Device for guiding a filament around one or more vertebrae

Abstract

Device (1) for guiding a filament (2) around one or more vertebrae (3), in particular around the spinous processes of the respective vertebrae (3), the device (1) comprising a first lever (4) having a first transfer port (9) and a second lever (5) having a second transfer port (10) as well as a sickle (6). The sickle (6) is interconnectable to the first lever (4) and / or second lever (5) in a pivotable manner around a first pivot axis (11) and comprises a carrier (8) for the filament (2). The sickle (6) is hereby pivotable into a transfer position where the carrier (8) is docked to the first and second transfer port (9, 10) to transfer a hold on the filament (2) from the carrier (8) to the first and second lever (4, 5).

Description

[0001] P28785PC00 15.08.2025

[0002] 1 / 41

[0003] Device for guiding a filament around one or more vertebrae

[0004] FIELD OF THE DISCLOSURE

[0005] The present disclosure relates to a device for guiding a filament around one or more vertebrae, in particular around the respective spinous process of the one or more vertebrae.

[0006] BACKGROUND OF THE DISCLOSURE

[0007] Posterior fixation of the spine is a standard procedure for managing cervical and / or lumbar region instability, irrespective of its origin. This approach is applicable for a variety of conditions such as e.g. to compensate for instabilities of the aging spine, iatrogenic instabilities after decompression surgery, or else.

[0008] As our understanding of the spine’s structure and mechanics has grown, alongside improvements in spinal implant technology, numerous techniques have emerged to effectively restore the posterior tension band structure without significantly impeding extension, rotation, or lateral flexion, such as wiring techniques or semi-rigid fixation techniques.

[0009] However, these conventional techniques still produce unsatisfactory clinical results. In particular, achieving effective control of flexion while not stressing adjacent segments remains challenging. It is also difficult to allow movement in directions of motion other than flexion, at least within a controlled, physiologically healthy range of motion. P28785PC00 15.08.2025

[0010] 2 / 41

[0011] SUMMARY OF THE DISCLOSURE

[0012] Modern interspinous fixation techniques aim at a more dynamic fixation of the spine, allowing a higher degree of freedom for the patient while still providing sufficient stabilization. New wiring techniques are being developed for flexible filaments or the application around the spinous processes of the vertebrae. At the same time, advanced devices are needed to guide the filaments around the vertebrae.

[0013] The present disclosure presents a device for guiding a filament around one or more vertebrae, in particular around the respective spinous process of the one or more vertebrae. The device according to the disclosure thereby provides an easy-to-use device for the practitioner and a minimally invasive procedure for the patient. The device facilitates the looping of the filament in a reliable fashion and, ideally, under tension to ensure proper fixation. Therefore, the device is configured such that the filament is first guided along a first guiding path along the one or more vertebrae by a sickle before the hold on the filament is transferred from the sickle to a first and / or second lever to pull the filament on one or two different transfer locations on the filament along a second guiding path around the one or more vertebra to form a loop.

[0014] A loop is hereby understood as an open loop (with the filament encircling at least partially the respective vertebrae) or closed loop (with the filament fully encircling the respective vertebrae). The two transfer locations on the filament are thereby advantageously arranged in direction of the first guiding path in front of, respectively behind, the respective vertebrae during the procedure.

[0015] In general, the filament may be an implantable filament intended to loop around the vertebrae and to stay within the patient’s body. The filament may however also be an auxiliary filament of the herein disclosed device for pulling a thereto attachable implantable filament around the vertebrae before the fixation of the implantable filament around the P28785PC00 15.08.2025

[0016] 3 / 41 vertebrae. The implantable filament can for example be a natural material, a synthetic material or a hybrid material comprising a natural component and a synthetic component. For example, the implantable filament can be a graft, such as an allograft, autograft or xenograft, a tendon or a ligament.

[0017] The first and second lever of the device according to the disclosure serve to be inserted at least partially in a patient’s body. The levers may be operable from outside the patient’s body via a proximal end of the respective levers. Preferably, each lever has a lateral section and a longitudinal section to simplify the handling of the filament and / or pulling the same around the vertebrae. Hereby, each longitudinal section extends essentially in a longitudinal direction and each lateral section essentially in a lateral direction of the respective levers. The lateral direction may further be arranged essentially perpendicular to the longitudinal direction of the respective lever. The lateral sections each advantageously extend from a respective distal end of the longitudinal section. Handle(s) for operating the levers may be arranged on the proximal end of the longitudinal sections. Thus, the first and / or the second lever can each be L-shaped. The transfer ports are advantageously arranged on the lateral section, in particular on the respective distal ends of the lateral sections.

[0018] It is particularly advantageous for the first lever and / or the second lever to be L-shaped, in particular to be L-shaped when viewed from a direction orthogonal to the first pivot axis in the mounted position. These embodiments are advantageous e.g. for guiding a filament around one or more vertebrae because they effectively allow bridging across the vertebrae and placing the filament e.g. on opposite sides of a spinous process.

[0019] Depending on the application, the respective lateral sections may further comprise a positioning interface to position the respective lever on opposite sides of the one or more vertebrae to be looped by the filament. The positioning interfaces can each be arranged P28785PC00 15.08.2025

[0020] 4 / 41 between the distal end and a transition area towards the longitudinal section. The positioning interface may e.g. feature a structured surface such that slippage from the vertebrae is prevented. Alternatively or in combination, the positioning interfaces may comprise a concavity for receiving the one or more spinous processes, preferably the spinous process of the one or more vertebrae.

[0021] In addition to the levers, the device comprises a sickle with a carrier for carrying the filament. The carrier carries the filament at least partially along the first guiding path. In the procedure, the sickle can be moved from an initial position (during procedure outside of the patient’s body) along the first guiding path to at least one transfer position (during procedure inside of the patient’s body), where the hold on the filament is transferred from the carrier to at least one of the levers. The movement of the sickle into the transfer position is preferably a rotation around a first pivot axis. In the transfer position(s), the sickle, and in particular a carrier of the sickle is advantageously docked to both transfer ports. Docking encompasses among others that the carrier is at least partially inserted in an opening of the respective transfer port.

[0022] The opening of the transfer port can be a through opening, in particular extending around the first pivot axis, into which the carrier is guided through. Alternatively, the opening can be left open to one side to form a slit for a section of the carrier. Hence, multiple possible transfer positions may exist, where the sickle is docked to one or both transfer ports. Depending on the application, the first and second transfer port are interspacable and / or interspaced from each other in the transfer position.

[0023] For some applications, the filament may be inserted into the carrier in the initial position, and by rotating the sickle with the carrier, the filament is then guided along the first guiding path into both transfer ports, where the hold on the filament is transferred from the sickle to the first and second lever to pull the filament on two different transfer locations P28785PC00 15.08.2025

[0024] 5 / 41 on the filament along a second guiding path around the one or more vertebra to form the loop. The movement of the carrier along the first guiding path can be a push movement or a pull movement. However, alternatively, the filament can also e.g. be initially arranged on the first transfer port of the first lever, and by rotating the carrier, the carrier takes (temporarily) hold of the filament at the first transfer port and from there carries the filament along the first guiding path to the second transfer port. At the second transfer port, the hold of the filament is then transferred from the sickle to the second lever. At the same time, the first lever preferably maintains hold on the filament, such that a hold on two different transfer locations on the filament on both levers is achieved after the transfer back from carrier at the second transfer port. Hence, both levers can subsequently be displaced along the respective second guiding direction to form the loop.

[0025] Depending on the application, the sickle is interconnectable or interconnected in a pivotable manner to the first lever and / or second lever. Interconnectable is hereby understood as the sickle being directly interconnected to the first lever and / or second lever or indirectly interconnected via further elements, arranged between the sickle and the first lever and / or second lever. Advantageously, the sickle is interconnectable or interconnected to the first lever and / or second lever via a swivel arm of the sickle. Hereby, the carrier may be arranged on the swivel arm, preferably on a distal end of the swivel arm. Advantageously the carrier further extends circumferentially around the first pivot axis. Thus, in an interconnected state of the swivel arm to the first and / or second lever, the carrier extends around the first pivot axis such that by pivoting the swivel arm around the first pivot axis the carrier (and thus the filament) is rotated towards the transfer ports on a circular first guiding path. The circular path of the carrier thereby ensures a minimal invasion of the surrounding tissue during the insertion of the carrier carrying the filament. Depending on the application, also variation may exist, whereby the first pivot axis is displaceable during rotation of the sickle around said pivot axis. P28785PC00 15.08.2025

[0026] 6 / 41

[0027] To prevent unnecessarily deep penetration of the sickle, the device can comprise a stop for the sickle in one transfer position. The stop may e.g. be a shoulder arranged on the first and / or second lever for abutting against the sickle, respectively the swivel arm in the transfer position.

[0028] The swivel arm is preferably spaced a distance apart from the first and / or second lever along the first pivot axis. Alternatively or in combination, the sickle may be spaced a distance apart from the first and / or second lever along the first pivot axis in the mounted position. In particular, for example, the sickle may be spaced a distance (e.g. at least 1 mm, particularly at least 5 mm, or even at least 10 mm) apart from the longitudinal section of the first lever and / or from the longitudinal section of the second lever along the first pivot axis in the mounted position. Hence, in the mounted position of the sickle, a receiving room for the vertebrae to be looped is formed between the carrier and the lateral sections and (parts of) the longitudinal sections of the respective levers.

[0029] Depending on the application, the first lever, the second lever and the swivel arm may be interconnectable to each other in different ways. For example, in some embodiments, the swivel arm comprises a first interface for releasably engaging with second interface arranged on the first lever. Typically, when the first interface and the second interface are engaged with each other, the swivel arm is rotatable with respect to the first lever around the first pivot axis. In some embodiments, the first interface comprises a pin and the second interface comprises a recess or groove for receiving the pin. For example, the groove may be a groove extending circumferentially around the first pivot axis. These embodiments are advantageous because they allow easy mounting and dismounting of the first lever, the second lever and the swivel arm. The pin forming the first interface may optionally be arranged on an inner surface of a first sleeve of the swivel arm. P28785PC00 15.08.2025

[0030] 7 / 41

[0031] It is particularly advantageous to use the swivel arm for securing or releasing the interconnection between the first and second lever because this minimizes the manual operations required for mounting, while also ensuring a secure assembly in the mounted position. For example, in some embodiments, when the second lever is interconnected to the first lever and the first interface is engaged with the second interface, the second lever is blocked from being disconnected from the first lever. For example, it may be the swivel arm that blocks the second lever from being disconnected from the first lever in the mounted position.

[0032] In some embodiments, the swivel arm comprises a third interface for releasably engaging with a fourth interface arranged on the second lever. In some embodiments, when the third interface and the fourth interface are engaged with each other, the engagement between the third and fourth interface blocks the second lever from being disconnected from the first lever.

[0033] Depending on the application, the interfaces between the first lever and / or the second lever and / or the swivel arm may be realized in different ways. In some embodiments, the first lever and the second lever form together a pivoting shaft in the mounted position. The swivel arm may optionally comprise a first sleeve (e.g. a first annular sleeve) mountable onto the pivoting shaft formed in the mounted position by the first and second lever. Typically, the pivoting shaft is arranged coaxially with respect to the first sleeve in the mounted position. Preferably, the pivoting shaft and the first sleeve are rotatable with respect to each other about the first pivot axis in the mounted position. In some embodiments, the first sleeve circumferentially encompasses in the mounted position the pivoting shaft. The pivoting shaft typically extends parallel to, preferably along, the first pivot axis. The embodiments described in this paragraph have the advantage of allowing simple mounting and dismounting of the first lever, the second lever and the swivel arm, P28785PC00 15.08.2025

[0034] 8 / 41 while still ensuring that all three parts may be rotatable with respect to each other about the first pivot axis.

[0035] Preferably, the first lever may form a first circumferential segment of the pivoting shaft, and the second lever may form a second circumferential segment of the pivoting shaft, different from the first circumferential segment. This allows to establish a blockade in the mounted position where the first and second lever are blocked by the swivel arm from being disconnected from each other in the mounted position.

[0036] To accommodate the filament, the carrier can comprise a mounting slot for at least partially receiving the filament. Depending on the application, the mounting slot can extend through the carrier as a through opening. However, the mounting slot can also be designed to be open towards a side of the carrier, e.g. an outer side of the carrier facing away from the first pivot axis or towards an inner side of the carrier facing towards the first pivot axis. If the carrier extends around the first pivot axis, the mounting slot can also be curved.

[0037] For reliably carrying the filament without risk of losing the same, the device of the present disclosure preferably comprises a front tip releasably mountable on a front end of the carrier. The front tip is preferably interconnected or interconnectable to the filament. For example, the front tip may be a front tip of the filament, i.e. the front tip may be integrally formed with the filament, e.g. the front tip may be a portion of the filament. Alternatively, the front tip may be separate or separable from the filament. For example, the front tip may be a separate part that is interconnectable, preferably releasably interconnectable, to the filament.

[0038] In some embodiments, the carrier comprises at its front end a front recess for receiving at least partially the front tip. Alternatively or in combination, the front tip may comprise P28785PC00 15.08.2025

[0039] 9 / 41 a rear recess for at least partially receiving the front end of the carrier. The rear recess may for example be a blind hole or a through-hole. It is particularly advantageous for the rear recess to be a through-hole extending through the front tip, such that the front tip is slipped over the front end of the carrier. This holds the front tip firmly in place and reduces the risk of the front tip being pushed off the front end

[0040] Furthermore, depending on the application, the front tip may be made of a single piece or of multiple interconnected pieces, including e.g. a first elastically deformable piece and a second piece which may optionally be essentially undeformable. The second piece may for example be used to increase structural rigidity and stability, while the first piece may be used to enable efficient filament shuttling by elastic deformation

[0041] The front tip advantageously has at least partly a spherical shape. The spherical front tip serves to push the tissue to the side with minimal tissue damage during insertion of the carrier. Depending on the application, the filament may further comprise a rear tip. Equivalently, the carrier can further comprise at a rear end a rear recess for receiving the rear tip. The rear recess is in particular useful, if the filament is flexible in the extension direction of the filament. In that case, the filament is clampable between the front and the rear recess. However, alternatively the filament may also be clamped by an (alternative) clamping means on the rear end of the carrier or on the distal end of the swivel arm. The clamping member can e.g. be a screw clamping the filament in a respective recess. This placement is advantageous, as the clamping member is easily assessable in the transfer position of the carrier. For applications with a clamped filament, the mounting slot is preferably designed open towards the outer side of the carrier.

[0042] As explained above, the filament may be an auxiliary filament and as such part of the device. In other words, the device may comprise the filament. The (auxiliary) filament P28785PC00 15.08.2025

[0043] 10 / 41 may optionally comprise a front tip and / or a rear tip. In the mounted position of the filament on the carrier, the front tip preferably extends from a front end of the carrier and has a larger diameter than the front end of the carrier.

[0044] In the (at least one) transfer position of the carrier, the carrier is docked to one, preferably both transfer ports of the first and second lever. The first transfer port and / or the second transfer port, thereby serve to transfer the hold on the filament from the carrier to the respective levers, as described below. After the transfer of the hold on the filament in the transfer position, the carrier can be disengaged from the transfer port(s) and again be moved, in particular rotated, backwards into the initial position. Initiating the reverse movement (back towards the initial position) can automatically discharge the filament from the carrier. This can be achieved by using a front tip interconnected or interconnectable to the filament, which front end has a larger diameter than the front end of the carrier, as described above.

[0045] It is preferable to use elastic deformation of the front tip and / or of the opening of the first and / or second transfer port to automatically discharge the filament from the carrier. For example, in some embodiments, the front tip is elastically deformable between an undeformed state and a deformed state, wherein in the undeformed state the front tip has a larger diameter than the opening of the first transfer port and / or than the opening of the second transfer port, and in the deformed state the front tip has a smaller diameter than the opening of the first transfer port and / or than the opening of the second transfer port. This allows the front tip to be passed through the opening by exerting an additional force to cause elastic deformation. Once the front tip has passed through the opening, the front tip assumes the undeformed state again, which allows the front tip to be held back or otherwise retained by the opening, thereby preventing the front tip from passing through the opening in the reverse direction again (at least not without repeated elastic deformation). During application, the filament is typically loosened after the front tip has P28785PC00 15.08.2025

[0046] 1 1 / 41 been passed through the opening. Thus, when the sickle is then moved in a reverse direction, the front tip is held back by the opening and released from the front recess of the carrier. It is understood that it is also possible for the opening to be elastically deformable, in addition to or alternatively to the front tip being elastically deformable. Therefore, alternatively or in combination, in some embodiments, the opening of the first transfer port and / or the opening of the second transfer port is elastically deformable between an undeformed state and a deformed state, wherein in the undeformed state the front tip has a larger diameter than the opening of the first transfer port and / or than the opening of the second transfer port, and in the deformed state the front tip has a smaller diameter than the opening of the first transfer port and / or than the opening of the second transfer port. More generally, in some embodiments, the front tip and / or the first transfer port and / or the second transfer port is elastically deformable between an undeformed state and a deformed state, wherein in the undeformed state the front tip is not able to pass through (e.g. has a larger diameter than) the opening of the first transfer port and / or through (e.g. has a larger diameter than) the opening of the second transfer port, and in the deformed state the front tip is able to pass through (e.g. has a smaller diameter than) the opening of the first transfer port and / or through (e.g. has a smaller diameter than) the opening of the second transfer port.

[0047] Alternatively or in addition, an ejection unit may be used to eject the filament in the transfer position of the carrier. The ejector unit may e.g. comprise at least one ejector pin extending at least partially along the first and / or second lever. The ejector pin(s) serves to push the front tip out of the front recess and / or the rear tip out of the rear recess to resolve the clamping of the filament.

[0048] When the carrier is again in the initial position, the hold on the filament has been transferred to one or both transfer ports of the respective levers. For a reliable hold on the filament, the first and / or second lever advantageously comprise a retaining element for P28785PC00 15.08.2025

[0049] 12 / 41 taking over the hold on the filament, in particular on the transfer location on the filament. The retaining element may comprise a clamping element and / or a gripping element. The retaining element can e.g. be a hook or a contractible loop. The hook can extend into the opening of the transfer port, in particular on a side of the opening facing towards the distal end of the respective lateral section. This allows the hook to grab the filament by pulling back the lever after the filament has passed through the transfer port and the carrier is pulled back towards the initial position. In addition or alternatively, the retaining element can be a contractible loop extending in an open position around the first and second transfer port. The contractible loop can be contracted into the closed position to grab the filament. The contractible loop can even be contracted, before the carrier is pulled back, such that, when a larger front tip is used, said front tip cannot pass the contracted loop(s). This has the advantage of a very reliable transfer mechanism with a reduced risk of losing the filament.

[0050] Depending on the application, the respective retaining element can be arranged on a traction cord extending at least partially along the first or second lever. The traction cord can be formed like a lasso with only one section of the traction cord extending along the lever towards an (operable) end of the traction cord, with the retaining element arranged on the opposite end of the traction cord. Alternatively, two sections of the traction cord extending towards a first and a second end of the traction cord can extent along the lever, with the retraining element placed on or be part of the traction cord, between these two sections. One or both ends of the traction cord may be interconnected to an activation element, as explained in more detail below.

[0051] Depending on the application, the at least one traction cord can be arranged at least partially in a second sleeve. The second sleeve thereby serves to protect the traction cord. Furthermore, if the traction loop extends with two sections along the respective lever, a distal end of the second sleeve arranged at the transfer port can serve as an P28785PC00 15.08.2025

[0052] 13 / 41 eyelet for the traction cord. The purpose of the second sleeve, respectively the eyelet is therefore the creation of a sufficiently large but sufficiently small contractible loop.

[0053] It is understood that the terms first sleeve and second sleeve are used primarily to ter- minologically distinguish between the two sleeves. They are independent of each other. For example, in embodiments, in which the device comprises the second sleeve, the embodiment may or may not also comprise the first sleeve.

[0054] As pointed out above, the device may comprise an activation element to pull the traction cord and for contracting the contractible loop of the traction cord around the filament. The activation element can hereby have two positions, an open position, where the contractible loop is in an open position and a closed position, where the contractible loop is in the closed position. At least one end, preferably both ends of the traction cord can be attached to the activation element. In the closed position of the activation element, an attachment location, where the at least one end of the traction cord is interconnected to the activation element, is displaced away from the respective transfer port. Hence, when the activation element is moved from the open position in the closed position the traction cord is pulled towards the activation element and the loop is contracted. Alternatively or in addition, the activation element may comprise a lever surface, which engages with the traction cord in the closed position. When the activation element is moved from the open position to the closed position, the engagement of the traction cord with the lever surface pulls the traction cord towards the activation element so that the contractible loop is closed. Other technical solutions are also possible.

[0055] Depending on the application, it may be advantageous for the retaining element to be actuated automatically when the sickle is pivoted into the transfer position, e.g. when the sickle passes through the opening of the first transfer port and / or through the opening of the second transfer port. For example, the front tip and / or the opening of the first transfer P28785PC00 15.08.2025

[0056] 14 / 41 port and / or the opening of the second transfer port may be elastically deformable as described above. In some embodiments, the retaining element is automatically actuated when the sickle is pivoted into the transfer position where the carrier is docked to the first and / or second transfer port. Thereby, once the retaining element is automatically actuated, the hold on the filament may automatically be taken over by the first and / or second transfer port. For example, in some embodiments, the clamping element is elastically deformable and / or the gripping element is elastically deformable and / or the front tip is elastically deformable. More generally, for example, the retaining element may be elastically deformable and / or the front tip may be elastically deformable. As outlined hereinbefore, the front tip is interconnected or interconnectable to the filament, and is typically received at least partially by a front recess at a front end of the carrier.

[0057] After the transfer of the hold on the filament from the sickle to the respective levers, the levers can be displaced at least in parts to pull the filament around the vertebrae. This is usually done manually by the practitioner. By displacing the levers, in particular in direction of the second guiding path, the filament is pulled at the two transfer locations of the filament around the vertebrae to form a (non-closed) loop. During the displacement of the levers in direction of the second guiding path, the filament is secured on the respective transfer location on which said filament is pulled. The transfer locations can be arranged spaced a distance apart from a front end and / or a rear end of the filament. Therefore, when the filament is pulled along the second guiding path, the sections of the filament adjacent to the transfer locations may lie side-by-side with the transfer location arranged between and being pulled forward. The levers can therefore be either displaced at least in parts together or, if the levers are interconnectable / disconnectable from each other, displaced at least in parts separately from each other in a disconnected state of the levers. P28785PC00 15.08.2025

[0058] 15 / 41

[0059] A joint displacement of the levers can be easily performed if the levers are integrally connected. The first and second lever can e.g. be connected to each other on the proximal end of the longitudinal sections of the respective levers. Thereby, the longitudinal sections may extend parallel to each other and / or lateral sections may extend parallel to each other. The integrally connected levers have thus the shape of a fork. This variant is particularly useful for applications in which the second guiding path extends essentially perpendicular to the extension direction of the spine.

[0060] However, the guidance of the filament in the second guidance direction is preferably done in a disconnected or even disassembled state of the levers, as explained hereinafter in more detail. Therefore, the first lever may be interconnectable to, respectively disconnectable from the second lever. This has the advantage that the looping of the filament can be achieved more easily in the disconnected state. An interconnection can further allow to adjust the position of the transfer ports with respect to each other, such that differently sized vertebrae can be looped by the same device. Therefore, the first lever is advantageously interconnectable to the second lever in a displaceable and / or pivotable manner around a second pivot axis such that a distance between the transfer ports is adjustable. In some variants, the first and second pivot axis extend essentially parallel to each other and are interspaced from each other. For example, in some variants, the second pivot axis may be arranged nearer to the first and / or second transfer port than the first pivot axis in the transfer position. However, for a compact design, the second pivot axis is preferably coaxially arranged to the first pivot axis. Thus, in an interconnected state of the first and second lever, the levers are preferably interconnected to each other such that only a rotary movement relative to each other about the second pivot axis is possible. P28785PC00 15.08.2025

[0061] 16 / 41

[0062] Furthermore, the first and second levers are preferably arranged crosswise with respect to each other when viewed from the direction of the second pivot axis. Hereby, the second pivot axis can e.g. extend though the respective longitudinal sections of both levers in the interconnected state or extend between the longitudinal sections in the interconnected state. The crosswise arrangement allows for an easy adjustment of the distance of the transfer ports of the respective levers with respect to each other. Thus, the device is adjustable to the individual width of the one or more vertebrae to be looped by the filament. This setup is in particular useful for an application, in which the first guiding path extends in direction of the extension of the spine, and the second guiding path extends between the vertebrae, in particular the spinous processes of the vertebrae. Hence, this application can be used for all dynamic fixation of two adjacent vertebrae. In some embodiments, the first lever and the second lever cross each other when viewed from the direction of the first pivot axis. More specifically, in some embodiments, the longitudinal section of the first lever and the longitudinal section of the second lever may cross each other when viewed from the direction of the first pivot axis. Thus, for example, the first lever and the second lever may for example form an X in the mounted position when viewed from the direction of the first pivot axis.

[0063] Depending on the application, it may be advantageous to realize the first and second lever in such a way that the device can be operated even through small incisions or other small body openings. For example, it may be advantageous for the first and second lever to form an X in the mounted position when viewed from the direction of the first pivot axis as described above. Such an X shape has a minimal width in a central section where the first and second lever may enter into the skin through an incision. X shapes or related shapes can for example be realized when the first lever and the second lever cross each other and / or contact each other and / or approach each other. It is understood that the position of crossing or contact or approach does not need to be central as is the case in a typical X. P28785PC00 15.08.2025

[0064] 17 / 41

[0065] In some embodiments, the first lever and the second lever cross each other and / or contact each other at an insertion position arranged between a proximal end of the first lever and a distal end of the first lever in the mounted position. Preferably, the first lever and the second lever cross each other and / or contact each other at an insertion position which is arranged such that, in a cross-section orthogonal to the first pivot axis, a distance between the insertion position and the first transfer port is smaller than a distance between the first pivot axis and the first transfer port in the mounted position. These embodiments may alternatively or in combination also apply to the second lever. Thus, alternatively or in combination, the first lever and the second lever may cross each other and / or contact each other at an insertion position arranged between a proximal end of the second lever and a distal end of the second lever in the mounted position. Preferably, the first lever and the second lever cross each other and / or contact each other at an insertion position which is arranged such that, in a cross-section orthogonal to the first pivot axis, a distance between the insertion position and the second transfer port is smaller than a distance between the first pivot axis and the second transfer port in the mounted position.

[0066] In some embodiments, in the mounted position of the first and second lever, a distance between the first lever and the second lever first decreases from the proximal end of the first lever towards the distal end towards the first lever, and then increases again.

[0067] In some embodiments, a first outer side of the longitudinal section of the first lever which first outer side faces the longitudinal section of the second lever in the mounted position, is convex (or at least comprises a convex section). Alternatively or in combination, a second outer side of the longitudinal section of the second lever which second outer side faces the longitudinal section of the first lever in the mounted position, is convex (or at least comprises a convex section). As an exemplary illustrative embodiment, the longitudinal section of the first lever may have a ) shape or a > shape when viewed from the P28785PC00 15.08.2025

[0068] 18 / 41 direction of the first pivot axis. Alternatively or in combination, the longitudinal section of the second lever may have a ( shape or a < shape when viewed from the direction of the first pivot axis. When combining these embodiments, for example, the longitudinal section of the first lever and the longitudinal section of the second lever may in the mounted position together form a )( shape or a >< shape when viewed from the direction of the first pivot axis. The embodiments described in this paragraph are advantageous because they allow the device to be operated even through small incisions.

[0069] The disconnection of the levers is preferably done in an easy manner without unnecessary displacement. Advantageously, the first and the second lever are thereby interconnectable to, respectively disconnectable from each other in an interconnection direction parallel to the first pivot axis. Alternatively or in combination, in some embodiments, the first lever and the second lever are interconnectable to each other in an interconnection direction orthogonal to the first pivot axis and / or orthogonal to the second pivot axis. The interconnection direction may be chosen in accordance with the anatomical environment and such that the size of the incision required for insertion of the first and second lever is minimized. For example, an interconnection direction orthogonal to the first pivot axis and / or orthogonal to the second pivot axis was found particularly advantageous because it allows the first and second lever to be disconnected in such a way that the position of the first transfer port and the position of the second transfer port can be essentially maintained.

[0070] For the pivotable interconnection, the device may comprise at least one pivot joint. The pivot joint can comprise multiple interconnectable sections, each section being arranged on the first lever and / or the second lever and / or the sickle. In an interconnected state of the sections, the sections are thereby preferably fixated with respect to each other in direction of the first and second pivot axis, while still being rotatable with respect to each other. An alternative but also advantageous interconnection mechanism is achieved, if P28785PC00 15.08.2025

[0071] 19 / 41 the pivot joint comprises a pivoting shaft arranged on the sickle and / or the swivel arm, wherein the first and second lever are mountable on the pivoting shaft. Thus by mounting, respectively interconnecting the sickle to the levers, the levers are interconnected to each other. This has the advantage, that on one hand, the levers are automatically disconnected from each other, when the sickle is dismounted, and on the other hand, unnecessary movement of the levers to disconnect the same from each other is avoided. Therefore, both levers can e.g. have an opening to mount the levers on the pivoting shaft. The openings may be arranged on the levers or on a joint structure extending from the first or the second lever.

[0072] Depending on the application, the interconnection of the sickle to the first and / or second lever can be achieved via further elements, arranged between the sickle and the first lever and / or second lever. The device may e.g. comprise a guiding structure for guiding the sickle and for interconnecting the sickle to the first and / or second lever. The guiding structure can e.g. comprise at least one guiding opening or at least one guiding slot, each having a guiding interface, which corresponds to a respective guiding interface arranged on the sickle, and in particular on the carrier. The sickle and in particular the carrier can be inserted in the guiding opening or guiding slot such that the corresponding guiding interfaces engage with each other and the sickle is guided around the first pivot axis in a pivotable manner into the transfer position. Hence, the at least one guiding opening or at least one guiding slot preferably extend around the first pivot axis. Furthermore, preferably more than one guiding opening or guiding slot are present to ensure a more precise movement of the carrier along the first guiding path to reliably meet the at least one transfer port.

[0073] To facilitate the looping of the filament under tension the device may further comprise a tension bar to exert a compressive force on the vertebrae to be looped together. Hereby, the first and second lever can be connectable via the tension bar to exert a force on the P28785PC00 15.08.2025

[0074] 20 / 41 first and second lever and via the first and second lever on the respective vertebrae. Depending on the design of the levers, the tension bar can thereby exert a compressive or tensile force on the levers, which in turn exert the compressive force on the vertebrae. The compressive or tensile force thereby brings the respective vertebrae closer together for the looping process. The distance between the first and second transfer port can be changed as a result of the compressive or tensile force respectively. Preferably, the tension bar interconnects the respective longitudinal sections, and is in particular arranged in the longitudinal direction of the respective levers between the proximal end and the second pivot axis. The closer the placement towards the proximal end, the more the lever force can be optimally utilized.

[0075] The tension bar is thereby designed to interconnect the first and the second lever along a tension axis at respective connection locations and by operating the tension bar, displacing the connection locations, respectively the levers along the tension axis closed towards each other. Therefore, the tension bar may have a thread engageable to a counter-thread arranged on either one of the (first or second) levers. Depending on the design of the levers, the tension bar can be attached in a pivotable manner around a third pivot axis to the remaining (first or second) lever. The third pivot axis thereby preferably extends parallel to the first and / or second pivot axis. In direction of the tension axis, the tension bar is further preferably directly or indirectly connected to the remaining levers. The tension bar may e.g. feature at least one shoulder abutting in the mounted position against the remaining lever to transfer the force. Alternatively, a spring element may indirectly connect the tension bar and the second lever in the direction of the tension axis to prevent the compression force on the vertebrae from being set too high.

[0076] For an optimally adjustable compression force matched to the filament, the tension bar may further comprise a read out unit to read out the exerted compressive force. The read out unit can e.g. feature a display or a different type of force indication. P28785PC00 15.08.2025

[0077] 21 / 41

[0078] To properly loop the filament while exerting the compression force, the respective levers may each be disassembled into a clamping portion and an operation portion. The operation portion can be interconnected to the clamping portion by interconnection elements, such as e.g. a latch. Hereby each clamping portion preferably features the respective positioning interface and is attachable to the tension bar. The respective operation portions can feature (partly or fully) the transfer ports and / or retaining element and / or the second sleeve and / or the traction cord. In the disassembled state of the respective levers into the clamping portion and the operation portion, the clamping portion serves to maintain the compression force and the operation portion serves to be displaced by the practitioner to loop the filament. The operation portion(s) may be arranged at least partially in a recess within the clamping portion. The recess may extend along the longitudinal section and / or the lateral section of the respective lever. The recess further serves to drag the filament in the second guiding direction after disconnecting the operational portion from the clamping portion.

[0079] It is to be understood that both the foregoing general description and the following detailed description present embodiments, and are intended to provide an overview or framework for understanding the nature and character of the disclosure. The accompanying drawings are included to provide a further understanding, and are incorporated into and constitute a part of this specification. The drawings illustrate various embodiments, and together with the description serve to explain the principles and operation of the concepts disclosed.

[0080] BRIEF DESCRIPTION OF THE DRAWINGS

[0081] The herein described disclosure will be more fully understood from the detailed description given herein below and the accompanying drawings which should not be considered limiting to the disclosure described in the appended claims. The drawings are showing: P28785PC00 15.08.2025

[0082] 22 / 41

[0083] Fig. 1 A variation of the device for guiding a filament around one or more vertebrae according to the disclosure in a front view and in a mounted position;

[0084] Fig. 2 The device according to Fig. 1 in a perspective view;

[0085] Fig. 3 The first and second lever of the device according to Fig. 1 in a disconnected state and in a perspective view;

[0086] Fig. 4 The levers according to Fig. 3 in an interconnected state in a perspective view;

[0087] Fig. 5 The device with a carrier interconnected to the levers according to Fig. 4 in an initial position in a front view; Fig. 6 The device according to Fig. 5 in a transfer position in a front view;

[0088] Fig. 7 The device according to Fig. 6 in the transfer position in a perspective view from the back;

[0089] Fig. 8 The device according to Fig. 6 with the carrier pulled back from the transfer position and a discharged filament in a front view; Fig. 9 The device after removal of the sickle with the filament held by the interconnected levers in a front view;

[0090] Fig. 10 The device according to Fig. 9 in a perspective view from the back;

[0091] Fig. 11 The device according to Fig. 10 in a disassembled state in a perspective view from the back; P28785PC00 15.08.2025

[0092] 23 / 41

[0093] Fig. 12 A second variation of the device for guiding a filament around one or more vertebrae according to the disclosure in a perspective view

[0094] Fig. 13 A further variation of the device for guiding a filament around one or more vertebrae according to the disclosure in a perspective view (top right) and in a mounted position;

[0095] Fig. 14 The device according to Fig. 13 in a front view and in a mounted position;

[0096] Fig. 15 The device according to Fig. 13 in another perspective view (top left) and in a mounted position;

[0097] Fig. 16 The device according to Fig. 13 in an exploded view (with Figs. 16B and 16C showing close-up views of sections A and B of Fig. 16A, respectively);

[0098] Fig. 17 The device according to Fig. 13 (shown in Fig. 17A in an exploded view where the levers are shown from a perspective front view, and the sickle is shown from a perspective back view; Fig. 17B shows the sickle from a back view; Fig. 17C shows a close-up perspective view of section C of Fig. 17A);

[0099] Fig. 18 The device according to Fig. 13 during use in a first step before mounting of the front tip (Fig. 18A shows the entire device and Fig. 18B shows a closeup view of section D of Fig. 21 A);

[0100] Fig. 19 The device according to Fig. 13 during use in a second step where the sickle has been docketed to the first transfer port but not yet to the second transfer port; P28785PC00 15.08.2025

[0101] 24 / 41

[0102] Fig. 20 The device according to Fig. 13 during use in a third step where the sickle has been docketed to the first and second transfer port;

[0103] Fig. 21 The device according to Fig. 13 during use in a fourth step where the sickle has been partially retracted and the front tip has been retained by the membrane of the second transfer port (Fig. 21 A shows the entire device and Fig. 21 B shows a close-up view of section E of Fig. 21 A).

[0104] DESCRIPTION OF THE EMBODIMENTS

[0105] Reference will now be made in detail to certain embodiments, examples of which are illustrated in the accompanying drawings, in which some, but not all features are shown. Indeed, embodiments disclosed herein may be embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will satisfy applicable legal requirements. Whenever possible, like reference numbers will be used to refer to like components or parts.

[0106] Figure 1 and Figure 2 show a variation of the device 1 for guiding a filament 2 around one or more vertebrae 3 according to the disclosure in different views in a mounted position. The illustrated device 1 thereby comprises a first lever 4 having a first transfer port 9 and a second lever 5 having a second transfer port 10 as well as a sickle 6. The sickle 6 further comprises a swivel arm 7 interconnectable to the first lever 4 and / or second lever 5 in a pivotable manner around a first pivot axis 1 1 , and a carrier 8 extending in a mounted position from a distal end 25 of the swivel arm 7 circumferentially around the first pivot axis 1 1 . P28785PC00 15.08.2025

[0107] 25 / 41

[0108] In the shown variation, the first and second lever 4, 5 are separate entities interconnectable and disconnectable from each other. In the shown example, the two levers 4, 5 are interconnectable in a pivotable manner around a second pivot axis 12, however also other possibilities exists. The first and second pivot axis 1 1 , 12 further lie on top of each other, resulting in a very compact design. The first and second pivot axis 11 , 12 hereby extend between the first and second lever 4, 5 arranged crosswise with respect to each other. The device 1 can further comprise a tension bar 30 interconnecting the two levers 4, 5, in particular as shown in the area of a proximal end of the respective levers 4, 5. The tension bar 30 is mounted pivotable around a third pivot axis to the first lever 4. The third pivot axis extends thereby parallel to the first and / or second pivot axis 11 , 12. The tension bar 30 is interconnected to the second lever 5 by means of a thread.

[0109] Figure 3 thereby illustrates the first and second lever 4, 5 in a disconnected state, wherein Figure 4 illustrates the interconnected state of the levers 4, 5. Both levers 4, 5 have a longitudinal section 13 and a lateral section 14 extending from a respective distal end of the longitudinal section 13 in a lateral direction. Handles 15 are arranged on a proximal end of the respective longitudinal sections 13. A mounting structure 16 extends from the longitudinal sections 13 for interconnecting the levers 4, 5 with each other. The mounting structure 16 of the second lever 5 thereby features a pivoting shaft 28 and the mounting structure 16 of the first lever 4 features an opening 29 through which the pivoting shaft 28 extends in the interconnected state, as illustrated by Figure 4. In the interconnected state, the levers 4, 5 are arranged crosswise with respect to each other. On each distal end of the lateral sections 14 of the levers 4, 5 a transfer port 9, 10 is located. The transfer ports 9, 10 each comprise an opening 17 for receiving the carrier 8 of the sickle 6 in a transfer position of the sickle 6.

[0110] The transfer of the filament 2 from the carrier 8 to the levers 4, 5 is explained in more detail in context of Figure 5 to Figure 9. In Figure 5 the sickle 6 is interconnected to the P28785PC00 15.08.2025

[0111] 26 / 41 levers 4, 5 and in an initial position, in which the sickle 6 is generally outside of the patient’s body 27 during the procedure. The sickle 6 is interconnected to the first lever 4 though the opening 29 of the second lever 5. Hence by interconnecting the sickle, the levers 4 ,5 are interconnected with each other. During the procedure, the levers 4, 5 are partially inserted into the patient’s body 27 in the initial position with the lateral sections 14 of the levers 4, 5 placed adjacent to the (one or more) vertebrae 3 to be looped. The filament 2 is placed inside a mounting slot 21 of the carrier 8, with the front tip 26 being visible at a front end 22 of the carrier 8. After an incision of the skin is performed, the sickle 6 is pivoted and the carrier 8 at least partially inserted into the tissue, with the front tip 26 of the carrier 8 pushing the tissue away, thereby building a circular first guiding path for the carrier 8. When the sickle 6 reached its transfer position, as displayed in Figure 6 and 7, the carrier 8 has reached and is docked to both transfer ports 9, 10 of the levers 4, 5.

[0112] After the docking, the filament 2 can be discharged from the carrier 8. In the shown example, this can simply be done by rotating the sickle 6 backwards, such that due to the friction of the front tip 26 and the surrounding tissue, the filament 2 remains in the tissue and in the transfer ports 9, 10, as illustrated in Figure 8 to Figure 10.

[0113] However, for a more secure transfer of the filament 2 with reduced risk of losing the filament 2, at least one traction cord 20 may be used. In the shown example, a traction cord 20 for each lever 4, 5 is present. The traction cords 20 extend along the respective levers 4, 5 forming a contractible loop 32 extending in an open position around the first and second transfer port 9, 10, to allow the sickle 6 being docked in the transfer position. This is best seen in Figure 7 and Figure 10. The contractible loop 32 can be contracted to grab the filament 2 and / or to form a loop around the sickle 6. When rotating the sickle 6 backwards (illustrated in Figure 8), the front tip 26 and thus the filament 2 will remain within the loop 32 of the traction cord 20, as illustrated in Figure 9 and Figure 10. The P28785PC00 15.08.2025

[0114] 27 / 41 larger front tip 26 with respect to the front end 22 of the carrier 8 reduces the risk of losing the filament 2. The device 1 may further comprise one or two activation elements 34 to pull the respective traction cords 20 into a contracted position. In the shown example, only one activation element 34 is shown on the first lever 4, however an equivalent activation element can also be used on the second lever 5.

[0115] As can be seen in Figure 10, the at least one traction cord 20 can be arranged at least partially in a second sleeve 33 attachable and detachable from the rest of the respective lever 4. The second sleeve 33, the traction cord 20 and the activation element 34 thus form an operation portion 19 of the respective lever, with which a closed loop of the filament 2 can be generated by the practitioner later on in the procedure. The remaining part of the levers form the respective clamping portions 18, which can remain in position clamping the vertebrae 3 with the help of the tension bar 30, if present. A disassembled state of the levers 4, 5 in respective operation portions 19 and clamping portions 18 is illustrated in Figure 11 . As can be seen both clamping portions 18 are still interconnected by the tension bar 30 (here shown only schematically). The operation portions 19 of the respective levers are disconnected from the interconnection members 36 arranged on the clamping portions 18. Both operation portions 19 in the disconnected state can be operated independently from each other. Depending on the application, the operation portions 19 may each comprise a second sleeve and optionally a handle. The operation portion are thereby arranged in the mounted position in a recess within the clamping portion. The recess extends along the longitudinal section and / or the lateral section of the respective lever, as can be seen in Figure 10. The recess on the lateral sections may be open towards the respective other levers.

[0116] Figure 12 illustrates a second variation of the device 1 according to the disclosure. The device 1 comprises a first and a second lever 4, 5 integrally joined at the respective P28785PC00 15.08.2025

[0117] 28 / 41 proximal ends of the longitudinal sections 13 and merging into a handle 15. Lateral section 14 of the levers 4, 5 extend from each distal end of the longitudinal sections 13. On each lateral section 14 a transfer port 9, 10 is arranged. In the present example, the transfer ports 9, 10 are each designed as an opening 17 in the lateral section 14 through which the carrier 8 extends in the transfer position. In the opening 17, also retaining elements, such as hooks or other means to better secure the hold on the filament 2, may be present. In a transition area between the proximal ends of the levers 4, 5 and the handle 15, a pivoting shaft 28 extends in a direction of a first pivot axis 11 .

[0118] On the pivoting shaft 28 the sickle 6 is (removably) mounted. The sickle 6 is spaced a distance apart from the levers 4, 5 in the area of pivoting shaft 28. Also in this variation of the disclosure, the sickle 6 comprises a swivel arm 7 and a carrier 8 arranged on the swivel arm 7. A curved mounting slot 21 is arranged within the carrier 8, designed open towards an outer side of the carrier 8 facing away from the first pivot axis 11 . The device 1 may comprises an (auxiliary) filament 2 with a front tip 26. The front tip 26 is placed in a front recess 24 of the front end 22 of the carrier 8. At the rear end 23 of the carrier 8 or at the swivel arm 7, the filament 2 may be fixed and / or tensioned by a clamping member 35 such as e.g. by means of screws. If screws are present for tensioning, these have to be loosened before rotating the carrier 8 backwards for discharging of the filament 2. The shown example further discloses a stop 31 for the sickle 6 in the transfer position. The stop 31 (widening of the cross-section of the carrier 8) is hereby arranged on the carrier 8, which abuts against the opening 17 of the transfer port 9 of the first lever 4.

[0119] Figures 13-21 show a further embodiment of the device 1 described herein. The device is shown in a mounted position in Figs. 13-15 (specifically in perspective views in Figs. 13 and 15 and in front view in Fig. 14), and in an exploded view in Figs. 16A-16C (with Fig. 16A showing the full device and Figs. 16B and 16C showing close-up views of sections A and B of Fig. 16A). Furthermore, Fig. 17 illustrates how a swivel arm 7 is mounted P28785PC00 15.08.2025

[0120] 29 / 41 onto a first and second lever 4, 5 (with Fig. 17A showing a perspective view of the full device, Fig. 17B showing a back view of the sickle and with Fig. 17C showing a closeup view of section C of Fig. 17A). Finally, Figs. 18-21 illustrate different steps of the device in use. In the following, the device 1 will be described with reference to Figs. 13- 21 . Specific reference will be made to certain figures which illustrate selected features of the device in more detail.

[0121] The device 1 illustrated in figures 13-21 comprises a first lever 4 and a second lever 5 which are interconnected to each other in a pivotable manner around a second pivot axis 12. The device further comprises a sickle 6 which is rotatably interconnected to the first and second lever 4, 5 through intermediacy of a swivel arm 7. More specifically, the sickle 6 is connected with a rear end 23 to a distal end 25 of the swivel arm 7. The swivel arm 7 is pivotably connected to the first lever 4, such that the swivel arm 7 and the sickle 6 are pivotable about a first pivot axis 11. In the illustrated embodiment, the first pivot axis 11 coincides with the second pivot axis 12.

[0122] The mounting of the device is illustrated in particular in Figs. 16-17. For mounting, the first lever 4 and the second lever 5 are first interconnected to each other, as illustrated by the dashed arrow in Fig. 16A. To this end, the second lever 5 comprises a disc 46 which is inserted into a corresponding receiving slot 47 of the first lever 4, as visible most clearly in Fig. 16A.

[0123] After the first and second lever 4, 5 have been interconnected to each other, the swivel arm 7 will be interconnected with the first lever 4. This is illustrated in particular in Fig. 17A where the first and second lever are shown from a perspective front view and the swivel is illustrated from a perspective rear view so as to show the different engaging interfaces. The swivel arm 7 comprises a first interface 38 formed by two pins which are arranged opposite with respect to each other on an inner surface of a first sleeve 45 of P28785PC00 15.08.2025

[0124] 30 / 41 the swivel arm 7. The two pins are configured to be engaged with and held back by a groove 39 extending circumferentially with respect to the first pivot axis. The groove 39 forms an undercut in the direction of the first pivot axis, thereby allowing to be engaged in a form-fit fashion by the pins 38. Thereby, the groove forms a second interface 39 that is arranged on the first lever 4. To allow the pins 38 to move past the groove and thereby to engage with the groove, the groove is interrupted in circumferential direction by two oppositely arranged openings or indentations. Thus, for mounting the swivel arm 7 onto the first lever 4, the swivel arm 7 is rotated about the first pivot axis until the pins 38 are aligned with the openings or indentations in the groove 39 (as illustrated by the dashed line in Fig. 17A), and then the swivel arm 7 is pushed onto the first lever 4.

[0125] Towards the end of pushing the swivel arm 7 onto the first lever 4, the first sleeve 45 of the swivel arm 7 will eventually be mounted onto and circumferentially encompass a pivoting shaft 44 that is formed by the first lever 4 and by the second lever 5 (see in particular Fig. 17C). Once the first sleeve 45 circumferentially encompasses the pivoting shaft 44 in the mounted position, the second lever 5 and the first lever 4 are blocked by the swivel arm 7 from being translatably displaced with respect to each other in a direction orthogonal to the first and / or second pivot axis. Furthermore, translatable displacement of the second lever 5 with respect to the first lever 4 in a direction parallel to the first and / or second pivot axis is also blocked in the mounted position because the second lever 5 is inserted with a disc 46 of the second lever 5 is arranged inside the receiving slot 47 of the first lever 4. Furthermore, once the swivel arm 7 is rotated about the first pivot axis 11 to an operative pivot position, it is also blocked from translatable displacement with respect to the first lever 4 and with respect to the second lever 5 due to the pins 38 being engaged with the groove 39. At the same time, all three parts (first lever 4, second lever 5 and swivel arm 7) are free to rotate with respect to each other about the first and / or second pivot axis 1 1 , 12. Thus, in the mounted position, only the rotational degrees of freedom that are needed during use of the device are free, while translation P28785PC00 15.08.2025

[0126] 31 / 41 of these parts with respect to each other, which are undesired during the looping operation, is blocked (with the exception, of course, of displacement of the swivel arm 7 out of the first lever 4 upon dismounting, provided the swivel arm 7 is rotated out of the operative pivot position such that the pins 38 align with the groove 39 again). The mechanism has the further advantage that it allows the device to be dismounted and mounted easily and only with a few operationally simple steps, but that it still provides a secure interconnection in the mounted position, in particular in the operative pivot position.

[0127] Furthermore, in the illustrated embodiment, the swivel arm 7, the first lever 4 and the second lever 5 also comprise marks facing in a proximal direction, for illustration the relative rotational positions of these parts with respect to each other.

[0128] The first and second lever 4, 5 of the device 1 illustrated in Figs. 13-21 have an L-shape when viewed from the side (i.e. from a direction orthogonal to the first pivot axis 1 1 ). The L-shape is advantageous because it allows a first transfer port 9 of the first lever to be interspaced in direction of the first pivot axis 11 from a longitudinal section 13 of the first lever 4, and conversely also a second transfer port 10 to be interspaced in direction of the first pivot axis 11 from a longitudinal section 13 of the second lever 5. This arrangement makes the device suitable for effectively bridging a body structure and thereby passing a suture around the body structure. This is particularly useful for vertebral applications, in particular when passing sutures, straps or other filaments around the spinous processes of vertebrae.

[0129] Furthermore, when viewed from the direction of the first pivot axis, the first and second lever 4, 5 have a curved shape with a minimal distance at an insertion position 37 of the first and second lever 4, 5. More specifically, the first and second lever 4, 5 are configured to contact each other (as shown in Fig. 17A) at an insertion position 37. This insertion position 37 is arranged in longitudinal direction of the first lever 4 between a proximal P28785PC00 15.08.2025

[0130] 32 / 41 end of the first lever 4 and a distal end of the first lever 4, and, similarly for the second lever 5, the insertion position 37 is arranged in longitudinal direction of the second lever 5 between a proximal end of the second lever 5 and a distal end of the second lever 5. This is advantageous because during use, the insertion position may be arranged at an incision position through which the device enters the body of a patient. Because the first and second lever 4, 5 contact each other at the insertion position, small incisions are sufficient.

[0131] The sickle 6 is configured for temporarily holding a filament (shown e.g. in Fig. 21 B), e.g. a suture, and to transfer the filament through the first transfer port 9 and the second transfer port 10. To this end, the sickle 6 comprises a carrier 8 comprising a mounting slot 21 which is arranged on an outer circumferential side of the sickle 6, facing away from the first pivot axis 11. During mounting, the filament is inserted into the mounting slot 21 . At a first end of the sickle 6 at which the sickle 6 is connected to the swivel arm 7, the filament may be fixated using a filament holder 43. At an opposite second end of the sickle 6, the sickle 6 comprises a front recess 24 through which the filament end extends (as shown e.g. in Fig. 16B and 21 B). The front recess 24 is arranged at a front end 22 of the sickle 6 and is configured for receiving during mounting a front tip 26, which in the embodiment shown in Figs. 13-21 is realized as a separate piece. More specifically, the front tip 26 comprises an opening through which the filament may be passed for fixation. The front tip 26 is spear-shaped, which allows the front tip 26 to be passed through the opening 17 of the first transfer port 9 of the first lever 4, and through the opening 17 of the second transfer port 10 of the second lever 5. More specifically, the openings 17 of the two transfer ports 9, 10 each comprise a membrane 42 (as shown most clearly in Fig. 16C) which is made of an elastically deformable material. This allows the front tip 26 to be automatically retained, as will be explained in detail below. P28785PC00 15.08.2025

[0132] 33 / 41

[0133] In the following, the use of the device 1 is illustrated in further detail with reference to Figs. 18-21. In a first step, as illustrated in Fig. 18, the filament 2 is passed through the opening of the front tip 26, and the front tip 26 is then inserted into the front recess 24 of the sickle 6. Subsequently, the filament 2 is positioned inside the mounting slot 21 , and subsequently tensioned using the filament holder 43.

[0134] In a second step, as illustrated in Fig. 19, the sickle 6 and the swivel arm 7 are rotated about the first pivot axis 11 , which causes the front tip 26 to penetrate through the membrane 42 of the opening 17 of the first transfer port 9. Specifically, the spear-like shape of the front tip 26 makes this penetration easy. During penetration, the membrane 42 is elastically deformed to allow passage of the spear-shaped front tip 26.

[0135] In a third step, as illustrated in Fig. 20, the sickle 6 and the swivel arm 7 are further rotated about the first pivot axis 11 to penetrate the front tip 26 also through the opening 17 of the second transfer port 10. At this point, the filament has been guided through the first and second transfer ports 9, 10, and the hold of the loop must now be transferred from the sickle 6 to the first transfer port 9 and to the second transfer port 10. To this end, the filament is initially loosened from the filament holder 43 (cf. Fig. 21 ). Subsequently, the sickle 6 and the swivel arm 7 are retracted by rotating in opposite direction about the first pivot axis 1 1 , as shown in Figs. 21 A and 21 B. Once the front tip 26 starts to contact the membrane 42 of the opening 17 of the second transfer port 10, the front tip 26 will be retained by the membrane 42 and will not be pulled through the opening 17 of the second transfer port 10 along with the sickle 6 which is continuously pulled back through the opening, as shown in Fig. 21 A and in particular in Fig. 21 B showing a closeup view of section E of Fig. 21 A. The sickle 6 is further rotated until it is also pulled back through the opening 17 of the first transfer port 9 (not shown). At this point, the hold of the filament 2 has been transferred to the first transfer port 9 and to the second transfer port 10. P28785PC00 15.08.2025

[0136] 34 / 41

[0137] Subsequently, the sickle 6 and the swivel arm 7 may be removed from the first and second lever 4, 5, and the first and second lever 4, 5 may be disengaged from each other in order to then perform the further looping steps as described in further detail above.

[0138] P28785PC00 15.08.2025

[0139] 35 / 41

[0140] LIST OF DESIGNATIONS

[0141] 1 Device 25 Distal end

[0142] 2 Filament 26 Front tip

[0143] 3 Vertebrae 27 Body

[0144] 4 First lever 28 Pivoting shaft

[0145] 5 Second lever 29 Opening

[0146] 6 Sickle 30 Tension bar

[0147] 7 Swivel arm 31 Stop

[0148] 8 Carrier 32 Retaining element

[0149] 9 First transfer port 33 Second sleeve

[0150] 10 Second transfer port 34 Activation element

[0151] 11 First pivot axis 35 Clamping member

[0152] 12 Second pivot axis 36 Interconnection element

[0153] 13 Longitudinal section 37 Insertion position

[0154] 14 Lateral section 38 First interface

[0155] 15 Handle 39 Second interface

[0156] 16 Mounting structure 40 Third interface

[0157] 17 Opening 41 Fourth interface

[0158] 18 Clamping portion 42 Membrane

[0159] 19 Operation portion 43 Filament holder

[0160] 20 Traction cord 44 Pivoting shaft

[0161] 21 Mounting slot 45 First sleeve

[0162] 22 Front end 46 Disc

[0163] 23 Rear end 47 Receiving slot

[0164] 24 Front recess

Claims

P28785PC00 15.08.202536 / 41PATENT CLAIMS1 . Device (1 ) for guiding a filament (2) around one or more vertebrae (3), in particular around the respective spinous process of the one or more vertebrae (3), the device (1 ) comprising: a. a first lever (4) having a first transfer port (9); b. a second lever (5) having a second transfer port (10); and c. a sickle (6) interconnectable to the first lever (4) and / or second lever (5) in a pivotable manner around a first pivot axis (1 1 ) and comprising a carrier (8) for the filament (2); wherein d. the sickle (6) is pivotable into a transfer position where the carrier (8) is docked to the first and / or second transfer port (9, 10) to transfer a hold on the filament (2) from the carrier (8) to the first and / or second lever (4, 5).

2. Device (1 ) according to claim 1 , wherein the first lever (4) and the second lever (5) are interconnectable to each other in a displaceable and / or pivotable manner around a second pivot axis (12).

3. Device (1 ) according to claim 2, wherein the first lever (4) and the second lever (5) are interconnectable to each other in an interconnection direction parallel to the first pivot axis (11 ).P28785PC00 15.08.202537 / 414. Device (1) according to claim 2 or 3, wherein the first lever (4) and the second lever (5) are interconnectable to each other in an interconnection direction orthogonal to the first pivot axis (11) and / or orthogonal to the second pivot axis (12).

5. Device (1) according to any one of claims 2-4, wherein the first and second pivot axis (11 , 12) extend essentially parallel to each other, preferably lie on top of each other.

6. Device (1 ) according to any one of the preceding claims, wherein the first and the second lever (4, 5) are arranged crosswise with respect to each other when viewed from the direction of the first pivot axis (11).

7. Device (1) according to any one of the preceding claims, wherein the first lever (4) and the second lever (5) cross each other and / or contact each other at an insertion position (37) arranged between a proximal end (38) of the first lever and a distal end (39) of the first lever (4) in the mounted position.

8. Device (1 ) according to any one of the preceding claims, wherein the first and / or second lever (4, 5) are L-shaped.

9. Device (1) according to any one of the preceding claims, wherein the sickle (6) is interconnectable to the first lever (4) and / or second lever (5) via a swivel arm (7) from which in a mounted position the carrier (8) extends circumferentially around the first pivot axis (11 ).

10. Device (1) according to claim 9, wherein the swivel arm (7) is in direction of the first and / or second pivot axis (11 , 12) spaced a distance apart from the first and / or second lever (4, 5).P28785PC00 15.08.202538 / 4111 . Device (1) according to any one of claims 9-10, wherein the swivel arm (7) comprises a first interface (38) for releasably engaging with a second interface (39) arranged on the first lever (4).

12. Device (1) according to claims 11 and 2, wherein when the second lever (5) is interconnected to the first lever (4) and the first interface (38) is engaged with the second interface (39), the second lever (5) is blocked from being disconnected from the first lever (4).

13. Device (1) according to any one of the preceding claims, wherein the swivel arm comprises an first sleeve (45) mountable onto a pivoting shaft (44) formed in the mounted position by the first and second lever.

14. Device (1 ) according to any one of the preceding claims, wherein the carrier (8) comprises a mounting slot (21 ) to accommodate at least partially the filament (2).

15. Device (1) according to claim 14, wherein the mounting slot (21) is open towards one side of the carrier (8).

16. Device (1 ) according to any one of the preceding claims, further comprising a front tip (26) releasably mountable on a front end (22) of the carrier (8), wherein the front tip (26) is interconnected or interconnectable to the filament (2).

17. Device (1 ) according to claim 16, wherein the front tip (26) has a larger diameter than the front end (22) of the carrier (8).

18. Device (1 ) according to any one of the preceding claims, wherein the first and second lever (4, 5) are connectable via a tension bar (30) to exert a compressive or tensile force on the first and second lever (4, 5).P28785PC00 15.08.202539 / 4119. Device (1 ) according to claim 18, wherein the tension bar (30) interconnects respective longitudinal sections (13), in particular a handle (15), of the first and second lever (4, 5).

20. Device (1 ) according to any one of the preceding claims, wherein the device (1 ) comprises a stop (31 ) for the sickle (6) in the transfer position.21 . Device (1 ) according to any one of the preceding claims, wherein the first and / or second transfer port (9, 10) comprise a retaining element (32) for taking over the hold on the filament.

22. Device (1 ) according to claim 21 , wherein the retaining element (32) comprises a clamping element and / or gripping element.

23. Device (1 ) according to claim 21 or 22, wherein the clamping element and / or the gripping element and / or the front tip is / are elastically deformable.

24. Device (1 ) according to any one of claims 21 -23, wherein the retaining element is automatically actuated when the sickle is pivoted into the transfer position where the carrier (8) is docked to the first and / or second transfer port (9, 10).

25. Device (1 ) according to any one of claims 21 -24, wherein the retaining element (32) is arranged on a traction cord (20) extending along the first and / or second lever (4, 5).

26. Device (1 ) according to claim 25, wherein the traction cord (20) is arranged at least partially in a second sleeve (33) of the first or second lever.P28785PC00 15.08.202540 / 4127. Device (1) according to any one of claims 21-26, wherein the retaining element (32) is a hook or a contractible loop.

28. Device (1) according to claim 25 and 27, wherein the device (1) comprises an activation element (34) to contract the loop (32) of the traction cord (20) around the filament (2).

29. Device (1) according to claim 27 or 28, wherein the contractible loop (32) extends in an open position around the respective transfer port (9, 10).

30. Device (1) according to any one of the preceding claims, wherein the respective first and second transfer port (9, 10) are each arranged on a lateral section (14) of the respective first and second lever (4, 5) extending essentially parallel to the first pivot axis (11).

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