Fixing plate for intervertebral implant

Abstract

A plate is described for fixation to an intervertebral implant and for fixation to the vertebral body in order to stabilize the implant during a surgical procedure and in particular when repositioning the patient from a lateral position to a prone position, for example, during the surgical procedure. The plate includes a fixation member movable between an unlocked configuration in which the fixation member is positioned for insertion into the implant and a locked configuration that couples the fixation member to the intervertebral implant. The fixation member is also movable to a fixation position that fixes the plate to the intervertebral implant so as to define a rigid structure.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application claims priority to U.S. patent application serial number 63 / 343,992 filed on May 19, 2022, the disclosure of which is hereby incorporated by reference as if fully set forth herein. Background Art

[0003] The human spine is composed of a series of vertebrae separated by intervertebral discs. The natural intervertebral disc contains a gelatinous nucleus pulposus surrounded by a fibrous annulus fibrosus. Under axial load, the nucleus pulposus compresses and transmits the load radially to the annulus fibrosus. The laminar nature of the annulus fibrosus provides it with high tensile strength, thus allowing it to expand radially in response to the transmitted load.

[0004] In a healthy intervertebral disc, cells within the nucleus pulposus produce an extracellular matrix (ECM) containing a high percentage of proteoglycans. These proteoglycans contain sulfated functional groups that retain water, thus providing the nucleus pulposus with its buffering properties. These nucleus pulposus cells can also secrete small amounts of cytokines, such as interleukin-1β and TNF-α, and matrix metalloproteinases ("MMPs"). These cytokines and MMPs help regulate the metabolism of nucleus pulposus cells.

[0005] In some cases of degenerative disc disease (DDD), the gradual degeneration of the intervertebral disc is caused by the mechanical instability in other parts of the spine. In these cases, increasing the load and pressure on the nucleus pulposus can cause the cells in the intervertebral disc (or invading macrophages) to release the above-mentioned cytokines higher than normal. In other cases of DDD, genetic factors or apoptosis may also cause the cells in the nucleus pulposus to release these cytokines and MMPs of toxic amounts. In some cases, the pumping action of the intervertebral disc may fail (for example, due to the reduction of proteoglycan concentration in the nucleus pulposus), thereby hindering nutrients from flowing into the intervertebral disc and waste from flowing out of the intervertebral disc. The ability to eliminate waste products reduced by this can lead to high levels of proinflammatory cytokines and / or MMP accumulation, which can lead to nerve irritation and pain.

[0006] As DDD progresses, toxic levels of cytokines and MMPs present in the nucleus pulposus begin to degrade the extracellular matrix. In particular, MMPs (mediated by cytokines) begin to cleave the water-retaining portion of proteoglycans, thereby reducing its water-retaining capacity. This degradation causes the nucleus pulposus to become less flexible, thus changing the load pattern within the disc, which can lead to delamination of the annulus fibrosus. These changes create greater mechanical instability, which can cause cells to release even more cytokines, which typically upregulates MMPs. As this destructive cascade continues and DDD progresses further, the disc begins to bulge out ("disc herniation") and then eventually ruptures, causing the nucleus pulposus to contact the spinal cord and cause pain.

[0007] A proposed method for managing these problems is to remove the problematic disc from the disc space and replace it with an intervertebral implant that restores the disc height and allows bone fusion with adjacent vertebrae. These devices are commonly referred to as fusion devices or "intervertebral fusion devices." Current spinal fusion surgeries include transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF), and extreme lateral interbody fusion (XLIF). Once the fusion device has been inserted into the disc space, the patient is typically repositioned from a lateral position to a prone position to implant supplemental fixation.

[0008] Therefore, there is a need for a method and apparatus for maintaining the position of a fusion device in the intervertebral disc space during patient repositioning. Summary of the invention

[0009] In one example, the plate is configured to be fixed to an intervertebral implant extending in a distal direction from the plate. The plate may include a plate body having at least one bone fixation hole, the at least one bone fixation hole being configured to receive a bone fixation element extending into a vertebral body, wherein the plate body defines a support. The plate may also include a fixing member configured to rotate from an unlocking configuration to a locking configuration in a first rotational direction around an axis of rotation. In one example, the fixing member may be configured to be driven to translate to a fixed position in a fixed direction along the axis of rotation until the retaining wall of the intervertebral implant is captured between the support and the fixing member when the fixing member is in the locking configuration. BRIEF DESCRIPTION OF THE DRAWINGS

[0010] The above content of the invention and the following detailed description of the illustrative embodiments of the intervertebral implant of the present application will be better understood by reading in conjunction with the accompanying drawings. For the purpose of illustrating the intervertebral implant of the present application, exemplary embodiments are shown in the accompanying drawings. However, it should be understood that the present application is not limited to the precise arrangements and means shown. In the accompanying drawings:

[0011] Figure 1A is a perspective view of a bone fixation system including an intervertebral implant and a plate secured to the intervertebral implant, showing a screw inserted through a screw hole of the plate;

[0012] Figure 1B yes Figure 1A Another perspective view of the bone fixation system of FIG. 1 , wherein the screws are omitted;

[0013] Figure 1C yes Figure 1B A top plan view of the bone fixation system;

[0014] Figure 1D yes Figure 1C Side elevation view of the bone fixation system;

[0015] Figure 1E yes Figure 1D Cross-sectional view of the bone fixation system;

[0016] Figure 2A Built according to one example and shown in a locked configuration Figures 1A to 1E Cross-sectional view of the bone fixation system;

[0017] Figure 2B Shown in unlocked configuration Figure 2A A perspective view of a plate of a bone fixation system whereby portions of the plate are shown as transparent;

[0018] Figure 2C yes Figure 2B A cross-sectional elevation view of a plate;

[0019] Figure 3A is a plan view of a plate having a pair of screw holes;

[0020] Figure 3B yes Figure 3A Plans of boards, but of different sizes;

[0021] Figure 3C yes FIG. 3A to FIG. 3B Plans of boards, but of different sizes;

[0022] Figure 4A is a plan view of a plate having screw holes in a first orientation;

[0023] Figure 4B yes Figure 4A Plans of boards, but of different sizes;

[0024] Figure 4C yes FIG. 4A to FIG. 4B Plans of boards, but of different sizes;

[0025] Figure 5A is in Figure 4A a plan view of a plate having screw holes in a second orientation different from the first orientation;

[0026] Figure 5B yes Figure 5A Plans of boards, but of different sizes;

[0027] Figure 5C yes FIG. 5A to FIG. 5B Plans of boards, but of different sizes;

[0028] Fig. 6A is a perspective view of a board constructed according to another example with portions cut away for purposes of illustration;

[0029] Figure 6B yes Fig. 6A A front elevation view of a plate;

[0030] Figure 6C yes Fig. 6A A side elevation view of a plate;

[0031] Fig.6D yes Fig. 6A A front perspective view of a board;

[0032] Fig. 6E yes Fig. 6A A rear perspective view of the board;

[0033] Fig. 6F An inserter instrument is shown aligned to be coupled to a plate that has been inserted into an intervertebral implant in an unlocked configuration;

[0034] Figure 6G shows a driver instrument inserted through an inserter instrument after the driver instrument has driven a securing member of a plate from an unlocked configuration to a locked configuration;

[0035] Figure 6H is another cross-sectional view of the driver shown coupled to a stationary member;

[0036] Fig. 7A is a perspective view of a panel constructed according to yet another example, with portions cut away for purposes of illustration;

[0037] Figure 7B yes Fig. 7A A cross-sectional side elevation view of a plate shown inserted into an intervertebral implant;

[0038] Figure 7C yes Fig. 7A Another cross-sectional view of the plate;

[0039] Figure 8 A plurality of bone screws that may be included in a kit are shown;

[0040] Fig. 9A is a side elevation view of a plate insert;

[0041] Fig. 9B yes Fig. 9A a cross-sectional side elevation view of a plate insert shown partially removed;

[0042] Fig. 10A is constructed to be inserted FIG. 9A to FIG. 9B A side elevation view of a driver in an insert;

[0043] Fig. 10B is shown as being operably coupled to the plate Fig. 10A a cross-sectional side elevation view of a portion of a drive;

[0044] Fig.11A is a side elevation view of a driver and insert coupled to a plate and showing the plate secured to an implant prior to inserting the implant into an intervertebral space;

[0045] Fig. 11B is a side view of a driver and inserter coupled to a plate and configured to couple the plate to an implant after the implant has been inserted into the intervertebral space;

[0046] Fig. 12A A kit showing a trial plate attached to a trial implant and a trial insert attached to the trial plate in one of a plurality of angular positions;

[0047] Fig. 12B A kit comprising a plurality of differently sized test plates attached to corresponding test inserts is shown;

[0048] Fig.13A A kit comprising a trial plate attached to a trial implant and a trial insert attached to the trial plate in one of a plurality of angular positions is shown, wherein the trial plate includes insertion depth markings;

[0049] Fig. 13B yes Fig.13A A top plan view of the trial implant;

[0050] Fig. 13C It is inserted into the intervertebral space Fig. 13B A side elevation view of the trial implant;

[0051] Fig.14A Shown is a trial implant insert coupled to a trial implant and a trial insert member coupled to a trial plate, wherein the trial insert member partially surrounds the trial implant insert.

[0052] Fig. 14B Shows Fig.14A An assembly of wherein the trial implant is shown exploded from the trial implant insert;

[0053] Fig. 14C yes Fig. 14C An enlarged view of a portion of the trial implant, trial plate, and trial insert member is shown;

[0054] Fig.14D Shows Fig. 14C , but showing the trial implant coupled to the trial implant insert;

[0055] Fig.15A A guide sleeve is shown inserted into a fixing hole of a test plate at a fixed angle;

[0056] Fig. 15B A guide sleeve is shown inserted into a fixing hole of a test plate at a variable angle;

[0057] Fig. 15C It is shown Fig.15A a perspective view of the interlocking ends of the guide sleeve shown;

[0058] Fig.15D It is shown Fig. 15B A perspective view of an articulation surface of a guide sleeve;

[0059] Fig.15E An opening device, which in one example is configured as a drill, is shown; and

[0060] Fig.15F An opening device in the form of an awl is shown in another example. DETAILED DESCRIPTION

[0061] First reference Figures 1A to 1E The intervertebral implant 20 is configured to be inserted into the intervertebral space. FIG. 11A to FIG. 11B As shown in the figure, the intervertebral space 51 can be defined by an upper vertebral body 53 and an adjacent lower vertebral body 55 of the human spine. The upper vertebral body 53 defines an upper vertebral surface. The lower vertebral body 55 defines a lower vertebral surface. The lower vertebral surface and the upper vertebral surface can define the intervertebral space 51. The vertebral bodies 53 and 55 can be anatomically adjacent to each other. However, it should be understood that the intervertebral implant 20 can alternatively be configured to fit in the intervertebral space defined by the upper vertebral body and the lower vertebral body, which are retained after performing a corpectomy to remove one or more vertebral bodies between the upper vertebral body and the lower vertebral body. The intervertebral implant can be inserted into the intervertebral space after performing a discectomy, whereby the intervertebral disc material has been removed or at least partially removed to prepare the intervertebral space to receive the intervertebral implant. The intervertebral space can be defined in the lumbar region of the spine, or alternatively defined in the cervical region or thoracic region of the spine.

[0062] As will be understood from the following description, intervertebral implant 20 is configured to be inserted into the intervertebral space along a lateral anatomical approach (referred to as a lateral intervertebral implant). However, it should be understood that unless otherwise indicated, the present invention is not limited to lateral intervertebral implants and may be, for example, a TLIF implant, a PLIF implant, or an XLIF implant.

[0063] Reference now Figures 1A to 1E, intervertebral implant 20 is described herein as extending horizontally along longitudinal direction "L" and lateral direction "A", and extending laterally along transverse direction "T". Unless otherwise specified herein, the terms "longitudinal", "lateral" and "horizontally" are used to describe the orthogonal direction components of each implant component and the axis of the implant component. The longitudinal direction L may be perpendicular to the transverse direction T. The lateral direction A may be perpendicular to the longitudinal direction L and the transverse direction T. It should be understood that although the longitudinal and lateral directions are shown as extending along the horizontal direction, and the transverse direction T is shown as extending along the vertical direction, these directions may be different according to the orientation of the implant during use. For example, when implant 20 is inserted into the intervertebral space, the transverse direction T extends roughly along the upper-lower (or tail-head) direction, and the horizontal plane defined by the longitudinal direction L and the lateral direction A is roughly located in the anatomical plane defined by the front-back direction and the middle-lateral direction. For example, the lateral direction A may extend roughly along the front-back direction. The longitudinal direction L may extend roughly along the middle-lateral direction.

[0064] The intervertebral implant 20 defines a front end 22 and a rear end 24 opposite to the front end 22 along a longitudinal direction L. The longitudinal direction L can extend generally along the insertion direction into the intervertebral space. Therefore, after the intervertebral implant 20 has been inserted into the intervertebral space along the insertion direction, the longitudinal direction L can be said to extend along the anatomical medial-lateral direction. Specifically, the front end 22 can be said to be spaced apart from the rear end 24 in the insertion direction. The front end 22 can be tapered to facilitate insertion into the intervertebral space. The rear end 24 is spaced apart from the front end 22 in a direction opposite to the insertion direction. The front end 22 can also be said to define a distal end, and the rear end 24 can be said to define a proximal end opposite to the distal end. Therefore, it can be said that the implant 20 defines a distal direction from the rear end 24 to the front end 22 along the longitudinal direction L. The implant 20 can also be said to define a proximal direction from the front end 22 to the rear end 24 along the longitudinal direction L. Therefore, the distal direction can be consistent with the insertion direction. The proximal direction can be consistent with the direction opposite to the insertion direction.

[0065] The intervertebral implant 20 may further define a first lateral surface 26 and a second lateral surface 28 that are opposite to each other along a lateral direction A. When the intervertebral implant 20 is a lateral implant, the first lateral surface 26 may define an anterior surface, and the second lateral surface 28 may define a posterior surface. The lateral direction A may be oriented perpendicular to each of the longitudinal direction L and the transverse direction T. The lateral direction A may be said to define the width of the implant. When the intervertebral implant 20 is a lateral implant, the width may be measured along the anatomical anterior-posterior direction.

[0066] The intervertebral implant 20 may define an upper surface 30 and a lower surface 32, the upper surface being configured to engage and contact the upper vertebral surface of the upper vertebra, and the lower surface being configured to engage and contact the lower vertebral surface of the lower vertebra. Therefore, the upper surface 30 may be referred to as an upper or upper vertebral contact surface, and the lower surface 32 may be referred to as a lower or lower vertebral contact surface. The upper surface 30 and the lower surface 32 are spaced apart from each other along a transverse direction T perpendicular to each of the longitudinal direction L and the lateral direction A. The transverse direction T may define the height of the intervertebral implant 20. The height may be measured along the anatomical tail-head direction. The height of the intervertebral implant 20 may be measured along the transverse direction T from the upper surface 30 to the lower surface 32. As used herein, the term "superior" and its derivatives refer to the direction from the lower surface 32 toward the upper surface 30. As used herein, the term "inferior" and its derivatives refer to the direction from the upper surface 30 toward the lower surface 32.

[0067] In one example, the intervertebral implant 20 can be configured to define a lordotic or kyphotic profile as desired. Thus, the anterior surface 26 can define a height along the transverse direction T that is equal to the height of the posterior surface 28 along the transverse direction T. Alternatively, the anterior surface 26 can define a height along the transverse direction T that is greater than the height of the posterior surface 28 along the transverse direction T. For example, one or both of the upper surface 30 and the lower surface 32 can be inclined relative to each other in the direction from the anterior surface 26 to the posterior surface 28. The slope of either or both of the upper surface 30 and the lower surface 32 can be defined in a plane oriented along the transverse direction T and the lateral direction A. In one example, the lower surface 32 can be inclined, and the upper surface 30 can be oriented substantially along a plane defined by the longitudinal direction L and the lateral direction A. Alternatively, the upper surface 30 can be inclined, and the lower surface 32 can be oriented substantially along a plane defined by the longitudinal direction L and the lateral direction A. Alternatively, each of the upper surface 30 and the lower surface 32 can be inclined. The upper surface 30 and the lower surface 32 can define any suitable angle as required in the plane defined by the lateral direction A and the transverse direction T. The angle can be substantially 8 degrees, substantially 16 degrees, or any other angle as required. Alternatively, the upper surface 30 and the lower surface 32 can be substantially parallel to each other as required. The implant 20 can be 3D printed or otherwise constructed as required. In addition, the implant 20 can be non-expandable or expandable along the transverse direction T as required.

[0068] Continue to refer Figures 1A to 1E, the bone fixation system 38 may include an intervertebral implant 20 and a plate 40, the plate being configured to be fixed to the implant 20 and further configured to be coupled to at least one or both of the vertebrae defining the intervertebral disc space. The implant 20 may extend from the plate 40 in the distal direction into the intervertebral disc space. Advantageously, the plate 40 may stabilize the implant 20 to limit or prevent migration of the implant 20 when the patient is repositioned during a surgical procedure. For example, when the patient is in a lateral position, the plate 40 may be fixed to the implant 20 and coupled to at least one of the vertebrae. Therefore, when the patient is repositioned to a prone position, the plate 40 limits or prevents migration of the implant 20 in the intervertebral space.

[0069] The plate 40 may include a plate body 41 that defines an anterior surface 42 facing the intervertebral implant 20 and the vertebrae, and a posterior surface 44 opposite the anterior surface 42. The anterior surface 42 may be said to be spaced apart from the posterior surface 44 in a forward direction, which may also be the insertion direction of the intervertebral implant 20. Thus, the forward direction may define a distal direction. Conversely, the posterior surface 44 may be said to be spaced apart from the anterior surface 42 in a posterior direction opposite to the forward direction. Thus, the posterior direction may be referred to as a proximal direction.

[0070] The plate 40 may include at least one bone fixation hole 46 extending from the front surface 42 through the plate body 41 to the rear surface 44. When the intervertebral implant 20 is implanted, the bone fixation hole 46 may receive a bone fixation element 48, which is inserted through the hole 46 and enters one of the intervertebral bodies when the plate 40 is fixed to the intervertebral implant 20. In one example, the plate 40 may include two fixation holes defined by a first fixation hole 46a and a second fixation hole 46b, which are positioned so that the first bone fixation element 48a can be driven through the first fixation hole 46a and enter the upper vertebra. The second bone fixation element 48b can be driven through the second fixation hole 46b and enter the lower vertebra. In one example, the bone fixation element can be configured as a bone screw. Therefore, the first fixation hole 46a can be referred to as an upper fixation hole, and the second fixation hole 46b can be referred to as a lower fixation hole. Therefore, in one example, the plate 40 can have two and no more than two fixation holes. As will be appreciated from the following description, in other examples, the plate 40 may include only a single bone fixation hole.

[0071] As will now be described, the plate 40 is configured to be secured to the intervertebral implant 20. Specifically, reference will now be made to FIG. 2A to FIG. 2C, the plate 40 may include a fixing member 50 supported by the plate body 41. The fixing member 50 can rotate relative to the plate body 41 around the rotation axis 43, and can also translate relative to the plate body 41 along the rotation axis 43. The rotation axis 43 can be defined by the longitudinal direction L and can be defined by the central axis of the fixing shaft. The fixing member 50 may include a fixing shaft 52 and an enlarged fixing head 54, which is supported in the plate body 41 and extends from the fixing shaft 52 in a direction perpendicular to the longitudinal direction L. The fixing head 54 can be rectangular and in a first orientation in the unlocked configuration, and in a second orientation different from the first orientation in the locked configuration. For example, the fixing head 43 can extend in opposite directions from the fixing shaft and specifically from the terminal distal end of the fixing shaft 52. Therefore, the fixing member 50 can be substantially T-shaped. When the fixing shaft 52 is supported by the plate body 41, the fixing head 54 can be disposed on the distal side of the plate body 41. A distal portion of the fixation shaft 52 may extend from the plate body 41 and may terminate at a fixation head 54 .

[0072] The fixing member 50 is configured to rotate about the rotation axis 43 in a first rotational direction from an unlocked configuration to a locked configuration. The fixing head 54 may be in a first orientation ( Figure 2B to Figure 2C ), and in the locked configuration may be a second orientation different from the first orientation ( Figure 2A ). Specifically, the fixing member 50 can also be rotated from the locked configuration to the unlocked configuration in a second rotational direction opposite to the first rotational direction. In the unlocked configuration, the fixing member 50 can be removed from the intervertebral implant 20 by translating the plate 40 proximally away from the implant 20. When the fixing member is in the locked configuration, the fixing member 50 and specifically the fixing head 54 are longitudinally aligned with the retaining wall 56 of the implant 20 along the longitudinal direction L, as shown in FIG. Figure 2A In addition, the fixing head 54 is positioned distal to the retaining wall 56. Therefore, movement of the plate 40 relative to the implant 20 in the proximal direction will cause the fixing head 54 to abut against the retaining wall 56, thereby preventing the plate 40 from being removed from the implant 20. Figure 2B to Figure 2C In the unlocked configuration shown, the securing head 54 is not aligned with the retaining wall along the longitudinal direction L. The first and second orientations of the securing head 54 may be angularly offset from one another by any amount, such as by approximately 90 degrees, as desired.

[0073] When the fixing member 50 is in the locked configuration, the fixing member 50 is configured to be driven to translate in a fixed direction along the rotation axis 43 so that the fixing head 54 moves toward the support 58 of the plate 40 and specifically the floor body 41. In some examples, the fixing direction can be defined by the proximal direction. The support 58 can be defined by the front surface 42 of the plate body 41. The fixing member 50 moves in the fixed direction until the fixing member 50 reaches the fixed position, whereby the retaining wall 56 is captured between the support 58 and the fixing member 50. Specifically, the fixing member 50 is configured to translate in the fixed direction until the retaining wall 56 is captured between the support 58 and the fixing head 54. When the retaining wall 56 is captured, the plate 40 and the implant 20 can define a rigid structure.

[0074] Continue to refer FIG. 2A to FIG. 2C , the plate 40 may also include an actuator 60 threadedly engaged with the fixed shaft 52. In this regard, the proximal end portion of the fixed shaft 52 may be threaded. The actuator 60 may define a cap that is disposed above the proximal end portion of the fixed shaft 52 and is threadedly connected to the proximal end portion of the fixed shaft 52. The actuator 60 may be configured to rotate in a first rotational direction during a first rotational stroke to drive the fixed member 50 to rotate to a locked configuration in the first rotational direction. Therefore, during the first rotational stroke of the actuator 60, the actuator 60 and the fixed member 50 are rotatably coupled. The actuator 60 may then further rotate in the first rotational direction during a second rotational stroke, during which the actuator 60 rotates relative to the fixed shaft 52. Therefore, the actuator 60 and the fixed shaft 52 are rotatably decoupled during the second rotational stroke. It should be appreciated that the second rotational stroke may be continuous with the first rotational stroke. Because the actuator 60 is threadably coupled to the stationary shaft 52 , rotation of the actuator during the second rotational stroke causes the stationary shaft 52 to translate or otherwise travel in a stationary direction relative to the plate body 41 and the implant 20 .

[0075] The plate 40 may also include an auxiliary shaft 62 that can provide a locking member that is fixed in position to the plate body 41 and is configured to interface with the fixed shaft 52 during rotation and translation of the fixed shaft 52. Specifically, the auxiliary shaft 62 can extend into a slot 64 of the fixed member 50 and specifically the fixed shaft 52. The slot 64 can extend circumferentially around the rotation axis 43 along a portion of the outer periphery of the fixed shaft 52. The slot 64 can be defined by a first end and a second end, the first end and the second end defining a first stop surface 66 and a second stop surface 68, respectively, and the auxiliary shaft 62 can abut the first stop surface and the second stop surface during use. For example, when the fixed shaft 52 is in an unlocked configuration, the auxiliary shaft 62 can abut the second stop surface 68.

[0076] During the first rotational stroke of the actuator 60, the actuator 60 and the fixed member 50 rotate together relative to the plate until the first stop surface 66 abuts the auxiliary shaft 62. When the actuator 60 rotates during the first rotational stroke, the fixed member 50 similarly rotates from the unlocked configuration to the locked configuration. The abutment between the auxiliary shaft 62 and the first stop surface prevents the fixed member 50 from continuing to rotate in the first direction relative to the plate 40. Therefore, the continued rotation of the actuator 60 in the first rotational direction is relative to the fixed member 50. The threaded connection between the actuator 60 and the fixed member 50 allows the fixed member 50 to move in the fixed direction during the second rotational stroke of the actuator 60. The slot 64 of the fixed member 50 may define a longitudinal opening 70 adjacent to the first stop surface 66. The longitudinal opening 70 may extend distally so that when the fixed member moves proximally in the fixed direction relative to the plate body 41 and the auxiliary shaft 62, the auxiliary shaft 62 moves into the longitudinal opening. It should be appreciated that, in one example, the actuator 60 drives the securing member 50 to travel in the securing direction only when the securing member 50 is in the locked configuration.

[0077] If it is desired to decouple the plate 40 from the implant 20, the actuator 60 can be rotated relative to the plate body 41 in a second rotational direction opposite to the first rotational direction. The rotation of the actuator 60 in the second rotational direction causes the auxiliary shaft 62 to abut against the surface of the fixing member 50 and, in particular, the fixing shaft 52, which partially defines the longitudinal opening 70. Therefore, the fixing member 50 cannot be rotated relative to the plate body 41 in the second rotational direction, and the actuator 60 is therefore rotated relative to the fixing member 50. The relative rotation of the actuator 60 relative to the fixing member 50 in the second rotational direction causes the fixing member 50 to move distally in the disengagement direction, whereby the fixing head 54 moves away from the retaining wall 56 of the implant 20 and the support 58 of the plate body 41. The fixing member 50 continues to move distally until the auxiliary shaft 62 is disposed in the slot 64, which then rotatably couples the fixing member 50 and the actuator 60 in the second rotational direction. The actuator 60 is rotated together with the fixing member 50 in the second rotational direction to the unlocked configuration, whereby the auxiliary shaft 62 seats against the second stop member 68 , which prevents further rotation of the actuator 60 and the fixing member 50 in the second rotational direction.

[0078] The plate body 41 may also include a first stop member and a second stop member, such as a pair of first stop members and second stop members, which abut the fixed head 54 when the fixed member 50 is in the locked configuration and the unlocked configuration, respectively. Therefore, the abutment between the fixed head 54 and the stop member combined with the abutment between the auxiliary shaft 62 and the stop surfaces 66 and 68 can distribute the load that prevents excessive rotation of the fixed member 50.

[0079] During operation, the fixing member 50 may be in its unlocked configuration. Plate 40 may be brought to the proximal end of the implant 20 until the fixing head 52 is inserted into the internal space 74 of the implant 20 through the opening 72, which is partially defined by the retaining wall 56. The opening 72 may be large enough to accommodate the fixing head 52 when the fixing member 50 is in the unlocked configuration, but not large enough to accommodate the fixing head 52 when the fixing member 50 is in the locked configuration. When the fixing head 52 is disposed in the space 74, the fixing member 50 may be iterated to the locked configuration, whereby the fixing head 52 is aligned with the retaining wall 56 in the above-described manner. The fixing member 50 is then forced to advance in the fixed direction until the retaining wall 56 is captured between the fixing head 52 and the abutment 58 in the above-described manner.

[0080] like FIG. 2A to FIG. 2C As shown, the auxiliary shaft 62 can extend from the plate body 41 into the slot 64 of the fixing member 50. Therefore, the auxiliary shaft 62 extends into the fixing shaft 52 but does not pass through the fixing shaft. In addition, the auxiliary shaft 62 terminates without intersecting the rotation axis 43. The auxiliary shaft 62 can be threadedly engaged with the plate body 41 so as to fix the auxiliary shaft 62 in position relative to the plate body 41. Alternatively, as 7A to 7C As shown, the auxiliary shaft 62 can be configured as a pin that extends across the rotation axis 43 and can intersect the rotation axis 43. Specifically, the auxiliary shaft 62 can extend completely through the fixed member 50, and specifically through the fixed shaft 52. The opposite end of the auxiliary shaft 62 can be fixed in the plate body 41. It should be understood that the auxiliary shaft can be described as extending at least into the fixed member 50, which means extending into the fixed member 50 or extending through the fixed member. The auxiliary shaft 62 can be oriented substantially perpendicular to the rotation axis 43.

[0081] Reference now 6A to 6H In yet another example, the fixing member 50 may define an angled recess 76 that receives the auxiliary shaft 62 when the fixing member 50 is rotated 50 about the rotation axis 43, which drives the fixing member 50 to selectively move proximally in the fixing direction and distally in the disengagement direction. Specifically, when the recess 76 extends circumferentially around at least a portion of the outer periphery of the fixing member 50 and specifically the fixing shaft 52, the recess may extend in the longitudinal direction. The auxiliary shaft 62 interfaces with the fixing shaft 52 so as to drive the fixing member 50 to selectively move in the fixing direction and the disengagement direction during rotation of the fixing member 50.

[0082] During operation, the fixing member 50 may be in an unlocked configuration so that the fixing head 54 can be inserted into the implant 20 in the above-described manner. Next, the fixing member 50 is rotated in a first rotational direction, which causes the auxiliary shaft 62 to ride in the recess 76. The auxiliary shaft 62 then drives the fixing member 50 to translate along the rotation axis 43. Specifically, the rotation of the fixing member 50 in the first rotational direction causes the auxiliary shaft 62 to drive the fixing member 50 to translate in the proximal fixing direction until the retaining wall 56 is captured between the fixing head 54 and the support 58, as described above. It should be recognized that because the retaining wall 56 is aligned with the auxiliary head 54 along the longitudinal direction L, the fixing head 54 can be said to be in a locked configuration. On the contrary, the rotation of the fixing member 50 in the second rotational direction causes the auxiliary shaft 62 to drive the fixing member 50 to translate in the distal disengagement direction, which causes the fixing head 54 to move away from the retaining wall 56 until the fixing member 50 is in an unlocked configuration, whereby the fixing head 54 can be removed from the implant 20 by moving the plate 40 in the proximal direction relative to the implant 20.

[0083] While in one example the auxiliary shaft 62 rides in the recess 76, it should be understood that the recess 76 is only one example of any suitable track that can be coupled to the auxiliary shaft 62. The auxiliary shaft 62 can ride along the track while being fixed in position to the plate body 41, thereby driving the securing member 50 to rotate to the locked configuration and the unlocked configuration as it travels in the securing direction and the disengaging direction, respectively. In one example, the track can be a spiral track or can have any suitable alternative shape as desired that allows the securing member to travel along the rotation axis 43 as it rotates about the rotation axis 43.

[0084] Reference again Figure 1A and Figure 2A, the plate 40 can be adjusted angularly and translationally between multiple positions along the adjustment surface 25, which is arranged at the proximal end or rear end 24 of the intervertebral implant 20, at which multiple positions, the plate 40 is configured to be fixed to the implant 20. These positions can be offset translationally from each other along the horizontal plane, and can also be offset angularly relative to each other along the horizontal plane. The horizontal plane can be perpendicular to the transverse direction T, and is therefore defined by the longitudinal direction L and the lateral direction A. The adjustment surface 25 can be generally convex in the horizontal plane. The plate 40 can define a complementary concave adjustment surface 45, which is configured to engage the adjustment surface 25 of the implant 20. Each of the adjustment surfaces 25 and 45 can be scalloped so that when the plate 40 is positioned at one of the multiple positions, it engages with each other. Because the adjustment surface 25 is curved, the angle of the plate 40 is adjusted when the plate is translated along the adjustment surface 25. Should be understood that plate 40 can be fixed to implant as described above, so that plate can be releasably locked in the position in multiple positions.The different angles at various positions can be at most 45 degrees, including at most 30 degree positions.In one example, plate 40 is configured to be fixed as required with any angle (such as about zero degree, about 15 degree and about 30 degree as limited by the insertion direction of rotation axis 43 and implant 20).

[0085] Referring now to FIGS. 3-5 , a kit 35 may include a plurality of plates 40 as described above, but with a different number of bone fixation holes 46 and / or bone fixation holes 46 positioned at different relative positions. FIG. 3A to FIG. 3C As shown and described above, the plate may include a first bone fixation hole 46a and a second bone fixation hole 46b. FIG. 4A to FIG. 4C and FIG. 5A to FIG. 5C In other examples shown, the plates 40 may each include only a single bone fixation hole 46. The plates 40 may be oriented in a first orientation so as to be coupled and fixed to the implant 20 with the fixation hole 46 aligned with the superior vertebral body. Alternatively, the plates 40 may be oriented in a second orientation so as to be coupled and fixed to the implant 20 with the fixation hole aligned with the superior vertebral body.

[0086] A first plate or a first plurality of plates 40 of the kit 35 may include a corresponding single bone fixation hole 46 at a first location, such as FIG. 4A to FIG. 4C As shown, a second plate or a second plurality of plates 40 of the kit may include a corresponding single bone fixation hole at a second position different from the first position, such as FIG. 5A to FIG. 5CAs shown. Therefore, when the first and second plates 40 are superimposed on each other so that their respective outer peripheries are aligned, the corresponding bone fixation holes 48 will not be aligned. In one example, the first plate 40 can be a mirror image relative to the second plate. The kit may include a third plate or a third plurality of plates 40 having first bone fixation holes 46a and second bone fixation holes 46b as described above. In addition, the kit may include the plates 40 of Figures 3, 4, and 5 of different sizes. Now referring to Figure 8 The kit may also include bone fixation elements 48, which may be configured as bone screws of varying lengths configured to be inserted through the bone fixation holes 46 of the plates 40 of the kit and into the underlying bone.

[0087] Now refer to it again Figure 1A and FIG. 3A to FIG. 5C Each of the plates 40 described herein may include a cam member 78 associated with each bone fixation hole 46, and is capable of moving from a first position spaced apart from the head of the bone fixation element to a second position, whereby the cam member interferes with the head to prevent the bone fixation element from withdrawing. Therefore, the bone fixation element 48 can be inserted through the fixation hole 46 when the cam member 78 is in the first position, and the cam member 78 can then move to the second position. In one example, the cam member 78 can rotate from the first position to the second position. For example, the cam member 78 can rotate around an axis oriented along the longitudinal direction L. When the cam member 78 moves to the second position, the inner surface of the cam member 78 can move toward the head of the bone fixation element 48 until the inner surface overlies the head of the bone fixation element 48. In addition, the cam member 78 can apply a retaining force to the head of the bone fixation element 48, and when the cam member is in the second position, the retaining force pushes the bone fixation element 48 toward the bone below in the insertion direction into the bone.

[0088] It should be understood that the bone fixation system 38 may include a plate 40 and an implant 20. In addition, a kit may include multiple implants 20 of varying sizes and lordotic profiles. FIG. 9A to FIG. 9B, the bone fixation system 38 may also include an insert 80 configured to be coupled to the plate 40. The insert 80 may include an inner sleeve 82 having a plate engaging end 84 and an outer sleeve 86 that surrounds the inner sleeve and is coupled to an engagement member 88 that is movable in a rearward direction to correspondingly move the outer sleeve 86 rearward from the plate engaging end 84 of the inner sleeve 82. In some examples, the engagement member 88 may be manually movable in a rearward direction to expose the plate engaging end 84 of the inner sleeve 82. The plate engaging end 84 is configured to be inserted into a groove of the plate body 41 along an insertion direction and then rotated along a rotational direction to a position where the plate engaging end 84 interferes with one or more flanges of the plate body 41 to prevent the inner sleeve 82 from being withdrawn from the plate body 41 in a direction opposite to the insertion direction, thereby coupling the insert 80 to the plate body 41. The rotational direction may be around the insertion direction. Subsequently releasing the engagement member 88 may allow the outer sleeve 86 to advance forwardly so as to engage the plate body 41 and prevent relative rotation between the insert 80 and the plate body 41. The outer sleeve 86 may be spring loaded so that movement of the engagement member 88 in the rearward direction resists the spring force of the spring 90 biasing the outer sleeve 86 in the forward direction. Thus, releasing the engagement member 88 allows the outer sleeve 86 to move in the forward direction under the force of the spring 90. An actuator 92, which is configured as an end cap in one example, may be rotated to tighten the interface between the plate body 41 and the inner sleeve 82 and the outer sleeve 86. In one example, the forward direction may be defined by the distal direction, and the rearward direction may be defined by the proximal direction.

[0089] Now also refer to FIG. 10A to FIG. 10B , the bone fixation system 38 may also include a driver instrument 94, which is configured to be received by the insert 80 or otherwise connected to the insert. Specifically, the inner sleeve 82 of the insert 80 can be hollow so that the fixing member 50 or the actuator 60 is exposed in the cannula. The fixing member 50 or the actuator may include a rearward interface, which is configured to receive the driver instrument 94, which is configured to drive the fixing member 50 or the actuator 60 to rotate between the unlocking configuration and the locking configuration in the above-mentioned manner. The driver instrument 94 may include a handle 95 and a shaft 97, which extends from the handle 95 to the far side and is configured to be inserted into the inner sleeve 82 and driven to the far side until the engagement end 99 of the driver instrument is connected with the fixing member 50 or the actuator 60. The engagement end 99 may be defined by the shaft 97, and is specifically defined as the most distal part of the shaft 97. In one example, engagement end 99 of driver instrument 94 may be received in a suitably shaped receptacle 69 of fixation member 50 or actuator 60. Insert 80 may provide reverse torque to plate body 41 when driver instrument 94 drives fixation member 50 or actuator 60 to rotate.

[0090] like FIG. 11A to FIG. 11B As shown, insert 80 can be coupled to plate 40, and driver instrument 94 can secure plate 40 to implant 20 to create a rigid structure prior to inserting implant 20 into intervertebral space 51. Alternatively, implant 20 can first be inserted into intervertebral space 51, and insert 80 can then be coupled to plate 40, and driver instrument 94 can then secure plate 40 to implant 20 in the manner described herein.

[0091] Reference now Fig. 12A 15 , in general, the trial kit 37 may include a trial plate 100 corresponding to each of the plates 40 described herein with reference to FIGS. 3 to 5 , and one or more trial implants 102 corresponding to the intervertebral implant 20 described above. The trial kit 37 including the trial plate 100 and the trial implant 102 may be included in the kit 35 described above, or may be a separate kit as desired. The trial plate 100 may be placed against the trial implant 102 or the permanent implant to determine the appropriate size of the plate 40 to be secured to the implant. The trial plate 100 may be coupled to or integral with a trial insert member 104 that is configured to be received in an internal void of the trial implant to simulate a fixation member 50 in an unlocked configuration. The trial insert member 104 may also be positioned at one of the plurality of different angles described above to determine the appropriate plate 40 and the appropriate angle within the range of angles at which to couple the appropriate plate 40 to the implant 20. For example, as Fig. 12A As shown, the insertion member 104 can be oriented at any suitable angle along the plane defined by the anterior-posterior direction and the medial-lateral direction as desired. Fig. 12B As shown, the trial plate 100 may have different sizes and may include corresponding first and second fixation holes 146a and 146b spaced apart from each other at different distances that may correspond in position to the fixation holes 46a and 46a of the final plate 40 to be implanted.

[0092] refer to FIG. 13A to FIG. 13C , the trial implant 102 may include an insertion depth marking 106. The depth marking 106 indicates the insertion depth of the trial implant when the trial implant 102 is inserted and fully seated in the intervertebral space 51. Thus, an appropriately sized final implant 20 may be selected that has the measured insertion depth of the trial implant, or an insertion depth that otherwise corresponds to the measured insertion depth of the trial implant.

[0093] Reference now FIG. 14A to FIG. 14D, the trial kit 37 may also include a trial implant insert 108 that may be removably attached to the trial implant 102 or integral with a corresponding one of the trial implants 102. The trial implant insert 108 may deliver the trial implant 102 into the intervertebral space 51. The trial insert member 104 may be configured as a sleeve 106 that at least partially surrounds the trial implant insert 108 to position the trial plate 100 relative to the trial implant 102 as desired. In this manner, the desired size and configuration of the final intervertebral implant 20 and final plate 40 may be determined.

[0094] Reference now FIG. 15A to FIG. 15F , any suitable opening instrument 110 can be driven through the fixation holes 146a and 146b of the trial plane 100 to create a guide hole in the underlying bone for later insertion of bone screws through the fixation holes 46a and 46b of the final plate 40 in the manner described above. The trial kit 37 can also include one or more guide sleeves 112 that are configured to be inserted into either or both of the fixation holes 146a and 146b. Each of the guide sleeves 112 can define an outer wall having an inner surface defining a through hole 113 and an outer surface opposite the inner surface. The opening instrument 110 can be driven through the through hole 113 so that the inner surface guides the opening instrument 110 to the underlying bone to form a guide hole in the underlying bone. The guide sleeve 112 can define an insertion end 114 that is configured to be selectively driven into the fixation holes 146a and 146b. The insertion end 114 can define an interlocking member 116, such as Fig. 15C As shown, the interlocking piece can be inserted into the fixation hole so as to lock the guide sleeve 112 in position in the fixation hole. Therefore, the opening instrument 110 forms a guide hole along a fixation trajectory defined by the fixation angle of the guide sleeve 112. Alternatively, the insertion end 114 can define an articulation surface 118, which can be rounded or otherwise shaped so as to articulate along an interior surface of the test plate 110 defining the fixation hole. It should be understood that when the articulation surface 118 articulates, the guide sleeve 112 is angled in the fixation hole relative to the test plate 100, thereby correspondingly adjusting the trajectory of the guide hole formed in the underlying bone. As shown in FIG. FIG. 15E to FIG. 15F As shown, in one example, the opening instrument 110 can be configured as a drill 120 having a cutting groove 122. Alternatively, the opening instrument 110 can be configured as an awl 124 having a smooth outer surface 126 and a tapered tip 128. It should be understood that the opening instrument 110 can be alternatively configured as desired.

[0095] It should be appreciated that the plates described herein can provide stability to the intervertebral implants to resist or prevent migration of the implants when the patient is repositioned (e.g., from a lateral position to a prone position) during a surgical procedure. It will be appreciated that additional posterior fixation devices, such as pedicle screws and one or more spinal rods, etc., can be implanted when the patient is in a prone position.

[0096] Although the present disclosure has been described in detail, it should be understood that various changes, substitutions and modifications may be made herein without departing from the spirit and scope of the present invention as defined by the appended claims. In addition, the scope of the present disclosure is not intended to be limited to the specific embodiments described in this specification. It will be readily understood by those of ordinary skill in the art that existing or later developed processes, machines, manufactures, compositions of matter, devices, methods or steps that perform substantially the same functions or achieve substantially the same results as the corresponding embodiments described herein may be utilized in accordance with the present disclosure.

Claims

1. A plate configured to be secured to an intervertebral implant extending in a distal direction from the plate, the plate comprising: a plate body having at least one bone fixation hole configured to receive a bone fixation element driven into a vertebral body, wherein the plate body defines a seat; as well as a securing member configured to rotate about a rotational axis in a first rotational direction from an unlocked configuration to a locked configuration, The fixation member is configured to be driven to translate in a fixed direction along the rotational axis to a fixed position until a retaining wall of the intervertebral implant is captured between the seat and the fixation member when the fixation member is in the locked configuration.

2. The plate according to claim 1, wherein The fixation member includes a fixation shaft and a fixation head, wherein the fixation head is configured to be inserted into the implant when the fixation member is in the unlocked configuration and subsequently iterate to the locked configuration.

3. The plate according to claim 2, wherein The fixing direction is defined by a proximal direction opposite to the distal direction.

4. The plate according to claim 3, wherein The fixed head is aligned with the retaining wall when the fixed head is in the locked configuration and is not aligned with the retaining wall when the fixed head is in the unlocked configuration.

5. A plate according to any one of claims 2 to 4, wherein The fixed head is rectangular and is in a first orientation in the unlocked configuration and in a second orientation different from the first orientation in the locked configuration.

6. The plate according to claim 5, wherein The fixed heads extend from the fixed shaft in opposite directions.

7. A board according to any one of claims 5 to 6, wherein The fixing heads extend in opposite directions from a terminal end of the fixing shaft such that the fixing member is substantially T-shaped.

8. A panel according to any one of claims 5 to 7, wherein The first orientation and the second orientation are offset from each other by approximately 90 degrees.

9. A plate according to any one of claims 1 to 8, wherein When the securing member is in the locked configuration and the retaining wall is captured, the securing member is configured to be driven to translate in a disengaging direction opposite to the securing direction, wherein the securing head moves away from the seat.

10. A panel according to any one of claims 1 to 9, wherein The rotation axis is defined by the central axis of the stationary shaft.

11. A panel according to any one of claims 1 to 10, wherein The fixing member is configured to be driven to translate in the fixing direction when the fixing member is rotated in the first rotational direction.

12. The panel of claim 11 further comprising an auxiliary shaft fixed in position relative to the panel body, wherein the auxiliary shaft interfaces with the fixed shaft to drive the fixed member in the fixed direction during rotation of the fixed member.

13. The plate according to claim 12, wherein The rotation axis is oriented along a longitudinal direction, the fixing member comprises a track extending along the longitudinal direction when the fixing member extends circumferentially around the fixing shaft, and the auxiliary shaft is coupled to the track and is fixed in position relative to the plate body.

14. The plate according to claim 13, wherein The track includes a recess extending into the fixed shaft, and the auxiliary shaft extends into the recess.

15. A panel according to any one of claims 13 to 14, wherein The track is a spiral track.

16. A panel according to any one of claims 11 to 15, wherein The auxiliary shaft is configured to drive the fixing member in a disengaging direction opposite to the fixing direction when the fixing member rotates in a second rotational direction opposite to the first rotational direction.

17. A plate according to any one of claims 1 to 10, further comprising an actuator, wherein the actuator is configured to rotate in the first rotational direction to drive the fixed member to rotate in the first rotational direction to the locked configuration, wherein continued rotation of the drive in the first rotational direction causes the fixed member to move in the fixed direction.

18. The plate according to claim 17, wherein The actuator is configured to drive the securing member in the securing direction only when the securing member is in the locked configuration.

19. A panel according to any one of claims 17 to 18, wherein The fixed member rotates with the actuator in the first rotational direction until the fixed member is in the locked configuration, at which time further rotation of the actuator in the first rotational direction is relative to the fixed axis.

20. The plate of claim 19, wherein The actuator is rotated in a second direction relative to the stationary member until the stationary member travels into the slot, at which point the stationary shaft rotates with further rotation of the actuator.

21. A plate according to any one of claims 17 to 20, further comprising an auxiliary shaft, which is positionally fixed to the plate body and abuts against a first stop surface of the fixed shaft when the fixed member is in the locking configuration, wherein when the fixed member is not in the locking configuration, the auxiliary shaft is spaced apart from the first stop member.

22. The plate of claim 21, wherein When the securing member is in the locked configuration, rotation of the actuator in the second rotational direction opposite the first rotational direction causes the securing shaft to travel in a disengaging direction opposite the securing direction until the auxiliary shaft seats against a second stop surface of the securing member.

23. A panel according to any one of claims 17 to 22, wherein The actuator includes an interface configured to receive a driver tool that drives the actuator to rotate.

24. The plate of claim 23, wherein the actuator includes a cap disposed about a proximal end portion of the stationary shaft.

25. A panel according to any one of claims 17 to 24, wherein The actuator is coupled to the fixed shaft by threads.

26. A panel according to any one of claims 22 to 25, wherein The auxiliary shaft extends into a slot of the fixed shaft, wherein opposite circumferential ends of the slot define the first stop surface and the second stop surface, respectively.

27. A plate according to claim 26, wherein The rotation axis is oriented along a longitudinal direction, and the slot defines a longitudinal opening adjacent to the first stop surface, wherein the auxiliary shaft travels into the opening when the fixing shaft travels in the fixing direction.

28. A panel according to any one of claims 2 to 27, wherein The plate body defines a first stop surface and a second stop surface that abut the fixed head when the fixed head is in the locked configuration and the unlocked configuration, respectively.

29. A plate according to claim 28, wherein The first stop surface and the second stop surface include a first pair of stop surfaces and a second pair of stop surfaces.

30. A panel according to any one of claims 20 to 29, wherein The auxiliary shaft extends into the fixed shaft but does not pass through the fixed shaft.

31. The plate of claim 30, wherein The auxiliary shaft terminates without intersecting the axis of rotation.

32. A panel according to any one of claims 20 to 29, wherein The auxiliary shaft extends through the fixed shaft across the rotation axis.

33. A panel according to any one of claims 20 to 32, wherein The auxiliary axis is oriented substantially perpendicularly to the axis of rotation.

34. A panel according to any one of the preceding claims, wherein The plate is configured to be selectively secured to the intervertebral implant before and after the implant is implanted into the intervertebral space.

35. A panel according to any one of the preceding claims, wherein The at least one bone fixation hole includes a first bone fixation hole and a second bone fixation hole, wherein the first bone fixation hole is configured to receive a first bone fixation element extending into a first vertebral body, and the second bone fixation hole is configured to receive a second bone fixation element extending into a second vertebral body, wherein an intervertebral space is provided between the first vertebral body and the second vertebral body, and the intervertebral space is configured to receive the intervertebral implant.

36. A panel according to any one of the preceding claims, wherein At least one bone fixation hole is the only bone fixation hole of the plate, wherein the bone fixation hole is in a first position.

37. A plate according to any one of the preceding claims, further comprising a cam member rotatable from a first position spaced apart from a head of the bone fixation element to a second position wherein the cam member interferes with the head to prevent withdrawal of the bone fixation element.

38. A plate according to claim 37, wherein As the cam member rotates in a direction from the first position to the second position, an inner surface of the cam member gradually moves toward the head of the bone fixation element.

39. A plate according to claim 38, wherein When the cam member is in the second position, the inner surface of the cam member applies a retaining force against the head of the bone fixation element.

40. A kit of parts according to claim 36, comprising: a first plurality of plates wherein a sole bone fixation hole is in a first position; and a second plurality of plates wherein the only bone fixation holes are at a second location different from the first location.

41. The kit of claim 40, wherein: The first plurality of plates are mirror images relative to the second plurality of plates.

42. The kit according to any one of claims 40 to 41 further includes a third plurality of plates, each of the third plurality of plates having a first bone fixation hole and a second bone fixation hole, wherein the first bone fixation hole is configured to receive a first bone fixation element extending into a first vertebral body, and the second bone fixation hole is configured to receive a second bone fixation element extending into a second vertebral body, wherein an intervertebral space is disposed between the first vertebral body and the second vertebral body, and the intervertebral space is configured to receive the intervertebral implant.

43. A panel according to any one of claims 1 to 39, wherein The plate is configured to be selectively secured to the intervertebral implant at a plurality of different locations that are translationally and superiorly offset from one another, and are further angularly offset relative to one another.

44. A plate according to claim 43, wherein The anterior surface of the plate is scalloped to interengage with the scalloped curved surface of the intervertebral implant at each of the plurality of different locations.

45. A panel according to any one of claims 43 to 44, wherein The intervertebral implant defines a front end and a rear end spaced apart from each other along a selected direction, and the rotational axis and the selected direction define a different angle at each of the plurality of different directions.

46. ​​A plate according to claim 45, wherein The different angles are in the range of up to about thirty degrees.

47. A bone fixation system comprising a plate according to any one of claims 1 to 39 and 44 to 46 and the intervertebral implant.

48. An insert configured to be coupled to a panel according to any one of claims 1 to 39 and 43 to 46, the insert comprising: an inner sleeve having a plate engaging end; as well as an outer sleeve surrounding the inner sleeve and coupled to an engagement member movable in a rearward direction to correspondingly move the outer sleeve rearwardly from the plate engagement end, wherein the plate engaging end of the inner sleeve is configured to be inserted into a recess of the plate body and subsequently rotated to prevent withdrawal of the inner sleeve, thereby coupling the insert to the plate body, and Wherein subsequent release of the engagement member causes the outer sleeve to advance forwardly to engage the plate body so as to prevent relative rotation between the insert and the plate body.

49. An insert according to claim 48, wherein The inner sleeve is hollow to receive a driver instrument configured to rotate the actuator or the fixing member of the plate.

50. The insert of claim 48, wherein: The outer sleeve is spring loaded such that moving the engagement member in the rearward direction opposes a spring force biasing the outer sleeve forwardly.

51. A drive configured to iterate a fixing member of a plate according to any one of claims 1 to 39 and 43 to 46 from the unlocked configuration to the locked configuration and to the fixed position, wherein the drive is insertable into the inner sleeve of an insert according to any one of claims 48 to 50, and the drive is configured to drive one of the fixing member and the actuator to rotate when the insert provides a reverse torque to the plate.

Images