, thereby providing an expansion of the implant 600 ratchet mechanism. To make. In the second "disengagement" configuration (shown in Figure 78E), the stem 660 is rotated so that one or more flat areas 667 are located adjacent to the ratchet recess 675, thereby causing the ratchet mechanism. It becomes inoperable. In this second disengagement configuration, the stem 660 can be pulled back, thereby causing the implant 600 to contract.

The stem 660 is insertable through the collar 670, thereby placing it in either a "locking" ratchet configuration or an "disengaging" non-ratchet configuration. In some embodiments, the collar 670 comprises a C-shaped ring with an inner ratchet recess 675 formed along the inner wall. In some embodiments, the collar 670 is housed within the anterior through hole 616 of the body 610. In some embodiments, the collar 670 comprises a compressible C-ring type body that is compressible within the anterior through hole 616. In some embodiments, the collar 670 is not rotatable and can be locked in place to prevent rotation. Advantageously, the collar 670 may include a tab 679 that prevents the collar 670 from rotating within the body 610. A stem 660 attached to the collar 670 forms a ratchet mechanism, whereby the expansion tool 710 (shown in Figure 78C) extends into the stem 660 through the collar 670 and through the shaft opening 663. Can be done. The expansion tool 710 can pull or ratchet the stem 660 towards the second end of the first end plate 620 and the second end plate 630. When the stem 660 is operably connected to the nose 680, the nose 680 is also retracted, whereby the corresponding tilt of the body 610 to the tilt of the first end plate 620 and the second end plate 630. Slide the stem and nose 680 upwards.

The nose portion 680 is provided with a through hole 685, through which the head portion 662 of the stem 660 can extend. The pair of nose pins 682a, 682b then extend through the nose portion 680 into the head portion 662, thereby holding the stem 660 into the nose portion 680. As mentioned above, the nose portion 680 comprises one or more upper nose slopes 684a, 684b, which are configured to fit and engage the corresponding slopes on the second end plate 630. Has been done. In addition, the nose portion 680 comprises one or more lower nose slopes 682a, 682b, which are configured to fit and engage the corresponding slopes on the first end plate 620. There is.

FIGS. 69A-69C are side views of the expandable fixed device of FIG. 68 of the expansion process, according to some embodiments. In some embodiments, the expandable fixed device 600 can advantageously perform expansion, especially lordosis expansion. In some embodiments, the device 600 can be started in a contracted state, as shown in FIG. 69A. The device 600 can then be expanded and tilted to lordosis, as shown in FIG. 69B, by pulling the nose portion 680 through the ratchet mechanism. Once the device 600 reaches the maximum lordosis, the device 600 can continue to expand its height in a parallel fashion, as shown in Figure 69C, whereby the implant 600 reaches the maximum expansion. Up to, both anterior and posterior sides expand at the same rate. In other words, once the device 600 reaches a certain lordosis angle (as shown in Figure 69B), the device 600 will span the entire expansion range until maximum expansion is achieved, as shown in Figure 69C. The lordosis angle will be maintained. Further details regarding the expansion of the device 600 are provided for FIGS. 70A-72C.

70A-70C are different views of the expandable fixed device of FIG. 68 in a contracted state, according to some embodiments. From the contracted state, the device 600 can first expand and tilt to the lordosis and then expand in a parallel fashion. The tilt angle is brought about by the difference in tilt angle x seen between the first edge tilted portions 636a, 636b of the second end plate 630 and the upper nose tilted portions 684a, 684b of the nose portion 680. Similarly, the same difference in tilt angle x is also found between the tilted portions 638a, 638b of the second end plate 630 and the rear upper tilted portions 618a, 618b of the main body 610. In other words, in contraction height, the difference x in angle between the different slopes is the first edge gap 702a formed towards the first end of the second end plate 630 and the second end plate 630. A gap 702 including the second end gap 702b formed towards the second end of the is created between the slopes. The degree of gap 702 will determine the lordosis that the device tilts as it expands. For example, if the degree of the gap 702 is 4 degrees (eg, x = 4), the second end plate 630 will tilt to a 4 degree lordosis. Since the same mechanism is provided for the first end plate 620, the first end plate 620 will also have a 4 degree lordosis tilt, thereby tilting both end plates 620, 630 once. And provides the entire 8th lordosis. In some embodiments, the end plates 620, 630 themselves can have a natural lordosis. For example, if the innate lordosis of both end plates 620, 630 is included 7 degrees, then the entire lordosis following the expansion, where x = 4, is a lordosis of 15 degrees. The present embodiment shows a difference of an angle x of 4 degrees, which may be smaller or larger, thereby resulting in a smaller or larger lordosis.

71A-71C are different views of the expandable fixed device of FIG. 68 in a fully unexpanded tilted state, according to some embodiments. To tilt the expandable fixed device 600 to the lordosis, the nose portion 680 is first ratcheted or pulled towards the body 610, thereby closing the gap x and fitting the corresponding tilted portion. Let me. The amount of lordosis will be predetermined based on the initial slope gap x. In this embodiment, the expandable fixed device 600 is tilted at a lordosis angle of 4 degrees with respect to the second end plate 630 and 4 degrees with respect to the first end plate 620, thereby summing up. The resulting lordosis is 8 degrees (as shown in Figure 71B). One of ordinary skill in the art can understand that the degree of lordosis may be less than or greater than 8 degrees, with 8 degrees being merely a representative example.

72A-72C are different views of the fully expanded state of the expandable fixed device of FIG. 68, according to some embodiments. When the nose 680 is further pulled back, the corresponding tilt of the device 600 is fully fitted and the implant then begins to expand its entire height in a parallel fashion. In other words, the front and rear sides of the device 600 expand at the same rate. When this happens, the device maintains the same lordosis and allows the lordosis angle to be visible over the extended range. For example, the degree of lordosis of device 600 in the fully expanded state (as shown in Figure 72B) is the degree of lordosis of device 600 after the end plate has been tilted (as shown in Figure 71B). It is the same. However, due to further parallel expansion, the height of the device 600 in the fully expanded state (as shown in FIG. 72B) is higher than the height of the device 600 after the end plate has been tilted (as shown in FIG. 71B). Is also expensive.

The expandable fixed device 600 can be advantageously expanded via a ratchet mechanism. Further details regarding the ratchet mechanism, in particular the stem 660 and collar 670, will be provided with reference to FIGS. 73-76.

FIG. 73 is a top view of the expandable fixed device of FIG. 68, according to some embodiments. From this figure, it can be seen how the collar 670 is housed in the body 610 and how the stem 660 is received within the collar 670. The stem 660 is further received within the nose section 680, whereby when the stem is pulled back, the nose section 680 can also be pulled back, thereby causing ratchet expansion of the device 600.

FIG. 74 is a top view of the expandable fixed device of FIG. 68, according to some embodiments. In this figure, it can be seen how the stem 660 with ratchet teeth 665 engages with the collar 670 to create an expandable ratchet mechanism. In some embodiments, the stem 660 has a "male" ratchet feature, while the collar 670 has a "female" ratchet feature.

FIG. 75 is an enlarged view of the expandable fixed device of FIG. 68, according to some embodiments. This figure shows in more detail the male ratchet of stem 660 and the female ratchet of collar 670. When the stem 660 is pulled back, the spring of the collar 670 opens like a C-ring, allowing the ratchet teeth 665 of the stem 660 to advance to the next slot or recess 675 formed within the collar 670. The stem 660 advantageously moves incrementally through the collar 670. These discontinuous increments result in an increase in height. In some embodiments, the increase in height can be increased in increments of&gt; 0.2 mm and&gt; 0.8 mm. In some embodiments, the height increase is an increment of about 0.5 mm.

FIG. 76 is an enlarged view of the expandable fixed device of FIG. 68, according to some embodiments. Each of the ratchet teeth 665 includes a cutting edge angle 668a and a back angle 668b. In some embodiments, the ratchet tooth 665 comprises a cutting edge angle 668a of 30-60 degrees, in particular about 45 degrees. In some embodiments, the dorsal angle 668b comprises 2-8 degrees, in particular about 5 degrees. Under load, the ratchet connection is pulled in the disengagement direction. Advantageously, the purpose of the dorsal angle 668b is to pull the collar 670 towards the ratchet teeth 665 when pulled in the disengagement direction, especially when the device 600 is under load, the stem 660. , To be more engaged and maintained in the rear area.

FIG. 77 is a top perspective view of the expandable fixed device of FIG. 68, according to some embodiments. In this configuration, the fixed device 600 can be ratchet-expanded. In addition to providing ratchet expansion, the device can also collapse and contract. To adapt to contraction, the device 600 advantageously provides the ratchet tooth 665 to only a portion of the stem 660, whereby the ratchet tooth 665 is separated by one or more flat areas 667. In certain embodiments, the device 600 comprises two sets of ratchet teeth 665, each of which is adjacent to two sets of flat areas 667. These features allow the device to change between a ratchet-enabled "locking" configuration and a ratchet-disabled "disengagement" configuration. These features are discussed below with respect to Figures 78A-78G.

78A-78G are top perspective views of the expandable fixed device of FIG. 68 transitioning from a locking configuration to an disengaging configuration, according to some embodiments. FIG. 78A shows an expandable fixed device in a "locking" configuration where the device can ratchet expand. As shown in FIG. 78A, the ratchet teeth 665 of the stem 660 are aligned and engaged with the ratchet recess 675 of the collar 670, thereby allowing ratchet expansion.

Figure 78B shows an expandable fixed device with an expansion tool inserted inside. The expansion tool 710 can engage the stem 660 in a "locking" configuration, whereby the stem 660 (and thus the nose portion 680) can be pulled back. When the stem 660 and nose 680 are pulled back, this results in an incremental ratchet expansion of the device 600 based on the ratchet tooth design.

Figure 78C shows an expandable fixed device when fully expanded. As shown in the figure, the stem 660 is further pulled into the body 610, thereby causing higher expansion of the device. The fixed device 600 has a height relatively higher in FIG. 78C than in FIG. 78B. Advantageously, the fixation device 600 can also be retracted by the surgeon if desired.

FIG. 78D shows an expandable stationary device before it contracts while the device remains in the "locked" ratchet configuration. A disengagement tool 720 (separate from the expansion tool 710) is provided to retract the device 600. The disengagement tool 720 comprises a shaft with a distal projection 730. The disengagement tool 720 is advantageously designed to rotate the stem 660 so that the device changes from a "locking" ratchetable configuration to a "disengagement" non-ratchetable configuration, as described above. .. To rotate the stem 660, the distal projection 730 of the disengagement tool 720 mates with the correspondingly shaped recess 669 in the stem 660. With the disengagement tool 720 engaged with the stem 660, the stem 660 can be rotated (eg, 90 degrees), thereby transforming the device into an disengagement configuration, as shown in Figure 78E. ..

Figure 78E shows an expandable fixed device in a "disengagement" ratchet non-capable configuration. The stem 660 is rotated so that its pair of flat areas 667 are aligned with and opposed to the collar 670. Thus, the ratchet teeth 665 of the stem are no longer engaged with the ratchet slot of the collar 670, which allows the stem 660 to be pushed forward and retract the device.

FIG. 78F shows an expandable fixed device in a "disengagement" configuration with the device fully retracted. At this stage, the device 600 is at the same height as before the expansion. The device 600 can be fully expanded again. The surgeon only needs to rotate the stem 660 90 degrees in the opposite direction, which returns the device to the "locking" ratchet configuration.

Figure 78G shows an expandable fixed device in which the device is returned to a "locking" ratchet configuration. By rotating the disengagement tool 720 90 degrees in the opposite direction, this rotates the stem 660, whereby the ratchet tooth 665 is again engaged with the ratchet slot of the collar 670. The fixed device 600 can be re-expanded via the ratchet mechanism if desired. Advantageously, each of the above expandable fixed devices can be inserted through the smallest incision so that the device can maintain its minimum shape prior to expansion.

Having described the invention in this way, it will be clear that the invention may differ in many respects. Such variations are not considered as deviations from the gist and scope of the invention, and all such variations are, as will be apparent to those skilled in the art, the scope of the claims below. It is intended to be included within.