Coupling device for coupling a rod to a bone anchor

Abstract

A coupling device for coupling a rod to a bone anchor, the coupling device comprising a receiving part (5) configured to receive a head (3) of a bone anchor (1), the receiving part (5) having a first end (5a), a second end (5b), a central axis (C) extending through the first end (5a) and the second end (5b), and two legs (54) defining at the first end a recess (53) for receiving the rod, and a pressure member (6) arranged in the receiving part (5) to exert a pressure on the inserted head (3), an actuation portion (7) configured to act on the pressure member (6), wherein the actuation portion (7) is configured to rotate at least partially around a rotation axis (R) extending at an angle with respect to the central axis (C) to move the pressure member (6) from a non-locked position in which the inserted head (3) is able to pivot in the receiving part (5) to a locked position in which the head (3) is clamped.

Description

Technical Field

[0001] This invention relates to a connection device for connecting a rod to a bone anchor, and more particularly to a multi-axis bone anchor device that allows locking the bone anchor in a multi-axis position independently of the rod. Background Technology

[0002] For example, this type of multiaxial bone anchoring device is known from US 9,155,567 B2. The multiaxial pedicle screw described in this document includes a receiving head with a transverse U-shaped passage and a shank having a threaded portion and a raised end rotatably received within the receiving head. A locking insert is also received within the receiving head and is capable of engaging the raised end. The receiving head includes a lateral hole that exposes the contact surface of the locking insert so that an external pressing member can act on the contact surface to hold the locking insert in its locked position.

[0003] US 2019 / 0209214 A1 describes a multiaxial bone anchoring device comprising a receiving member and a pressure member. The receiving member has two legs defining recesses for receiving a rod, and the pressure member is used to apply pressure to the head of a bone anchor in the receiving member. The pressure member has an engaging portion that extends at least partially into the legs of the receiving member and is capable of direct engagement from outside the bone anchoring device. For example, using a device, the pressure member can be adjusted from an unlocked position in which the head is pivotable to a locked position in which the head is clamped.

[0004] In spinal surgery, spinal rods and multiaxial bone anchors are often necessary to correct and / or stabilize multiple segments of the spine. During such procedures, repeated adjustment of the bone anchors and rods relative to the receiving components of the multiaxial bone anchoring device may be required. Therefore, the multiaxial bone anchoring device needs to be handled simply and efficiently for locking and unlocking the head and rods during the correction steps. Summary of the Invention

[0005] The object of the present invention is to provide an improved coupling device and an improved multiaxial bone anchoring device, as well as a system of such coupling device or such multiaxial bone anchoring device with an instrument that is easy to operate and / or effective in locking.

[0006] The stated objective is achieved by the connection device, bone anchoring device, or system according to this application. Furthermore, further development of the connection device can also be implemented as further development of the bone anchoring device and / or the system, and vice versa.

[0007] According to one embodiment, a coupling device for attaching a rod to a bone anchor includes a receiving member configured to receive a head of the bone anchor. The receiving member has a first end, a second end, a central axis extending through the first end and the second end, and two legs defining a recess at the first end for receiving the rod. The coupling device further includes a pressure member movable within the receiving member to apply pressure to an inserted head. An actuating portion configured to act on the pressure member is disposed on the receiving member. The actuating portion is configured to rotate at least partially about a rotation axis extending or inclined at an angle relative to the central axis, such that the pressure member moves from an unlocked position to a locked position in which the inserted head is pivotable within the receiving member, and in the locked position, the head is clamped. Preferably, the rotation axis is substantially perpendicular to the central axis, such that the pressure member moves downward toward the second end. More preferably, the actuating portion includes a cam portion, and the pressure member follows the movement of the cam portion.

[0008] Using this structure, the rotational motion of the actuating part can be converted into linear motion of the pressure member. This allows the pressure member to move only a small distance to lock the head. More specifically, the actuating part may include a rotating shaft and a cam portion acting on the pressure member. This allows for precise small movements of the pressure member with a simple structure.

[0009] As long as the instrument acts on the actuating part, the locking of the head can be temporary. Therefore, the step of adjusting the angular position of the coupling device relative to the bone anchor can be performed repeatedly in a quick and easy manner.

[0010] According to one embodiment, the actuating portion is rotatable in a first direction to move the pressure member to the locked position, and is rotatable in a second direction, preferably opposite to the first direction, to move the pressure member to the unlocked position.

[0011] According to one embodiment, the actuating portion is configured to engage with the receiving member in a non-threaded manner. According to another embodiment, the actuating portion is substantially stationary along the direction of the rotation axis during rotation. According to yet another embodiment, the actuating portion is configured to rotate when a force is applied to it along the direction of the central axis. According to yet another embodiment, the rotation axis intersects the central axis.

[0012] One embodiment of the device includes: a first device portion, preferably an outer tube, configured to engage the receiving member; and a second device portion, preferably an inner portion, at least partially disposed within the first device portion and displaceable relative to the first device portion, the second device portion being configured to engage the actuating portion. When the first device portion engages the receiving member and the second device portion engages the actuating portion and rotates the actuating portion, the pressure member is movable from an unlocked position to a locked position, in which a head inserted is pivotable in the receiving member, and in the locked position the head is clamped. In another embodiment, the second device portion is configured to rotate the actuating portion in the opposite direction, such that the pressure member moves from the locked position back to the unlocked position.

[0013] According to another embodiment, the device includes a first device portion and a second device portion. The first device portion is configured to attach to the receiving member, and the second device portion is configured to act on an actuating portion of the receiving member to rotate the actuating portion in a first direction to move the pressure member to a locked position, and to actuate the actuating portion in a second direction, preferably opposite to the first direction, to move the pressure member to an unlocked position. The actuating portion of the receiving member may include a dual-arm lever, the pivot axis of which coincides with the rotation axis of the actuating portion. The second device portion may include a first push member configured to act on one arm of the dual-arm lever and a second push member configured to act on the other arm of the dual-arm lever. Because the receiving member may have two actuating portions, a pair of first and second push members can be provided for each actuating portion. Using this embodiment, the head can be selectively locked and unlocked relative to the receiving member.

[0014] The device can be designed such that the recess in the receiving component that receives the rod remains unobstructed during locking of the head of the bone anchor. Therefore, the head of the bone anchor can be temporarily locked when the rod and / or fixation member is not yet placed in the rod channel or when the rod is in a position higher than the bottom of the rod channel. This can increase the feasibility of surgical correction procedures.

[0015] The bone anchoring device can be a bottom-mounted bone anchoring device, wherein the head of the bone anchor can be inserted from the lower end of the receiving component, or the bone anchoring device can be a top-mounted bone anchoring device, wherein the bone anchor can be inserted into the receiving component from the upper end. Attached Figure Description

[0016] Further features and advantages of the invention will become apparent from the description of the embodiments in conjunction with the accompanying drawings. In the drawings:

[0017] Figure 1 : An exploded perspective view of a first embodiment of a multi-axis bone anchoring device including the connecting device is shown.

[0018] Figure 2 : Show Figure 1 A three-dimensional view of a multi-axis bone anchoring device in its assembled state.

[0019] Figure 3 : Show Figure 1 and Figure 2 A perspective view of the receiving component of a multi-axis bone anchoring device viewed from above.

[0020] Figure 4 : Show Figure 3 A three-dimensional view of the receiving component viewed from the bottom.

[0021] Figure 5 : Show Figure 3 and Figure 4 A top view of the receiving component.

[0022] Figure 6 : Show Figures 3 to 5 A cross-sectional view of the receiving component, the cross-section being along... Figure 5 The line AA in the middle is cut off.

[0023] Figure 7 : Show Figure 1 and Figure 2 A perspective view of the pressure component of a multi-axis bone anchoring device from the top.

[0024] Figure 8 : Show Figure 7 A three-dimensional view of the pressure component viewed from the bottom.

[0025] Figure 9 : Show Figure 7 and Figure 8 A top view of the pressure component.

[0026] Figure 10 : Show Figures 7 to 9 A cross-sectional view of a pressure member, the cross-section being along... Figure 9 The line BB in the middle is cut off.

[0027] Figure 11 : Show Figure 1 and Figure 2 A perspective view from top of the actuating part of a multi-axis bone anchoring device in the form of an insert member.

[0028] Figure 12 : Show Figure 11 A three-dimensional view of the actuating part from the bottom.

[0029] Figure 13 : Show Figure 11 and Figure 12 Side view of the actuating part.

[0030] Figure 14 : Shows the contents Figure 1 and Figure 2 A three-dimensional diagram of a multiaxial bone anchoring device and the instruments attached to it.

[0031] Figure 15 : Show Figure 14 A three-dimensional view of the front part of the external components of the device, viewed from the top.

[0032] Figure 16 : Show Figure 15 A three-dimensional view of the front part from the bottom.

[0033] Figure 17 : Show Figure 15 and Figure 16 Side view of the front part.

[0034] Figure 18 : Show Figure 14 A three-dimensional view of the front part of the internal components of the device, viewed from the top.

[0035] Figure 19 : Show Figure 18 A perspective view of the front portion of the internal component shown from the bottom.

[0036] Figure 20 : Show Figure 18 and Figure 19 Side view of the front part of the internal components.

[0037] Figures 21a to 21d : Showing Figure 1 and Figure 2 The connecting device is installed to Figure 1 and Figure 2 A perspective view of the bone anchor and the steps of pre-locking the head of the bone anchor into the connecting device.

[0038] Figures 22a to 22d : Showing the steps of installing the coupling device to the bone anchor, corresponding to Figures 21a to 21d A cross-sectional view, the cross-section being taken in a plane containing the central axis of the connecting device and extending through the middle of the opposing legs of the receiving component of the connecting device.

[0039] Figures 23a to 23c : Showing Figure 14 The device is attached to Figure 1 and Figure 2 A perspective view of a multi-axial bone anchoring device and the steps of actuating the actuating part using the device.

[0040] Figure 24 : Show Figure 1 and Figure 2 A side view of a portion of a multiaxial bone anchoring device, in which Figure 14 The device is attached to the multiaxial bone anchoring device and the actuating part is in the first position.

[0041] Figure 25 : Show Figure 1 and Figure 2 A perspective view of a portion of a multiaxial bone anchoring device, in which Figure 14 The device is attached to the multiaxial bone anchoring device and the actuating part is in the second position.

[0042] Figure 26 : Show Figure 1 and Figure 2 A perspective view of another embodiment of a system of a multiaxial bone anchoring device and an instrument attached thereto.

[0043] Figure 27 : Show Figure 26 A three-dimensional view of the front part of the external components of the device, viewed from the top.

[0044] Figure 28 : Show Figure 27 A three-dimensional view of the front part from the bottom.

[0045] Figure 29 : Show Figure 26 A three-dimensional view of the front part of the internal components of the device, viewed from the bottom.

[0046] Figure 30 : Show Figure 1 and Figure 2 A perspective view of a portion of a multiaxial bone anchoring device, in which Figure 26 The instrument is attached to the multiaxial bone anchoring device.

[0047] Figure 31 : Show Figure 30 A side view of the multiaxial bone anchoring device to which the device is attached.

[0048] Figure 32 : A perspective view showing yet another embodiment of a system including a multiaxial bone anchoring device and yet another embodiment of an instrument.

[0049] Figure 33 : Show as Figure 32 An exploded perspective view of another embodiment of the multi-axis bone anchoring device shown.

[0050] Figure 34 : Show Figure 33 A three-dimensional view of a multi-axis bone anchoring device in its assembled state.

[0051] Figure 35 : Show Figures 32 to 34 A perspective view of the receiving component of a multi-axis bone anchoring device viewed from above.

[0052] Figure 36 : Show Figure 35 A three-dimensional view of the receiving component viewed from the bottom.

[0053] Figure 37 : Show Figure 35 and Figure 36 A top view of the receiving component.

[0054] Figure 38 : Show Figures 35 to 37 A cross-sectional view of the receiving component, the cross-section being along... Figure 37 The line DD in the middle is cut off.

[0055] Figure 39 : Show Figures 32 to 34 A perspective view of the pressure component of a multi-axis bone anchoring device from the top.

[0056] Figure 40 : Show Figure 39 A three-dimensional view of the pressure component viewed from the bottom.

[0057] Figure 41 : Show Figure 39 and Figure 40 A top view of the pressure component.

[0058] Figure 42 : Show Figures 39 to 41 A cross-sectional view of a pressure member, the cross-section being along... Figure 41 The line FF in the middle is cut off.

[0059] Figure 43 : Showing according to Figures 32 to 34 A three-dimensional view of the actuation part of a multi-axis bone anchoring device.

[0060] Figure 44 : Show Figure 43 Another three-dimensional view of the actuating part.

[0061] Figures 45a to 45d : Showing Figure 32 The device is attached to Figures 32 to 34Multiaxial bone anchoring device and actuation Figure 32 A perspective view of the steps of the device, wherein a rod is placed in a recess for the rod in the receiving component.

[0062] Figure 46 : Show Figure 32 Multiaxial bone anchoring devices and those attached to them Figure 32 A cross-sectional view of an embodiment of the device, wherein a rod is inserted into a multiaxial bone anchoring device, the cross-section being taken in a plane that includes the central axis of the connecting device and extends through the center of the leg of the receiving part of the connecting device.

[0063] Figure 47 : Show Figure 33 A cross-sectional view of a multiaxial bone anchoring device, wherein the instrument is removed and the rod is fixed.

[0064] Figure 48 : An exploded perspective view of another embodiment of the multiaxial bone anchoring device is shown.

[0065] Figure 49 : Show Figure 48 A three-dimensional view of a multi-axis bone anchoring device in its assembled state.

[0066] Figure 50 : Show Figure 48 and Figure 49 A perspective view of the receiving component of a multi-axis bone anchoring device viewed from above.

[0067] Figure 51 : Show Figure 50 A perspective view of the receiving component from the bottom.

[0068] Figure 52 : Show Figure 50 and Figure 51 A top view of the receiving component.

[0069] Figure 53 : Show Figures 50 to 52 A cross-sectional view of the receiving component, the cross-section being along... Figure 52 The line in the middle was cut by GG.

[0070] Figure 54 : Show Figures 50 to 53 Side view of the receiving component.

[0071] Figure 55 : Show Figure 48 and Figure 49 A perspective view of the pressure component of a multi-axis bone anchoring device viewed from above.

[0072] Figure 56 : Show Figure 55A three-dimensional view of the pressure component viewed from the bottom.

[0073] Figure 57 : Show Figure 55 and Figure 56 A top view of the pressure component.

[0074] Figure 58 : Show Figures 55 to 57 A cross-sectional view of a pressure member, the cross-section being along... Figure 57 The line HH in the middle is cut off.

[0075] Figure 59 : Show Figures 55 to 58 Side view of the pressure member.

[0076] Figure 60 : Show Figure 48 and Figure 49 A perspective view of the actuating part of the multi-axis bone anchoring device from the bottom.

[0077] Figure 61 : Show Figure 60 A three-dimensional view of the actuating part as seen from the top.

[0078] Figure 62 : Show Figure 60 and Figure 61 A top view of the actuating part.

[0079] Figure 63 : Show Figures 60 to 62 Side view of the actuating part.

[0080] Figure 64 : Showing the use of with Figure 48 and Figure 49 A perspective view of another embodiment of a device used in conjunction with a multiaxial bone anchoring device.

[0081] Figure 65 : Showing the attachment to Figure 48 and Figure 49 When the receiving component of the multi-axis bone anchoring device is in use Figure 64 A three-dimensional view of a part of the instrument.

[0082] Figure 66 : Show Figure 64 and Figure 65 A three-dimensional view of the front part of the instrument.

[0083] Figure 67 : Show Figures 64 to 66 A cross-sectional view of the front part of the instrument.

[0084] Figure 68 : Show Figure 48 and Figure 49Multiaxial bone anchoring devices and those attached to them Figures 64 to 67 A cross-sectional view of a portion of the device, the cross-section being taken in a plane containing the central axis of the receiving component and extending through the center of the leg.

[0085] Figure 69a and Figure 69b : Showing different configurations of the actuation portion of the instrument and the receiving component respectively, such as Figure 65 The image shows a side view of the device attached to the multiaxial bone anchoring device. Detailed Implementation

[0086] like Figure 1 and Figure 2 As shown, the bone anchoring device according to an embodiment of the invention includes a bone anchor 1 in the form of, for example, a bone screw, having a shank 2 with a threaded portion and a head 3 with a spherical outer surface portion. The head 3 may also have a recess 4 for engaging with a drive tool. The bone anchoring device also includes a connecting device comprising a receiving member 5 for receiving a rod (not shown) to be connected to the bone anchor 1. Additionally, a pressure member 6 forms part of the connecting device. The pressure member 6 is disposed in the receiving member 5 and is configured to apply pressure to the head 3 of the bone anchor 1 to clamp and / or ultimately lock the head 3 relative to the receiving member 5. Two actuating members 7, typically forming actuation portions, are mounted in opposing walls of the receiving member 5 and are configured to actuate the pressure member 6 to apply pressure to the head 3. The bone anchoring device may further include a fixing member (not shown), such as an internal screw or positioning screw for securing the rod to the receiving member 5.

[0087] Please refer to another source. Figures 3 to 6The receiving component 5 is described in more detail below. The receiving component 5 includes a first end 5a forming an upper end and an opposing second end 5b forming a lower end, and a central axis C passing through the first end 5a and the second end 5b. Except for structures such as protrusions and grooves formed on or within a cylindrical surface, the overall external shape of the receiving component can be generally cylindrical. A passage 50 extends through the receiving component 5 from the first end 5a to the second end 5b. The passage 50 may have several segments with different diameters. Starting at or near the first end 5a and extending to a segment at a distance from the first end 5a, the passage 50 is formed as a first coaxial hole 50a, which may have an internal thread 51 in at least a portion thereof. Between the first coaxial hole 50a and the second end 5b, a widened portion in the form of a second coaxial hole 50b may be provided, which allows a portion of the pressure member 6 to expand therein. A narrowing portion 50c is formed between the second end 5b and the second coaxial hole 50b, the narrowing portion narrowing towards the second end 5b, for example, in a conical shape. An opening 52 is formed at the second end 5b through the passage 50, the width of which is greater than the maximum outer diameter E of the head 3. Therefore, the receiving member 5 is adapted to insert the head 3 of the bone anchor 1 into the receiving member 5 through the opening 52 at the second end 5b.

[0088] In the region adjacent to the first end 5a of the receiving member 5, a generally U-shaped recess 53 extends from the first end 5a in the direction of the second end 5b. The width of the recess 53 is slightly larger than the diameter of the rod to be inserted, so that the rod can be placed in the recess 53 and guided therein. Thus, the recess 53 forms a rod receiving recess or a channel for the rod, wherein the sidewalls of the channel define two free legs 54. Each leg 54 includes a transverse hole 55. The transverse hole 55 extends completely from the outer surface of the receiving member 5 into the passage 50 and can be a generally cylindrical hole having a cylindrical axis R. In this embodiment, the cylindrical axis R extends perpendicular to and intersects the central axis C. The hole 55 can be located at a slightly higher axial height above the bottom 53a of the generally U-shaped recess 53. Moreover, the cylindrical axis R of the hole 55 can extend substantially through the circumferential center of the leg 54. Therefore, the holes are approximately symmetrical with respect to the plane extending through the central axis C and the center of the leg 54, and the cylindrical axes R of the two holes 55 coincide. The inner diameter of the holes 55 is only slightly larger than the outer diameter of the actuating member 7, so that the actuating member 7 can be inserted into the holes 55 respectively and rotatably supported therein. Therefore, the fit between the actuating member 7 and the receiving member is non-threaded.

[0089] On each leg 54, above the hole 55, a protrusion 56 is formed on the outer wall of the leg 54. This protrusion serves as an engagement portion for engaging the receiving member 5 with the instrument. The protrusions 56 are asymmetrical with respect to a plane extending through the central axis and the center of each leg. More specifically, each protrusion 56 is offset from the hole 55 along the same circumferential direction and abuts the boundary of the recess 53. As particularly in Figure 5 As can be seen in the top view, a protrusion 56 at one leg 54 on one side of the longitudinal axis of the recess 53 is offset toward a boundary of the recess 53 along the direction of the axis L. Another protrusion 56 at the other leg 54 is located on the opposite side of the longitudinal axis L of the recess 53 and is offset toward the opposite boundary of the recess 53 along the direction of the axis L. The protrusion 56 includes a quadrangular base 56a having a cylindrical outer surface and a roof-shaped portion 56b oriented toward the first end 5a. The roof-shaped portion 56b may have an inclined portion 56c at its top region. In the example shown, the protrusion 56 is flush with the boundary of the recess 53 on one side. It should be noted that the protrusion may have other shapes to adapt it for engagement with an instrument.

[0090] Additionally, the receiving member 5 includes a groove 57 on each leg 54 in its outer wall for guiding a portion of the instrument to the actuating member 7 when the actuating member 7 is placed into the hole 55. The groove 57 extends substantially parallel to the central axis C from the first end 5a to a distance from the second end 5b, and is adjacent to the hole 55 circumferentially on the side opposite the protrusion 56. Moreover, the groove 57 may open toward the hole 55. At a distance from the lowermost end of the internal thread 51, a circumferentially extending groove 58 may be formed in the inner wall of the receiving member, which serves as an abutment for a portion of the pressure member 6.

[0091] For further reference Figures 7 to 10The pressure member 6 will be described in more detail below. The pressure member 6 includes a first end 6a forming an upper end and a second end 6b forming a lower end. The upper portion 60 of the pressure member includes a rod receiving portion, and the lower portion 61 of the pressure member includes a head receiving portion. The outer surface of the pressure member 6 is generally cylindrical, with an outer diameter that allows the pressure member 6 to be placed in a passage and to slide within the coaxial hole 50a of the receiving member 5. When the pressure member 6 is installed to the receiving member 5, the central axis of the pressure member coincides with the central axis C of the receiving member. In the upper portion 60, a rod support surface 62 may be provided, which is configured to support the inserted rod. The longitudinal axis 1 of the rod support surface 62 extends transversely to the central axis C. The rod support surface 62 may have a V-shaped cross-section in the direction transverse to the central axis C to allow support of rods of different diameters. However, the rod support surface may also be flat or cylindrical, or may have any other shape. Upright legs 63 are formed on the left and right sides of the rod support surface 62, the upright legs having a generally flat inner surface and a generally cylindrical outer surface.

[0092] Adjacent to the first end 6a, a generally cylindrical edge portion 64 is formed on each leg 63, the edge portion protruding beyond the outer surface of the cylindrical main portion 60 of the pressure member 6. The outermost segment of the edge portion 64 may be cut off to form a flat outer end 64a. At the circumferential center of the leg 63, the flat end 64a may be flush with the cylindrical outer surface of the pressure member. The edge portion 64 is configured to engage a groove 58 of the receiving member 5 to prevent the pressure member 6 from disengaging through the first end after it has been placed into the receiving member 5 and is in the inserted position of the head 3. Between the rod support surface 62 and the upright leg 63, a groove 65 extending parallel to the rod support surface 62 is formed, the groove giving the upright leg 63 slight flexibility.

[0093] In the lower portion 61 of the pressure member 6, a head receiving recess 66 is provided for the head 3 of the bone anchor 1. The head receiving recess 66 may be generally spherical in shape, the radius of which corresponds to the radius of the head 3, and extends over the region of the head having the maximum outer diameter E. The lower portion also includes a plurality of slits 68 opening at the second end 6b. The number and size of the slits 68 make the walls defining the head receiving recess 66 flexible, more specifically, such that the head receiving recess can expand to snap onto the head 3 when the head 3 is inserted. To increase flexibility, the closed end portions 68a of the slits 68 may be widened. The outer surface portion 69 of the pressure member 6 adjacent to the second end 6b may be tapered, for example, conical. The outer surface portion 69 is configured to mate with the narrowed portion 50c of the passage of the receiving member 5. A coaxial hole 67 in the pressure member 6 allows access to the head 3 using a driving tool.

[0094] In each leg 63, a recess 600 is formed that extends completely through the leg from the outside to the inside. The recess 600 is elongated in the circumferential direction and has a generally cylindrical end 600a connected by two generally straight portions 600b. Moreover, the circumferential length of the recess 600 and its axial height along the central axis C cause the protrusion of the actuating member 7 to be configured to move in the recess approximately only in the longitudinal direction of the elongated hole 600. More specifically, the recess 600 is arranged asymmetrically with respect to the circumferential center of the leg, as particularly in Figure 9 and Figure 10 As can be seen, a recess 600 on one leg 63 is offset to one side from the center of the leg, and another recess 600 is offset to the opposite side from the center of the leg 63. As described below, this is due to the eccentric arrangement of the engagement portion on the actuating member 7.

[0095] like Figure 1 and Figure 2 And others Figures 11 to 13 As shown, the actuating members 7 can be identical and can each be designed as an integral piece that can be inserted into the hole 55 of the receiving member 5. More specifically, each actuating member 7 has a cylindrical main portion 70, the outer diameter of which allows the actuating member to be placed into the hole 55 in the leg 54 of the receiving member 5 and rotatably supported in the hole 55. The main portion 70 includes two opposing circular or partially circular end faces, one of which forms an outer surface 70a facing the outer side of the receiving member 5, and the opposing end face forms an inner surface 70b facing the inner side of the receiving member 5 when the actuating member is mounted to the receiving member 5. The thickness of the main portion 70 substantially corresponds to the wall thickness of the receiving member around the hole 55.

[0096] On the outer surface 70a, an operating rod-shaped protrusion 71 is formed having a rear end 71a and an opposing free front end 71b. The operating rod-shaped protrusion 71 has a thickness perpendicular to the outer surface, which smoothly increases from the rear end 71a to a distance from the rear end 71a, and then remains constant until the free end 71b. The free end 71b may protrude beyond the contour of the outer surface 70a. Specifically, as... Figure 13 As shown, the position of the operating lever-like protrusion 71 allows it to extend over the region of maximum diameter on the outer surface 70a, but it can be arranged closer to one side of the main portion 70 rather than the opposite side in a direction perpendicular to the axis of the operating lever. The upper side 71c of the operating lever-like protrusion 71 forms an engagement surface configured to engage with a portion of the instrument. Adjacent to the engagement surface 71c, the outer surface 70a has a recess 72 at which a portion of the main portion 70 is cut away. The recess 72 can provide guidance and space for a portion of the instrument.

[0097] When the actuating member 7 is inserted into the hole 55, the cylindrical axis of the main portion 70 coincides with the cylindrical axis R of the hole, forming a rotation axis R for the actuating member 7. At the inner surface 70b, a connecting portion in the form of a cylindrical protrusion 73 for engaging the pressure member is provided, the connecting portion having an outer diameter smaller than the outer diameter of the main portion 70 of the actuating member 7. The cylindrical protrusion 73 is located at the inner surface 70b at a position opposite to the front region of the operating rod-shaped protrusion 71, and can extend to the outer edge of the main portion 70. The cylindrical axis z of the cylindrical protrusion 73 extends parallel to the cylindrical axis R of the main portion 70, thus offsetting the cylindrical axis z of the cylindrical protrusion 73 from the rotation axis R of the main portion 70. Therefore, the cylindrical protrusion 73 acts as an eccentric actuating portion, more specifically, as a cam portion. The height of the cylindrical protrusion 73 is such that once the actuating member 7 is installed in the hole 55, the cylindrical protrusion 73 extends into the recess 600 of the leg 63 of the pressure member 6. As a result, when the operating rod-shaped protrusion 71 is engaged by the instrument and pressed downwards, the actuating member 7 rotates to a certain extent in the hole 55. During rotation, the actuating member 7 can remain stationary along the axis of rotation. The movement of the cylindrical protrusion 73 in the recess 600 is restricted between the ends 600a. When the cylindrical protrusion 73 moves along an eccentric path about the axis of rotation R, it moves downwards, and the pressure member 6 follows this movement, thereby applying a downward force to the inserted head 3. Therefore, the cylindrical protrusion acts as a cam.

[0098] Now for reference Figures 14 to 20 This section will explain an instrument suitable for use with the aforementioned bone anchoring device. Instrument 100 includes an inner member 120 and a first instrument portion in the form of an outer member 110. The inner member 120 is displaceable relative to the outer member 110 and is provided with a handle and / or actuation device, including, for example, a knob 130, for displacing the inner member relative to the outer member. Various mechanisms can be implemented to displace the inner member 120 relative to the outer member 110. The overall shape of the inner and outer members is tubular, but the tube may have slits so that they are not completely closed. When the instrument is attached to a receiving component, the central longitudinal axis of the tube coincides with the central longitudinal axis C of the receiving component. See also... Figures 15 to 17The front portion of the outer member 110 is shown in an enlarged view. The outer member 110 includes a front end 110a that faces the bone anchoring device in use. Two opposing slits 111, open at the front end 110a, extend along a portion of the outer member to form two arms 112, which are at least partially flexible so that they can unfold to engage a protrusion 56 at the receiving member 5. The width of the longitudinal slits 111 can be at least as large as the diameter of the rod to be inserted into the receiving member. This allows the instrument to be used either when the rod has already been inserted or when the rod must be inserted during attachment.

[0099] Furthermore, a generally rectangular cutout 113 is formed on each arm 112 adjacent to the recess 111 and the front portion 110a. The circumferential width of the cutout 113 allows a portion of the inner member 120 to extend therein. Moreover, when the instrument is attached to the receiving member 5, the cutout 113 is positioned asymmetrically relative to the generally U-shaped recess 53 of the receiving member 5. Specifically, the cutout 113 is located on different sides of the U-shaped recess 53 and at different ends of the U-shaped recess 53 along the longitudinal axis L of the U-shaped recess 53. Furthermore, at a distance from the front end 110a, an engagement recess 114 is provided on each arm 112. The engagement recess 114 is positioned on each arm 112 such that when the outer member 110 is placed on the receiving member 5, the engagement recess can engage the protrusion 56 on the receiving member 5. Moreover, the contour of the engagement recess 114 is such that it substantially matches the contour of the engagement protrusion, thereby achieving a form-fit engagement.

[0100] At approximately the center of each arm 112 along the circumferential direction, an axially elongated guide recess 115 is formed, the size and shape of which are designed to provide guidance for the protrusion of the internal member 120. More specifically, each recess 115 has an upper region 115a and a lower region 115b that narrows relative to the upper region 115a. This is achieved by two wings 115c that extend circumferentially toward the center from the longitudinal side of the recess 115. The wings 115c are positioned at a distance from the outer surface of the front portion 110 such that... Figure 14 As shown, a portion of the inner member 120 extending between the wings 115c remains within the recess 115, or in other words, does not protrude substantially outward.

[0101] exist Figures 18 to 20The front portion of the inner member 120 is shown in more detail. The outer diameter of the inner member 120 allows it to extend through the outer member 110. A circumferentially opposite elongated slit 121 extends a length from the front end 120a of the inner member to form two arms 122. The width of the slit 121 is at least as large as the diameter of the rod to be inserted into the receiving member. Adjacent to the slit 121, two extensions 123 are formed, which begin at a distance above the free end 120a and extend axially beyond the free end 120a. The extensions 123 may have a cylindrical inner surface that mates with the cylindrical outer surface of the receiving member 5. Additionally, the extensions 123 may have a cylindrical outer surface corresponding to the outer surface of the outer member 110. The radial position of the extensions 123 is such that when the inner member 120 is within the outer member 110 and the slits 121 of the inner member and 111 of the outer member overlap, the extensions fill the cutout 113.

[0102] At the center of each arm 122 along the circumferential direction, two axially spaced protrusions 124, 125 are formed, the protrusions being configured to engage an elongated recess 115 on the arm 112 of the outer member 110. The first protrusion 124 may be generally cuboid in shape and is configured to be received in the upper portion 115a of the recess 115 of the outer member 110. The second protrusion 125 is spaced apart from the first protrusion 124 toward the front end 120a and includes a narrower neck portion 125a and a generally plate-shaped head 125b. The neck portion 125a is configured to be guided between the wings 115c, and the head portion 125b is configured to extend over the wings 115c. When the inner member 120 is within the outer member 110 and the extension 123 extends into the recess 113, the axial movement of the inner member 120 relative to the outer member 110 is limited by the axial movement of the first protrusion 124 in the upper region 115a of the elongated recess 115. The extension 123 can move beyond the front end 110a of the outer member 110 until the first protrusion 124 abuts against the wing 115c. It should be noted that additional protrusions and recesses can be formed along the arms of the inner and outer members, such as... Figure 14 As shown in the diagram, the internal component can be moved relative to the external component using a knob or handle 130.

[0103] Components and parts of bone anchoring devices and instruments can be made of any material, but are preferably made of titanium or stainless steel, or of any biocompatible metal or metal alloy or plastic material. Nickel-titanium alloys, such as nitinol, can be used as biocompatible alloys. Other materials can be magnesium or magnesium alloys. Biocompatible plastic materials used can be, for example, polyetheretherketone (PEEK) or polylactic acid (PLLA). Components can be made of the same or different materials.

[0104] The actuating member 7 can preferably be pre-assembled with the receiving member. Once they have been inserted into the hole, a portion 57a ​​of the outer edge of the hole 55 can be slightly deformed so that it provides an obstruction for the inserted actuating member in an outward direction. Figure 22a This prevents the actuating member from being unintentionally pushed out of the hole 55. The deformed portion 57a ​​is preferably located at the bottom of the hole 55 in the direction toward the second end 5b of the receiving member 5. The orientation of the actuating member 7 in the hole is such that the operating rod-shaped protrusion 71 is on the outside and the cylindrical protrusions 73 extend into the recesses 600 of the pressure member 6, respectively. Since the two actuating members 7 are identical, when viewed along the rod channel, the free ends 71b of the operating rod-shaped protrusions 71 are shown in opposite directions. Correspondingly, the cylindrical protrusions 73 are located at the opposite ends 600a of the associated recesses 600 of the pressure member 6. When the actuating members 7 are actuated, they rotate in opposite directions.

[0105] The pressure member 6 can also be pre-assembled with the receiving member 5. For installation, the pressure member 6 can be inserted into the passage 50 of the receiving member 5 through its first end 5a until the head receiving recess 66 extends into the receiving space 50b. Because the legs 63 of the pressure member 6 are slightly flexible, the outwardly extending edge 64 can slide along the inner wall of the threaded area in the receiving member until the edge snaps into the slot 58 when the pressure member 6 has reached a position where the recess 600 overlaps with the hole 55. The rod support surface 62 is aligned with the generally U-shaped recess 53 of the receiving member 5.

[0106] The pre-assembled connection device can be installed outside the patient or in situ after the bone anchor 1 has been inserted into the bone or vertebra.

[0107] Reference Figures 21a to 21d as well as Figures 22a to 22d The corresponding cross-sectional diagrams describe the assembly of the connecting device and the bone anchor. First, as... Figure 21a and Figure 22a As shown, the pressure member is in the insertion position, in which the head receiving recess 66 is at least partially within the widened portion 50b of the passage 50 of the receiving member 5. The coupling device is oriented such that the second end 5b of the receiving member faces the head 3 of the bone anchor. Cylindrical protrusions 73 of the actuating member 7 extend into the recess 600, and they can move to a certain extent within the recess. Moreover, the protrusions substantially prevent the pressure member 6 from rotating within the receiving member 5.

[0108] Next, as Figure 21b and Figure 22bAs shown, the head 3 is inserted into the receiving member 5 through the opening 52 at the second end 5b, and more specifically into the head receiving recess 66 of the pressure member 6. Since the outwardly extending edge 64 abuts against the upper surface of the groove 58 in the receiving member, the pressure member 6 is not pushed out through the first end 5a of the receiving member 5 in this inserted position.

[0109] Furthermore, such as Figure 21c and Figure 22c As shown, the head 3 is fully inserted into the head receiving recess 66 of the pressure member. Due to the flexibility of the pressure member 6 in the region of the head receiving recess 66, the pressure member snaps onto the head 3. When the head 3 is inserted, the widened portion 50b of the passage provides space for the expansion of the pressure member therein. Depending on the size of the head receiving recess 66 relative to the head, the head 3 can be held in the head receiving recess by friction.

[0110] Finally, as Figure 21d and Figure 22d As shown, the pressure member 6 moves downward toward the second end 5b of the receiving member 5. Alternatively, when the bone anchor 1 has been inserted into the bone, the receiving member is pulled upward relative to the bone anchor 1. This causes the outer surface portion 69 of the pressure member 6 to enter the narrowing portion 50c of the passage 50, thereby reducing the size of the opening 52 in the receiving member 5 and preventing the head 3 from being removed through the opening 52. This constitutes a pre-locking configuration. Preferably, in the pre-locking configuration, the head 3 is additionally clamped by friction and temporarily held in an angular position before final locking. The downward movement of the pressure member 6 into the pre-locking configuration causes the cylindrical protrusions 73 to move slightly within the recesses 600, which rotates the actuating member 7. As a result, the operating rod-shaped protrusion 71 is in an inclined position.

[0111] In clinical applications, two bone anchors are typically anchored in the bone or vertebra, and the bone anchors should be connected by a rod. Figures 23a to 23c Showing bone anchoring device and Figures 14 to 20 The use of the device described herein. The bone anchoring device is in an assembled state and preferably in the position as described above. Figure 21d and Figure 22d In the pre-locked state shown. In the first configuration of the device, the internal member 120 is in the retracted position, meaning that the extension 123 is substantially completely within the recess 113. Preferably, in the first configuration, the front end 110a and the free end of the extension 123 are substantially flush with each other. The recesses 111 and 121 of the device 100 are substantially aligned with the U-shaped recess 53 of the receiving member 5. Figure 23a As shown, the device is moved toward the bone anchoring device.

[0112] Next, as Figure 23bAs shown, the instrument 100 is placed on the receiving member, and the outer member 110 is attached to the receiving member by engaging the engagement recess 114 at the outer member 110 with the protrusion 56 of the receiving member. The inclined portion 56c at the top of the protrusion 56 facilitates the engagement.

[0113] Finally, as Figure 23c As shown, the internal members 120 are pushed downwards, causing the extensions 123 to move axially away from the recess 113 and press their free ends against the engagement surface 71c of the operating rod-shaped protrusion 71 of the actuating member 7. When the operating rod-shaped protrusion 71 is pushed downwards, the actuating member 7 rotates slightly in the hole 55, which causes the pressure member 6 to move further axially into the narrowed portion 50c that locks the head 3.

[0114] Figure 24 and Figure 25 Two constructions are shown: one for the instrument and the other for the bone anchoring device. Figure 24 In the middle, the bone anchoring device is in Figure 21d and Figure 22d In the pre-locking configuration, the operating rod-shaped protrusion 71 contacts only the free end surface of the extension 123. Figure 25 In this configuration, the extension 123 has been pushed further downward to rotate the actuating member 7 by pressing the operating rod-shaped protrusion 71. In this configuration, the head is temporarily locked by the instrument. Once the inner member 120 retracts, the pressure is released, and the head 3 can pivot again within the head receiving recess 66 of the pressure member 6. It should be noted that the locking force on the head can be adjusted by adjusting the force applied by the instrument.

[0115] exist Figures 26 to 31 The second embodiment of the device is shown together with the multiaxial bone anchoring device of the first embodiment. Descriptions of components and parts of the device that are identical or highly similar to those of the first embodiment will not be repeated, and such components or parts will have the same reference numerals as those of the first embodiment. Device 100' has an internal member 120' comprising two strip-shaped actuating members 123' configured to press against the operating rod-shaped protrusion 71 of the actuating member 7. (As shown in...) Figure 26 As can be seen, the outer member 110' includes an axially extending compartment 116' at each arm 112' for guiding the strip-shaped push member 123'. Additionally, as... Figure 27 and Figure 28As shown, the outer member 110' is a generally tubular component with a front end 110a and two slits 111a' and 111b' separated by a bridging portion 111c'. The slits divide the outer member into two arms 112', which are free at the front end 110. Each arm includes a recess 114' at a distance from the front end 110a for engaging with a protrusion 56 of the receiving member. More specifically, when the outer member is attached to the receiving member and the slits 111a, 111b and the generally U-shaped recess 53 are aligned, the recess 114' is asymmetrically arranged at a position corresponding to the position of the protrusion 56 at the receiving member.

[0116] Each arm includes an elongated compartment 116' for actuating member 123'. The elongated compartment 116' extends from a distance from the rear end (not shown) of the outer member 110' to the front end 110a and opens toward the inside of the outer member 110'. The internal contour of the compartment 116' can generally mate with the external contour of the actuating member 123' so that the actuating member 123' is guided within the compartment 116'. The circumferential position of the compartment 116' is such that when the actuating member 123' extends through the compartment 116', the actuating member is configured to contact the front region of the engagement surface 71c of the actuating rod-like protrusion 71. Therefore, the compartment 116' is offset circumferentially from the center of the arm 112', and the two compartments 116' are arranged asymmetrically relative to each other in the same manner as the actuating rod-like protrusion 71 of the actuating member 7.

[0117] The actuating member 123' may have a square cross-section with rounded or flat corners. The front end 120a may be convex. The actuating member 123' is connected to the outer member 110' such that rotation of the handle or actuating member 130' causes the actuating member 123' to shift relative to the outer member 110'. It should be noted that a stabilizing sleeve 140 may be provided in the rear portion of the outer member to provide stability to the outer member 110'.

[0118] In use, such as Figure 30 and Figure 31 As shown, when the device 100' is attached to the receiving component 5, the multiaxial bone anchoring device is in the position as shown. Figure 21d and Figure 22dIn the pre-locked state shown, arm 112' is slightly extended so that the recess 114' of outer member 110' can engage the protrusion 56 of receiving member 5. Push members 123' move away from compartment 116' until they press their front surfaces 120a against the engagement surface 71c of operating rod-shaped protrusion 71. Because the front surfaces 120a of the push members are circular, sufficient contact can be achieved between the end surfaces 120a and the engagement surfaces 71a. Each push member 123' presses down on the operating rod-shaped protrusion 71, thereby causing the corresponding actuating member 7 to rotate within the hole. As in the first embodiment, the cylindrical protrusion 73 moves downward and pushes the pressure member 6 deeper into the narrowed portion 50c of the receiving member. As a result, the head 3 is temporarily locked as long as the push members 123' press against the operating rod-shaped protrusion 71. When the push members retract, the pressure applied to the pressure member by the actuating member 7 is released, and the head can pivot again.

[0119] Reference Figures 32 to 47 The third embodiment of the device and a modified embodiment of the receiving component are described. Components and portions of the multiaxial bone anchoring device that are identical or highly similar to those of the multiaxial bone anchoring device in the foregoing embodiments have the same reference numerals, and their description will not be repeated.

[0120] The multiaxial bone anchoring device includes the bone anchor 1 as described in the foregoing embodiment, a modified receiving component 5', a modified pressure member 6', and a modified actuating member 7'. See more details... Figures 33 to 38 The passage 50 in the receiving member 5' includes a generally conical tapered section 50c' that extends from the second end 5b across the region of the head receiving recess of the pressure member, including the region of the maximum diameter of the head, and is configured to mate with the corresponding conical tapered outer surface of the pressure member 6', as described below. The conical tapered section 50c' is interrupted in the axial direction by a widened portion 50b' having an increased inner diameter to allow the pressure member 6' to expand within the widened portion during insertion of the head 3. The hole 55 for receiving the actuating member 7 is located circumferentially at the center of each leg 54, as in the first embodiment, and extends axially above the bottom 53a of the generally U-shaped recess 53. Engaging protrusions 56' are provided between the upper edges of each hole 55 in the direction of the first end 5a, and are circumferentially symmetrical with respect to the center of each leg 54. The engaging protrusion 56' may have the same or similar shape as in the aforementioned embodiments, i.e., it has a base and a roof-shaped upper portion. The groove in the outer surface of the receiving component may be omitted.

[0121] The pressure member 6' has the same upper portion 61 as the upper portion in the aforementioned embodiment. The lower portion 62' includes a conical outer surface 69' that extends in an axial height such that when the head is inserted, the conical outer surface includes a portion having the maximum diameter of the head. When the pressure member 6' is in the receiving member 5', the conical outer surface portion 69' contacts the conical tapered portion 50c' above and below the widened portion 50b'.

[0122] The actuating member 7' in this embodiment, like in the first embodiment, includes a cylindrical main portion 70 and a cylindrical eccentric protrusion 73 projecting from the inner side 70b. On the outer side 70a, a connecting portion for the instrument is formed as a cylindrical protrusion 71', which may also be eccentrically arranged relative to the main portion 70 and positioned at the same location as the cylindrical protrusion 73 but on the opposite side of the main portion 70. The cylindrical axis z' of the cylindrical protrusion 71' is offset from the rotation axis R of the main portion 70. The dimensions of the cylindrical protrusion 71' may be the same as those of the cylindrical protrusion 73. Furthermore, the cylindrical axes of the cylindrical protrusions 71' and 73 may coincide. A cutout portion 74 or other markings may be provided on the outer side 70a for properly orienting the actuating member in the hole 55. More specifically, particularly refer to... Figure 34 The actuating member 7' is mounted to the receiving member 5' such that the cylindrical axis z' is offset from the center of the leg 54 in the circumferential direction. In this way, the protrusion 71' functions similarly to the operating lever 71 in the aforementioned embodiment.

[0123] like Figure 45aAs shown, the device 100" includes a generally tubular outer member 110" and an equally generally tubular inner member 120" guided within the outer member 110". The outer member 110" includes, at its front end 110a, a generally rectangular recess 111 that divides the front portion into two arms 112". The width of the recess 111" is such that the arms 112" are spaced apart to allow the front portion to be placed on the receiving member 5'. The axial length of the recess 111" ensures that, even after the front portion has been placed on the receiving member, there remains space in the axial direction for inserting a rod. The inner walls of each arm 112" include a recessed portion 113' at a distance from the front end 110a, the recessed portion for receiving the front portion of the inner member 120". A engagement recess 118” is formed on the inner wall of arm 112” at a certain distance from the front end 110a. The engagement recess has a generally U-shaped profile rotated 90° so that it opens circumferentially toward one edge of arm 112”. Engagement recesses 118” at the opposite arm 112” open in the same direction. The profile of the recess 118” allows the cylindrical protrusion 71’ of the actuating member 7’ to be received and guided therein. When the instrument is placed on the receiving member 5’ in a lateral position relative to the engagement protrusion 71’ of the actuating member 7’, the rotation of the instrument toward the protrusion 71’ causes the engagement recess 118” to engage the corresponding engagement protrusion 71’.

[0124] The internal component 120” can be displaced relative to the external component 110” via a mechanism 130”, the external mechanism including, for example, an operating lever 130”. Figure 32 Various mechanisms can be used to move the internal component relative to the external component. The front portion of the internal component 120” includes two arms 122” at the front end 120a. The arms 122” can be guided within the arms 112” of the external component 110”. An engagement recess 126” is formed on the inner wall of each arm 122”, the engagement recess having a shape on one side that mates with the shape of the protrusion 56’ of the receiving component, and opening circumferentially on the other side. The engagement recess 126” on the internal component is positioned and shaped to allow engagement with the engagement protrusion 56’ of the receiving component 5’ when the instrument is placed on the receiving component and rotated in one direction.

[0125] In use, such as Figure 45a and Figure 45b As shown, the arm of the instrument is positioned laterally on the receiving member 5' from the engaging protrusion 56'. The rod 200 may have been inserted into the recess 53.

[0126] Next, as Figure 45cAs shown, the device is rotated until the engagement recess 126” of the inner member 120” engages the engagement protrusion 56’ of the receiving member 5, while the engagement recess 118” of the outer member 110” engages the engagement protrusion 71’ of the actuating member 7’.

[0127] After that, as Figure 45d As shown, the outer member 110” is displaced downward relative to the inner member 120” in the direction toward the second end 5b of the receiving member 5'. The inner member applies force on the engaging protrusion 71', causing the actuating member 7' to rotate about the rotation axis R. At the same time, the eccentric protrusion 73 moves downward, resulting in the pressure member 6' being pressed into the conical section 50c” of the passage to lock the head 3.

[0128] In this embodiment, the outer member 110” can be retracted relative to the inner member 120”. The bottom edge of the recess 118” causes the protrusion 71’ to move upward, and the pressure member follows the upward movement so that the temporary lock on the head 3 can be released.

[0129] The locking and releasing of head 3 can be performed several times until the correct position of bone anchor 1 relative to receiving part 5' can be found. Typically, as shown, rod 200 may have been inserted into recess 53 of receiving part, or recess 53 may remain unobstructed and / or rod 200 may be inserted during the calibration step. The instrument can be released by rotating the instrument in opposite directions to disengage protrusion 56' from recess 126' and protrusion 71' from recess 118'.

[0130] like Figure 47 As shown, once the correct angular position of the bone anchor 1 relative to the receiving part 5' has been found and the rod has been inserted, the fixation member 8 (in this embodiment, a fixation screw) can be inserted between the legs and tightened to secure the rod and head. The rod or fixation member can also be inserted before multi-axis angle correction or locking occurs.

[0131] exist Figures 48 to 69b This illustration shows another embodiment of a multiaxial bone anchoring device and an apparatus for use with such a device. Components and portions that are identical or highly similar to those in the foregoing embodiments are labeled using the same reference numerals. Reference Figures 48 to 54 The receiving component 5 is similar to Figures 35 to 38The receiving component 5' differs in some details. A receiving space for accommodating a portion of the pressure member includes a conical tapered lower section 50c” near the second end 5b, the conical tapered lower section being configured to mate with the conical outer surface of the pressure member. Adjacent to the conical section 50c”, a cylindrical widening portion 50b” allows the pressure member to expand during insertion of the head 3. Above the widening portion 50b”, an upper portion 50d” provides space for the upper region of the conical portion of the pressure member. Around the hole 55” located at the center of the leg 54 in the circumferential direction, a plurality of, preferably shallow, recesses 501 are formed in the outer wall of the receiving component 5”. The shape and size of the recesses 501 are designed to accommodate a portion of the actuating member 7” therein. More specifically, the recesses 501 may be rectangular and slightly teardrop-shaped, having a narrow end 501a and a relatively wide end 501b. In the embodiment, four such recesses 501 are provided, which are arranged near the corners of a virtual square surrounding the hole 55”, such that the narrow ends 501a face each other.

[0132] The protrusions 56” for engaging with the instrument are located circumferentially above the holes 55' in the middle of the leg 54. In this embodiment, the protrusions 56” have a base with a generally rectangular outline and a low, roof-shaped portion in the direction of the first end 5a. The protrusions 56” may be surrounded by two axial grooves 57” for guiding the instrument.

[0133] Finally, the receiving component 5” has two extensions 502 that extend from the leg 54 above the first end 5a and are of such length that they are configured to protrude from the patient’s skin when the multiaxial bone anchoring device is inserted into the bone or vertebra. The extensions 502 may have internal threads 51” in at least a portion thereof, which continue into internal threads 51 on the leg 54. The purpose of the extensions 502 is to allow instruments and components (e.g., fixation screws) to be guided from the outside to the receiving component 5”. Adjacent to the first end 5a (which in this case is the outer end of the leg 54), a weakened segment 503 is formed on each leg 54, the weakened segment having a reduced thickness in the radial direction and allowing the extensions 502 to be disconnected from the receiving component 5”. Once the multiaxial bone anchoring device has been inserted and the extensions are no longer needed, preferably after locking the head and fixing the rod, the extensions 502 can be removed.

[0134] The pressure member 6” has a generally cylindrical upper portion 60” and a conical lower portion 61”. It is related to Figures 39 to 42The difference in pressure member 6' is that the lower portion 61" includes a conical outer surface portion 69", which extends axially to approximately the middle of the recess 600 for actuation portion 7". As in the previous embodiment, the recess 600 is offset from the center of the leg 63 of pressure member 6" toward the opposite side. Specifically in Figure 58 As can be seen, the head receiving recess 66' may include an enlarged conical section 666 at a certain distance from the second end 6b, the conical section widening towards the second end 6b. This can help the inserted head pivot to a larger angle in the head receiving recess 66'.

[0135] refer to Figures 60 to 63 The actuating part 7” includes a cylindrical main part 70 and a cylindrical eccentric protrusion 73 protruding from the inner side 70b of the main part 70, as per [the provided text]. Figures 43 to 44 As in the embodiment. The cylindrical axis z of the cylindrical protrusion 73 is offset from the rotation axis R of the main portion 70. A strip 71” is formed on the outer surface 70a of the main portion 70, the strip being configured to be joined by a device. The strip 71” preferably extends beyond the outer contour of the main portion 70 with its free end portions 71a”, 71b”. It functions similarly to a double-arm lever, wherein the pivot axis of the lever is coaxial with the rotation axis R of the main portion 70. More specifically, one lever arm 75a extends from the pivot axis to one free end 71a”, and the other lever arm 75b extends from the pivot axis to the opposite free end 71b”. The strip 71” is oriented relative to the eccentric protrusion 73 such that the longitudinal axis l of the strip 71” is substantially parallel to the axis of rotation of the main portion 70. Figure 62The line connecting the rotation axis R of the main part 70 and the rotation axis z of the eccentric part 73 in the top view shown. Therefore, the strip 71” is generally aligned with the eccentric protrusion 73. Furthermore, the strip 71” may have a convex outer surface 76a facing away from the cylindrical main part 70 and a concave inner surface 76b facing the main part 70. The end portions 71a”, 71b” may be slightly thicker along the direction of the main part 70 to provide greater stability to the strip 71”. When the actuating part 7” is inserted into the corresponding hole 55” of the receiving member 5” and oriented such that the longitudinal axis l of the strip 71” extends substantially perpendicular to the central axis C of the receiving member 5”, the end portions 71a”, 71b” of the strip 71” contact the outer surface of the receiving member 5” between the two recesses 501. When the operating lever is pivoted, the thickened end portions 71a”, 71b” move into the recesses 501. This allows for a more compact design of the receiving member with the actuating part. The rod 71” has a first operating lever surface 71c” and an opposing second operating lever surface 71d”. The first and second operating lever surfaces are oriented substantially parallel to the axis of rotation R of the main part 70 and can engage with the instrument depending on which of the surfaces is oriented toward the instrument. The two actuating parts 7” are arranged in the hole 55” of the receiving part 5” such that for one of the actuating parts 7”, the first operating lever surface 71c” faces the top end 5a of the receiving part 5”, while for the other actuating part 7”, the second operating lever surface 71d” faces the upper end 5a of the receiving part 5”.

[0136] refer to Figures 64 to 67 The explanation will be suitable for and based on Figures 48 to 63 An instrument used in conjunction with a bone anchoring device. The instrument includes a first instrument part or external member 1100 in the form of a generally tubular component having a front end 1100a and two slits 1111, each slit being bridged by a bridging portion 1112. Slit 1111 divides the first instrument portion 1100 into two arms 1120, which may be slightly flexible so that they can be clamped onto the receiving member 5”. Each arm 1120 includes a recess 1140 at a distance from the front end 1100a for engaging with a protrusion 56” of the receiving member 5”. More specifically, the recess 1140 is arranged circumferentially in the middle of each arm 1120 at a position corresponding to the position of the protrusion 56” of the receiving member 5”. Thus, when the first instrument portion 1100 is attached to the receiving member 5” and slit 1111 is aligned with the generally U-shaped recess 53, the protrusion 56” can engage the recess 1140 to secure the first instrument portion 1100 to the receiving member 5”.

[0137] The device 1000 further includes a second device portion or internal component in the form of a pair of rod-shaped actuating members 1230a, 1230b, which are received in corresponding axially elongated compartments 1160 on the left and right sides of a recess 1140 in each arm 1120. Each actuating member 1230a, 1230b of an arm 1120 is configured to press against one of the operating lever arms 75a, 75b of the actuation portion 7”. The compartment 1160 can open radially toward the interior and exterior of the arm 1120, and the actuating member is guided within the compartment 1160. Moreover, the compartment 1160 is positioned such that the actuating members 1230a, 1230b are configured to press against the corresponding operating lever arms 75a, 75b in regions close to the corresponding end portions 71a”, 71b” of the bar 71”. Each actuating member's end portion 1231 may have a convex outer surface to ensure contact with the operating lever surfaces 71c", 71d" in various pivoting positions of the bar 71". Each actuating member 1230a, 1230b on each arm 1120 is axially movable from a first position to a second position, in the first position the actuating member does not contact the bar 71" of the actuating portion 7" and in the second position the end portion 1231 contacts one of the operating lever arms 75a, 75b of the bar 71". Additionally, each actuating member 1230a, 1230b is movable from the second position to the first position by the action of another operating lever arm that pushes the actuating member back.

[0138] like Figure 64 As shown, the device 1000 includes a mechanism 1300 for selectively actuating one of the push members 1230a, 1230b on each arm 1120 axially downward from the first position to press against the operating lever arm 75a, 75b associated with that push member. Simultaneously, another push member on that arm moves upward by pressure applied by a corresponding other operating lever arm. Specifically, the mechanism 1300 may include an operating lever 1310 having two positions associated with the first and second positions of the push members.

[0139] Figure 68 The pressure member 6” is shown in the locked position of the head 3, wherein the conical outer surface 69” of the pressure member 6” engages the conical inner surface 50c” of the receiving member 5”, thereby compressing the pressure member 6” around the head 3. The push member 1230a on the left is pushed downward, while the corresponding push member 1230a on the right side of the other arm (not shown in the cross-sectional view) is pushed downward to press against the corresponding operating lever arm 75a. It should be noted that because the overlap between the conical outer surface 69” of the pressure member and the conical inner surface 50c of the receiving member 5” is relatively small, a relatively small unlocking force is required.

[0140] like Figure 69a As shown, when one of the push members 1230a of one arm 1120 is pushed downward to press against the corresponding operating lever arm 75a, the actuating portion 7” rotates clockwise and the eccentric protrusion 73 causes the pressure member 6” to move downward (i.e., toward the second end 5b of the receiving member), which forms a lock on the inserted head. Thus, the other 1230b of the push member moves upward via the other operating lever arm 75b. Figure 69b As shown, when the other 1230b of the pushing member moves downward, it presses against the other operating lever arm 75b, causing the actuating member 7” to rotate counterclockwise, which causes the pressure member 6” to move upward. Therefore, the inserted head can be unlocked. It should be noted that since the other actuating part 7” is flipped into another hole 55” in the receiving member 5”, the actuating part provided on the other leg 54 of the receiving member 5” rotates in the opposite direction in each case.

[0141] Therefore, locking and unlocking can be associated with a specific configuration of the actuation mechanism 1300 of the device. Preferably, pressing the operating lever arm 1310 can be associated with locking the head 3, and releasing the pressure on the operating lever arm 1310 can be associated with unlocking the head. In use, the device can be snapped onto the receiving part until the protrusion 56” engages with the corresponding recess 1140 provided on the arm 1120. Thereafter, the actuating member can be actuated to lock the inserted head 3 and unlock the inserted head 3. This process can be performed several times.

[0142] Modifications to the described embodiments are possible. Features of one embodiment can also be combined with features of another embodiment to produce various further embodiments. Components are not limited to the specific shapes depicted in the embodiments.

[0143] For example, a bone anchoring device is shown as a bottom-mounted bone anchoring device, wherein the head 3 is inserted into the receiving member from a second or lower end. However, the bone anchoring device can be a top-mounted bone anchoring device, wherein the bone anchor is inserted into the receiving member from a first or top end. In such a case, the pressure member can have a slightly different design, wherein the pressure member covers the upper portion of the head and presses the head against a seat provided in the receiving member. In a further modification, only one actuating portion exists.

[0144] For bone anchors, various bone anchors can be used, such as screws, nails, hooks, etc.

[0145] Mechanisms for shifting internal and external components of an instrument can be implemented in various ways.

Claims

1. A coupling device for connecting a rod to a bone anchor, the coupling device comprising: A receiving component (5, 5', 5") is configured to receive the head (3) of the bone anchor (1). The receiving component (5, 5', 5") has a first end (5a), a second end (5b), a central axis (C) extending through the first end (5a) and the second end (5b), and two legs (54) that define a recess (53) at the first end for receiving the rod. as well as A pressure member (6, 6', 6") is arranged in the receiving member (5, 5', 5") to apply pressure to the inserted head (3). The actuating portion (7, 7', 7") is configured to act on the pressure member (6, 6', 6"). The actuating portion (7, 7', 7") is configured to rotate at least partially about a rotation axis (R) extending at an angle relative to the central axis (C) to move the pressure member (6, 6', 6") from an unlocked position to a locked position, in which the inserted head (3) is pivotable in the receiving member (5, 5', 5"), and in the locked position, the head (3) is clamped; and The actuating portion (7, 7', 7") is configured to rotate when a force is applied to the actuating portion in the direction of the central axis (C).

2. The connecting device according to claim 1, characterized in that, The actuating portion (7, 7', 7") can be engaged from outside the receiving component by instruments (100, 100', 100", 1000).

3. The connecting device according to claim 2, characterized in that, The actuating portion (7, 7', 7") is configured to temporarily hold the pressure member (6, 6', 6") in the locked position whenever the actuating portion is engaged by the instrument (100, 100', 100", 1000).

4. The connecting device according to claim 1 or 2, characterized in that, The actuating portion (7, 7', 7") includes an insertion member configured to be rotatably supported in one of the legs (54).

5. The connecting device according to claim 1 or 2, characterized in that, The actuating portion (7, 7', 7") includes a joining portion (73) configured to engage the pressure member (6, 6', 6"), and wherein the joining portion (73) is asymmetrically positioned relative to the axis of rotation (R) of the actuating portion (7, 7', 7").

6. The connecting device according to claim 5, characterized in that, The joint portion is eccentric relative to the axis of rotation (R).

7. The connecting device according to claim 5, characterized in that, The pressure member (6, 6', 6") includes a recess (600) configured to receive an engagement portion (73) of the actuating portion, wherein the recess (600) allows the engagement portion (73) to move therefrom a first position associated with an unlocked position of the pressure member to a second position associated with a locked position.

8. The connecting device according to claim 7, characterized in that, The recess (600) allows the engagement portion (73) to move therein in a guided manner.

9. The connecting device according to claim 1 or 2, characterized in that, The actuating portion (7, 7', 7") is fixed to the receiving component to prevent axial movement of the actuating portion (7, 7', 7") along the rotation axis.

10. The connecting device according to claim 9, characterized in that, The actuating portion (7, 7', 7") is fixed to the receiving component by a stop (57a).

11. The connecting device according to claim 1 or 2, characterized in that, The rotation axis (R) of the actuating portion (7, 7', 7") extends substantially perpendicular to the central axis (C), and the pressure member (6, 6', 6") is configured to move axially along the central axis (C).

12. The connecting device according to claim 1 or 2, characterized in that, The actuating portion (7, 7', 7") includes an external engagement portion (71, 71', 71") extending to the outside of the receiving component (5, 5', 5"), and wherein the external engagement portion is capable of being engaged by a device.

13. The connecting device according to claim 12, characterized in that, The external joint portion (71, 71', 71) is a protrusion.

14. The connecting device according to claim 12, characterized in that, The outer engagement portion (71) includes an engagement region that is asymmetrical with respect to the axis of rotation (R), such that pushing the outer engagement portion in a direction generally parallel to the central axis (C) causes the actuating portion (7, 7') to rotate.

15. The connecting device according to claim 1 or 2, characterized in that, Two actuating portions (7, 7; 7', 7'; 7”, 7”) are provided on each leg (54) of the receiving component.

16. The connecting device according to claim 15, characterized in that, The two actuating parts are configured to rotate in opposite directions.

17. The connecting device according to claim 1 or 2, characterized in that, The receiving component (5, 5', 5") includes an additional engagement portion (56, 56', 56") for the instrument.

18. The connecting device according to claim 17, characterized in that, The additional engagement portion (56, 56', 56") is provided on the outer surface of the receiving component.

19. The connecting device according to claim 17, characterized in that, The additional joining portion (56) is offset circumferentially from the axis of rotation (R).

20. The connecting device according to claim 1 or 2, characterized in that, The receiving component (5, 5', 5") includes an opening (52) at the second end (5b) that is larger than the maximum width (E) of the head (3) to allow the head (3) of the bone anchor (1) to be inserted from the second end, and wherein the pressure member (6, 6', 6") includes a head receiving portion (66, 66") that is capable of compressing around the inserted head (3) when the pressure member is moved to the locked position by the actuating portion (7, 7', 7").

21. The connecting device according to claim 1 or 2, characterized in that, The actuating part (7) is configured to rotate in a first direction to move the head (3) from which the pressure member (6) is inserted to the locked position, which is pivoted in the receiving part (5), to the locked position, and to rotate in a second direction to move the pressure member (6) from the locked position to the unlocked position.

22. The connecting device according to claim 21, characterized in that, The second direction is opposite to the first direction.

23. A bone anchoring system, the bone anchoring system comprising the connection device and apparatus according to any one of claims 1 to 22, the apparatus comprising: First instrument portion (110, 110', 110", 1100), the first instrument portion being configured to engage the receiving component (5, 5', 5"). as well as A second instrument portion (120, 120', 120", 1200) is displaceable relative to the first instrument portion, and the second instrument portion is configured to engage the actuating portion (7, 7', 7"). When the first instrument part (110, 110', 110", 1100) engages the receiving part (5, 5', 5") and the second instrument part (120, 120', 120", 1200) engages the actuating part (7, 7', 7') and the actuating part (7, 7', 7') is rotated, the pressure member (6, 6', 6") is able to move from the unlocked position to the locked position, in which the inserted head (3) is able to pivot in the receiving part, and in the locked position, the head (3) is clamped.

24. The bone anchoring system according to claim 23, characterized in that, The first instrument part (110, 110', 110", 1100) is an external tube.

25. The bone anchoring system according to claim 23, characterized in that, The second instrument portion (120, 120', 120", 1200) is at least partially disposed within the first instrument portion.

26. A bone anchoring device comprising a connecting device according to any one of claims 1 to 22 and a bone anchor (1), the bone anchor (1) comprising a head (3) and a handle (2) to be anchored in a bone or vertebra.

27. The bone anchoring device according to claim 26, characterized in that, The head (3) has a spherical outer surface portion.

28. A bone anchoring system, the bone anchoring system comprising the bone anchoring device and apparatus according to claim 26 or 27, the apparatus comprising: First instrument portion (110, 110', 110", 1100), the first instrument portion being configured to engage the receiving component (5, 5', 5"). as well as A second instrument portion (120, 120', 120", 1200) is displaceable relative to the first instrument portion, and the second instrument portion is configured to engage the actuating portion (7, 7', 7"). When the first instrument part (110, 110', 110", 1100) engages the receiving part (5, 5', 5") and the second instrument part (120, 120', 120", 1200) engages the actuating part (7, 7', 7') and the actuating part (7, 7', 7') is rotated, the pressure member (6, 6', 6") is able to move from the unlocked position to the locked position, in which the inserted head (3) is able to pivot in the receiving part, and in the locked position, the head (3) is clamped.

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