KR101606358B1 - Polyaxial bone anchor with open planar retainer, pop-on shank and friction fit insert - Google Patents

Abstract

The multiaxial bone screw assembly includes a threaded shank body having an integral upper portion that is receivable in an integral receiver and the receiver has an upper channel for receiving the longitudinal coupling member and a lower cavity cooperating with the lower opening. The frictional engagement compression insert (with some of the locking and releasing features), the planar split retaining ring, and the shank upper portion provide pop-on or snap-on assembly of the shank with the receiver before or after implantation of the shank into the ulnar Cooperation. The shank and receiver can not be disassembled once assembled, and the receiver and the insert can include aligned tool receiving openings for locking and unlocking of the multi-axis mechanism.

Description

BACKGROUND OF THE INVENTION 1. Field of the Invention [0001] The present invention relates to a multi-axial bone anchor having an open planar retainer, a pop-on shank, and a frictional engagement insert.

The present invention relates to a multi-axial bone screw shank having a head for use in bone surgery, more particularly, spinal surgery, and more particularly to a multi-axial bone screw shank having a receiver member assembly including a compression or pressure insert, To a screw having an expansion dedicated split retainer for snapping, capturing and retaining the head, and subsequently securing the bone screw shank relative to the receiver assembly.

Bone screws are used in various types of spinal surgery to fix various implants to the ulna along the spinal column for the purpose of stabilizing and / or controlling spinal alignment. Although both closed-end and open-ended bone screws are known, an open-ended screw is particularly well-suited for connection to the rod and connector arm, since such a rod or arm is a closed bore And instead can be laid or pushed into an open channel in the head or receiver of such a screw. Generally, the screw must be inserted into the bone as a preassembled unit in the form of a shank and pivot receiver, such as a multi-axis bone screw assembly, or as an integral unit with the head.

A typical open-ended bone screw includes a threaded shank having a pair of parallel protruding branches or arms defining a U-shaped slot or channel having a channel to receive the rod. Hooks and other types of connectors as used in spinal fixation techniques may also include similar open ends for receiving portions of a rod or other secure or stabilizing structure.

A general approach to providing a spinal support is to implant a bone screw into a particular bone, which is then in turn supported or supported by such a rod-like longitudinal structure. This type of bone screw may have a fixation head or receiver for the shank, or it may be a multiaxial screw feature. In a fixed bone screw, the rod receiver head can not be moved relative to the shank, and the rod must preferably be positioned to position it in the receiver head. This is sometimes very difficult or impossible to perform. Thus, multi-axial bone screws are generally preferred. An open-ended multiaxial bone screw typically has a desired or desired shape of the receptacle by securing this position to the shank during the final stages of the medical procedure when a rod or other longitudinal connecting member is inserted into the receiver and subsequently a locking screw or other closure follows Allowing loose or floppy rotation of the head or receiver about the shank until the rotational position is achieved. This loose type feature may be undesirable in some cases, making the procedure more difficult. In addition, it is often desirable to insert bone screw shanks separately from the receiver or head due to the volume occupied by the physician's working path. Screws that enable this function are sometimes referred to as modular multiaxial screws.

With particular reference to a modular, snap-on or pop-on, multi-axis spinal light screw system with a shank receptor assembly, the prior art teaches the concept of a particular retainer part and receptor And a shrinkable locking engagement is created between the parts to secure the shank head about the receiver and retainer. Prior art receptors and shankhead retainer assemblies have a shank due to the direct contact between the retainer and the collet structure with the collet-like structure of the insert relative to the shank head and / or the receiver resulting in the shrinkage of the retainer ring And / or a lower pressing insert having an expandable and contractible collet-like structure having a retractable locking engagement for the head.

Also, the prior art for modular multiaxial screw assemblies requires that the interior of the receiver and the contact surface of the retainer and / or the exterior of the collet are tapered, conical, radial, spherical, curved, multi- Lt; RTI ID = 0.0 > shrinkable < / RTI > type of locking engagement for the shank head relative to the shank head.

The prior art for a modular multiaxial screw assembly also requires that the shank head escape from the retainer or from the retainer or from the collet-like structure on the insert, when the retainer is in the raised position and in the chamber or expansion recess of the receiver And may enter and take into consideration. This occurs unless the insert and / or retainer is prevented from being able to be propelled upwardly into the receiver bore or cavity.

The present invention is distinguished from the prior art in that parts are not allowed to be removed from the shank head once snap-on and connected. This is so even if the retainer is moved upward again into the expansion chamber. This approach or design has proved to be more robust and provides more resistance to pullout force than the prior art for modular multi-screw design. As shown in the prior art, when used in a modular, multiaxial screw design, the collet-like structure extending downward from the lower pressing insert proved somewhat fragile with respect to the pullout force experienced during some spinal reduction procedures. The present invention is designed to solve these problems.

The present invention is also distinguished from both prior art in that it provides a split retainer ring and a cooperating insert having a collet-like lower super structure portion, wherein the super structure comprises a shank head Lt; RTI ID = 0.0 > locking < / RTI > The inflation only split or open retainer ring of the present invention is located entirely below the shank head hemisphere in the receiver and may be a stronger and more durable structure for blocking the greater pull out force on the assembly. In addition, the retainer ring base can be better supported on a generally horizontal loading surface near the bottom opening of the bottom of the receiver. This design has proven to be stronger and more rigid as compared to the prior art using a certain type of shrinkable locking engagement between the components as described above and can not be disassembled once assembled.

Accordingly, a multiaxial bone screw assembly according to the present invention comprises a shank having an integral upper portion or body for fixation to the head and bone; An upper open channel, a central bore, a separate receiver forming a lower cavity and a lower opening; (a) a top drop and a rotational friction engagement bottom compression insert having a superstructure providing temporary friction engagement with the shank head and (b) a front structure of the superstructure and receiver arms providing a temporary friction engagement with the shank head A top drop, non-rotating friction engagement insert having an anchoring surface extending between the rear surface and the rear surface; The shank head frictionally engaging the receptacle and the frictional engagement insert prior to locking of the shank to the desired structure, but still retaining the non- floppy. In some embodiments, the insert extends completely between the receiver arms forming the receiver channel, and thus remains in alignment with respect to the receiver in any assembly step and can not rotate about it. In another embodiment, the top drop and rotation insert is secured with respect to the receiver by pressing or crimping portions of the receiver relative to the insert. The insert is operatively associated with the shank head and is spaced from the retainer by a shank head that is snap engaged into the insert superstructure illustrated as an elastic panel. Due to the downward force imparted on the compression insert by the closed top end, which is caught in the receiver bore and in the channel, which presses on the rod or other longitudinal connecting member, the split retainer and the insert disposed above the superstructure, The shank is finally locked in a fixed position relative to the receiver by frictional engagement between portions of the shank. In the illustrated embodiment, the retainer and the insert are down-loaded into the receiver, but an upwardly mounted retainer embodiment is also contemplated. The shank head may be positioned in the lower receiver cavity at its lower opening, either before or after insertion of the shank into the bone. Some compression inserts include locking and unlocking features for independent locking of the multi-axis mechanism, so that the screw can be used like a fixed single screw. The shank can be inserted cannulae for minimally invasive surgical applications. The receiver does not have any type of spring taps or collet-like structures. Both the pressure insert and / or retainer do not have any type of receiver-retaining shrinkable locking engagement with respect to the shank head. In some embodiments, the insert is further configured such that the retainer and the captured shank head are resiliently outwardly and upwardly deployed into the opening of the receiver cavity such that they enter and stabilize in the region of the receiver- May have an extended arm. In this way, the shank head and retainer can not move back up into the receiver cavity.

Again, the preassembled receptors, frictional engagement compression inserts and split retainers can be "push-on", "snap-on" or "pop-on" to the shank head before or after implantation of the shank into the ulnar. This "snap-on" procedure includes the steps of loading the shank head into the receptacle bottom opening, with the shank head being pressed against the base of the split retainer ring and moving the resilient retainer outwardly into the chamber or expansion portion of the receiver cavity Wherein after the hemispherical portion or the upper portion of the shank head has passed through the ring retainer, the retainer is subjected to an inverse elastic restoration to its original or approximate nominal shape. The shank head also enters the frictional engagement lower portion of the insert and when the retainer is returned to a neutral or near neutral orientation, the panel of the frictional engagement portion of the insert snaps onto the shank head, Provide the correct connection. Frictional engagement between the shank head and the insert is transient and not part of the final locking mechanism. In the illustrated embodiment, when the shank is ultimately locked between the compression insert and the lower portion of the retainer, the frictional engagement collet-type panel of the insert is no longer in a tight frictional engagement with the shank head, It does not come into contact with the receptor. The final fixation is accomplished as a result of the expanding non-tapered locking engagement between the locking chamber of the lower portion of the receiver cavity and the retainer ring and the locking expandable contact between the shank head and the split retainer. The retainer is expanded more in the expansion chamber or upper portion of the receiver cavity to allow the shank head to pass, but the retainer tapers against the locking chamber surface in the lower portion of the receiver cavity and the shank heads are pressed against the retainer ring during final locking And has a regulated swelling that retains the shank head when it is released. In some embodiments, when the multi-axis mechanism is locked, the portion of the insert may be force or wedge-coupled to the opposing surface of the receiver to create an interference, non-shrinking locking engagement resulting in a lossless loss of the desired angular relationship between the receiver and the shank, Thereby enabling removal or adjustment of other connecting members. This independent, non-shrinking locking feature allows the multi-axis screw to function like a fixed single screw.

The lower pressurized insert may also be configured to be independently locked by a tool or mechanism so that the pop-on multiaxial screw is distracted, compressed and / or rotated along the rod around the rod to provide an improved chiropractic technique I will. These tools engage the pop-on receptors from the sides and then engage the inserts to press the insert downward into the locked position in the receptacle. With the tool still in place and the calibration maintained, the rod is then locked in the receiver channel by the closure top portion, followed by removal of the tool. This process can involve multiple screws that are all manipulated simultaneously with multiple tools to achieve the desired calibration.

It is also an object of the present invention to provide an apparatus and method that is easy to use and particularly configured for its intended use, wherein the tool is relatively low in manufacturing cost. Other objects and advantages of the present invention will become apparent from the following description, taken in conjunction with the accompanying drawings, which illustrate, by way of illustration and example, specific embodiments of the invention.

This drawing constitutes a part of this specification, including exemplary embodiments of the invention, and illustrates various objects and features thereof.

BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 is an exploded front view of a multiaxial bone screw assembly according to the present invention comprising a shank, a receiver, an open expansion dedicated retainer and a frictionally coupled lower compression insert, wherein a portion of the closed top and a rod- Respectively.
Figure 2 is an enlarged top view of the shank of Figure 1;
3 is an enlarged cross-sectional view taken along line 3-3 of FIG.
Figure 4 is an enlarged side view of the receptacle of Figure 1;
Figure 5 is an enlarged perspective view of the receptacle of Figure 4;
Figure 6 is an enlarged top view of the receiver of Figure 4;
Figure 7 is an enlarged bottom view of the receptacle of Figure 4;
8 is an enlarged cross-sectional view taken along line 8-8 of Fig.
9 is an enlarged cross-sectional view taken along line 9-9 of Fig.
10 is an enlarged perspective view of the retainer of FIG.
11 is a reduced top view of the retainer of Fig.
Figure 12 is a bottom view of the retainer of Figure 10;
13 is an enlarged cross-sectional view taken along line 13-13 in Fig.
Figure 14 is an enlarged perspective view of the insert of Figure 1;
Figure 15 is another enlarged perspective view of the insert of Figure 1;
Figure 16 is a front view of the insert of Figure 14;
Figure 17 is a reduced top view of the insert of Figure 14;
Figure 18 is a bottom view of the insert of Figure 14;
19 is an enlarged cross-sectional view taken along line 19-19 of Fig.
20 is an enlarged cross-sectional view taken along line 20-20 of Fig.
FIG. 21 is an enlarged front view of the retainer and receiver of FIG. 1, with the portion of the receiver broken to show its detail, and the retainer being shown in a state of being down-loaded into the receiver into an embedded assembly phase (imaginary line).
22 is a front view of the receiver and retainer in the partially broken state, similar to that shown in FIG. 21, showing the insert of FIG. 1 also in the initial assembly phase and in front view.
23 is an enlarged front view of a retainer, receiver and insert in a partially broken state, similar to that shown in FIG. 22, showing an insert of a subsequent assembly step, wherein the resilient arms of the insert are pressed against the inner surface of the receiver .
Similar to Fig. 23, Fig. 24 is a reduced front view of the partially fractured state, and also shows the enlarged partial shank of Fig. 1 of the first assembly step in which both the retainer, hemispherical portion of the shank head, / RTI >
25 is a partial front view of a partially fractured condition, similar to FIG. 24, showing a retainer in a deployed state about a mid portion of the shank head, hemispherical portion shown in phantom;
26 is a partial front view of a partially fractured condition, similar to FIG. 25, with the shank upper portion or head completely captured by the retainer;
27 is another partial front view of the partially broken state, similar to FIG. 26, with the shank upper portion or head portion frictionally engaged with the lower panel of the insert.
28 is an enlarged partial cross-sectional view taken along line 28-28 of Fig.
29 is a partial front elevational view in a partially broken state and the shank upper portion and the retainer are shown pulled downwardly into a position seated within the lower receiver cavity and the insertion arm is inserted in a substantially neutral state, The sieve is trapped under the receiver ridge.
Fig. 30 is a partial front view of the state in which all of the components shown in Fig. 1 are partially broken, and the assembly is shown in an assembling step with the rod and the closing upper end as in Fig.
31 is an enlarged and partial front view of a partially fractured condition, similar to FIG. 30, shown in a final locking position.
32 is another enlargement and partial front view of the partially broken state, similar to FIG. 31;
33 is an enlarged cross-sectional view taken along the line 33-33 in Fig.
34 is an enlarged perspective view of an alternative locking insert for use with the assembly of FIG. 1, instead of the insert shown in FIG.
Figure 35 is a top view of the insert of Figure 34;
Figure 36 is a front view of the insert of Figure 34;
Figure 37 is an enlarged front view of the insert of Figure 34 and the receptacle and retainer of Figure 1 in a partially fractured front view in a reduced front view, wherein the insert is captured in the receiver and shown in the unlocking transport position.
Figure 38 is a partial front elevational view of the shank, receiver, retainer, rod and closure of Figure 1 in a partially fractured state, assembled with a locking insert as shown in Figure 37, but in a locked assembled state.
39 is an enlarged partial front elevational view, similar to FIG. 38, illustrating the interference locking of the insert relative to the receiver.
40 is an enlarged and partial cross-sectional view taken along line 40-40 of FIG.
41 is an enlarged and partial front view of a partially broken state similar to FIG. 39, showing the shank, retainer, insert and receiver remaining in the locked state after removal of the rod and closure of FIG. 1, An alternative deformable rod and an alternate closed top end that cooperate.
42 is a partial front view of a partially fractured condition, similar to FIG. 41, showing an alternative rod and closure top portion secured to the rest of the assembly.
43 is a reduced and partial front view of the partial rupture state of the assembly of FIG. 42 without alternative rod and closed top ends; and FIG. 43 is a cross-sectional view from a receiver with a two-piece tool having an inner insert engagement portion and an outer tubular retention portion. Showing the unlocking of the insert.
Figure 44 is a reduced and partial front view of the two-piece tool of Figure 43, with the retaining prong of the inner insert engaging portion shown in phantom.
Fig. 45 is an enlarged and partial perspective view of the inner insert engaging portion of the tool shown in Fig. 44, which is partially broken to show its detail.
FIG. 46 is an enlarged and partial perspective view of the assembly of FIG. 30, with the shank angled relative to the receiver and also showing the closed upper end and the receptacle when the rod is in a loose unlocking relationship with the receptacle as shown Lt; RTI ID = 0.0 > locking < / RTI >
Figure 47 is a partial perspective view of a portion of the locking tool of Figure 46;
Fig. 48 is an enlarged and partial front view of the locking tool and assembly of Fig. 46 in a partially broken state to show its detail.
49 is an exploded perspective view of another embodiment of a multiaxial bone screw assembly in accordance with the present invention including a shank, receiver, retainer in the form of an open ring, and a frictional engagement crown compression insert, and further comprising a longitudinal connection in the form of a rod and a closed- A part of the member is shown.
50 is an enlarged top view of the shank of FIG. 49;
51 is an enlarged cross-sectional view taken along line 51-51 in FIG.
52 is an enlarged perspective view of the receptacle of FIG. 49;
Figure 53 is a side view of the receiver of Figure 52;
Figure 54 is a top view of the receiver of Figure 52;
Figure 55 is a bottom view of the receiver of Figure 52;
56 is an enlarged cross-sectional view taken along line 56-56 of FIG.
57 is an enlarged cross-sectional view taken along line 57-57 of FIG.
Fig. 58 is an enlarged perspective view of the retainer of Fig. 49;
59 is a front view of the retainer of Fig. 58;
60 is a top view of the retainer of FIG. 58;
61 is a bottom view of the retainer of Fig. 58;
62 is an enlarged cross-sectional view taken along line 62-62 in Fig.
Figure 63 is an enlarged perspective view of the insert of Figure 49;
64 is a front view of the insert of FIG. 63;
65 is another perspective view of the insert of FIG. 63;
66 is a side view of the insert of FIG. 63;
67 is a top view of the insert of FIG. 63;
68 is a bottom view of the insert of FIG. 63;
FIG. 69 is an enlarged cross-sectional view taken along line 69-69 of FIG. 67; FIG.
70 is an enlarged cross-sectional view taken along line 70-70 of Fig.
71 is an enlarged front view of the holder and holder of Fig. 49 with the intermediate portion of the retainer being down-loaded into the receiver shown in phantom and the receiver partially fractured to show its detail; Fig.
72 is a partial front elevation view similar to FIG. 71, and also shows the insert of FIG. 49 with an initial assembly step of the insert being shown in phantom and an enlarged side view.
73 is a front elevational view of the partially fractured condition, similar to FIG. 72, showing the insert rotated in the receiver during the subsequent assembly step shown in FIG. 72;
74 is an enlarged perspective view of the partially broken state of the assembly shown in FIG. 73 and also shows a subsequent step of crimping a portion of the receiver with respect to the insert.
75 is an enlarged side view of the assembly shown in FIG. 74;
76 is a reduced front view of a partially fractured condition similar to that of FIG. 73, with crimping of FIGS. 74 and 75, and also shows an alternative assembly stage wherein the shank of FIG. And is followed by assembly with the receiver, retainer and insert.
77 is an enlarged partial front elevational view of a partially fractured condition, similar to FIG. 76, showing the shank (not implanted in the ulna) in the assembling step with the retainer; and the retainer is propelled upwardly in engagement with the insert.
78 is an enlarged partial front elevational view of the partially fractured state, similar to FIG. 77, showing the retainer in an expanded state about the upper portion of the shank, with the shank upper portion being in the assembly phase with the insert.
79 is a reduced partial front view of the assembly as shown in FIG. 78, and the other portion is broken to show the assembly step between the upper shank portion, retainer and insert.
80 is a reduced partial front view of the partially fractured state, similar to FIG. 78, with the shank upper portion frictionally engaged with the retainer and the insert in a substantially neutral state.
FIG. 81 is an enlarged partial front view of the assembly as shown in FIG. 80, and the other portion is broken to show the engagement between the insert and the shank upper portion.
82 is a reduced partial front view of a partially broken state similar to FIGS. 80 and 81 and also shows the assembly in the locked position with the rod and closed top of FIG. 49 shown in a front view of the partially broken state.
83 is a reduced and partial side view of the assembly of FIG. 82;
84 is an enlarged perspective view of an alternative locking insert according to the present invention for use in the assembly of FIG. 49 instead of the insert shown in FIG. 49;
85 is an enlarged side view of the insert of FIG. 84 in a partially broken state to show its detail.
86 is an enlarged front view of the insert of Fig. 84, which is partially broken to show its detail; Fig.
Fig. 87 is also an enlarged front view of the holder and holder of Fig. 49, shown assembled with the insert of Fig. 84, in a front elevation view in partial break to show its detail.
88 is a reduced side view of the assembly of FIG. 87;
89 is a reduced front view of the receptacle (partial rupture state), retainer, and insert of Fig. 87 and is shown in an assembled condition with the shank of Fig. 49, also shown in partial front view, With the rod and closed top end of Fig.
90 is an enlarged partial front elevational view of the partially fractured state, similar to FIG. 89, but showing the insert in the locked assembly with the receiver, retainer, rod and closed top.
91 is a reduced partial front view of a partially broken state similar to FIG. 90, but with the rod and closure top portions removed, the locking insert remains in a locked position relative to the receiver, and alternatively, The closed upper end cooperating with the rod is shown in an exploded view.
92 is a partial front view of the partially broken state, similar to FIG. 91, showing alternative deformable rods and closed top ends in a locked relationship with the rest of the assembly.
93 is a reduced and partial front view of the partial rupture state of the assembly of FIG. 91 without an alternative rod and a closed top end, and also from a receiver with a two-piece tool having an inner insert engagement portion and an outer tubular retention portion Lt; RTI ID = 0.0 > of < / RTI >
94 is a reduction and partial front view of the two-part tool of Fig. 93, and the retaining prong of the inner insert engagement portion is shown in phantom.
95 is an enlarged partial perspective view of the inner insert engaging portion of the tool shown in Fig. 94, which is partially broken to show its detail;
96 is an enlarged and partial perspective view of the same assembly as shown in Fig. 90, except for the shank in angled position with respect to the receiver; and Fig. 96 is an enlarged and partial perspective view of the shank with respect to the receiver when the closure top and the rod are in a loose un- Lt; RTI ID = 0.0 > locking < / RTI >
97 is a partial perspective view of a portion of the locking tool of FIG. 96;
FIG. 98 is an enlarged and partial front view of the locking tool and assembly of FIG. 96, partially broken away to illustrate its detail.

Where necessary, detailed embodiments of the present invention are disclosed herein, it should be understood that the disclosed embodiments are merely examples of the present invention and can be embodied in various forms. Accordingly, the specific structural and functional details disclosed herein should not be construed as limitations, but merely as a basis for the claims and may enable those skilled in the art to variously utilize the invention in virtually any appropriate detailed structure As a representative basis for enabling It should also be understood that any reference to words, top, bottom, upward, downward, and the like in this application refers to the alignment shown in the various figures and the general meaning applied to such a device and is intended to limit the positioning of the bone attachment structure It should be noted that this is not the case.

1 to 33, reference numeral 1 denotes the entire multi-axial bone screw apparatus or assembly according to the present invention. The assembly 1 includes a shank 4 having a body 6 integral with an upwardly extending upper portion or head structure 8, a receptacle 10, an open ring retainer 12, Further comprises a compression or pressurizing insert (14) having a structure for engagement in friction engagement with the head (8). The receptacle 10, the retainer 12 and the compression insert 14 are first assembled and further the implantation of the shank body 6 into the ulna 17 as described in more detail below ) Or may be assembled with the shank 4 before or after. Figures 1 and 31-33 further illustrate a closure structure 18 for capturing a longitudinal connecting member, for example a rod 21, which in turn is in fixed friction contact with the retainer 12 Engages the compression insert 14 pressing against the shank upper portion 8 to capture and secure the longitudinal linking member 21 within the receiver 10 and thus the member 21 against the ulnar 17 Fixed. The illustrated rod 21 is rigid, rigid, inelastic, cylindrical, and has an outer cylindrical surface 22. In another embodiment, the rod 21 may be resilient, deformable, and / or of different material and cross-sectional shape. The receptacle 10 and the shank 4 are connected to the shank 4 to allow flexible or articulated engagement of the receptacle 10 with the shank 4 until both are locked or secured against each other near the end of the implantation procedure. The receptors 10 and the shanks 4 cooperate in such a way that they can be fixed in any of a plurality of angles, joints or rotational alignment with respect to each other within a range of angles selected from front to back and from front to back.

The shank 4 best illustrated in Figures 1-3 is elongated and the shank body 6 extends from a portion proximate the neck portion 26 located adjacent to the upper portion or head 8, Has a spiral wound bone implantation thread 24 (single or double lead screw configuration and various thread types) that extend to and extend radially outwardly from tip 28. During use, the body 6 using the threaded portion 24 for grasping and advancing is mounted or driven into the ulnar to a position at or near the neck 26, as more fully described in the paragraphs below, (Not shown) and is implanted into the ulna 17, which leads to the tip 28. The shank 4 has a three-elongated rotation axis whose entirety is indicated by the reference character A.

The neck portion 26 extends axially upward from the shank main body 6. The neck 26 is of the same or typically slightly reduced radius compared to the adjacent upper end or upper end 32 of the body 6 where the threaded portion 24 terminates. It is also contemplated that the shank upper portion or head 8 that provides a connection or capture device that is spaced from the upper end 32 and thus spaced from the ulna 17 when the body 6 is implanted into this ulna And extends axially outwardly from the neck 26.

The shank upper portion 8 is configured for pivotable connection between the receiver 10 and the retainer 12 and the shank 4 prior to securing the shank 4 to a desired position relative to the receiver 10. [ The shank upper portion 8 has an outer, convex and substantially spherical surface 34 which in some embodiments extends outwardly and upwardly from the neck 26 and terminates in a substantially planar top portion or rim surface 38. In the illustrated embodiment, the truncated conical surface 39 provides additional clearance during pivoting of the shank about the receiver 10 and the insert 14 by extending from the spherical surface 34 to the top surface 38. The spherical surface 34 is temporarily frictionally, non-loosely, slidingly cooperating with the panel of the insert 14 having a concave or flat surface, as will be more fully described in the following paragraphs, Has an outer radius configured to ultimately frictionally engage the insert (14). The shank top surface 38 is substantially perpendicular to the axis A. The spherical surface 34 shown in this embodiment is substantially smooth, but in some embodiments, includes roughening or other surface treatment, and cooperating with and ultimate frictional engagement with the compression insert 14, ) For the ultimate frictional engagement with < RTI ID = 0.0 > a < / RTI > The shank spherical surface 34 is entirely locked in place by the insert 14 and retainer 12 and is not locked by the inner surface forming the receiver cavity.

A counter-sunken substantially planar base or stepped seating surface 45 partially forms an inner drive feature or imprint 46. [ The illustrated internal drive feature 46 is an opening formed in the top surface 38 and is adapted to receive a tool (not shown) of the Allen wrench type into an opening for rotating and driving the bone screw shank 4 It has a designed star shape. It is contemplated that such an internal tool engagement structure may take a variety of tool engagement configurations and may include one or more apertures of various shapes such as a pair of spaced openings or multiple lobes or hexagonal openings. The seat or base surface 45 of the drive feature 46 is disposed substantially perpendicular to the axis A and the drive feature 46 is otherwise coaxial with the axis A. 2 and 3, the drive seat portion 45 may include an inclined or stepped surface that may further improve gripping with the drive tool. In operation, a drive tool (not shown) is received in the internal drive feature 46, is positioned in the base 45, and the shank 4 is attached to the receiver 10, Engages with the surface of the drive feature 46 to drive and rotate the shank body 6 into the ulnar 17 prior to or after the shank 4 has been attached to the receiver 10, Is driven into the ulna 17 with the drive tool extending into the receiver 10.

The shank 4 shown in the drawing is cannulated and has a small central bore 50 extending along the entire length of the shank 4 along the axis A. [ The bore 50 is formed by the inner cylindrical wall of the shank 4 and has an upper opening and a circular opening of the shank tip 28 in communication with the outer drive 46 at the drive seat 45. The bore 50 is coaxial with the threaded body 6 and the upper portion 8. The bore 50 provides a passage through the interior of the shank 4 for the length of the wire (not shown) inserted into the ulna 17 prior to insertion of the shank body 6, And provides a guide for insertion of the shank main body 6. [ The shanks may be medium-sized and are considered to be made of a variety of materials, including metals and non-metals.

In order to provide a biologically active interface with the bone, the threaded shank body 6 may be coated, perforated, porous or otherwise treated. The treatment may include, but is not limited to, roughening, puncturing, or indenting of a shank surface such as a plasma spray coating or other type of coating or sputtering of metals or calcium phosphate, for example, sand blasting or acid etch, It is not limited. Certain metal coatings act as scaffolds for bone internal growth. The bioceramics calcium phosphate coating is composed of alpha-tri-calcium phosphate and beta-tri-calcium phosphate (Ca ₃ (PO ₄ ) ₂ , tetra-calcium phosphate (Ca ₄ P ₂ O ₉ ), amorphous calcium phosphate and hydroxyapatite (Ca ₁₀ (PO ₄ ) ₆ (OH) ₂ ). The coating with hydroxyapatite is, for example, hydroxyapatite chemically similar to the bone with respect to mineral content, Activity, and are therefore preferred because they participate not only in the support of bone internal growth but also in active bone engagement.

In particular, and referring to Figures 1 and 4-9, receiver 10 has a generally discontinuous, partially faceted and partially curved outer profile and a generally U-shaped appearance with a partially cylindrical inner and outer profile. The receptacle 10 has a rotational axis B as shown in Figure 1 which is identical to and aligned with the rotational axis A of the shank 4 and which orientation is preferred but during assembly of the shank 4 and the receiver 10 Not required. Before or after the shank 4 is implanted into the ulna 17 after the receptacle 10 is pivotally attached to the shank 4, the shaft B may be, for example, an assembly having an operating and locking tool 1, as shown in Fig. 46. In Fig.

The receptacle 10 includes a curved lower base portion 60 that defines a bore or inner cavity 61 and the base 60 includes an upper opening 66 and a substantially planar lower channel portion 68, The channel 64 is integral with a pair of opposed upstanding arms 62 forming a channel 64 and forming a cradle between the arms 62 with the sides 62 of the insert 14, Has a width for receiving tightly and operatively receiving a portion of another longitudinal connector or rod (21) between the arms (62), the channel (64) communicating with the base cavity (61). A substantially planar circumferential arm surface 69 internally opposed partially forms a channel 64 and is positioned on each side of each arm substantially cylindrical surface 70 generally. The lower opposing surface portion 71 of the arm surface 69 terminates at the lower side surface 68. Each of the arm interior surfaces 70 includes a variety of internal cylindrical profiles, the upper one of which is a partially spirally wound guide and advancement structure 72 positioned adjacent the upper surface 73 of each of the arms 62, to be. In the illustrated embodiment, the guide and advancement structure 72 is in the form of a partially spirally wound interlocking flange configured to engage under rotation with a like structure on the closed structure 18 as described in more detail below. However, in certain embodiments of the present invention, the guide and advancing structure 72 may alternatively be provided with a resulting torque imparting when the closing structure 18 abuts against the rod 21 or other longitudinal connecting member, A buttress thread, a reverse angle thread, or other threaded or non-threaded helical wound discontinuity (not shown) for actuated guidance during downward advancement and rotation of the closure structure 18 It may be a forward structure. It is expected that the arm 62 may have a break off extension.

A pair of opposed upper chamfered rounded off triangular or delta shaped tool receiving and engaging openings 74, each having a through bore formed by a top arcuate surface 75 and a substantially planar bottom surface 75 ' (Not shown). Each through bore surface 75, 75 'extends through the arm interior surface 70. The opening 74 having the through bore portions 75 and 75 'is sized and shaped to accommodate locking, unlocking and other manipulation tools, and in the illustrated embodiment, retained within the receptacle 10, (As shown by the phantom lines in Figure 21) during top mounting of the machine 12. Each aperture 74 further includes a tilted tool alignment surface 77 that surrounds the arcuate bore portion 75 and does not extend completely through each arm 62. It should be noted that the receptacle 10 is an integral structure and there are no spring taps or collet-like structures. The shape of the insert 14 that extends outwardly into the receiver channel 64 at the peripheral arm surface 69 prevents the rotation of the insert 14 during assembly and thus provides a different type of compression Preventing any misalignment of the receiver 10 and the rod 21 or other longitudinal linking member that occasionally occurs in the insert. Opening 74 and additional tool receiving apertures or grooves (not shown) during assembly of insert 14, retainer 12, and shank 4; During insertion of the shank body 6 into the ulna when the shank is preassembled with the receptacle 10; During assembly of the bone anchor assembly 1 with the closure structure 18 and the rod 21; And may be used for retention of the receptacle during locking and unlocking of some of the inserts according to the present invention with respect to the receptacle 10 into or out of frictional engagement with the interior surface of the receptacle 10, . The tool receiving grooves or openings can be configured in various sizes and shapes and are considered to be capable of being disposed at different locations on the receiver arms 62.

Returning to the inner surface 70 of the receiver arm 62, a discontinuous cylindrical surface 80 that partially forms run-out features for the guide and advancing structure 72 beneath the guide and advancement structure 72, . The cylindrical surface 80 has a diameter that is equal to or slightly larger than the larger diameter of the guide and advancement structure 72. Which extends downwardly toward the base 60 along the cylindrical surface 80 of each arm and extends inwardly toward the axis B while extending vertically or somewhat inclined toward the axis B, 0.0 > 82 < / RTI > The surface 82 has a diameter smaller than the diameter of the surface 80. The surface 82 is sized and shaped to initially initially tightly receive and frictionally retain a portion of the insert 14, as will be described in more detail below. Below the surface 82 is a discontinuous annular surface or narrow ridge 84 disposed substantially perpendicular to the axis B. A partially discontinuous cylindrical surface 86 is positioned on each arm adjacent and below the ridge surface 84. The surface 86 has a larger diameter than the diameter of the surface 82. A portion of the aperture surface 75 abuts the cylindrical surface at each arm and the surface 86 terminates at the lower ridge 87 in another manner. A partially discontinuous cylindrical surface 88 is positioned on each arm in proximity to and below the lower ridge 87. The diameter of the surface 88 is greater than the diameter of the surface 86. The surface 88 terminates in a lip 89 which extends inwardly towards the receiver axis B. Below the lip 89 is a partially discontinuous cylindrical surface 90. The surface 90 also partially defines the interior cavity 61 below the channel interior portion 68 and generally below the opening 74 at the surface 75 '. The cylindrical surface 90 has a diameter slightly larger than the diameter of the discontinuous surface 88. The surface 90 terminates at the cavity bottom ridge surface 91 which extends outwardly away from the axis B and may be perpendicular to the axis B but may extend downwardly and outwardly from the axis B in a spaced- And is illustrated as a truncated conical surface extending. Each of the through bores 75 of the aperture 74 extend through the arms at the surfaces 86,88 and 90 and the inclined tool engaging wall 77 extends substantially on each side of each bore surface 75 And is formed on the arm outer surface 76 at a position primarily opposite the inner surfaces 86, 88.

Referring specifically to Figures 1, 5, 6 and 8, returning to the substantially planar peripheral surface 69, each arm 62 includes a pair of protruding ridges or stops And a total of four stops 92 are located proximate the annular surface 87 and extend from the front or rear surface or arm surface 94 to the cylindrical surface 88. The stop 92 of one arm 62 directly faces an opposing pair of stops 92 on the other arm 62 and each stop 92 is spaced apart from each planar surface 69 in a spaced- . The illustrated stop 92 is elongated and extends in a direction perpendicular to the axis B. The stop 92 cooperates with the surface of the insert 14 to retain the insert 14 in the channel 64 of the receiver 10, as will be described in greater detail below. In the illustrated embodiment, each stop 92 includes a bottom surface or ridge 95 adjacent the partially planar and partially curved surface 96. The planar portion of the surface 96 positioned directly beneath the stop 92 may be in series with or inset from the surface 69. Each set of opposing surfaces 96 is bent toward each other and terminated at each adjacent lower surface portion 71. The edge 97 forms a junction of each adjacent lower surface portion 71 and each curved surface 96. The first width measured between the opposing surface portions 71 is less than the second width measured between the stop 92 and the opposing surface 69 located between the arm top surface 73, To provide an opposing planar locking interference interlocking surface for the insert 14 '. The insert 14 is sized and shaped to be received tightly between the surfaces 71 but slidable.

Returning to Figures 8 and 9, an annular or frusto-conical surface 91 partially forms the base cavity 61 and is located beneath and adjacent the cylindrical surface 90. Another cylindrical surface 99 is located beneath and adjacent to surface 91. In addition, the surface 99 forms part of the base cavity 61. The cylindrical surface 99 is oriented substantially parallel to the axis B and sized and shaped to accommodate the expanded retainer ring 12. The surfaces 91 and 99 are sized to receive the receptacle 12 as the shank 8 is expanded upwardly through the receiver base during assembly and as it expands around the shank upper portion 8 as it moves toward the channel 64. [ And forms a circumferential recess formed therein. The recess is considered to be tapered or conical in structure. The cylindrical surface 101 positioned below the cylindrical surface 99 is sized and shaped to closely receive and enclose the lower portion of the retainer 12 when the retainer is in a substantially neutral position, . Thus, the cylindrical surface 101 has a diameter that is smaller than the diameter of the cylindrical surface 99 forming the expansion zone or expansion chamber of the retainer 12. Surface 101 is bonded or connected to surface 99 by one or more tilted, curved or conical surfaces 102. The surface 102 includes a slide and a neutral or nominal positioning of the retainer 12 into the space defined by the surface 101 and a lower substantially horizontal annular surface 104 positioned adjacent and below the cylindrical surface 101. [ Thereby enabling the ultimate retention of the retainer 12 on the web. The annular surface 104 is disposed substantially perpendicular to the axis B.

A further substantially cylindrical surface 106 is located beneath and adjacent to the annular rest surface 104 which communicates with a tapered or widened bottom opening surface 107 which is in contact with the outer surface of the base 60 (Generally 110) into the base cavity 61 of the receiver 10 by communicating with the base surface 108.

1 and 10-13, a lower opening or split retainer 12, which is operative to capture the shank upper portion 8 within the receiver 10, includes a shank upper portion 8 and a retainer (not shown) 12 having a central axis that operates identically to axis B associated with receiver 10 when installed in receiver 10. The retainer ring 12 is made of an elastic material such as stainless steel or a titanium alloy so that the retainer 12 can be expanded during various assembly steps as will be described in more detail below. The retainer 12 has a central channel or hollow through bore (generally 121) that passes through the ring 12 entirely from the top surface 122 to the bottom surface 124 thereof. The surface forming the channel or bore 121 includes a discontinuous inner cylindrical surface 125 adjacent the top surface 122 and a discontinuous truncated conical surface 127 adjacent the surface 125, 12) is coaxial when it is a neutral uncompressed, nonexpanded orientation. The edge 128 is defined by the junction of the top surface 122 and the cylindrical surface 125. 31, the shank upper portion 8 ultimately frictionally engages the retainer 12 at the edge 128 when the assembly 1 is locked in its final position. The retainer 12 further includes an outer oblique or truncated conical surface 132 adjacent the bottom surface 124 and an outer cylindrical surface 130 positioned adjacent the top surface 122. The surface 130 is oriented parallel to the central axis of the retainer 12. In some embodiments of the invention, spaced notches (not shown) may be formed in the cylindrical surface 130 to accommodate retention and manipulation tools (not shown). In some embodiments, other notches on the inner or outer surface of the retainer may be formed to evenly distribute the stress across the entire retainor 12 during its expansion.

The elastic retainer 12 further includes first and second end surfaces 134,135 that are spaced apart from one another when the retainer is in the neutral uncompressed state. Also, surfaces 134 and 135 may contact when the retainer is in a neutral state. Both end surfaces 134, 135 are disposed substantially perpendicular to the bottom surface 124 and the top surface 122. The width X between the surfaces 134,135 is very narrow to provide stability to the retainer 12 during operation (the slit can be formed by an EDM process). The width X is less than that required for the bottom mount compressible retainer ring because the retainer 12 is top mounted in a neutral state and the retainer 12 need not be compressed to engage in the receiver cavity 61. [ Can be much smaller. The clearance X serves only as an expansion so as to allow the retainer 12 to expand around the shank upper portion 8. This results in a stronger retainer that provides more surface contact with the shank upper portion 8 upon locking, resulting in a more durable connection that is less likely to fail than a retainer ring having a larger gap. In addition, because retainer 12 is only inflated and not inwardly compressed, retainer 12 is mechanically biased against the mechanical stress normally imparted on the spring-loaded retainer known in the art to be outwardly expanded and inwardly compressed during assembly I do not accept.

In some embodiments of the present invention, the inner surface of the retainer 12 may be roughened to increase frictional engagement with the shank upper portion 8 prior to being down-locked by the rod 21 or other longitudinal linking member Additional materials may be included. In addition, while the embodiments shown in Figures 10-13 illustrate surfaces 134,135 substantially parallel to the center axis of the retainer, it may be desirable to orient the surface at an oblique or minute angle .

1 and 14 to 20, a frictional engagement compression insert 14 sized and shaped to be received by the receiver 10 at the upper opening 66 and down-loaded into the receiver 10 Are illustrated. The compression insert 14 has the same central axis of movement as the central axis B of the receiver 10. In operation, the insert is advantageously frictionally engaged with the bone screw shank upper portion 8 so that, prior to locking of the shank relative to the receptacle near the end of the procedure, Enabling an unlocked, but tight fit of the angle. In some embodiments of the present invention, as described in more detail below with respect to the insert 14 'illustrated in Figures 34-40, An insert that locks the shank 4 at a desired angular position relative to the portion 10 is also pushed into interference fit with the receiver 10 in a pair of its opposed receiver planar arm surfaces 71, The shank 6 can be retained in the locked position even when the upper end portion 21 and the closed upper end portion 18 are removed. Also, this locked position may be released by the physician if necessary. The locking insert 14 and the locking insert 14 'are preferably made of stainless steel so as to provide a frictional engagement panel and also to allow the arm portion of the insert to be pinched or pressed towards each other in some embodiments Such as steel or a titanium alloy, which portions press out against the receptacle 10 during transportation and initial assembly steps.

The non-locking compression insert 14 includes a body 150 having a partially outer cylindrical surface and an inner U-shaped surface, the insert having opposing ends (generally 151) The opposite front and rear surfaces or surfaces of arm 62 to cooperate with receiver side surface 69, stop 92, surfaces 96 and 71 under stop 92, Lt; RTI ID = 0.0 > U-shaped < / RTI > A U-shaped channel surface or saddle 153 formed in the body 150 also extends between the insert ends 151 and when the insert 14 is assembled with the receiver 10, (153) is substantially aligned with the receiver channel (64). The saddle 153 is formed by the insert body 150 and the two upstanding arms 156 and is sized and shaped to closely receive the rod 21 or other longitudinal connecting member. It is contemplated that the alternative insert embodiment may be configured to include a planar retaining surface that closely holds a square or rectangular bar and retains a cylindrical rod shape, cord or sleeve cord longitudinal coupling member.

Thus, the body 14 of the insert 14 is integral with a pair of upstanding arms 156 at its upper end and also has a downwardly extending superstructure 16, illustrated as an opposite pair of crown collet extensions 158 at its bottom end, And each superstructure extension 158 is terminated at the slotted bottom surface 159. As shown in FIG. The bore (generally 160) is disposed primarily in and through the insert body 150 and the insert body 150 extends along the axis B and is formed by the saddles 153 and the upstanding arms 156, Shaped channels and also extends between the collet extensions 158. [ The bore 160 is sized and shaped to provide space and clearance for the shank drive and other manipulation tools.

The arms 156 disposed on each side of the saddle 153 are sized and configured to extend upwardly therefrom and be spaced apart and ultimately disposed below the closed top portion 118 in the receiver cylindrical surfaces 86 and 88 . The inner upper arm surface 157 extends upwardly and slightly outwardly from the remainder of the U-shaped saddle 153. In addition, the arm 156 is sized and shaped to resorb the resilient cylindrical surface 82. The arm 156 includes an outer lower convex surface 162 that is illustrated as a partially cylindrical outer upper curved surface 163 adjacent the surface 162 and the surface 163 is curved and convex, 150, respectively. The surface 163 is adjacent to a planar top surface 164 that is ultimately located in spaced relation to the closed top portion 18 so that the closed top portion 18 merely frictionally engages the rod 21, Down against the insert saddle 153 and then the upper portion 8 of the shank 4 is pressed against the retainer 12 to lock the multiaxial mechanism of the bone screw assembly 1 at the desired angle . Each top surface 164 is tilted upwardly and away from adjacent saddle surfaces 157.

Each partial cylindrical surface 162 positioned below each flared surface 163 extends from surface 163 to a partially annular lower or bottom surface 165 of the insert body 150. Each surface 162 is sized and shaped to substantially engage within a receiver arm inner surface 70 (generally 70). In some embodiments of the present invention, the arm 156 may extend, the top surface may not be tapered, and the closed top may, by way of example, be such that when the rod 21 is formed of a deformable material, Specifically, it is contemplated that the arm top surface is ultimately configured to engage directly with the closed top end 18 for locking of the multi-axis mechanism. The arm outer surface 162 further includes notches or grooves formed thereon for receiving and engaging the locking tool. Specifically, in the illustrated embodiment, each surface 162 has a v-notch or recess for receiving a tool, the notch is formed by a top ramp surface 167, and the central motion of the insert 14 Intersects a lower planar surface 168 disposed substantially perpendicular to the axis. The surfaces 167 and 168 are configured such that when the insert 14 is captured and operatively positioned within the receiver 10 as described in more detail below, the respective receiver aperture bore 75, surface and surface 75 ' Cooperation and alignment. It is also contemplated that the arms 163 may extend upwardly, and in some embodiments may not be widened or tapered outwardly.

The insert 14 extends evenly outwardly from the substantially cylindrical outer arm surface 162 to each end 151. A substantially planar outer side surface 170 extends from each arm surface 162 to a substantially planar surface 171 disposed perpendicular thereto with a surface 171 substantially forming each of the ends 151. Each end surface 171 is adjacent a lower extending surface 172 extending inwardly toward the insert body 150 while extending substantially parallel to the surface 165. There is a substantially planar top or top surface 173 extending from one of the arms 156 to each of the end surfaces 171, adjacent each side surface 170. Each surface 170 forms a narrow outer strip and is adjacent to and perpendicular to the lower narrow ridge 174. The ridge 174 extends parallel to the upper surface 173. The insert planar surface 175 is adjacent each of the lower ridge surfaces 174 and extends parallel to each of the outer planar side surfaces 170. The width between the opposing surfaces 175 is sized such that the surface 175 is slidably received between opposing receiver lower arm surfaces 71. In another embodiment of the present invention, the surface 175 provides interference locking of the locking non-shrinking type of the insert relative to the receiver as described below with respect to the insert 14 ', and thus the multiaxial mechanism of the bone screw assembly The width between the surfaces 175 may be expanded so that it must be pressed downwardly between the planar surfaces 71 to lock. The surface 175 terminates at the planar end surface 177 and the lower extension surface 178. A portion of each surface 175 extends all the way to the planar end surface 171.

An inner substantially cylindrical surface 180 communicating with the saddle 153 and also in communication with a lower recessed substantially spherical surface 181 having a radius equal to or substantially similar to the radius of the shank upper portion or surface 34 of the head 8, An insert bore (generally 160) is formed in the body 150 substantially. A portion of surface 181 terminates at body bottom surface 165. The surface 181 also forms the inner surface of the crown collet extension 158. Shank grasp surface portion 182 is located along spherical surface 181 between cylindrical surface 180 and partial annular lower body surface 165. The gripping surface portion 182 includes one or more stepped surfaces or ridges sized and shaped to grasp and penetrate into the shank head 8 when the insert 14 is locked against the head surface 34. The stepped surface portion 182 may include more or fewer stepped surfaces and is expected to cover a larger or smaller surface area of the spherical surface 181. The shank finger surface portion 182 and also the spherical surface 181 may additionally or alternatively be scored, knurled, etc. to improve frictional engagement with the shank upper portion 8, or may be roughened or textured Or a surface finish or a surface finish.

Two collet extensions 158 having a discontinuous inner spherical surface 181 generally extending in a direction opposite to the two arms 156 are also located adjacent to the shank grip surface portion 182 through the bottom surface 159 Through slots or slots (183) that extend substantially perpendicularly from the portion of the substrate. The illustrated embodiment includes one slot 183 located centrally in each extension 158. [ It is contemplated that other embodiments of the present invention may include more or fewer slots 183 or may not include any slots. The slot 183 substantially equally divides each of the extensions 158 to form four separate resilient, partially spherical resin portions, tabs or panels 196 that extend from the shank grip portion 182 to the bottom Extends to the surface 159. In other words, the discontinuous inner spherical surface 181 is further separated into four sections or panels 184 each having an outer surface 185 that is substantially cylindrical in shape and has a discontinuous partial inner spherical surface 181, respectively. The panel 184 is sized and shaped to resiliently expand about the spherical surface 34 of the shank upper portion 8 and then snap-on to frictionally grasp the surface 34. In the illustrated embodiment, the spherical surface 181 is designed such that the grip tab or panel 184 has a neutral or unexpanded radius that is equal to or slightly less than the radius of the shank surface 34, 184 are grasping the surface 34, the collet expanding portion 138 of the insert 14 is in a neutral or slightly inflated condition. In another embodiment, the unexpanded radius is equal to or greater than the radius of the shank surface. The contact surface area between the shank and the insert is sufficient to provide a good friction fit in this example. In addition, the shank surface 34 and / or the spherical surface 181 may include roughened or grooved surface features to provide frictional engagement between the shank and the insert. In another embodiment, the elastic panel 184 has a slightly larger pre-assembly radius than the shank surface 34 and can be flexed inward to result in tighter friction engagement with the shank surface. When the shank 4 is locked in place by the rod 21 or other connecting member which is pushed down by the closed top end 18 onto the insert inner surface 153, The shank grip portion 182 of the insert 14 that can be engaged then fits or penetrates into the surface 34 and thus securely secures the shank upper portion 8 to the insert at portion 182. It is contemplated that the spherical surface 181 may be flat or planar in some embodiments.

The bore 160 is sized and shaped to receive a drive tool (not shown) through which the shank drive feature 46 engages when the shank body 6 is driven into the bone to which the receiver 10 is attached. In addition, the bore 160 may receive a manipulation tool used to release the alternative locking insert 14 'from the receiver and locked position, the tool urging the shank and also engaging the opposing through bore 166 'Or other locking feature of the locking insert 14'. In addition, a manipulation tool for wedge engagement of the insert 14 'from the receiver 10 can access the bore 166' from the receiver through bore 74. Referring back to insert 14, the outer notch formed by surfaces 167, 168 also engages receiver through bore 74 to temporarily lock the multi-axis mechanism as described below and shown in Figures 46 and 48 Lt; RTI ID = 0.0 > a < / RTI > The illustrated insert 14 includes additional grooves and recesses for manipulating and retaining the insert 14 within the receiver 10 and providing appropriate clearance between the retainer 12 and the insert 14 And may further include other features.

Referring to Figures 1 and 30-33, the illustrated elongated rod or longitudinal connecting member 21 (only a portion of which is shown) may be any of a variety of implants used in reconstructive spinal surgery, Is a cylindrical elongate structure having an outer substantially smooth cylindrical surface (22) of uniform diameter. The rod 21 may be made of a variety of metals, metal alloys, non-metals, and deformable, less compressible plastics and may be made of elastomeric polyetheretherketone (PEEK) and other types such as polycarbonate urethane (PCU) and polyethelene But is not limited to, a rod made of the same material.

The longitudinally extending members for use with the assembly 1 may take various shapes including but not limited to oval, rectangular or other bars or rods of curved or polygonal cross-section. The shape of the insert 14 can be modified to closely hold the specific longitudinal connecting members used in the assembly 1. Some embodiments of the assembly 1 may also be used with a tensioned cord. Such cords may be made of a variety of materials including polyester or other plastic fibers, such as polyethylene terephthalate, strands or threads. Also, the longitudinal connector may be a component of a longer overall dynamic stabilizing connecting member, and the cylindrical or bar-shaped portion may have a U-shaped, rectangular, or other shaped channel Is sized and shaped to be received by the compression insert (14). The longitudinal connecting members may be integrated or otherwise fixed to the bendable or damping component sized and shaped to be positioned, for example, between adjacent pairs of bone screw assemblies 1. The damping component or bumper may be attached to the longitudinal linking member at one side or both sides of the bone screw assembly 1. The rod or bar (or rod or bar component) of the longitudinal linking member may be made of a variety of materials ranging from a deformable plastic to a hard metal, depending on the desired application. Thus, the bars and rods of the present invention can be made of metals and metal alloys including, but not limited to, stainless steel, titanium, titanium alloys, and cobalt chrome, or polyetheretherketone (PEEK), ultra high molecular weight polyethylene (UHMWP) Such as, but not limited to, a plastic material such as a synthetic polymer, such as a synthetic polymer, such as a carbon fiber, a natural or synthetic elastomer such as polyisoprene (natural rubber) and a synthetic polymer, a copolymer and a thermoplastic elastomer For example, polyurethane elastomers such as polycarbonate-urethane elastomers.

Referring to Figures 1 and 30-33, a closed structure or closed top portion 18 shown with the assembly 1 is rotatably received between spaced apart arms 62 of the receiver 10. It should be noted that the upper end of the closure 18 may be a twist-in or slide-in closure structure. The illustrated closed structure 18 is substantially cylindrical and includes an outer spiral wound guide and advancement structure 193 in the form of a flange having a guide and advancement structure (not shown) disposed on the arm 62 of the receiver 10 72, respectively. Flange shapes used in accordance with the present invention can take a variety of forms, including those described in Applicant's U.S. Patent No. 6,726,689, incorporated herein by reference. The closed structure guide and the advancing structure may alternatively be configured such that when the closed structure 18 is advanced into the channel 64, Square threaded portion, counter-angled threaded portion or other threaded or non-threaded spiral wound advancement structure to move the closed structure 18 downwardly between the threaded portion 62 and the threaded portion 62. However, The flange configuration illustrated herein is more preferred because the additional strength provided by this flange configuration is better suited for use with a receiver that can more advantageously engage the longitudinal link member component, Since it compensates for and advantageously cooperates with any intensity reduction caused by any reduction profile of the system 10. The illustrated closed structure 18 also includes a top surface 194 having an inner drive portion 196 in the form of an opening that is illustrated as a star shaped inner drive portion, such as sold under the trade designation TORX, A tri-wing, a spanner, two or more openings of various shapes, and the like. A drive tool (not shown) sized and shaped to engage the internal drive 196 is used for both the rotational coupling and, if necessary, the separation of the closure 18 from the receiver arm 62. It is also contemplated that the closure structure 18 may alternatively include a breaking head designed to allow such a head to fall from the base of the enclosure at a preselected torque of 70 to 140 pounds inches, for example. Such a closure structure also includes a base with an internal drive used for closure removal. The base or bottom surface 198 of the closure is planar and further comprises a rim 199 for engaging and penetrating the surface 22 of the rod 21 in certain embodiments of the present invention. It should be noted that in some embodiments, the closed upper end bottom surface 198 may include a central point, and in other embodiments it need not include a point and / or rim. The closed top portion 18 may further include a cannulation through bore (not shown) extending along its central axis and through its top and bottom surfaces. This through bore provides a passage through the interior of the closure 18 for the length of the internally inserted wire (not shown) to provide a guide for insertion of the closed top portion into the receiver arm 62.

An alternate closed top portion 218 for use with a deformable rod such as a PEEK rod 221 is shown in Figs. 41 and 42. The top portion 218 is identical to the top portion 18 except that the point or nub 289 is located on the dome shaped surface 290 instead of the rim of the closed top portion 18. Closure top portion 218 may alternatively include a guide and advancement structure 283, a top portion 284, an internal drive portion 286 and a bottom outer annular surface 288 which are described herein with respect to closed top portion 18 The upper portion 194, the inner drive portion 196, and the bottom surface 198 of each of the guide and forward structures 193, 193, and 193, respectively. In some embodiments, the inner drive portion 286 is not as large as the drive portion 196 of the closed top portion 18, and such smaller drive portion imparts a lesser force on the deformable rod, for example, , It is not necessary when the insert 14 'described below is used as the bone screw assembly of the present invention.

Returning to the assembly 1, preferably, the receiver 10, retainer 12 and compression insert 14 are assembled in a factory setting that includes machining for retaining, aligning and manipulating the component pieces. In some circumstances, the shank 4 is also assembled with the receiver 10, retainer 12, and compression insert 14 at the factory. In another example, it is desirable to first implant the shank 4 and subsequently add the preassembled receiver, retainer and compression insert to the insertion point. In this way, the surgeon can advantageously and easily implant and manipulate the shank 4, disturb or compress the ulna with a shank, and operate the shank upper portion or head circumference can do. In another example, this may be accomplished by providing a surgical staple with a desired size and / or variety (e.g., surface treatment to roughen the top portion 8 and / or hydrocolloids on the shank 6) with the receptacle, It is preferable to pre-assemble the shank of the shiapatite. Allowing a physician to select a suitable size or treatment shank 4 advantageously reduces inventory requirements and thus reduces overall cost and improves logistics and distribution.

A preassembly of the receiver 10, retainer 12, and compression insert 14 is shown in Figs. 21-23. 21, first, the retainer 12 is formed into a cylindrical shape having a bottom surface 124 and an upper surface 122 facing the opposing arms 62 of the receiver 10 (shown in phantom) Is inserted into the upper receptacle opening 66 with the surface 130 at the head. The receptacle 12 is then lowered into the channel 64 in this side-by-side manner and is subsequently removed from the receptacle opening 74 (Fig. 7) such that the top surface 122 now faces the receptacle opening 66 The retainer 12 is inclined. The retainer 12 is then lowered into the receiver cavity 61 until the bottom surface 124 is resting on the annular lower cavity surface 104 as shown by the solid line in FIG.

Referring to Figures 22 and 23, the insert 14 is mounted within the receiver 10. The insert 14 is configured so that when the bottom surface 159 of the frictional engagement crown collet 158 faces the receiver cavity 61 and the surfaces 170 and 175 are in a state in which the insert 14 is lowered into the channel 64 Is mounted in the receiver through opening 66, as shown in Figure 22, with facing planar arm surface 69 forming channel 64. When the insert 14 is lowered into the receiver, the side surface 170 is positioned to face the opposing receiver internal arm surface 69 forming the channel 64 until the insert 14 reaches the stop 92. [ As shown in Fig. The insert 14 can be further pushed downward until the insert 14 is captured within the receiver 10 as best seen in Figure 23 and the surface 170 can be pressed down to the receiver axis B And then the stop 92 is moved outwardly of the receiver channel 64. The stopper 92 is then pushed inwardly or minutely toward the receptacle channel 64 to allow the opposing surfaces 170 to engage and then move down past the receiver stop 92, Thereby suppressing the upward movement of the insert 14 of the user. Specifically, when the insert 14 is moved upward toward the aperture 66 of the receiver, the insert surface 173 abuts against the bottom surface 95 of the stop 92, Movement of the insert 14 upwardly, while not using a tool to pin the surface 170 toward one another.

23 and 24, the insert 14 is not further downwardly lowered toward the retainer 12 at this point, since the outer arm surface 163 is moved downward relative to the receiver arm surface 82 And is thereby pressed inwardly by a small amount. The insert 14 is thus retained in its position shown in Figures 23 and 24 by its resilient arm 156 resiliently urged against the inner cylindrical surface 82 of the receptacle, Which is a preferred position for transport as an assembly. Thus, the combination of the receiver 10, retainer 12 and insert 14 is now preassembled and can be pre-assembled at the factory, by the surgical staff immediately prior to transplantation, or on the implanted shank 4 (as described herein) , Ready to be assembled with the shank.

24, the entire assembly 1 composed of the bone screw shank 4 or the assembled shank 4, the receiver 10, the retainer 12, and the compression insert 14 has an internal drive (not shown) Such as the ulnar 17 (shown in phantom) by rotating the shank 4 using a suitable drive tool (not shown) that operatively drives and rotates the shank body 6 by its engagement in the arms 46 And are screwed into the bone. Specifically, the ulna 17 can be pre-drilled to minimize stress on the bone and has a guide wire (not shown) inserted therein to provide a guide for the angle and placement of the shank 4 relative to the ulna . The other tapped hole may be formed using a tab having a guide wire as a guide. The bone screw shank 4 or the entire assembly 1 then uses the cannula bore 50 by first inserting the wire into the opening in the bottom 28 and threading out of the top opening in the drive feature 46 And inserted on the guide wire. Thereafter, the shank 4 is driven into the ulna using a wire as a placement guide. A shank and other bone screw assembly, a rod 21 (also with a central lumen in some embodiments), and a closed top 18 (also with a central bore) engage the receiver with an attachable tower tool and guide wire May be percutaneously or minimally invasive. When the shank 4 is driven into the ulna 17 without the remainder of the assembly 1 the shank 4 can be driven to the desired final position or it can be moved to the desired pre- To a small upper position to provide ease of assembly of the < RTI ID = 0.0 >

24, the preassembled receptors, inserts, and retainer are placed over the shank upper portion 8 until the shank upper portion is received within the receiver opening 110. [ 25-29, when the shank upper portion 8 is moved into the interior 61 of the receiver base, the shank upper portion 8 is urged upwardly against the retainer 12 to urge the retainer (not shown) 12 into the expanded portion of the receiver cavity 61 partially formed by the cylindrical surface 99 and the annular top or ridge surface 91. As section 8 continues to move upwardly toward channel 64, surface 34 forces outward movement of retainer 12 toward cylindrical surface 99 as shown in Figure 25, 12 is prevented by the annular surface 91. [0064] Referring to Figures 26 and 27, retainer 12 begins to return to its neutral state when the center of the sphere of head 8 (shown in dashed lines) passes the center of retainer expansion recess. 27 and 28, at this point in time, the spherical surface 34 also extends beyond the discontinuous surface 181 of the insert 14 in the bend tab or panel 184 of the crown collet extension 158 . Tab 184 is slightly outwardly expanded to receive surface 34 as best seen in FIG. With further reference to both FIGS. 28 and 29, the spherical surface 34 is then advanced into complete frictional engagement with the panel interior surface 181. At this point the insert 14 panel and surface 34 are in a very tight frictional fit and the surface 34 can pivot about the insert 14 with a predetermined force. Thus, tight fit ball and socket joints are now created between the insert 14 and the shank upper portion 8, even before the retainer 12 is lowered to the rest position on the receiver annular surface 104.

29, the receiver is then pulled upward or the shank 4 and the attached retainer 12 are then moved downward to the desired position where the retainer 12 is placed on the surface 104 . This can also be achieved by upward traction on the receptacle 10 or, in some cases, further actuation of the shank 4 into the ulna 17. At this point the insert arm 156 bounces outward into the receiver surface located below the ridge 84 formed by the discontinuous cylindrical surface 86 so that the insert 14 can not move upward without a special tool , Making it impossible for the retainer 12 to move out of the locking portion of the receiver chamber formed by the cylindrical surface 101 and the receiver seat 104. In some cases, when the receptacle 10 is pre-assembled to the shank 4, the entire assembly 1 inserts a drive tool (not shown) into the receptacle and shank drive 46, RTI ID = 0.0 > 17, < / RTI > 46 and 48, at this point, the receiver 10 is positioned between the shank upper portion 8 and the insert 14 bending tab 184, as shown by way of example in FIGS. 29 and 30, and also by way of example, By frictional engagement, it can be articulated to the desired angular position with respect to the shank 4 which is retained but not locked.

30 to 33, the rod 21 can eventually be placed in an open or percutaneous manner in cooperation with at least two bone screw assemblies 1. The closed structure 18 is then advanced between the arms 62 of each receiver 10. The closed structure 18 is rotated using a tool associated with the internal drive 196 until the selected pressure is reached and at this point the rod 21 is moved to the U- 153 to press the stepped gripping surface 182 against the shank spherical surface 14 so that the edge of the stepped surface 182 penetrates into the spherical surface 34 and retains the shank upper portion 8 To the locked frictional engagement with the base (12). Specifically, when the closure structure 18 rotates and moves down into each receiver 10, the rim 199 engages and penetrates the rod surface 22, and the closure structure 18 engages the rod 21 The insert 14 biases the shank upper portion 8 toward the inner body edge 128 of the retainer 12 and to the inner body edge 128 of the retainer 12, And the bottom surface 124 of the retainer 12 has an outer cylindrical surface 130 and a surface 104 that are in contact with the receiving cylindrical surface 101 forming the receiver locking chamber and expanding outwardly, / RTI > As an example, about 80 to about 120 pounds inches on the closed top can be applied to secure the bone screw shank 6 with respect to the receiver 10. If disassembly of the assembly 1 is required, this is accomplished in the reverse order of the procedure described hereinabove for assembly.

34-40, alternative locking and unlocking for use with the shank 4, receiver 10, retainer 12, closed top portion 18, and rod 21 described herein above, Compression insert 14 'is illustrated and the resulting assembly is shown, by way of example, as assembly 1' in Figures 39 and 40. The insert 14 'may be the same as the insert 14 described hereinabove and may have an adjacent planar surface 71 and edge 97 of the receiver 10 as will be described in greater detail below. Except that it is dimensioned for locking interference engagement with the insert 14, as described above. The illustrated insert 14'also includes an insert 14'including a tool receiving opening 166'and an outwardly extending arm resiliently engaging the receptacle 10 during the transportation and early assembly steps And is different from the insert 14 in that it does not.

Thus, the locking insert 14 includes a body 150, a pair of opposite ends 151 ', a saddle surface 153', a pair of arms 156 ', a pair of arm top surfaces 157' A pair of crown collet extensions 158 ', bores 160', an outer cylindrical arm surface 162 ', an arm top surface 164', a body bottom surface 165 'having a bottom surface 159' A pair of v-shaped openings 167 'including an outer oblique surface and a lower planar surface 168', an elongated portion 170 'having an outer planar side surface, a planar end surface 171' A pair of base extensions 172 ', a top surface 173', a narrow bottom ridge 174 ', an insert planar side surface 175', a planar end surface 177 ', a bottom surface 178' Includes a flex panel 184 'having an inner cylindrical surface 180', an inner spherical surface 181 ', an inner grip surface portion 182', a slit 183 'and an outer surface 185' The body 150, the pair of opposite ends 151, respectively, with respect to the insert 14, A saddle surface 153, a pair of arms 156, a pair of arm top surfaces 157, a pair of crown collet extensions 158 having a bottom surface 159, a bore 160, A pair of v-shaped openings 167 including an arm surface 162, an arm top surface 164, a body bottom surface 165, an outer oblique surface and a bottom planar surface 168, A pair of base extensions 172, an upper surface 173, a narrow lower ridge 174, an insert planar side surface 175, a planar end surface 177, a planar end surface 171, a pair of base extensions 172, A curved panel 184 having a bottom surface 178, an inner cylindrical surface 180, an inner spherical surface 181, an inner grip surface portion 182, a slit 183, and an outer surface 185, The functions are the same or substantially similar. As discussed above, the insert 14 'does not include a widened top outer surface 163, but instead a cylindrical surface 162' extends from the top surface 164 'to the bottom or bottom surface 165' Extend. Also, the arm top surface 164 'is not tapered, but instead is a planar surface that is disposed substantially parallel to the bottom surface 165'. The insert 14'includes a through bore 166'for receiving a manipulation tool and the hole 166'is formed on the arm surface 162'and is adjacent to the sloped surface 167 ' Lt; / RTI >

The insert 14 'planar side surface 175' is sized and shaped to engage locking interference with the receiver in the lower portion of the receiver channel 64. In other words, the width measured between the surfaces 175 'is such that the width of the insert 14' is greater than the width of the insert 14 'with sufficient force to intermittently lock the insert into the receiver between the planar surfaces 71 Is sufficient to require that it must be pushed into the space between the receptacle surfaces 71, starting at the edge surface 97, by a closed top portion 18 that presses the rod 21 downwardly or by a tool or tools Is set to a large size.

Referring to Figures 37-40, the insert 14 'is configured such that the shank 4 is locked in place, as compared to the relationship in which the insert 14' easily slides between the insert 14 and the receiver 10. [ The retainer 12, the shank 4, the rod 21 and the closed top portion 18 and to the assembly 1, except that the retainer 12, the shank 4, the rod 21 and the closed top portion 18, Assembled in the same manner as described above, resulting in assembly 1 '. In addition, the receiver arm 156 'does not engage the surface 82 of the receiver 10. Rather, prior to assembly with the rod 21 and the closed top portion 18, the outer surface 170 'of the compression insert 14' is slidably received by the receiver surface 71, but the surface 175 ' Not like that. Thus, any additional downward movement at the edge 97 is inhibited, unless the insert 14 'is downwardly biased by the closed top end pushing down the rod phase or by the locking tool, 38 to 40 as shown in FIG. 38, the receptacle 10 is retained by frictional engagement between, for example, the shank upper portion 8 and the insert panel 184 ', but not shown in Figs. 46 and 48 And can be articulated to a desired angular position about the shank 4, such as one.

The rod 21 is eventually positioned in an open or percutaneous manner in cooperation with at least two bone screw assemblies 1 '. The closure structure 18 is then inserted and advanced between the arms 62 of each receiver 10. The closed structure 18 is rotated using a tool associated with the internal drive 196 until a selected pressure is reached, at which point the rod 21 is moved to the U-shaped seat surface 14 of the compression insert 14 ' Shaped shank grip surface 182 'against the shank surface 34 and the edge of the stepped surface 182' into the spherical surface 34 And presses the shank upper portion 8 into a locked frictional engagement with the retainer 12. [ Specifically, when the closed structure 18 rotates and moves down into each receiver 10, the rim 199 engages the rod surface 22 to penetrate the rod surface 22, and the closed structure 18 Is urged downward against the insert 14 'and biases the rod 21 in compression with it, which causes the shank upper portion 8 towards the retainer 12 and into the locking engagement with it The retainer 12 is in frictional contact with the surface 104 and expands outwardly with respect to the cylindrical surface 101. By way of example, a torque of about 80 to about 120 pounds inches on the closed top can be applied to secure the bone screw shank 6 with respect to the receiver 10. Tightening the helical flange shape up to 100 pounds inches can produce a force of 1000 pounds and can result in a planar surface 71 and edge 97 of the receptacle between about 700 and 900 pounds inches, It has been found that interference bonding is created between the surfaces 175 '. Thus, as the closure structure 18 and the rod 21 press down the insert 14 'toward the base of the receiver 10, the insert surface 175' is pushed into the receiver at the edge 97 Thereby locking and securing the insert 14 in frictional interference engagement with the receiver surface 71.

Referring now to Figure 41, the closed top 18 can be loosened or removed and / or the rod 21 can be adjusted and / or removed and the receiver 10 at the insert surface 175 ' Frictional engagement between the insert 14 'and the insert 14' remains locked in place to advantageously maintain the locked angular position of the shank 4 relative to the receiver 10.

41 and 42, another rod, such as deformable rod 221, and a cooperating alternative closed top portion 218 are then mounted on the already locked assembly to effect an alternative assembly 201 ' . As described above, the closure drive 286 is advantageously formed smaller than the drive of the closure 18 so that the deformable rod 221 is not excessively pressurized or deformed during assembly, since the multi- It is because it is.

Referring to Figs. 43-45, a two-piece tool 600 is illustrated to release the insert 14 'from the receiver 10. The tool 600 includes an inwardly flexible tubular structure with opposing inwardly oriented prongs 612 positioned on either side of the through channel 616. Channel 616 may terminate at a location spaced from prong 612 or may result in a two-piece tool 610 by further extending upward through the tool. The tool 600 includes an external, more rigid tubular member 620 having a smaller through channel 622. [ The member 620 is slidably locked on the tube 610 after the prong 612 of the flexible member 610 has been bent outward and is then coupled over the receiver 10 and thereafter Is coupled to an aligned opposing bore 166 'positioned within the through bore of opposite opening 74 and on the arm of the insert 14'. In Figure 43, a tool 600 is shown during the unlocking process of the insert 14 'from the receiver 10, and the outer member 620 is positioned such that the tool 600 is moved upwardly in the direction away from the shank 4 Retains the prongs 612 within the openings of the receiver 10 and the insert 14 'and surrounds the inner member 610 while being pulled. The tool 600 can further include a structure for pushing down the receptacle 10 while the prongs and tubular members are pulled upwards and such a structure can be positioned within the tool 600, Downwardly on the upper surface (73)

Alternatively, another manipulation tool (not shown) may be used, which is inserted into the receiver at opening 66 and into an insert channel formed by saddle 153 ', which prong or extension is inserted through the insert Extends inwardly into the bore 166 'and then the piston-like portion of the tool pulls the insert 14' away from the receiver surface 90 by directly pushing on the shank upper portion 8, Thus, the multi-axis mechanism is released. At this point the shank 4 may be articulated with respect to the receiver 10 and the desired frictional engagement is returned between the shank surface 34 and the bend panel of the insert 14 so that an adjustable, A proper relationship is also present between the shank 4 and the receiver 10. When further disassembly of the assembly is required, this is accomplished in the reverse order of the procedure described herein for assembly 1.

46-48, another manipulation tool (not shown) may be used for independent locking of the insert 14 ', or for temporary independent locking of the locking insert 14 with respect to the receiver 10, 700 in total) are illustrated. The tool 700 includes a pair of opposing arms 712 each of which is configured such that one or more internal surfaces 718 of the coupling extension 716 engage the insert 14 when the tool is moved downward toward the receiver. And the surface 720 has an engagement extension disposed at an angle relative to each arm 712 to slide along the surface 167 of the insert 14 and the surface 77 of the receiver to engage the assembly 1 Lt; RTI ID = 0.0 > 168 < / RTI > As shown in Figure 48, when the insert 14 is locked against the receiver 10, the tool bottom surface 720 does not protrude below the receiver surface 75 'and is held away therefrom. In the illustrated embodiment, surface 718 is slightly rounded and each arm extension 716 includes a bottom surface 720 for insertion and gripping of insert 14 at the junction of surface 168 and surface 167 Gt; 722 < / RTI > that produces an edge having a substantially planar surface (e. The tool 700 may include various retention and propulsion / traction mechanisms such as, for example, a rotary screw-on device, a hinged tool, or a pistol grip tool that may include a ratchet feature.

Referring to Figures 49-83, reference numeral 1001 represents another multiaxial bone screw apparatus or assembly according to the present invention. The assembly 1001 includes a shank 1004 further comprising an upwardly extending upper portion or a body 1006 integral with the headed catch structure 1008 and a receptacle 1010 and a retainer 1010 illustrated as an elastic opening ring 1012 And a frictional engagement crown collet compression or pressure insert 1014, as shown in FIG. The receptacle 1010, the retainer 1012 and the compression insert 1014 are initially assembled and may be preassembled prior to or subsequent to implantation of the shank body 1006 into the ulna 1017 as described in more detail below. And can be further assembled with the shank 1004. 49 and 82 and 83 further illustrate a closed structure 1018 for capturing a longitudinal connecting member, e.g., rod 1021, which in turn is in a fixed frictional contact with retainer 1012 Engages the compression insert 1014 which presses against the shank upper portion 1008 and thus engages and secures the longitudinal linking member 1021 within the receiver 1010 and thus against the ulnar 1017 Thereby fixing the member 1021. The illustrated rod 1021 is substantially similar in shape and function to the rod 21 described hereinabove. In other embodiments, the rod 1021 may be resilient, deformable, and / or other cross-sectional shape. An angle selected from both sides and from front to back so as to enable flexible or articulated coupling of receptacle 1010 with shank 1004 until both are locked or secured against each other near the end of the implantation procedure The receptors 1010 and shanks 1004 cooperate in a manner that allows the receptors 1010 and shanks 1004 to be secured within a range and at any of a plurality of angles, joints, or rotational alignment with respect to each other.

Shank 1004 is elongated and is best seen in Figures 49-51 and shank body 1006 extends from the vicinity of neck 1026 positioned adjacent to the upper portion or head 1008 to the tip of body 1006 (In the form of a single or double lid thread) extending spirally and extending radially outwardly therefrom. During use, the body 1006 using the threaded portion 1024 for gripping and advancing is implanted into the ulna 1017 with the tip 1028 as the head, and is driven downward into the ulna by a mounting or drive tool (not shown) , So that it is implanted into the ulna at or near the neck 1026. Shank 1004 has a three-elongated rotation axis that is generally indicated by reference letter A. [

The neck portion 1026 extends axially upward from the shank body 1006. [ The neck portion 1026 is typically made or made with a slightly reduced radius relative to the adjacent upper end or upper end portion 1032 of the body 1006 where the threaded portion 1024 terminates. It is also contemplated that the shank upper portion or head 1008 providing a continuous or catching device at a distance from the upper end 1032 when the body 1006 is implanted in this ulna and thus at a distance from the ulna 1017, Extends axially and outwardly from the neck portion 1026. [

The shank upper portion 1008 is configured for pivotable connection between the shank 1004 and the retainer 1012 and the receiver 1010 prior to securing the shank 1004 to the desired location relative to the receiver 1010 . The shank upper portion 1008 has an outer, convex, and substantially spherical surface 1034 that terminates in a substantially planar top or rim surface 1038 extending outwardly and upwardly from the neck portion 1026. The spherical surface 1034 has an outer radius configured to ultimately frictionally engage and penetrate by the stepped, gripped portion of the slide cooperate and insert 1014, which fits snugly against the discontinuous concave surface of the compression insert 1014 . Top surface 1038 is substantially perpendicular to axis A. Although the spherical surface 1034 shown in this embodiment is substantially smooth, in some embodiments, it may include roughening or other surface treatment, and the ultimate frictional engagement with the retainer 1012 and the compression insert 1014, And is sized and shaped for ultimate frictional engagement and cooperation. Shank spherical surface 1034 is entirely locked in place by insert 1014 and retainer 1012, and not by the inner surface forming the receiver cavity.

A substantially planar base or stepped seating surface 1045 countersunk partially forms the inner drive feature or imprint 1046. The illustrated internal drive feature 1046 is an opening formed in the top surface 1038 and includes a hexagonal shape designed to receive an Allen wrench type hex tool (not shown) into an opening for rotating and driving the bone screw shank 1004 Respectively. Such an internal tooling attachment structure may take various tool engagement shapes and may include one or more openings of various shapes, such as a pair of spaced openings, or a multi-leaf or star shaped opening, such as those sold under the trade name TORX. The inner surface or base surface 1045 of the drive feature 1046 is disposed substantially perpendicular to the axis A and the drive feature 1046 is otherwise coaxial with the axis A. As illustrated in Figs. 50 and 51, the drive seat portion 1045 may include an inclined or stepped surface that may further improve gripping with the drive tool. In operation, a drive tool (not shown) is received in the internal drive feature 1046, which may be in a position before the shank 1004 is attached to the receiver 1010 or after the shank 1004 is attached to the receiver 1010 Engages with the hexagonal face of the inner drive feature 1046 to engage and rotate the shank body 1006 into the ulna 1017 and is positioned in the base 1045 and the shank body 1006 is inserted into the ulna 1017 And the drive tool extends into the receiver 1010. [

The shank 1004 shown in the drawing is cannulated and has a small central bore 1050 extending along the entire length of the shank 1004 along the axis A. [ The bore 1050 is formed by the inner cylindrical wall of the shank 1004 and has an upper opening and a circular opening of the shank tip 1028 in communication with the outer drive portion 1046 at the drive seat 1045. The bore 1050 is coaxial with the threaded body 1006 and the upper portion 1008. The bore 1050 provides a passage through the interior of the shank 1004 for the length (not shown) of the wire inserted into the ulna 1017 prior to insertion of the shank body 1006, And provides a guide for insertion of the shank body 1006. The shank body 1006 can be treated or coated as described hereinabove with respect to the shank body 6 of the assembly 1.

49 and 52-57, receiver 1010 has a generally U-shaped appearance with partial discontinuities and a partially cylindrical internal and external profile. The receptacle 1010 has a rotation axis B as shown in Figure 49 as being identical to and aligned with the axis of rotation A of the shank 1004 and this orientation is preferred but the orientation of the receptacle 1010 with the shank 1004, (See FIG. 76, which shows a receptacle 1010 that is "popped-on" to a shank 1004 that is placed at an angle relative to the receptacle and is implanted within the ulna 1017). Before or after the shank 1004 is implanted into the ulna 1017 after the receptacle 1010 is pivotally attached to the shank 1004, the axis B is generally shown as an example, Are arranged at an angle relative to the axis A as shown.

The receptacle 1010 includes a substantially cylindrical base 1060 that forms a bore or inner cavity (generally 1061), a top opening (generally 1066), and a U-shaped bottom channel portion or face portion 1068, Is integral with a pair of opposing upstanding arms 1062 that form a channel 1064 between the arms 1062 while forming a cradle and the channel 1064 is integral with another flexible or dynamic connector between the arms 1062 The channel 1064 communicates with the base cavity 1061. The channel 1064 has a width that accommodates a portion of another longitudinal connector, such as a sleeve of a tensioned cord connector or a rod 1021, The outer front and rear opposed substantially planar arm surfaces 1069 partially form channels 1064 directly above the anchoring portion 1068 and the surface 1069 preferably reduces the amount of extension on the rods (i.e., Which provides an access path between the bone anchors along with more space, and hence more, rod or other connecting member, in sequence), a sleeve, bumper or spacer cooperating with a rod or cord type connecting member And provides a planar surface 1069 for surface-to-surface or intimate contact with other connecting member components of the same particular embodiment.

Each of the arms 1062 has an inner surface (generally 1070) that includes a variety of inner cylindrical profiles, the upper one of which is a partially helical wound guide positioned adjacent the upper surface 1073 of each of the arms 1062, (1072). In the illustrated embodiment, the guide and advancement structure 1072 is in the form of a partially helically wound interlocking flange configured to mate under rotation with a similar structure on the closed structure 1018 as described more fully below. However, in certain embodiments of the present invention, the guide and advancement structures 1072 are alternatively arranged to operatively guide and advance the closed structure 1018 downwardly between the arms 1062, A square threaded portion, a buttress threaded portion, a reverse angled threaded portion, or other threaded or non-threaded spiral wound discrete forward progressive structure for imparting a torque when the closed structure 1018 abuts against the rod 1021 or another longitudinal connecting member . ≪ / RTI > The arm is considered to be a break-off extension.

An opposing pair of upper round triangular or delta-shaped tool receiving and engaging openings, each having a through bore formed by a generally arcuate surface 1075 and a substantially planar bottom surface 1075 ', which is generally 1074, Gt; 1076 < / RTI > Each through bore surface 1075, 1075 'extends through the arm inner surface 1070. The opening 1074 with the through bore portions 1075 and 1075 'is sized and shaped to accommodate locking, unlocking and other manipulation tools and is held in place during the upper mounting of the retainer 1012 into the receiver 1010, It may help to accept and lower the ring 1012. Each opening 1074 further includes an inclined tool alignment surface 1077 that surrounds the arcuate bore portion 1075 and does not extend completely through each arm 1062. In this embodiment, the portion of the receiver forming the surface 1077 located along the arcuate opening portion is crimped into the insert 1014 during its assembly with the receiver 1010, as described in more detail below. In another embodiment of the present invention, another wall or surface forming opening 1074 or other material forming another opening or groove may be crimped inwardly. It should be noted that the illustrated receptacle 1010 is an integral structure and there are no spring taps or collet-like structures. Alternatively, in some embodiments, the spring taps or other moveable structure may be configured to hold the insert 1014 at a desired position relative to the rotation and axial movement (along axis A) May be included on the acceptance insert 1014 or the receiver 1010. Advantageously, the insert and / or receiver is constructed of a structure for blocking rotation of the insert relative to the receiver, but permits upward and downward movement of the insert relative to the receiver during assembly and implantation procedures.

A cylindrical recess or opening 1078 is formed in each arm surface 1076 but does not extend through the inner surface 1070 is positioned directly on top of each delta shaped opening 1074. [ Two additional pairs of tool receiving and engaging openings 1079 are also formed in the front and rear surfaces 1069 of the receiver arms 1062. [ The transition base surface 1080 spans between the cylindrical base 1060 and the planar surfaces 1069 at the U-shaped mounting portion 1068 and the surface 1080 extends between the base 1060 ). Some or all of apertures 1074, 1078, and 1079 may be removed during assembly with insert 1014, retainer 1012, and shank 1004; During implantation of the shank body 1006 into the ulna when the shank is preassembled with the receptacle 1010; During assembly of the bone anchor assembly 1001 with the closure structure 1018 and the rod 1021; And retains the receptacle 1010 during locking and unlocking of some of the inserts of the present invention with respect to the receptacle 1010 into or out of frictional engagement with the interior surface of the receptacle 1010, Lt; / RTI > It is contemplated that the tool receiving recess, recess, or opening is located at another location on the receiver arm 1062 and can be configured in various sizes and shapes.

Returning to the inner surface 1070 of the receiver arm 1062 a discontinuous cylindrical surface 1082 partially forming the run-out feature for the guide and adjustment structure 1072 is positioned below the guide and advance structure 1072 . The cylindrical surface 1082 has a diameter equal to or slightly larger than the larger diameter of the guide and advancement structures 1072. Out sheet or surface 1084 that extends inward toward axis B and inwardly toward the axis B is adjacent to the cylindrical surface 1082 of each arm when moving downward toward the base 1060 . Adjacent to and below surface 1084 is another cylindrical surface 1086 having a diameter that is smaller than the diameter of surface 1082. The through bore surfaces 1075 and 1075 'extend primarily through the arms at the surface 1086 and the upper portion of each arch portion 1075 extends through one of the surfaces 1082. Around each aperture surface 1075 is a thin wall of surface 1077 when the thin wall of the surface 1077 is crimped toward the insert 1014 during assembly of such an insert in the receiver 1010, Lt; RTI ID = 0.0 > 1084 < / RTI > A continuous annular surface 1088 is positioned adjacent to and below the cylindrical surface 1086. Another type of discontinuous cylindrical surface 1086 that partially forms the receiver arms 1062 is also continuous at and near the interface between the annular surface 1088 and the surface 1086 to provide an upper portion of the receiver cavity 1061 . The surface 1088 is inclined inward or substantially perpendicular to the axis B. A continuous inner cylindrical surface 1090 is adjacent the annular surface 1088 and extends down into the receiver base 1060. The surface 1090 is disposed parallel to the receiver axis B. Surface 1090 has a diameter that is slightly smaller than the diameter of surface 1086. Cylindrical surfaces 1086 and 1090 are sized to receive portions of insert 1014 and, in some embodiments, provide locking interferential coupling with the cylindrical portion of the locking insert, as will be described in greater detail below.

Now, with respect to the base 1060 and, more particularly, with respect to the base cavity 1061, the lower portion of the surface 1090 that extends into the base and partially defines the base cavity 1061 is defined by the annular surface or ridge 1095, Lt; / RTI > Ridge 1095 extends outwardly in a direction away from axis B and is substantially perpendicular thereto.

A cylindrical surface 1099 extends downwardly from the ridge 1095, which partially defines the base cavity 1061 and, in particular, forms an expansion chamber for the retainer 1012. Cylindrical surface 1099 is oriented substantially parallel to axis B and is sized and shaped to accommodate expansion retainer 1012. The surfaces 1095 and 1099 form a circumferential recess that is retained when the shank 1004 is expanded about the shank upper portion 1008 as it moves upwardly toward the channel 1064 during assembly. And a stop or restriction to prevent the inflated retainer 1012 from moving upward with the shank portion 1008 and the surface 1095 is sized and shaped to receive the retainer 1012, Thereby preventing the retainer 1012 from passing upwardly out of the cavity 1061 depending on whether the retainer 1012 is in a partially or fully expanded position or condition. The cylindrical surface 1101 located below the cylindrical surface 1099 is sized and shaped to closely hold the retainer 1012 when the retainer is in the neutral position, as shown, for example, in FIG. Thus, the cylindrical surface 1101 has a diameter that is smaller than the diameter of the cylindrical surface 1099 forming the inflation region for the retainer 1012. Surface 1101 is bonded or connected to surface 1099 by one or more tilted, curved or conical surfaces 1102. The surface 1102 is defined by the sliding movement of the retainer 1012 into the space or locking chamber formed by the surface 1101 and the retention of the retainer 1012 on the lower annular surface 1104 located beneath and adjacent the cylindrical surface 1101 1012 < / RTI >

Another substantially cylindrical surface 1106 in communication with the tapered or worn bottom opening surface 1107 is positioned beneath and adjacent to the annular seating surface 1104 and the surface 1107 is located below the base cavity 1061 of the receiver 1010 To the outer base surface 1108 of the base 1060 forming a bottom opening (generally 1110)

49 and 58-62, a lower opening or split retainer 1012, which is operative to capture the shank upper portion 1008 within the receiver 1010, includes a shank upper portion 1008 and a retainer (not shown) 1012 have a central axis that operates identically to axis B associated with receiver 1010 when installed in receiver 1010. [ The retainer ring 1012 is made of an elastic material such as stainless steel or a titanium alloy so that the retainer 1012 can be expanded during various assembly steps as will be described in more detail below. The retainer 1012 has a central channel or hollow through bore (generally 1121) that passes entirely through the ring 1012 from the top surface 1122 to its bottom surface 1124. The surface forming the channel or bore 1121 includes a discontinuous frusto conical surface 1127 adjacent the surface 1125 and a discontinuous internal cylindrical surface 1125 adjacent the top surface 1122, Lt; RTI ID = 0.0 > 1012 < / RTI > The edge 1128 is formed by the joining of the top surface 1122 and the cylindrical surface 1125. The edge 1128 may include a chamfer or an inclined portion. 82, the shank upper portion 1008 ultimately frictionally engages the retainer 1012 at the edge 1128 as the assembly 1001 is locked into its final position. The retainer 1012 further includes an outer cylindrical surface 1130 positioned adjacent the top surface 1122 and an outer tapered or frusto conical surface 1132 adjacent the bottom surface 1124. [ The surface 1130 is oriented parallel to the central axis of the retainer 1012. In some embodiments of the present invention, spaced notches (not shown) may be formed in the cylindrical surface 1130 to accommodate retention and manipulation tools (not shown). In some embodiments, other notches on the inner or outer surface of the retainer may be configured to evenly distribute the stress across the entire retainor 1012 during its expansion.

The elastic retainer 1012 further includes first and second end surfaces 1134 and 1135 disposed in spaced relation to each other when the retainer is in the neutral uncompressed state. Surfaces 1134 and 1135 may also be contacted when the retainer is in a neutral state. Both end surfaces 1134 and 1135 are disposed substantially perpendicular to top surface 1122 and bottom surface 1124, respectively. The width X between the surfaces 1134 and 1135 is very narrow to provide stability to the retainer 1012 during operation (the slit can be formed by an EDM process). Since the retainer 1012 is top mountable in a neutral state and the retainer 1012 does not need to be compressed to engage in the receiver cavity 1061, the width X is required for the loaded compressible retainer ring It can be much smaller than it can. The gap X functions exclusively for expansion to allow the retainer 1012 to expand around the shank upper portion 1008. [ This results in a stronger retainer that provides more surface contact with the shank upper portion 1008 upon locking, thereby resulting in a more rigid connection that is less likely to fail than a retainer ring having a larger clearance. Also, since retainer 1012 is dedicated to expansion and is not absolutely inwardly compressed, retainer 1012 is typically imparted on a spring ring retainer known in the art to achieve both inward compression and outward expansion during assembly No mechanical stress is applied.

In some embodiments of the present invention, the inner surface of the retainer 1012 may be roughened or further roughened to increase frictional engagement with the shank upper portion 1008 before being locked by the rod 1021 or other longitudinal linking member And may be considered to include materials. 58-62 illustrate surfaces 1134 and 1135 that are substantially parallel to the center axis of the retainer, it is preferred that the surface be oriented at an oblique or minute angle, .

49 and 63-70, a frictional engagement crown compression insert 1014 sized and shaped to be received by the receiver 1010 at the top opening 1066 and down-loaded into the receiver 1010 ) Are exemplified. The compression insert 1014 has the same center of gravity as the center axis B of the receiver 1010. In operation, the insert advantageously engages the bone screw shank upper portion 1008, thereby locking the angle of the shank 1004 relative to the receiver 1010 during operation, prior to locking the shank about the receiver near the end of the procedure. But it allows for a well-balanced placement. In some embodiments of the invention, as described in more detail below with respect to inserts 1014 'illustrated in FIGS. 84-92, by way of example, compression from the rod 1021 and the closed top portion 1018, An insert that locks the shank 1004 at a desired angular position relative to the inner surface 1010 is also forced into an interference fit condition with the receiver 1010 at the inner cylindrical surface 1090 and thus the rod 1021 and the closed top end 1018 may be removed, the shank 1006 may be retained in the locked position. This locked position can also be released by the physician if necessary. The unlocked insert 1014 and the locking insert 1014 'are preferably made of a solid elastomeric material such as stainless steel or a titanium alloy so that portions of the insert are snap-engaged onto the shank upper portion 1008 Or may be popped and pinched or pressed against the receiver 1010 by the release tool and released from the wedge engagement therefrom.

The unlocked crown collet compression insert 1014 has a downwardly extending elasticity in the form of an opposing pair of crown collet extensions 1138 integral with the pair of upstanding arms 1137 at its upper end and at its lower end And a substantially cylindrical body 1136 integral with the superstructure. The bore (generally 1140) is disposed generally within and through body 1136 and is generally formed by upright arms 1137 and by saddles 1141 formed partially by body 1136 U-shaped through channels. The saddle 1141 is sized and shaped to fit tightly and snugly with the cylindrical rod 1021 and includes a flexure lower seat portion 1142. Alternative embodiments may be configured to include a planar retaining surface that closely retains a square or rectangular bar and retains a cylindrical rod shape, cord or sleeve type cord longitudinal connecting member. An arm 1137 disposed on each side of the saddle 1141 extends upward from the body 1136. The arm 1137 is sized and configured for ultimate placement at or near the cylindrical runout surface 1082 and interior surfaces 1084 and 1086 located below the receiver guide and advancement structure 1072. [ In some embodiments of the present invention, the insert arm 1137 may be extended and the closed upper end may be configured such that, for example, when the rod 1021 is formed of a deformable material, 1018, < / RTI > In this embodiment, the insert 1014 includes a rotation cutout structure or feature on its outer surface that abuts against a cooperating structure located on the inner wall of the receiver 1010 so that the closed upper end is in engagement with the insert To prevent rotation of the insert relative to the receiver. The arm 137 includes an outer surface 1143 illustrated as a partially cylindrical shape and extends from the substantially planar top surface 1144 to the vicinity of the bottom surface 1148 of the collet extension 1138, The top surface 1144 is ultimately disposed in spaced relation to the closed top portion 1018 so that the closed top portion 1018 merely frictionally engages the rod 1021, And presses against the upper portion 1008 of the shank 1004 and this upper portion is retained to lock the multi-axis mechanism of the bone screw assembly 1001 at a desired angle Lt; / RTI > Specifically, each of the illustrated partially cylindrical surfaces 1143 extend from one of the arm top surfaces 1144 from a bottom surface 1148 of the collet extension 1138 to a rim or ridge 1150 spaced apart. Each rim or ridge 1150 is positioned adjacent an annular lower surface 1151 of the insert body 1136. A discontinuous outer cylindrical surface 1152 is disposed between each rim 1150 and each elongated bottom surface 1148 which partially defines each collet extension 1138 and has a diameter greater than the diameter of the arm cylindrical surface 1143 And has a small outer diameter. The through slot 1154 includes an extension of the bottom surface 1148, an outer cylindrical surface 1152 and a respective collet extension 1138 that partially extends into the outer cylindrical surface 1143 from the insert body 1136 ). ≪ / RTI > The illustrated embodiment includes one slot 1154 located in the middle of each extension 1138. [ It is contemplated that other embodiments of the invention may include more or fewer slots 1154. The slots 1154 substantially separate each of the extensions 1138 to form four separate resilient fingers, tabs or panels 1154, which extend to the bottom surface 1148.

The surface 1143 is sized and shaped to substantially engage within the receiver arm 1062. The arm outer surface 1143 also includes notches or grooves formed thereon to receive the manipulating, unlocking, and locking tools. Although not shown, each surface 1143 may include one or more through bores or other openings for receiving a tool as shown, for example, on the locking insert 1014 'of FIG. 84. A lower planar surface (not shown) that receives a tool partially defined by the upper beveled surface 1157 and is disposed substantially perpendicular to the central axis of the insert 1014 (and the center axis B of the receiver when the insert is disposed in the receiver) A delta or triangular notch or recess 1156 (generally 1156) that intersects the surface 1158 is centrally located (and in some embodiments below the through bore) within each surface 1143. Each of surface 1167 and surface 1168 includes a respective receiver aperture through bore surface 1077,1075 'and a respective receiver aperture through bore surface < RTI ID = 0.0 > 1077,1075 < / RTI > when catch 1014 is captured and operatively disposed within receiver 1010, Collaborate and align. In the illustrated embodiment, a pair of spaced apart v- or square notches or grooves (1160, 1161) extending from each top surface 1144 to the vicinity of the surface 1158 of the central delta cut or notch 1156 And is also formed on each surface 1143. The grooves 1160 and 1161 cooperate with the receiver crimp wall inner surface 1087 to aid alignment of the insert channel saddles 1141 with the receiver channel 1064, as shown, for example, in FIGS. 74 and 75 . The illustrated pair of grooves 1160,1161 extend slightly from each bottom surface 1162,1163 to the nearest location of the arm top surface 1144 by tilting slightly toward one another, do.

The u-shaped channel formed by the saddles 1141 is also partially formed by the inner planar surface 1165 located near the arm top surface 1144. The saddle 1141 also communicates with the bore 1140 at the inner cylindrical surface 1166 and the surface 1166 is centered within the insert body 1136 and also communicates with the lower collet space, Extends to the discontinuous bottom surface 1148 of the collet extension 1138. The inner cylindrical surface 1166 also communicates with a lower recessed surface portion 1168 having a generally spherical profile having a radius that is the same as or substantially similar to the radius of the shank upper portion or surface 1034 of the head 1008. Surface 1168 terminates primarily in body bottom surface 1151, but also extends into the inner surface of collet extension 1138 to partially define the inner surface. Shank gripping surface portion 1170 is located along inner surface 1168 between cylindrical surface 1166 and body lower surface 1151. The gripping surface portion 1170 includes one or more stepped surfaces or ridges sized and shaped to grip and penetrate the shank head 1008 when the insert 1014 is locked against the head surface 1034 do. In the illustrated embodiment, substantially all interior surfaces 1168 are comprised of stepped portions, and thus the entire surface can also be described as having a plurality of cylindrical surfaces of progressive diameter. The stepped surface portion 1170 may include more or fewer stepped surfaces and may include more of the inner surface 1168 having the same or similar spherical profile as the surface 1034 of the shank head 1008 It can cover large or smaller surface area. Any and all of the shank grip surface portion 1170 and surface 1168 may additionally or alternatively comprise a roughened or textured surface or surface finish or may include frictional engagement with the shank upper portion 1008 Scoring, knurling and the like can be done to improve. Below the body bottom surface 1151 is placed a respective collet extension 1138 that includes a pair of inner upper bends 1172 and a pair of planar surface portions 1173, 1173 are positioned between each adjacent bottom surface 1148 and the adjacent bend portion 1172. The planar surface portion 1173 is sized, formed, and positioned with respect to each other to provide a frictional engagement with the shank upper portion or the spherical surface 1034 of the head 1008, as will be described in greater detail below. In some embodiments of the present invention, the planar surface 1173 may be replaced by a radial surface having the same, larger or smaller radius as the shank surface 1034. [

The insert bore 1140 is sized and shaped to receive a drive tool (not shown) engaging the shank drive feature 46 when it is driven into the bone with the receiver 1100 to which the shank body 1006 is attached . In addition, the bore 1140 may receive a manipulation tool used to release an alternative locking insert 1014 'from its locked position with the receiver, which may press down the shank and also engage in the opposite through bore And grips the insert 1014 'with the other tool engaging feature. A manipulation tool for wedge-disengaging insert 1104 'from receiver 1100 may also access such a tool bore from receiver through bore 1074. The illustrated insert 1014 may also include other features that include grooves and recesses for manipulating and retaining the insert 1014 within the receiver 1010 and may include a retainer 1012, 0.0 > 1014 < / RTI >

The insert body 1136 positioned between the arm 1137 and the collet extension 1138 has a slightly smaller outer diameter than the diameter between the crest of the guide and the advancement structure 1072 of the receiver 1010 Such that the arm 1137 of the insert 1014 allows for the top loading of the compression insert 1014 into the receiver opening 1066 while the arm 1137 of the insert 1014 allows the insertion of the insert 1014 into the receiver 1010 during insertion of the insert 1014 into the receiver 1010. [ (6102). Once the arm 1137 of the insert 1014 is positioned generally below the guide and advancement structure 1072, the insert 1014 is moved to a position where the upper surface 1144 is in contact with the guide and advancement structure 1072, And is rotated to the home position about the receiver axis B until it is positioned directly underneath.

Referring to Figures 49 and 82 and 83, the illustrated elongated rod or longitudinal connecting member 1021 (only a portion of which is shown) may be any of a variety of implants used in reconstructive spinal surgery, And is a conventional cylindrical elongate structure having an outer substantially smooth cylindrical surface 1022 of uniform diameter. The illustrated rod 1021 is identical or substantially similar to the rod 21 described hereinabove. Other longitudinal connecting members for use with the assembly 1001 may take a variety of shapes including, but not limited to, oval, rectangular, or other curved or polygonal short rod or bar. The shape of the insert 1014 can be modified to hold the longitudinal linking member tightly with respect to the assembly 1001, and to capture or slidably capture when necessary. Some embodiments of assembly 1001 may also be used with a tensioned cord. Such cords can be made of a variety of materials, including other plastic fibers, strands or threads, such as polyester or polyethylene terephthalate. Also, the longitudinal connector may be a component of a longer overall dynamic stabilizing connecting member, and the cylindrical or bar-shaped portion may have U-shaped, rectangular or other-shaped channels to closely accommodate the longitudinal connecting members Lt; RTI ID = 0.0 > 1014 < / RTI > The longitudinal linking members may be integrated or otherwise secured to a bendable or damped component sized and shaped to be positioned, for example, between adjacent pairs of bone screw assemblies 1001. The damping component or bumper may be attached to the longitudinal linking member at one or both sides of the bone screw assembly 1001. The rod or bar (or rod or bar component) of the longitudinal linking member may be made of a variety of materials ranging from nonmetallic materials such as plastics, which are ductile deformable, to hard metals depending on the desired application. Thus, the bars and rods of the present invention include metals and metal alloys including, but not limited to, stainless steel, titanium, titanium alloys and cobalt chromium; Or other suitable materials including polyetheretherketone (PEEK), ultra high molecular weight polyethylene (UHWP), polyurethane and composites, and the composites can be made of carbon fibers, polyisoprenes (natural rubber) Natural or synthetic elastomers, such as polymers, copolymers and thermoplastic elastomers, such as polycarbonate-urethane elastomers.

49 and 82 and 83, a closed structure or closed top portion 1018 shown with the assembly 1001 may be identical or substantially identical to the closed top portion 18 described hereinabove with respect to the assembly 1 similar. It should be noted that the closed top portion 1018 can be a torsional or buckling structure. The illustrated closed structure 1018 is substantially cylindrical and includes a guide disposed on the arm 1062 of the receiver 1010 and an outer spiral wound guide in the form of a flange that is operatively engaged with the advanced structure 1072 and the advanced structure 1182). The illustrated enclosed structure 1018 may also include other internal structures, such as a hexagonal drive or slotted, three winged, spanner, two or more openings of various shapes, etc., as illustrated or exemplified as a star shaped internal drive as sold under the trade designation TORX And an upper surface 1184 having an inner drive portion 1186 in the form of an opening, which may be a drive portion. A drive tool (not shown) sized and shaped to engage with the internal drive 1166 is used for both rotatable engagement and disengagement of the closure 1018 from the receiver arm 1062 as needed. It is also contemplated that the closure structure 1018 may alternatively include a breaking head designed to allow such a head to break from the base of the enclosure by a preselected torque of 70 to 140 pounds inches, for example. Such a closure structure also includes a base with an internal drive used for closure removal. The base or bottom surface 1188 of the closure is planar and may also include a rim 1190 and may or may not include an additional containment center point (not shown) (Not shown) is intended to engage and penetrate into the surface 1022 of the rod 1021 of a particular embodiment of the present invention. The closed top portion 1018 may further include a cannulation through bore (not shown) extending along its central axis and through its top and bottom surfaces. This through bore provides a passage through the interior of the closure 1018 for the length (not shown) of the wire inserted therein to provide a guide for insertion of the closed top portion into the receiver arm 1062.

An alternative closed top portion 1218 for use with a deformable rod such as a PEEK rod 1221 is shown in Figures 91 and 92. The top portion 2118 is identical to the top portion 1018 except that the point or nub 1289 is located on the dome surface 1290 instead of the rim of the closed top portion 1018. Alternatively, the closed top portion 1218 includes a guide and advancement structure 1283, a top portion 1284, an internal drive portion 1286, and a bottom outer annular surface 1288, which are seen about the closed top portion 1018 Is similar or substantially similar to the guide and advancing structure 1183, top portion 1184, internal driver portion 1186 and bottom surface 1188 described in the specification. In some embodiments, the inner drive portion 1286 is not as large as the drive portion 1186 of the closed top portion 1018, and such a smaller drive portion provides, for example, a smaller force disposed on the deformable rod, , E.g., when the insert 1014 'described below is used in the bone screw assembly of the present invention.

Returning to the assembly 1110, preferably, the receiver 1010, the retainer 1012 and the compression insert 1014 can be used to crimp a portion of the receiver 1010 toward the insert 1014, (1014) compression or expansion of the arm and / or collet extension, and processing for retaining, pressing and aligning the component pieces. In some circumstances, the shank 1004 is also assembled with the receiver 1010, the retainer 1012, and the compression insert 1014 at the factory. In another example, it may be desirable to first implant the shank 1004, followed by the addition of preassembled receptors, retainers, and compression inserts at the time of insertion. In this way, the surgeon can more easily and more easily implant and manipulate the shank 1004, divide or compress the ulna with the shank, move the shank upper portion or head circumference Lt; / RTI > In another example, the surgical staple may include a surface to roughen the hydroxyapatite and / or top portion 1008 of the desired size and / or variety (e.g., shank 1006) with the receiver, It is preferable to pre-assemble the shank of the shank. Allowing a physician to select an appropriately sized or treated shank 1004 preferably reduces inventory requirements and thus reduces the overall cost.

Pre-assembly of receiver 1010, retainer 1012 and compression insert 1014 is shown in Figures 71-75. First, the retainer 1012 is mounted in a lateral manner in the receptacle 1010 via the upper opening 1066 with the outer surface 1130 facing the receptacle channel inner surface 1068. The retainer 1012 is then lowered between the arms 1062 and toward the receiver base 1060 as shown in phantom in Figure 71 and the retainer is moved into the receiver base 1060 inner cavity 1061 Where the retainer base bottom surface 1124 is manipulated to a position facing the annular surface 1104 (also shown in phantom), and then, as shown by the solid line in Figure 71 Is fully rested on the inner base annular surface 1104. 72, the compression insert 1014 is then down loaded into the receiver 1010 through the top opening 1066 and the crown collet extending bottom surface 1148 faces the receiver top surface 1073, The insertion arm 1137 and the insertion collet extension 1138 are located between opposing receiver arms 1062. The insert 1014 is then inserted into the channel seat portion 1068 until the arm top surface 1144 of the insert 1014 is adjacent the runout region formed by the surface 1082 of the receiver below the guide and advancement structure 1072 . The upper arm surface 1144 is then inserted into the guide 1030 as illustrated in Figure 73 with the U-shaped channel 1141 of the insert 1014 aligned with the U-shaped channel 1064 of the receiver 1010, The insert 1014 is rotated clockwise or counterclockwise about the receiver axis B until it is just under the advancing structure 1072. In some embodiments, the insert arm 1137 and the collet extension 1138 may need to be compacted slightly during rotation to escape the inner surface of the receiver arm 1062. 73-75, the outer cylindrical surfaces 1143, 1152 of the insert 1014 are received within the cylindrical surfaces 1086, 1090 of the receiver. 74 and 75, the receiving thin wall of the inclined surface 1077 positioned about the arcuate through bore portion 1075 is then inserted into the receiving opening 1074 by inserting a tool (not shown) B and the tool is inwardly crimped against the inner wall surface 1087 when the inner wall surface 1087 engages the insert 1014 in the grooves 1160,1161 formed into the outer cylindrical surface 1143 of each insert arm 1137 Lt; RTI ID = 0.0 > 1077 < / RTI > Crimping of the opposing wall surface 1087 into the grooves 1160,1161 maintains the insert 1014 U-shaped channel 1141 substantially aligned with the receiver U-shaped channel 1064, To allow upward movement of the insert 1014 along the receiver axis B during bottom mounting of the shank 1004, as shown in Fig. Crimping of the receiver wall 1077 thus prevents rotation of the insert 1104 about the receiver axis B but does not cause the crimped surface 1087 to move up or down along the grooves 1160, To permit limited axial movement of the insert 1014 with respect to the receiver 1010 along the axis B when some force is applied to slide the insert 1010 along the axis B. The arm 1137 of the insert 1014 is fully trapped within the receiver 1010 by the guide and advancing structure 1072 thereby to move the receiver 1012 located in the receiver 1010 base 1060 below the insert 1014, And the receptacle annular surface 1104 and through the receptacle opening 1066 upwardly and outwardly.

The top or side surface of the insert 1014 may be temporarily attached to the inner surface of the receiver 1010 to retain the insert 1014 in the upper portion of the receiver 1010 during some assembly steps. The inclusion of resilient protrusions or protrusions for frictional engagement also provides a frictional but slidable engagement between the insert 1014 and the receptacle 1010. In the illustrated embodiment, the insert 1014 is sized and shaped such that the insert 1014 is positioned over the cylindrical surface 1099 during extension of the retainer 1012 about the shank head 1008, The surface 1099 can be substantially free to slide axially within the upper portion of the receiver 1010 and the surface 1099 functions as an expansion chamber or recess of the retainer 1012.

The combination of the receiver, the insert and the retainer is then ready for transport to the end user and both the compression insert 1014 and the retainer 1012 are moved or moved out of the receiver 1010, Is trapped in the receiver 1010 in a manner that substantially prevents loss. The combination of receptacle 1010, compression insert 1014 and retainer 1012 can now be removed from the implanted shank 1004 as shown in Figure 76 by a surgical step prior to implantation, And the shank axis A and the receiver axis B are aligned during assembly as shown in Figure 77 and most of the figures are assembled with each other as shown in Figure 76, Axis or an assembly process that is angled about the axis of rotation.

76, a bone screw shank 1004 or an entire assembly 1001 comprised of a shank 1004, a receiver 1010, a retainer 1012 and a compression insert 1014 may be coupled to a suitable drive tool (not shown) Is screwed into the bone, such as the ulna 1017, by rotation of the shank 1004 using a tool (not shown) which rotates and actuates the shank body 1006 by its engagement in the internal drive 10046 . Specifically, the ulna 1017 is pre-drilled to minimize stress on the bone and has a guide wire (not shown) inserted therein to provide a guide for the angle and placement of the shank 1004 relative to the ulna. The other tapped hole may be formed using a tab having a guide wire as a guide. The bone screw shank 1004 or the entire assembly 1001 is then inserted into the opening of the bottom portion 1028 and then inserted into the opening of the top opening at the drive feature 1046, ). ≪ / RTI > Shank 1004 is then driven into the ulna using a wire as a placement guide. The shank and other bone screw assembly portions and the rod 1021 (also having a central lumen in some embodiments) and a closed top portion 1018 (also having a central bore) can be percutaneously or minimally Can be inserted by an invasive surgical procedure. When the shank 1004 is driven into the ulna 1017 in the absence of the remainder of the assembly 1001 the shank 1004 may be driven to a desired final position or may be moved to a pre- Or slightly projected to provide ease of assembly of the < RTI ID = 0.0 >

Referring to Figures 76 and 77, the preassembled receptors, inserts, and retainer are disposed over the shank upper portion 1008 until the shank upper portion is received within the opening 1110. 77 and 78, when the shank upper portion 1008 is moved into the interior 1061 of the receiver base, the shank upper portion 1008 is partially and partially formed by the annular surface 1095, And presses retainer 1012 upward into the recess formed partly by surface 1099. 78 and 79, when the portion 1008 continues to move upwardly toward the channel 1064, the top surface 1122 of the retainer 1012 abuts against the receiving annular surface 1095 To force the outward movement of the retainer 1012 toward the cylindrical surface 1099 that stops the upward movement of the retainer 1012 and forms the receiver expansion recess as the spherical surface 1034 continues to enter upward. 80 and 81, when the center of the sphere of the head 1008 passes past the center of the retainer expansion recess formed by the surface 1099, the retainer 1012 is in contact with the spherical surface 1034, It begins to shrink around. The spherical surface 1034 then moves to engage the collet panel 1155 in the insert 1014 at the inner panel planar surface 1173 and the panel 1155 is initially moved slightly to accommodate the surface 1034 Extend outwardly. The panel 1155 pushes outwardly toward the surface 1090 and the surface has sufficient clearance for the spherical surface 1034 to be in a state of complete frictional engagement with the panel inner surface 1173, to provide. At this point, insert 1014 and surface 1034 are in a very tight frictional engagement and surface 1034 can be pivoted about insert 1014 with slight force. Thus, now tight fit ball and socket joints are created between the insert 1014 and the shank upper portion 1008.

The shank 1004 and the attached insert 1014 are then inserted into the load 1021 or other species by further driving the shank 1004 by upward traction on the receiver 1010 or in some cases into the ulna 1017. [ And can be further down-operated to a desired position for the directional connecting member. Also, in some embodiments, when the receptacle 1010 is preassembled with the shank 1004, the entire assembly 1001 then inserts a drive tool (not shown) into the receptacle and shank drive 1046, By rotating and driving the shank 1004 to the desired position of the shank 1004. Also, at this time, the receiver 1010 may be articulated to a desired angular position relative to the shank 1004, as shown in FIG. 83, but prior to insertion of the rod or closure top portion, the retainer 1012 and the shank upper portion 1008, but is not locked.

82 and 83, the rod 1021 is eventually positioned in an open or percutaneous manner in cooperation with at least two bone screw assemblies 1001. Closure structure 1018 is then inserted between arms 1062 of each receiver 1010 and advanced therebetween. Closure structure 1018 uses a tool associated with internal drive 1186 until the selected pressure reaches a point at which rod 1021 engages U-shaped face surface 1142 of compression insert 1014 Thereby pressing the insert-stepped shank grip surface 1170 against the shank spherical surface 1034 so that the edge of the stepped surface penetrates into the spherical surface 1034 and also retains the shank upper portion 1008 And presses it in the locking friction engagement state with the cylinder 1012. Specifically, when the closure structure 1018 rotates and moves down into each receiver 1010, the rim 1190 engages and penetrates the rod surface 1022, and the closure structure 1018 moves the shank upper portion 1008 ) Against the retainer (1012) and against the insert (1014) pushing against it in the locking engagement with it to bend the rod (1021) in compression with it, and the retainer (1012 Is in frictional contact with surface 1104 and expands outwardly with respect to cylindrical surface 1101. As an example, a torque of about 80 to about 120 pounds inches on the closed top can be applied to secure the bone screw shank 1006 with respect to the receiver 1010.

84-89, alternative locking and unlocking compressions for use with the shank 1004, receiver 1010, retainer 1012, closed top portion 1018, and rod 1021 described herein above, An insert 1014 'is illustrated and the resulting assembly is shown, for example, as an assembly 1001' in Figures 89 and 90. The insert 1014'may be configured such that the insert 1014'is locked, friction interlocked with the receiver 1010, specifically, the outer cylindrical surface 1143 'of the insert arm 1137' as described in more detail below. Is similar or substantially similar to insert 1014 described herein except that it is dimensioned for locking interference between the lower portion of receptacle 1010 and the cylindrical inner surface 1090 of receiver 1010. [ In addition, the illustrated insert 1014 'includes an insert 1014' in that the insert 1014 'includes a pair of opposing through bores 1159' for receiving the tool, as will be described in greater detail below. .

84-86, the locking insert 1014 includes a body 1136 ', a pair of opposing arms 1137', a pair of crown collet extensions 1138 ', a through bore 1140' Shaped saddle surface 1141 ', an outer surface 1143', an arm top surface 1144 ', a collet extending bottom surface 1148', an arm rim or a ridge surface 1142 'having an inner surface 1142' The upper inclined surface 1157'and the lower planar surface 1152'are formed by the slots 1151 ', the annular lower body surface 1151', the lower outer cylindrical surface 1152 ', the slots 1154' A pair of grooves 1160 ', 1161' each having a bottom surface 1162 ', 1163', an inner planar opposing surface 1165 ', an inner cylindrical surface 1156' Includes an inner spherical profile 1168 'having a gripping surface portion 1170', a gripping surface portion 1170 ', a curved inner surface 1172' and a collet planar inner grip friction engagement surface 1173 ' Each of the angles < RTI ID = 0.0 > Shaped saddle surface 1141 with a pair of opposing arms 1137, a pair of crown collet extensions 1138, a through bore 1140, a notch 1142, an arm outer surface 1143, Formed by an arm top surface 1144, a collet extending bottom surface 1148, an arm rim or ridge surface 1150, an annular lower body surface 1151, a lower outer cylindrical surface 1152, a slot 1154, A notch 1156 having a panel 1155, a top ramped surface 1157 and a bottom planar surface 1158, a pair of grooves 1160 and 1161 with respective bottom surfaces 1162 and 1163, an inner planar opposing surface 1615 The internal spherical profile 1168 having an inner cylindrical surface 1166, a gripping surface portion 1170, a curved inner surface 1172 and a planar frictional engagement gripping surface 1173 .

An outer cylindrical surface 1143 'below an insert 1014' located at or near the ridge or rim 1150 'below the tool notch 1156' has a cylindrical surface 1090 Lt; RTI ID = 0.0 > 1010 < / RTI > Stated another way, the measured width or diameter between the arm surface 1143 'at or just above the rim 1150' is sufficient to interference lock the insert 1014 'into the receptacle 1010 at the cylindrical surface 1090 Starting from an edge formed by the surface 1090 and the receiver surface 1088 by a closed top portion 1018 pushing the rod 1021 downwardly against the insert 1014 'by force or by a tool or tools, Is sized sufficiently large to require that the insert 1014 ' must be pushed into the space formed by the insert 1090 '.

Referring to Figures 87-90, an insert 1014 'includes a receptacle 1010, a retainer 1012, a shank 1004, a rod 1021 and a closed top portion 1018, a receiver 1010, Except for the fact that the insert 1014 'must be propelled down into the locking interference engagement with the receptacle 1010 when the shank 1004 is locked in place, relative to the easy sliding relationship between the receptacle 1014 and the receptacle 1014, ), Resulting in assembly 1001 '. In particular, prior to assembly with the rod 1021 and the closed top portion 1018, the compression insert 1014 'outer cylindrical surface 1152' is slidably received by the receiver cylindrical surface 1090, while the surface 1143 ' ) Is not. Thus, the insert 1014 'is pushed downward by a closed top portion pressed downward on the rod or by a locking tool such that the rods are sequentially moved downwardly on the insert 1014', as shown in Figures 89 and 90 Any additional downward movement at the receiver surface 1088 is inhibited unless it is pressurized. 89, the receptacle 1010 is retained by frictional engagement between the retainer 1012 collet panel and the shank upper portion 1008, but is not locked, as shown in FIG. 96 And may be articulated to a desired angular position with respect to the shank 1004 as well.

The rod 1021 is eventually positioned in an open or percutaneous manner in cooperation with at least two bone screw assemblies 1001 '. Closure structure 1018 is then inserted into arms 1062 of each receptacle 1010 and advanced therebetween. Using the tool associated with the internal drive 1186 until the selected pressure reaches the point at which the rod 1021 engages the U-shaped face surface 1142 'of the compression insert 1014', the closed structure 1018 Pushes against the shank spherical surface 1034 and into the interposer shank gripping surface 1170 'and the edge of the stepped surface 1170' into the spherical surface 1034 And presses the shank upper portion 1008 into the locking frictional engagement with the retainer 1012. Specifically, as the closure structure 18 rotates and moves down into each receiver 1010, the rim 1190 engages and engages the rod surface 1022, and the closure structure 1018 engages the rod 1021 And biases the rod 1021 into the compression engaged state with the insert 1014 'which urges the shank upper portion 1008 toward the retainer 1012 and into its locking engagement with it, And retainer 1012 is in frictional contact with surface 1104 and outwardly expands relative to cylindrical surface 1101. As an example on the closed top, a torque of about 80 to about 120 pounds inches can be applied to secure the bone screw shank 1006 relative to the receiver 1010. Clamping the spiral flange shape to approximately 100 pounds inches may produce a force of 900 to 1000 pounds and may result in interference between the cylindrical surface 1090 of the receiver and the cylindrical surface 1143 ' of the insert 1014 ' And can be overcome by between about 500 and 700 pounds inches, depending on manufacturing tolerances between these parts. Thus, when the closure structure 1018 and the rod 1021 press down the insert 1014 'toward the base of the receiver 1010, the insert surface 1143' is pressed against the cylindrical surface 1090 and the receiver annular surface 1090 Axis 1088 and thus does not substantially affect the locking of the multi-axis mechanism itself, so that the insert 1014 can be frictionally coupled to the receptacle at the surface 1090 and along therewith It is pushed and fixed in the interference bonding state.

91, the closed top portion 1018 may be loosened or removed, and / or the rod 1021 may be adjusted and removed and the receptacle 1010 and / The frictional engagement between the inserts 1014 'remains locked in place to advantageously maintain the locked angular position of the shank 1004 relative to the receiver 1010.

91 and 92, other rods, such as deformable rod 1221, and cooperating alternative closed top 1218 may be mounted on an already locked assembly to effect an alternative assembly 1201 ' . As described above, it is advantageous for the closing drive portion 1286 to be formed smaller than the driving portion of the closing body 1018 so that the deformable rod 1221 is not unduly pressed or deformed during assembly because the multi-axis mechanism is already locked .

93-95, a two-piece tool (generally 1600) for disengaging insert 1014 'from receiver 1010 is illustrated. The tool 1600 includes an inner flexible tubular structure having an inwardly directed prong 1612 located on each side of the through channel 1616. Channel 1616 terminates at a location spaced from prong 1612 or results in a two-piece tool 1610 by further upwardly extending through the tool. The tool 1600 includes an external, more rigid tubular member 1620 having a smaller through channel 1622. [ The member 1620 is slidably engaged on the tube 1610 after the prong 1612 of the flexible member 1610 is outwardly curved and then coupled onto the receiver 1010 and thereafter inserted into the receptacle 1010 Is coupled into the through bore of the opposing opening 1074 and is aligned with the opposing bore 1159 'located on the arm of the insert 1014'. In Figure 93, a tool 1600 is shown during the process of unloading the insert 1014 'from the receiver 1010, the outer member 1620 surrounds the inner member 1610, Retains the prongs 1612 in receptacles 1010 and inserts 1014 'openings while being pulled up in a spaced direction away from the receptacle 1004. The tool 1600 may further include a structure for pushing the receiver 1010 downward while the prongs and tubular members are being pulled upward and such a structure may be positioned within the tool 1600, Can press on top surface 1073.

Alternatively, other manipulation tools (not shown) inserted into the receptacle at opening 1066 and inserted into an insert channel formed by saddle 1141 'may be used, and the prong or extension may be inserted through insert through bore 1159 , And then the piston-like portion of the tool directly pushes against the shank upper portion 1008, thereby pulling the insert 1014 'away from the receiver surface 1090 and thus , The multiaxial mechanism is released. At this point the desired friction coupling is maintained so that the shank 1004 is articulated with respect to the receptacle 1010 and is adjustable but a tight fit still exists between the shank 1004 and the receptacle 1010, And the shank surface 1034. If separation of the assembly requires different separation, this is accomplished in the reverse order of the procedure described herein for assembly 1001.

96-98, another manipulation tool (not shown) may be used to independently lock the insert 1014 'or, in other embodiments, to temporarily lock the unlocked insert 1014 to the receiver 1010 1700 as a whole). The tool 1700 includes a pair of opposing arms 1712 each of which is configured such that one or more inner surfaces 1718 of the coupling extension 1716 when the tool is moved down toward the receptacle, And then sliding along the inserts 1014 'to engage the insert 1014' with the surface 1720 pressing down on the insert surface 1158 'to form a cylindrical arm surface 1143' (Not shown) to engage locking locking engagement within the receptacle cylindrical surface 1090. The coupling extension 1716 is positioned at a predetermined angle relative to the respective arm 1712, 98, when the insert 1014 'is locked with respect to the receiver 1010, the tool bottom surface 1720 does not protrude downwardly on the receiver surface 7105' but remains away therefrom. In the illustrated embodiment, the surface 1718 is slightly rounded and each arm extension 1716 has a bottom portion 1714 for insertion and gripping of the insert 1014 'at the junction of the surface 1157' and the surface 1158 ' Further includes a planar bottom surface 1722 that creates an edge having a surface 1720. The tool 1700 may include various retention, propulsion / traction mechanisms such as a ratchet feature, a hinged tool, or a pistol grip tool that may include, for example, a rotatably threaded device.

Although specific forms of the invention have been illustrated and described herein, it should be understood that they are not limited to the arrangements or specific forms of the parts shown and described.

Claims (22)

A multi-axial bone anchor assembly comprising:
a) a receiver having a body defining a first chamber and a second chamber, the body being integral with a pair of opposing arms forming a channel, the channel communicating with the first chamber and the second chamber, Is configured to have a size and shape for receiving a portion of the longitudinal connecting member, the second chamber communicating with a lower opening of the receiver, and the first chamber being located above the second chamber;
b) a shank having an upper bend and a body having a spherical surface, the body of the shank extending through a lower opening of the receiver;
c) an elastic opening retainer having a non-tapered outer surface engaging an inner surface that partially defines a first chamber and a second chamber of said receiver, said resilient opening retainer being initially located in said second chamber, The upper portion of the shank being capable of expanding in the first chamber about the upper portion of the shank when the first portion of the shank is mounted through the lower opening of the receiver, The retainer being in an expanded state about the receptacle and only about the upper portion of the shank in the first chamber; And
d) an insert coupled with a top portion of the shank and located between a portion of the longitudinal linking member located within the channel of the receiver and an upper portion of the shank, the insert having a pair of opposed upstanding arms, And wherein said retainer is located within said second chamber when said shank is in its final position relative to said receiver.
Multi-axis bone anchor assembly. The method according to claim 1,
Said insert having an outer surface that is releasably frictionally locked against said receptacle,
Multi-axis bone anchor assembly. The method according to claim 1,
Wherein the channel of the receiver is a first channel, the insert has a second channel, the insert is top loaded into the receiver, and then the second channel is aligned with the first channel To a position on the retainer,
Multi-axis bone anchor assembly. The method according to claim 1,
Wherein the arm of the insert further comprises a laterally extending portion,
Multi-axis bone anchor assembly. The method according to claim 1,
The receptacle having one or more crimped wall surfaces that are pressed into the insert,
Multi-axis bone anchor assembly. delete delete The method according to claim 1,
Wherein the insert comprises a base structure comprising a plurality of elastic panels for temporary frictional engagement with an upper portion of the shank,
Multi-axis bone anchor assembly. 9. The method of claim 8,
Wherein the surface of the panel is concave,
Multi-axis bone anchor assembly. 9. The method of claim 8,
The surface of the panel is planar,
Multi-axis bone anchor assembly. As a bone anchor,
a) a shank having a body for fixation to the bone and an integral upper portion having a first spherical surface;
b) a receiver having a top portion and a base, the top portion of the receiver forming an open channel, said base having a first surface partially defining the cavity, said channel communicating with the cavity;
c) an insert disposed within the receiver and sized and shaped to directly engage and interact with the tool; And
d) an elastomeric opening ring having a planar surface and an outer cylindrical surface, said ring expanding into said cavity when said shank is mounted into said cavity through the base of said receptacle, said ring expanding about an upper portion of said shank And an upper portion of the shank is received through the ring to capture an upper portion of the shank within the cavity of the receiver, the ring being seated on the annular surface of the receiver and secured in an inflated state And wherein said spherical surface engages said cylindrical surface while retained.
Bone anchor. 12. The method of claim 11,
Wherein the insert has a base having a downwardly directed structure temporarily engaged with the upper portion of the shank prior to locking of the shank in its final position relative to the receiver, When the shank is in its locked position with respect to the receiver, the ring is in an inflated state and is fixed with respect to the receiver, and when in the locked position the upper portion of the shank Is pressed against the ring and is spaced apart from the receiver,
Bone anchor. 12. The method of claim 11,
Said insert having an outer surface releasably frictionally locked with respect to said receptacle,
Bone anchor. 12. The method of claim 11,
Wherein the channel of the receiver is a first channel and the insert has a second channel and the insert is mounted on top of the receiver and then the second channel is aligned with the first channel, Lt; / RTI >
Bone anchor. 12. The method of claim 11,
Wherein the insert further comprises a laterally extending portion,
Bone anchor. As an improved bone anchor,
a) a shank having a body for fixation to the bone and an integral upper portion having a spherical surface;
b) a receiver having a top portion and a base, the top portion of the receiver forming an open channel, the base partially defining a cavity, the channel communicating with the cavity, Having a chamber;
c) an insert disposed within the receptacle and extending completely through the open channel from the front side to the rear side of the receptacle, the insert mating with a spherical surface of the shank, -; And
d) an elastically releasable retaining ring having an upper planar seating surface and an outer surface initially located in said second chamber and being urged into and expanded into said first chamber when said shank is mounted into said cavity through the base of said receiver, The retaining ring expanding around an upper portion of the shank to lock in the first chamber and receive the upper portion of the shank through the retaining ring, the retention ring returning to the second chamber and within the cavity of the receiver And wherein said spherical surface contacts said seating surface while capturing said upper portion such that said retaining ring remains fixedly inflated in said first chamber.
Improved bone anchor. 17. The method of claim 16,
Wherein the insert further comprises an elastic arm having an outwardly projecting surface capable of frictionally engaging a portion of the receiver, the outwardly projecting surface having an insert within the upper portion of the cavity of the receiver during assembly with the shank Temporary holding,
Improved bone anchor. As an improved bone anchor,
a) a shank having a body for fixation to the bone and an integral upper portion having a spherical surface;
b) a receiver having a top portion and a base, the top portion of the receiver forming a first channel, the base partially defining a cavity, the channel communicating with the cavity, 2 chambers;
c) an insert having a second channel, the insert being top mounted into the receiver, the second channel then being rotated to a position on the holders in alignment with the first channel, A downwardly directed panel frictionally engaging a spherical surface of the shank; And
d) an elastically opening shank retention ring having a planar seating surface initially located in said second chamber, said retention ring having an outer surface, said retaining ring having an outer surface, said retention ring having, when said shank is mounted into said cavity through said base of said receiver Wherein the retaining ring is inflated around an upper portion of the shank to be secured within the first chamber and receives the upper portion of the shank through the retention ring to capture the upper portion within the cavity of the receiver, And wherein the spherical surface contacts the seating surface while the retaining ring is held fixed in the inflated state within the first chamber.
Improved bone anchor. A bone anchor assembly comprising:
a) a receiver having a body defining a bottom opening and an inner cavity communicating with a pair of opposed arms defining a channel, the channel being formed to have a size and shape for receiving a portion of the longitudinal linking member;
b) a bone attachment structure having a body and an upper catch portion, the body extending through a lower opening of the receiver and pivoting with respect to the lower opening when mounted through a lower opening of the receiver;
c) an insert having an upstanding arm defining a second channel for receiving said longitudinal linking member, said insert being located in a first position and having a friction-type arrangement in said receiver prior to mounting of said upper catching portion of said bone attachment structure, So that when the bone attachment structure is mounted into the receiver, the insert is further moved downward into the cavity of the receiver into the locking position and the receiver inhibits upward movement of the insert.
Bone anchor assembly. 20. The method of claim 19,
Wherein at least one upstanding arm of the insert at a locking position of the insert engages an interior surface of the receiver located below the ledge surface,
Bone anchor assembly. 20. The method of claim 19,
Wherein the upper catch portion of the bone attachment structure is held within a cavity of the receiver by a separate retainer,
Bone anchor assembly. 20. The method of claim 19,
Wherein the insert provides a friction fit between the bone attachment structure and the receptacle,
Bone anchor assembly.

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