Dual expandable intervertebral device

Abstract

The present disclosure provides a spinal implant configured for lateral insertion technology deployable between a contracted position and an expanded position. The spinal implant may include a first end plate and a second end plate, each end plate having a plurality of guide walls and an inclined ramp. The spinal implant may also include a movement mechanism having a first pushing portion and a second pushing portion configured to act on the plurality of first ramps and the plurality of second ramps. The movement mechanism may also include a first set screw and a second set screw opposite the first set screw. The moving mechanism can be configured to operably adjust the distance between the first end plate and the second end plate when the first fixing screw and the second fixing screw simultaneously rotate along the rotation axis. And the inclination angle between the first end plate and the second end plate can be operably adjusted when the first fixing screw or the second fixing screw is rotated along the rotation axis.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] The present application is a continuation-in-part of U.S. patent application No. 17 / 391,403, filed on August 2, 2021, entitled “Expandable inter-body device, expandable plate system, and associated methods,” which is a continuation-in-part of U.S. patent application No. 17 / 246,932, filed on May 3, 2021, entitled “Expandable Inter-Body Device, System, and Method,” which is a continuation-in-part of U.S. patent application No. 17 / 123,889, filed on December 16, 2020, entitled “Expandable Inter-Body Device, System, and Method,” which claims the following interrelated patent applications and incorporates them by reference: U.S. patent application No. 17 / 246,932, filed on May 3, 2021, entitled “Expandable Inter-Body Device, System, and Method,” which is a continuation-in-part of U.S. patent application No. 17 / 123,889, filed on December 16, 2020, entitled “Expandable Inter-Body Device, System, and Method,” The present invention relates to the present invention to the invention of the present invention to the invention of the present invention, which is a continuation-in-part of U.S. patent application No. 17 / 123,897, filed on December 16, 2020, entitled “Expandable Inter-Body Device, System, and Method”; PCT / IB2020 / 000953, entitled “Screwdriver and Complimentary Screws”, filed on November 5, 2020; and PCT / IB2020 / 000942, entitled “Expandable Inter-Body Device, System, and Method”, filed on November 5, 2020. The present application is also a continuation-in-part of U.S. patent application No. 17 / 123,897, entitled “Expandable Inter-Body Device, System, and Method”, filed on December 16, 2020. The contents of each application are incorporated herein in their entirety.This application also incorporates by reference the following patent applications: U.S. Patent No. 17 / 11,285,014, filed on May 4, 2021, entitled “Expandable Inter-Body Device, System, and Method”; U.S. Patent No. 11,096,796, filed on March 4, 2013, entitled “Interbody spinal implant having aroughened surface topography on one or more internal surfaces”; and U.S. Patent No. 10,821,000, filed on June 29, 2017, entitled “Titanium implant surfaces free from alpha case and with enhanced osteoinduction”. Technical Field

[0003] The present disclosure relates generally to medical devices for treating musculoskeletal disorders and, more particularly, to surgical devices including expandable spinal implants, systems for implanting and manipulating expandable spinal implants, and methods for treating the spine. Background Art

[0004] Spinal disorders, such as degenerative disc disease, herniated discs, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumors, and fractures can be caused by factors including trauma, disease, and degenerative conditions caused by injury and aging. Spinal disorders often result in symptoms including pain, nerve damage, and partial or complete loss of mobility.

[0005] Non-surgical treatments (such as medication, rehabilitation and exercise) may be effective, however, they may not relieve the symptoms associated with these conditions. Surgical treatments for these spinal conditions include fusion, fixation, correction, discectomy, laminectomy and implantable prostheses. As part of these surgical treatments, spinal constructs (e.g., bone fasteners, spinal rods and interbody devices) can be used to provide stability to the treatment area. For example, during surgical treatment, an interbody device can be introduced into the space between adjacent vertebrae (interbody space) to properly separate the vertebrae and provide a container for bone growth promoting materials, such as transplants.

[0006] Recently, interbody devices have been introduced that provide additional capabilities beyond the static spacing of the vertebral bodies. For example, some devices have an expandable capability such that the implant can be introduced into the interbody space in a collapsed state and then expanded to create additional spacing and, in some cases, to introduce or restore curvature of the spine by selectively expanding. However, many existing expandable interbody designs have a limited range of expansion.

[0007] Because existing interbody devices have insufficiently sized load-bearing surfaces, there are additional problems associated with spinal surface subsidence. In the case of expandable devices, the loads on the load-bearing surfaces (including loads generated during implant expansion) are often significant. An expandable implant with a relatively large surface area is required to withstand the loads, including loads generated during implant expansion, in an attempt to avoid the need for subsequent surgery due to subsidence of the spinal surface.

[0008] Another problem is the instability of existing expandable interbody devices as they expand. Typically, as the interbody device expands, the load-bearing surfaces move relative to each other and relative to the insert, so that there is a risk of undesirable shifting of the positioning of the interbody device within the intervertebral space. In addition, and depending at least in part on the specific insertion technique employed, anatomical features such as the iliac crest and thorax present challenges to in situ adjustment of interbody designs.

[0009] The present disclosure seeks to address these and other shortcomings in the prior art. Summary of the invention

[0010] The technology disclosed herein generally relates to a height-adjustable intervertebral device that is inflatable to selectively increase / decrease the spacing distance between the end plates of the intervertebral device and is adjustable to selectively increase / decrease the inclination angle between the end plates of the intervertebral device. The technology disclosed herein generally relates to a height-adjustable intervertebral device that is inflatable to selectively increase / decrease the spacing distance between the end plates of the intervertebral device and is adjustable to selectively increase / decrease the inclination angle between the end plates of the intervertebral device. In addition, at least in some embodiments, the technology disclosed herein relates to a plate that can also be an inflatable plate configured to be positioned outside the intervertebral disc space and adjacent to the intervertebral disc space, and the inflatable plate is securely connected to an adjustable intervertebral device configured to be positioned within the intervertebral disc space. For example, the intervertebral device can be positioned between the upper end plate and the lower end plate, and the inflatable plate can be securely connected to the intervertebral device and positioned outside the intervertebral disc space so that bone screws can selectively penetrate into the upper end plate and the lower end plate.

[0011] The details of one or more aspects of the present disclosure are set forth in the following drawings and description. Other features, objectives, and advantages of the techniques described in the present disclosure will be apparent from the description and drawings, and from the claims.

[0012] In a first aspect, an expandable implant movable between a retracted position and an expanded position is disclosed. In various embodiments, for example, the implant may include an expandable body having a length extending from a proximal end to a distal end in a proximal to distal direction, a width extending from a first lateral side to a second lateral side in a width direction, and a height extending from an upper end to a lower end in a vertical direction. In various embodiments, the length may be greater than the width. For example, the expandable body may also include an upper end plate, the upper end plate including a first outer surface and a first inner surface opposite to the first outer surface, the first inner surface including a first proximal chamfer and a first distal chamfer disposed opposite to the first proximal chamfer. For example, the expandable body may also include a lower end plate, the lower end plate including a second outer surface and a second inner surface opposite to the second outer surface, the second inner surface including a second proximal chamfer and a second distal chamfer disposed opposite to the second proximal chamfer. The expandable body may also include a moving mechanism for expanding the upper end plate and the lower end plate. In various embodiments, for example, the moving mechanism may include a support block connected to the upper end plate and the lower end plate, the support block rotatably supporting the proximal fixing screw and the distal fixing screw along a rotation axis extending parallel to the direction from the proximal to the distal side. In various embodiments, for example, the moving mechanism may include a proximal push portion movably connected to the proximal fixing screw, the proximal push portion including a first upper inclined surface and a first lower inclined surface. In various embodiments, for example, the moving mechanism may include a distal push portion movably connected to the distal fixing screw, the distal push portion including a second upper inclined surface and a second lower inclined surface. In at least some embodiments, for example, in the retracted position, the proximal push portion and the distal push portion may be disposed in an intermediate position within the expandable body. In at least some embodiments, for example, in the first expanded position, the proximal push portion may be disposed proximal to the expandable body, and the spacing between the upper and lower end plates at the proximal end is greater than the spacing between the upper and lower end plates at the proximal end in the collapsed position. In at least some embodiments, in the second expanded position, the spacing between the upper and lower end plates at the distal end is greater than the spacing between the upper and lower end plates at the distal end in the collapsed position.

[0013] On the other hand, a laterally insertable spinal implant is disclosed. For example, the implant may include an expandable body having a length extending from the proximal end to the distal end in a proximal to distal direction, a width extending from the first lateral side to the second lateral side in a width direction, and a height extending from the upper end to the lower end in a vertical direction. In various embodiments, for example, the length may be greater than the width. For example, the implant may also include an upper end plate, the upper end plate including a first outer surface and a first inner surface opposite to the first outer surface, the first inner surface including a first proximal chamfer and a first distal chamfer disposed opposite to the first proximal chamfer. For example, the implant may also include a lower end plate, the lower end plate including a second outer surface and a second inner surface opposite to the second outer surface, the second inner surface including a second proximal chamfer and a second distal chamfer disposed opposite to the second proximal chamfer. For example, the implant may further include a support block coupled to the upper end plate and the lower end plate, the support block having a proximal screw guide and a distal screw guide opposite to the proximal screw guide. In various embodiments, for example, the proximal screw guide may define a first rotation axis, and the distal screw guide may define a second rotation axis, and the first rotation axis and the second rotation axis may extend in the direction from the proximal to the distal side. For example, the implant may further include a proximal set screw and a distal set screw, the proximal set screw being rotatably supported by the proximal screw guide, and the distal set screw being rotatably supported by the distal screw guide. For example, the implant may further include a proximal pusher, the proximal pusher being movably coupled to the proximal set screw and comprising a first upper inclined surface and a first lower inclined surface. For example, the implant may further include a distal pusher, the distal pusher being coupled to the distal set screw and comprising a second upper inclined surface and a second lower inclined surface. In at least some embodiments, for example, the proximal push portion is coupled to the proximal fixation screw and can be moved toward and away from the proximal end of the expandable body in the proximal-to-distal direction by rotation of the proximal fixation screw along the first rotation axis, and the distal push portion is coupled to the distal fixation screw and can be moved toward and away from the distal end of the expandable body in the proximal-to-distal direction by rotation of the distal fixation screw along the second rotation axis. In various embodiments, for example, the proximal push portion and the distal push portion are configured to simultaneously disperse the upper end plate and the lower end plate in a parallel manner when the proximal fixation screw and the distal fixation screw are simultaneously rotated in a first direction, and to simultaneously contract the upper end plate and the lower end plate in a parallel manner when the proximal fixation screw and the distal fixation screw are simultaneously rotated in a second direction opposite to the first direction.In various embodiments, for example, the proximal fixation screw is configured to push the proximal push portion toward the proximal end of the expandable body in the proximal-to-distal direction when the proximal fixation screw is independently rotated in the first direction, thereby dispersing the upper end plate and the lower end plate at the proximal end of the expandable body. In various embodiments, for example, the distal fixation screw is configured to push the distal push portion toward the distal end of the expandable body in the proximal-to-distal direction when the distal fixation screw is independently rotated in the first direction, thereby dispersing the upper end plate and the lower end plate at the distal end of the expandable body.

[0014] On the other hand, a spinal implant configured for lateral insertion surgical techniques is disclosed. For example, the implant may include an upper end plate and a lower end plate extending in a direction from the proximal side to the distal side. In various embodiments, for example, the upper end plate may include a first outer surface and a first inner surface opposite to the first outer surface, the first outer surface including at least one bone screw release portion, and the first inner surface including a plurality of first guide walls. In various embodiments, for example, the upper end plate may also include a first proximal end and a first distal end opposite to the first proximal end, a first proximal chamfer and a first distal chamfer disposed opposite to the first proximal chamfer, and a first transverse surface and a second transverse surface opposite to the first transverse surface, the first transverse surface and the second transverse surface extending between the first proximal end and the first distal end. For example, the implant may also include a lower end plate having a second outer surface and a second inner surface opposite to the second outer surface, the second outer surface including at least one bone screw release portion, and the second inner surface including a plurality of second guide walls. In various embodiments, for example, the lower end plate may further include a second proximal end and a second distal end opposite to the second proximal end, a second proximal chamfer and a second distal chamfer disposed opposite to the second proximal chamfer, and a third transverse surface and a fourth transverse surface opposite to the third transverse surface, the third transverse surface and the fourth transverse surface extending between the second proximal end and the second distal end. For example, the implant may further include a proximal plate including a plurality of bone screw holes and a central hole. For example, the implant may further include a moving mechanism operably coupled to the proximal plate, the upper end plate, and the lower end plate. For example, the moving mechanism may further include a support block and a first push portion and a second push portion disposed on opposite sides of the support block, a rotatable first fixing screw, and a rotatable second fixing screw opposite to the first fixing screw. In various embodiments, for example, the first fixing screw and the second fixing screw may be configured to rotate in a first rotation direction and a second rotation direction around a rotation axis protruding in a direction substantially parallel to the length of the expandable body, and the proximal plate may be directly connected to the support block. In at least some embodiments, for example, the first push portion may be operably coupled to the first fixing screw and be capable of moving toward and away from the support block in the proximal-to-distal direction by rotation of the first fixing screw along the rotation axis, and the second push portion may be operably coupled to the second fixing screw and be capable of moving toward and away from the support block in the proximal-to-distal direction by rotation of the second fixing screw along the rotation axis. In at least some embodiments, for example, the first push portion may include a first side surface and a second side surface opposite to the first side surface, and have a plurality of first protrusions protruding from the first side surface and the second side surface.In at least some embodiments, for example, the second push portion may include a third side surface and a fourth side surface opposite to the third side surface, and have a plurality of second protrusions protruding from the third side surface and the fourth side surface. In at least some embodiments, for example, the plurality of first protrusions and the plurality of second protrusions correspond to the cross-sectional shapes of the plurality of first guide walls and the plurality of second guide walls and are operably connected thereto, respectively, so that the plurality of first protrusions and the plurality of second protrusions move along the plurality of first guide walls and the plurality of second guide walls, respectively. In various embodiments, the moving mechanism may be configured to operably adjust the spacing between the upper end plate and the lower end plate when the first fixing screw and the second fixing screw are rotated simultaneously along the rotation axis. In various embodiments, for example, the moving mechanism may be configured to operably adjust the inclination angle between the upper end plate and the lower end plate when any one of the first fixing screw and the second fixing screw is rotated along the rotation axis. BRIEF DESCRIPTION OF THE DRAWINGS

[0015] Figure 1A is a perspective view of one embodiment of an expandable spinal implant in accordance with the principles of the present disclosure in a fully collapsed position;

[0016] Figure 1B According to the principles of this disclosure Figure 1A An exploded view of an embodiment of the invention;

[0017] Figure 1C is a perspective view of one embodiment of an expandable spinal implant in accordance with the principles of the present disclosure in a collapsed or closed configuration;

[0018] Figure 1D is a perspective view of one embodiment of an expandable spinal implant in accordance with principles of the present disclosure in an expanded or open configuration;

[0019] Figure 2A and Figure 2B According to the principles of the present disclosure Figure 1A and Figure 1B A top view of an implementation scheme of;

[0020] Figure 2C and Figure 2D is in a retracted position according to the principles of the present disclosure Figure 1A and Figure 1B A side view of an embodiment of the invention;

[0021] Figure 2E and Figure 2F is in an expanded position according to the principles of the present disclosure Figure 1A and Figure 1B A side view of an embodiment of the invention;

[0022] Figure 3A is a perspective view of one embodiment of an expandable spinal implant in accordance with the principles of the present invention in a closed configuration;

[0023] Figure 3B is a perspective view of one embodiment of an expandable spinal implant in an expanded configuration according to the principles of the present disclosure;

[0024] Figure 4A According to the principles of the present disclosure FIG. 2A to FIG. 2C A top view of an implementation scheme of;

[0025] Figure 4B is in a retracted position according to the principles of the present disclosure FIG. 2A to FIG. 2C A side view of an embodiment of the invention;

[0026] Figure 4C is in a partially expanded and tilted position according to the principles of the present disclosure FIG. 2A to FIG. 2C A side view of an embodiment of the invention;

[0027] Figure 4D is in a fully expanded position according to the principles of the present disclosure FIG. 2A to FIG. 2C A side view of an embodiment of the invention;

[0028] Figure 5A is a top view of an embodiment according to the principles of the present disclosure;

[0029] Figure 5B According to the principles of this disclosure Figure 5A A front view of an embodiment of the present invention;

[0030] Figure 5C According to the principles of this disclosure Figure 5A An alternative side view of an embodiment of ;

[0031] FIG. 6A to FIG. 6C is a top view of three exemplary footprint sizes of a top end plate according to the principles of the present disclosure;

[0032] 7A to 7C is a top view of three exemplary footprint sizes of a bottom end plate according to the principles of the present disclosure;

[0033] Figure 8 is a perspective view of one embodiment of an expandable spinal implant system according to the principles of the present disclosure;

[0034] Fig.9A is a cut-away perspective view showing a surgical tool in a first adjusted position, wherein an exemplary spinal implant is in a collapsed position;

[0035] Fig. 9Bis a cutaway perspective view showing a surgical tool in a first adjusted position after adjusting an exemplary spinal implant from a collapsed position to a first expanded position;

[0036] Fig. 10A is a cutaway perspective view showing a surgical tool in a second adjusted position, wherein an exemplary spinal implant is in Fig. 9B A first expansion position;

[0037] Fig. 10B is a cutaway perspective view showing a surgical tool in a second position after adjusting an exemplary spinal implant from a first expanded position to an expanded and angled position;

[0038] Fig.11A and Fig. 11B is a perspective view of a moving mechanism in a retracted position and an expanded position, respectively, according to the principles of the present disclosure;

[0039] Fig. 12A and Fig. 12B A device having a bottom end plate in a collapsed position and an expanded position according to the principles of the present disclosure Fig.11A and Fig. 11B A perspective view of the moving mechanism;

[0040] Fig.13A and Fig. 13B A device according to the principles of the present disclosure having a top end plate and a bottom end plate in a collapsed position and an expanded position, respectively. Fig. 12A and Fig. 12B A perspective view of the moving mechanism;

[0041] Fig.14A and Fig. 14B is a cross-sectional view of a moving mechanism according to the principles of the present disclosure;

[0042] Fig.15 According to the principles of this disclosure Fig.14A and Fig. 14B A cross-section of the moving mechanism along its longitudinal axis;

[0043] Fig.16 is a perspective view of a top endplate and a bottom endplate of one embodiment of an expandable spinal implant according to the principles of the present disclosure;

[0044] Fig.17 According to the principles of the present disclosure Fig.16 Exploded view of the top and bottom end plates;

[0045] FIG. 18A to FIG. 18B is a perspective view of a first surgical tool of an expandable spinal implant system according to the principles of the present disclosure;

[0046] FIG. 19A to FIG. 19Care side views of a first surgical tool and an adjustment rod of an expandable spinal implant system according to the principles of the present disclosure, respectively;

[0047] Fig. 20 A perspective view of one embodiment of an expandable spinal implant system with an anchor screw in accordance with the principles of the present disclosure is shown;

[0048] FIG. 21A to FIG. 21B lateral side view and anterior side view, respectively, of one embodiment of an expandable spinal implant system with an anchor screw according to the principles of the present disclosure;

[0049] Fig.22A is suitable for and according to the principles of the present disclosure Fig. 20 A side view of a second surgical device for use with an embodiment of the present invention;

[0050] Fig. 22B According to the principles of this disclosure Fig.22A Side view of a magnified area of ​​;

[0051] FIG. 23A to FIG. 23C is suitable for combining with the principles of the present disclosure FIG. 22A to FIG. 22B The second surgical tool Fig. 20 Various perspective views of exemplary anchor screws for use with embodiments of the present invention;

[0052] FIG. 24A to FIG. 24D are various side and top views of an exemplary bone graft according to the principles of the present disclosure;

[0053] Fig.25A and Fig.25B A first flexed position and a second flexed position, respectively, of one embodiment of an expandable spinal implant according to the principles of the present disclosure are shown;

[0054] Figure 26 to Figure 28 showing left side, right side and anterior side views, respectively, of an installed expandable spinal implant positioned between adjacent vertebral bodies in accordance with the principles of the present disclosure;

[0055] Fig.29A is a perspective view of one embodiment of an expandable spinal implant according to the principles of the present disclosure;

[0056] Fig.29B According to the principles of this disclosure Fig.29A An exploded view of an embodiment of

[0057] Fig. 30A is a top view of one embodiment of an expandable spinal implant according to the principles of the present disclosure;

[0058] Fig. 30Bis a perspective view of one embodiment of an expandable spinal implant according to the principles of the present disclosure;

[0059] Fig. 30C is a perspective view of one embodiment of an expandable spinal implant according to the principles of the present disclosure with the top end plate removed;

[0060] Fig.30D is an alternative perspective view of one embodiment of an expandable spinal implant according to the principles of the present disclosure with the top end plate removed;

[0061] Fig.30E is a top view of one embodiment of a top end plate according to the principles of the present disclosure;

[0062] Fig.30F is a top view of one embodiment of a bottom end plate according to the principles of the present disclosure;

[0063] Fig.31 is a perspective view of one embodiment of an expandable spinal implant according to the principles of the present disclosure, showing three alternative angular positions of an insertion tool;

[0064] Fig.32A is a top view of one embodiment of an expandable spinal implant according to the principles of the present disclosure;

[0065] Fig.32B According to the principles of this disclosure Fig.32A A perspective view of an embodiment of the invention;

[0066] Fig.33A is a perspective view of one embodiment of an expandable spinal implant according to the principles of the present disclosure;

[0067] Fig.33B is in an expanded position according to the principles of the present disclosure Fig.33A A perspective view of an embodiment of the invention;

[0068] Fig.33C is in a first tilted position according to the principles of the present disclosure Fig.33A A perspective view of an embodiment of the invention;

[0069] Fig.33D is in a second tilted position according to the principles of the present disclosure Fig.33A A perspective view of an embodiment of the invention;

[0070] Fig.34 is a perspective view of one embodiment of an expandable spinal implant system according to the principles of the present disclosure;

[0071] Fig.35 is a perspective view of one embodiment of an expandable spinal implant according to the principles of the present disclosure, showing three alternative angular positions of an insertion tool;

[0072] Fig.36 is a perspective view of one embodiment of an expandable spinal implant including a screw guiding endplate having at least one hole configured to receive an anchor screw therein;

[0073] Fig.37 yes Fig.36 A front view of an embodiment of the present invention;

[0074] Fig.38A and Fig.38B are various perspective views of a screw guide endplate having at least one hole configured to receive an anchor screw therein;

[0075] Fig.39A and Fig.39B is a top view of a top end plate and a bottom end plate including at least one slot configured to receive an anchor screw therein;

[0076] Fig.40 is a perspective view of one embodiment of an expandable spinal implant including a screw guiding endplate having at least one hole configured to receive an anchor screw therein;

[0077] Fig.41 yes Fig.40 A front view of an embodiment of the present invention;

[0078] Fig.42A is a front view of a screw guiding endplate having at least one hole configured to receive an anchor screw therein;

[0079] Fig.42B yes Fig.42A A front view of a screw guide end plate including an anchor screw installed in each corresponding hole;

[0080] Fig.43A and Fig.43B are various perspective views of a screw guide endplate having at least one hole configured to receive an anchor screw therein;

[0081] Fig.44A and Fig.44B is a top view of a top end plate and a bottom end plate including at least one recessed portion configured to receive an anchor screw;

[0082] Fig.45 is a perspective view of an additional embodiment of an expandable spinal implant including a front end plate according to the principles of the present disclosure;

[0083] Fig.46 According to the principles of this disclosure Fig.45An alternative perspective view of an embodiment of

[0084] Fig.47 According to the principles of this disclosure Fig.45 An exploded component view of an embodiment of the present invention;

[0085] Fig.48A According to the principles of this disclosure Fig.45 A first view of a bottom end plate of an embodiment of the present invention;

[0086] Fig.48B According to the principles of this disclosure Fig.45 a second view of a bottom end plate of an embodiment of the invention;

[0087] Fig.48C is in an expanded position according to the principles of the present disclosure Fig.45 A perspective view of an embodiment of the invention;

[0088] Fig.49 A method of manufacturing a bone screw according to the principles of the present disclosure comprising a plurality of bone screws Fig.45 A perspective view of an embodiment of the invention;

[0089] Fig.50 A method of manufacturing a bone screw according to the principles of the present disclosure comprising a plurality of bone screws Fig.45 An alternative perspective view of an embodiment of

[0090] Fig.51 A method of manufacturing a bone screw according to the principles of the present disclosure comprising a plurality of bone screws Fig.45 a rear perspective view of an embodiment of;

[0091] Fig.52 is a side view of an example bone screw;

[0092] Fig.53 1 to 2 are diagrams illustrating a schematic diagram of a circuit according to the principles of the present disclosure. Fig.44B A reference map of various cardinal directions and planes relative to a patient along which exemplary embodiments of the present invention may be manipulated, adjusted, and / or moved;

[0093] Fig.54 is a perspective view of a first expandable plate embodiment for coupling to a disclosed spinal implant;

[0094] Fig.55 is an alternative perspective view of a first expandable plate embodiment for coupling to the disclosed spinal implant;

[0095] Fig.56 is a front view of a first expandable plate embodiment for coupling to a disclosed spinal implant;

[0096] Fig.57is an exploded perspective view of a first expandable plate embodiment for coupling to a disclosed spinal implant;

[0097] Fig.58 is an alternative exploded components perspective view of a first expandable plate embodiment for coupling to a disclosed spinal implant;

[0098] Fig.59 is an alternative exploded components perspective view of a first expandable plate embodiment for coupling to a disclosed spinal implant;

[0099] Fig.60 is a front view of a first expandable plate embodiment coupled to a spinal implant;

[0100] Fig.61 yes Fig.60 A cross-sectional view of

[0101] Fig.62 is a perspective view of a second expandable plate embodiment for coupling to the disclosed spinal implant;

[0102] Fig.63 is an alternative perspective view of a second expandable plate embodiment for coupling to the disclosed spinal implant;

[0103] Fig.64 is a front view of a second expandable plate embodiment for coupling to the disclosed spinal implant;

[0104] Fig.65 is an exploded perspective view of a second expandable plate embodiment for coupling to the disclosed spinal implant;

[0105] Fig.66 is a perspective view of a second expandable panel embodiment in an expanded position;

[0106] Fig.67 is an alternative perspective view of a second expandable panel embodiment in an expanded position;

[0107] Fig.68 is a perspective view of a third expandable plate embodiment for coupling to the disclosed spinal implant;

[0108] Fig.69 is an alternative perspective view of a third expandable plate embodiment for coupling to the disclosed spinal implant;

[0109] Fig.70 is a front view of a third expandable plate embodiment for coupling to the disclosed spinal implant;

[0110] Fig.71is an exploded perspective view of a third expandable plate embodiment for coupling to the disclosed spinal implant;

[0111] Fig.72 is a perspective view of a third expandable panel embodiment in an expanded position;

[0112] Fig.73 is a perspective view of a third expandable panel embodiment in an expanded position;

[0113] Fig.74 is a flow chart of a method of operation of various expandable panels;

[0114] Fig.75 is a front perspective view of one embodiment of an expandable spinal implant according to the principles of the present disclosure;

[0115] Fig.76 is a rear perspective view of one embodiment of an expandable spinal implant according to the principles of the present disclosure;

[0116] Fig.77 is a first exploded component view of one embodiment of an expandable spinal implant according to the principles of the present disclosure;

[0117] Fig.78 is a first exploded component view of one embodiment of an expandable spinal implant according to the principles of the present disclosure;

[0118] Fig.79 is a top view showing various cross-sectional lines of one embodiment of an expandable spinal implant according to the principles of the present disclosure;

[0119] Fig.80 is through Fig.79 A perspective cross-sectional view of section A3;

[0120] Fig.81 is through Fig.79 A perspective cross-sectional view of section A1;

[0121] Fig.82 is through Fig.79 A perspective cross-sectional view of section A4;

[0122] Fig.83 is a front perspective view of one embodiment of an expandable spinal implant according to the principles of the present disclosure;

[0123] Fig.84 is in a partially expanded first position according to the principles of the present disclosure Fig.83 A front perspective view of an embodiment of the invention;

[0124] Fig.85 is in a partially expanded second position according to the principles of the present disclosure Fig.83 A front perspective view of an embodiment of the invention;

[0125] Fig.86 is in a fully expanded position according to the principles of the present disclosure Figure 83 to Figure 85 A front perspective view of an embodiment of the invention;

[0126] Fig.87 According to the principles of this disclosure Fig.86 A partial component diagram of an embodiment of the present invention, wherein the upper end plate is removed for ease of understanding;

[0127] Fig.88 is a front perspective view of an embodiment according to the principles of the present disclosure;

[0128] Fig.89 is a front perspective view of one embodiment according to the principles of the present disclosure; and

[0129] Fig.90 is a top view of an embodiment according to the principles of the present disclosure. DETAILED DESCRIPTION

[0130] For example, exemplary embodiments of anterior expandable interbody devices, lateral expandable interbody devices, interbody device systems, and methods of using interbody devices are discussed with respect to: medical devices for treating musculoskeletal diseases, and more specifically, various interbody devices suitable as spinal implants for anterior surgical techniques, oblique surgical techniques, and lateral surgical techniques. The exemplary embodiments also discuss, with relevant emphasis, specialized adjustment instruments, such as instruments capable of adjusting the spacing between the various interbody devices described above between adjacent vertebrae of the spine and adjusting the inclination angle relative to the patient's coronal and / or sagittal planes by expansion and contraction. The disclosed devices and systems may be capable of adjusting the curvature of the patient's spine for lordotic and kyphotic correction. Similarly, instruments capable of installing various anchor screws are described in conjunction with the disclosed intravertebral devices.

[0131] As used herein, unless clearly defined or otherwise explained, the standard anatomical terms for positions have their ordinary meanings that will be understood by those of ordinary skill in the art. It should be understood that the various aspects disclosed herein can be combined in combinations different from the combinations specifically presented in the specification and the drawings. For example, the features of an embodiment can be combined or replaced with the features of another different embodiment, unless these features are clearly interpreted as mutually exclusive. It should also be understood that, depending on the example, some actions or events of any process or method described herein can be performed in different orders, can be added, merged or completely omitted (for example, all described actions or events may not be necessary for performing the disclosed techniques and methods). In addition, although for clarity, some aspects of the present disclosure are described as being performed by a single module or unit, it should be understood that the technology of the present disclosure can be performed by a combination of units or modules associated with, for example, a medical device.

[0132] In some embodiments, the system includes an expandable spinal implant suitable for insertion for use in oblique techniques, posterolateral procedures and / or transforaminal lumbar interbody fusion (sometimes referred to as a TLIF procedure), a direct posterior approach (sometimes referred to as a PLIF procedure), a direct lateral approach (sometimes referred to as a DLIF procedure), an anterior lumbar interbody fusion (sometimes referred to as an ALIF procedure), or variations of these procedures, wherein the implant is inserted into the intervertebral space and then expanded to impart and / or augment a lordotic and / or kyphotic curve of the spine.

[0133] In some embodiments, this spinal implant system can also be used for recovering and / or giving patient sagittal balance by increasing and / or recovering suitable lordosis and / or kyphosis angle between vertebral bodies at the selected level of spinal implant implanted and expanded.In addition, some embodiments can also be used for recovering and / or giving coronal balance to correct for example scoliosis.In described various embodiments, spinal implant system can be used for treating various complicated spinal surgeries of the spinal pathology that surpasses one-level fusion.In addition, the spinal implant system described in the closed embodiment can also be used as the fusion device with expandable height, for implant being adjusted to specific intervertebral disc space, to recover the spacing between adjacent vertebral bodies, and promote spinal fusion between adjacent vertebral bodies.

[0134] In some embodiments, as mentioned above, the disclosure can be used for treating spinal disorders, such as, for example, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other abnormal curvatures, kyphosis, tumors and fractures. In some embodiments, the disclosure can be used for other skeletons and bone-related applications, and these applications include applications associated with diagnosis and treatment. In some embodiments, disclosed spinal implant system can be alternatively used for surgical treatment of the patient in prone or supine position, and / or various surgical approaches are adopted to the spine, including anterior approach, posterior approach, posterior midline approach, direct lateral approach, posterior lateral approach and / or anterolateral approach, and in other body regions. The disclosure can also alternatively be used together with the surgery for the waist, neck, chest, sacrum and pelvic region for the treatment of spinal column. Spinal implant system of the present disclosure can also be used in animals, bone models and other inanimate substrates, such as in training, testing and demonstration.

[0135] By referring to the following detailed description of the embodiments in conjunction with the accompanying drawings, the present disclosure can be more easily understood, and the accompanying drawings form a part of the present disclosure. It should be understood that the present application is not limited to the specific equipment, methods, conditions or parameters described and / or shown herein, and the terms used herein are only for describing specific embodiments by way of example, rather than for limiting. In some embodiments, as used in the specification, and including the appended claims, the singular forms "one" and "the" include plural numbers, and references to specific numerical values ​​include at least the specific value, unless the context clearly specifies otherwise. The range may be expressed as "about" or "approximately" a specific value and / or "about" or "approximately" another specific value in this article. When expressing such a range, another embodiment includes from one specific value and / or to another specific value. Similarly, when a value is expressed as an approximate value by using the antecedent "about", it should be understood that a specific value forms another embodiment. It should also be understood that all spatial references (such as, for example, horizontal, vertical, top, upper, lower, bottom, left and right) are only for illustrative purposes and can be changed within the scope of the present disclosure. For example, references to "upper" and "lower" are relative and are used only in context of another situation, and are not necessarily "upper" and "lower". In general, similar spatial references to different aspects or components, such as the "proximal end" of an end plate and the "proximal end" of a wedge, indicate similar spatial orientations and / or positioning, i.e., each "proximal end" is located at or points to the same end of the device. In addition, the use of various spatial terms herein should not be interpreted as limiting the orientation of the various insertion techniques or the positioning of the implant relative to the spine.

[0136] As used in the specification and the appended claims, "treatment" of a disease or condition refers to performing a procedure that may include administering one or more drugs, biologics, bone grafts (e.g., including allografts, autografts, xenografts), or bone growth promoting materials to a patient (normal or abnormal human, or other mammal) using an implantable device and / or using an instrument for treating the disease (such as, for example, a microdiscectomy instrument for removing a bulge or herniated disc and / or bone spurs) to alleviate the signs or symptoms of the disease or condition. Relief may occur before the signs or symptoms of the disease or condition appear, or after they appear. Thus, treatment or therapy includes prevention or prophylaxis of a disease or undesirable condition (e.g., preventing the disease from occurring in a patient who may be susceptible to the disease but has not yet been diagnosed as having the disease). In addition, treatment does not require complete relief of signs or symptoms, does not require a cure, and specifically includes procedures that have only a minimal effect on the patient. Treatment may include inhibiting the disease, such as curbing its development, or slowing the disease, such as causing regression of the disease. For example, treatment may include reducing acute or chronic inflammation; reducing and relieving pain and promoting the regrowth of new ligaments, bone and other tissues; as an adjunct to surgery; and / or any repair procedure. In addition, as used in the specification and the appended claims, the term "tissue" includes soft tissue, ligament, tendon, cartilage and / or bone, unless otherwise specifically stated. The term "bone growth promoting material" as used herein may include, but is not limited to: bone grafts (autografts, allografts, xenografts) of various forms and compositions (including, but not limited to, microparticulate bone grafts); osteoinductive materials such as bone morphogenetic proteins (BMPs) (including, but not limited to, those available from Medtronic); ) and alternative small molecule osteoinductive substances; osteoinductive materials such as demineralized bone matrix (DBM) in various forms and compositions (putty, chips, bags (including but not limited to those available from Medtronic series of products); collagen sponge; bone paste; ceramic-based void filler; ceramic powder; and / or other substances suitable for inducing, conducting or promoting bone growth and / or bone fusion of existing bone structures. Such bone growth promoting materials can be provided in the form of various solids, pastes, liquids, colloids, solutions or other preparations suitable for filling or placing in or around the various implants 100, 200, 300 embodiments described herein.

[0137] Various embodiments and parts may, for example, be coated with ceramic, titanium and / or other biocompatible materials to provide (a) macroscale, (b) microscale and / or (c) nanoscale surface textures. Similarly, parts may undergo a subtractive manufacturing process to provide a surface texture configured to promote bone bonding and cell adhesion and osteoblast maturation. Example surface texturing of additive and subtractive manufacturing processes may include (a) a macroscale structural feature with a maximum peak-to-valley height of about 40 microns to about 500 microns, (b) a microscale structural feature with a maximum peak-to-valley height of about 2 microns to about 40 microns, and / or (c) a nanoscale structural feature with a maximum peak-to-valley height of about 0.05 microns to about 5 microns. In various embodiments, for example, these three types of structural features may overlap each other. In addition, this surface texture may be applied to any surface, for example, both the external exposed surface of a part and the internal non-exposed surface of a part. Further discussion of related surface textures and coatings is described, for example, in U.S. Pat. No. 11,096,796, entitled “Interbody spinal implant having a roughened surface topography on one or more internal surfaces,” filed on March 4, 2013, the entire disclosure of which is incorporated herein by reference in its entirety. Therefore, it should be understood that any coating and texturing process described in U.S. Pat. No. 11,096,796 may be applied to any component of the various embodiments disclosed herein, such as, for example, exposed surfaces and internal surfaces of end plates. Another example technique for manufacturing an orthopedic implant having a surface having osteoinductive rough features including microscale structures and nanoscale structures is disclosed in U.S. Pat. No. 10,821,000, the entire disclosure of which is incorporated herein by reference. Additionally, an example of a commercially available product may be the Adaptix 3000 sold by Medtronic Spine. TM Intervertebral system, which includes Titan nanoLOCK TM Cage made of titanium.

[0138] The components of the expandable spinal implant system described herein can be made of biologically acceptable materials suitable for medical applications (including metals, synthetic polymers, ceramics and bone materials and / or composites thereof). For example, the components of the expandable spinal implant system can be made, individually or collectively, of materials such as stainless steel alloys, commercially pure titanium, titanium alloys, grade 5 titanium, superelastic titanium alloys, cobalt-chromium alloys, stainless steel alloys, superelastic metal alloys (e.g., nitinol, superelastic plastic metals such as GUM ), ceramics and their composites, such as calcium phosphate (e.g., SKELITE TM ), thermoplastics such as polyaryletherketone (PAEK) (including polyetheretherketone (PEEK), polyetherketoneketone (PEKK) and polyetherketone (PEK)), carbon-PEEK composites, PEEK-BaSO4 polymer rubber, polyethylene terephthalate (PET), fabrics, silicone, polyurethane, silicone-polyurethane copolymers, polymer rubber, polyolefin rubber, hydrogels, semi-rigid and rigid materials, elastomers, rubber, thermoplastic elastomers, thermosetting elastomers, elastomeric composites, rigid polymers (including polyphenylene, polyamide, polyimide, polyetherimide, polyethylene, epoxy resin), bone materials (including autografts, allogeneic resorbable materials (e.g., composites of metals and calcium-based ceramics, composites of PEEK and calcium-based ceramics, composites of PEEK and resorbable polymers), fully resorbable materials (e.g., calcium-based ceramics such as calcium phosphate, tricalcium phosphate (TCP), hydroxyapatite (HA)-TCP, calcium sulfate) or other resorbable polymers such as polyaetide, polyglycolide, polytyrosine carbonate, polycaprolactone, and combinations thereof.

[0139] The various components of the spinal implant system can be formed or constructed from a material composite including, but not limited to, the materials described above to achieve various desired properties such as strength, stiffness, elasticity, compliance, biomechanical properties, durability, and radiolucency or imaging preferences. The components of the expandable spinal implant system can also be made of heterogeneous materials individually or collectively, such as a combination of two or more of the above materials. The components of the expandable spinal implant system can be integrally formed, integrally connected, or include fastening elements and / or instruments, as described herein. For example, in some embodiments, the expandable spinal implant system can include an expandable spinal implant 100, 200, 300, which includes a PEEK and / or titanium structure having a radiolucent marker (such as a tantalum pin and / or nail) selectively placed in the implant to provide placement and / or size information to a practitioner when the expandable spinal implant 100, 200, 300 is placed in the spine. The components of the expandable spinal implant system can be formed using various subtractive and additive manufacturing techniques, including but not limited to machining, milling, extrusion, molding, 3D printing, sintering, coating, vapor deposition and laser / beam melting. In addition, the various components of the expandable spinal implant system can be coated or processed with various additives or coatings to improve biocompatibility, bone growth promotion or other features. For example, the end plates 110, 120 can be selectively coated with bone growth promoting surface treatment or bone growth promoting surface treatment (bone ongrowth promoting surface treatment), which surface treatment can include but is not limited to: titanium coating (solid, porous or textured), hydroxyapatite coating or titanium plate (solid, porous or textured).

[0140] The expandable spinal implant system can be used, for example, with minimally invasive surgery including percutaneous techniques, small incision surgical techniques, and incision surgical techniques to deliver and introduce instruments and / or one or more spinal implants at a surgical site (e.g., a portion of the spine) in the patient's body. In some embodiments, the expandable spinal implant system can be used with surgical procedures as described herein and / or, for example, vertebral resection, discectomy, fusion therapy, and / or fixation therapy that use spinal implants to restore the mechanical support function of the vertebrae. In some embodiments, the expandable spinal implant system can be used with surgical methods, including but not limited to: anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), oblique lumbar interbody fusion, transforaminal lumbar interbody fusion (TLIF), various types of anterior fusion surgeries, and any fusion surgery in any part of the spine (e.g., sacrum, lumbar, thoracic, and cervical).

[0141] Generally, in Figures 1 to Fig.44B, five exemplary embodiments of expandable spinal implants 100, 200, 300, 600 and 700 are shown (spinal implant 100 is shown in exemplary FIGS. 1 to 3). Fig.28 As highlighted in the figure, implant 200 is shown in the exemplary figures 29 to Fig.31 As highlighted in the figure, implant 300 is shown in the exemplary figures 32 to Fig.35 As highlighted in FIG. 6 , implant 600 is shown in the exemplary Figures 36 to 39B As highlighted in FIG. 7 , implant 700 is Figures 40 to 44B ). Exemplary embodiments of surgical tools 400, 450, and 500 are shown in the exemplary Figure 8 Figure 18 to Fig.23C For example, surgical tools 400, 450, and 500 are discussed simultaneously with exemplary spinal implant 100. It should be understood that exemplary Figure 8 Figure 18 to Fig.23C The same or similar surgical tools highlighted in the figures may be used with the expandable spinal implants 200, 300, 600 and 700. Similar and / or identically numbered corresponding elements may be used interchangeably between the various exemplary embodiments of the expandable spinal implants 100, 200, 300, 600 and 700 for ease of understanding and convenience of explanation. For example, the movement mechanism 250 is primarily discussed simultaneously with the exemplary spinal implant 100 and is not discussed in the exemplary embodiment. FIG. 9A to FIG. 15 250 is highlighted in FIG. 2 , but the same or similar movement mechanism 250 may be used with expandable spinal implants 200 , 300 , 600 , and 700 . Fig.53 Provided as a reference illustration only, various standard medical terms and orientations of a patient 1 are shown along with cardinal directions and planes of the patient's 1 body relative to the expandable spinal implants 100, 200, 300, 600, and 700 in which they may function.

[0142] Generally refer to Figures 1 to Fig.28 , shows a first exemplary expandable spinal implant 100, a movement mechanism 250, a first surgical tool 400, and a second surgical tool 500. The spinal implant 100 can be configured to be inserted into the intervertebral disc space between adjacent vertebral bodies according to a variety of surgical techniques, such as an anterior technique, an oblique technique, and a lateral technique.

[0143] Figure 1A The spinal implant 100 is shown in perspective view, and Figure 1BThe spinal implant 100 is shown in an exploded component view. The exemplary spinal implant 100 includes a top end plate 110 (first end plate) and a bottom end plate 120 (second end plate) and a moving mechanism 250, which will be described in more detail below. The spinal implant 100 includes a proximal end 101 and a distal end 102 opposite the proximal end 101, and a first side end 103 and a second side end 104 opposite the first side end 103. The first side end 103 and the second side end 104 extend between the proximal end 101 and the distal end 102. The proximal end 101 includes an exposed screw guide end plate 105, which defines a corresponding screw guide hole 107, which is disposed between the end plates 110 and 120. The screw guide end plate 105 and the guide hole 107 will be described in more detail below.

[0144] The top end plate 110 may include a first outer surface 111 and a first inner surface 112 opposite the first outer surface 111. Similarly, the bottom end plate 120 may include a second outer surface 121 and a second inner surface 122. The outer surfaces 111, 121 may be configured to be located between and / or contact the vertebral bodies in the patient's spine and have various surface features. For example, in some embodiments, the outer surfaces 111 and 122 may have a substantially linear surface profile extending through the face of its textured surface. In other embodiments, the outer surfaces 111 and 122 may have a curved surface profile extending through the face of its textured surface. Further details of the end plates 110, 120 will be described in more detail below. The inner surfaces 111, 122 may surround the movement mechanism 250 and have various profiles, guides, cavities and other operable features that facilitate movement and / or provide mechanical advantages to other operable and movable counterparts to facilitate contraction, angle adjustment, lateral bending, compression forces, absorption of shear forces, etc., which will be explained in more detail below.

[0145] In an exemplary embodiment, the top end plate 110 includes a pair of first proximal chamfers 114 and a pair of first distal chamfers 116 opposite to the first proximal chamfers 114. Each of the chamfers of the first proximal chamfers 114 includes an inclined surface extending away from the inner surface 112 and the moving mechanism 250. Similarly, each of the chamfers of the first distal chamfers 116 includes an inclined surface extending away from the inner surface 112 and the moving mechanism 250. The bottom end plate 120 includes a pair of second proximal chamfers 124 and a pair of second distal chamfers 126 opposite to the second proximal chamfers 124. Each of the chamfers of the second proximal chamfers 124 includes an inclined surface extending away from the inner surface 122 and the moving mechanism 250. Similarly, each of the chamfers of the second distal chamfers 126 includes an inclined surface extending away from the inner surface 112 and the moving mechanism 250. Furthermore, each of the inclined surfaces 114 , 116 , 124 , 126 includes a corresponding guide wall 130 extending along an inner surface thereof and extending in a direction substantially parallel to the inclined surface of the corresponding inclined surface.

[0146] The exemplary spinal implant 100 includes a moving mechanism 250 operably coupled to the top end plate 110 and the bottom end plate 120, as will be explained in more detail below. The moving mechanism 250 includes a first fixing screw 252 and a corresponding first push portion 256 operably connected thereto, and a second fixing screw 254 and a corresponding second push portion 258 operably connected thereto. A first functional feature of the moving mechanism 250 is that it is also configured to increase and decrease the spacing between the top and bottom end plates 110, 120 when the first fixing screw 252 and the second fixing screw 254 are simultaneously rotated in clockwise and counterclockwise directions, respectively. A second functional feature of the moving mechanism 250 is that it is also configured to increase and decrease the tilt angle between the top and bottom end plates 110, 120 when the first fixing screw 252 is rotated in clockwise and counterclockwise directions, respectively. Additional functions and properties of the moving mechanism 250 will be described in more detail below.

[0147] Figure 1C is a perspective view of spinal implant 100 in a collapsed position, and Figure 1D is a perspective view of spinal implant 100 in an expanded position. Figure 1C The top end plate 110 and the bottom end plate 120 are retracted to a fully closed position. Figure 1B The top end plate 110 and the bottom end plate 120 are expanded to an intermediate position, i.e., the end plates 110 and 120 can be expanded further if necessary. In some embodiments, the top end plate 110 can be referred to as a front wedge or front end plate, and the bottom end plate 120 can be referred to as a rear wedge or rear end plate.

[0148] As explained above, the spinal implant 100 includes a proximal end 101 and a distal end 102 opposite to the proximal end 101, and a first lateral end 103 and a second lateral end 104 opposite to the first lateral end 103. It should be understood that reference to other parts of the spinal implant 100 can be with respect to the above-mentioned orientation of the general reference spinal implant 100, for example, the end plate 110 can also include a proximal end 101 and a distal end 102 opposite to the proximal end 101, and a first lateral end 103 and a second lateral end 104 opposite to the first lateral end 103.

[0149] Figure 2A and Figure 2BA top view of a spinal implant 100 is shown. The spinal implant 100 has a length L and a width W that are primarily defined by the footprint of the end plates 110, 120. The spinal implant 100 has a first reference axis A1 and a second reference axis A2. The first reference axis A1 can be understood as a projection through the central portion of the guide hole 107 in a direction parallel to the end surfaces of the first lateral end 103 and the second lateral end 104, for example, the first reference axis A1 can pass through the center of the spinal implant 100 in the width direction. The second reference axis A2 can be understood as a projection that intersects the first reference axis A1 and passes through the center of the spinal implant 100 in the length direction. The top end plate 110 may have a plurality of channels 111c spaced apart from each other and extending in its length direction, for example, in a direction parallel to the reference axis A2. Similarly, the bottom end plate 120 may have a plurality of channels 122c spaced apart from each other and extending in its length direction, for example, in a direction parallel to the reference axis A2. In an exemplary embodiment, the channels 111c, 122c can each have a beveled edge portion that aids in positioning the spinal implant 100 between vertebral bodies and provides a surface for promoting bone growth thereon.

[0150] Figure 2C and Figure 2D The spinal implant 100 is shown in a side view in a collapsed position. Figure 2E and Figure 2F The spinal implant 100 is shown in a side view in an expanded position. It should be understood that Figure 2C to Figure 2F The spinal implant 100 is schematically shown, with some internal components being shown or simplified and other components being omitted for ease of explanation. Figure 2C to Figure 2F The first and second end plates 110 and 120 are shown schematically only to help explain the various positions of the first and second end plates 110 and 120 relative to each other. 1A It may be about 10 mm, and in the expanded position, the second height H of the proximal end 101 1B It can be about 22 mm. In the retracted position, the first height H of the distal end 102 2A can be about 7 mm, and in the expanded position, the second height H of the distal end 102 2B Can be about 12mm. In addition, in the contracted position, the first inclination angle θ1 between the end plates 110, 120 can be about 7°, and in the expanded position, the second inclination angle θ2 between the end plates 110, 120 can be about 25°. Although specific ranges are provided herein with reference to exemplary spinal implant 100, other embodiments can have corresponding dimensions, i.e., height, selected from those provided above. Similarly, other embodiments can have corresponding inclination angles selected between the end plates 110, 120.

[0151] Figure 3A and Figure 3B is a perspective view of an alternative embodiment of a second spinal implant 200. Spinal implant 200 may have the same or similar properties as spinal implant 100. As shown, spinal implant 200 includes a top patterned end plate 110a and a bottom patterned end plate 120a. The top patterned end plate 110a includes an outer surface 111 and an inner surface 112 opposite to the outer surface 111. Similarly, the bottom patterned end plate 120a includes a first outer surface 121 and a first inner surface 122 opposite to the outer surface 111. As shown, the outer surface 111 includes a plurality of raised diamond surfaces 111d (diamond tread pattern) and a plurality of first openings 111a, each of which may have a diamond shape, a circle and / or a diamond shape including chamfered or rounded corners. Although in Figure 3A and Figure 3B Although not visible in the figure, it is understood that the bottom patterned end plate 120a may also have a plurality of raised diamond-shaped surfaces and a plurality of openings, which are the same or similar to the plurality of raised diamond-shaped surfaces 111d and the plurality of first openings 111a of the top patterned end plate 110a.

[0152] As shown, the plurality of first openings 111a are circular and disposed in a central region of the top patterned endplate 110a, but in other embodiments they may have alternative shapes and / or be disposed in alternative locations. For example, the first outer surface 111 and the second outer surface 122 may include various anti-migration, anti-expulsion and / or bone-integration features, including but not limited to: ridges, teeth, pores, and coatings (including but not limited to porous titanium coatings (such as Capstone PTC available from Medtronic TM The end plates 110a, 120a may also include at least one second opening 115 defined therein and configured to allow bone growth material to be filled, placed or loaded into the spinal implant 200. In an exemplary embodiment, a pair of second openings 115 are shown, each having a D-like shape.

[0153] Figure 4A The spinal implant 200 is shown in a top view. FIG. 4B to FIG. 4D Each figure shows a spinal implant 200 in a side view and in a different respective position. Figure 4B The spinal implant 200 is shown in a first position, Figure 4C The spinal implant 200 is shown in a second position, and Figure 4D The spinal implant 200 is shown in a third position. In the first position, the first height H of the proximal end 101 1A The second height H of the proximal end 101 may be about 10 mm. In the second position, the second height H of the proximal end 101 1B The third height H of the proximal end 101 may be about 18 mm, and in the third position, the third height H of the proximal end 1011C In the first position, the first height H of the distal end 102 is about 18 mm. 2A The second height H of the distal end 102 may be about 6 mm. 2B may be about 5 mm, and in the third position, the third height H of the distal end 102 1C Can be about 11.8mm (about 12mm). In addition, in the first position, the first inclination angle θ1 between the end plates 110a, 120a can be about 9 °, in the second position, the second inclination angle θ2 between the end plates 110a, 120a can be about 30 °, and in the third position, the third inclination angle θ3 between the end plates 110a, 120a can be about 13 °. In some embodiments, the first position can correspond to the fully retracted position, the second position can correspond to the maximum inclination angle, and the third position can correspond to the fully expanded position. Although specific ranges are provided herein with reference to exemplary spinal implant 100, other embodiments may have those alternative corresponding dimensions provided above, i.e., height. Similarly, other embodiments may have alternative corresponding inclination angles between the end plates 110a, 120a.

[0154] Figure 5A 300 is a top view of the spinal implant 300. The spinal implant 300 may have the same or similar properties as the spinal implant 200 and the spinal implant 100. Figure 5B and Figure 5C yes Figure 5A . As shown, the spinal implant 300 includes a first reference axis A1 and a second reference axis A2. The first reference axis A1 passes through the center of the spinal implant 300 in the width direction, and the second reference axis A2 passes through the center of the spinal implant 300 in the length direction. The first reference axis A1 and the second reference axis A2 can be understood as linear projections that are perpendicular to each other. In addition, the first reference axis A1 can pass through the center of the guide hole 107 and other components operably disposed therein, for example, the moving mechanism 250 as will be discussed in more detail below.

[0155] As shown, spinal implant 300 includes top curved end plate 110c and bottom curved end plate 120c. Top curved end plate 110c is characterized by a concave profile protruding below it relative to first reference axis A1 and second reference axis A2. The concave profile is emphasized by the curve above it. Bottom curved end plate 120 is characterized by a convex profile protruding above it relative to first reference axis A1 and second reference axis A2. The convex profile is emphasized by the curve below it.

[0156] FIG. 6A to FIG. 6C1 is a top view of three exemplary footprint sizes of the first top end plate 110x, the second top end plate 110y, and the third top end plate 110z. It should be understood that according to the principles of the present disclosure, the first top end plate 110x, the second top end plate 110y, and the third top end plate 110z can replace the end plates 110, 110a, and 110c. 7A to 7C 1 is a top view of three exemplary footprint sizes of the first bottom end plate 120x, the second bottom end plate 120y, and the third bottom end plate 120z. It should be understood that according to the principles of the present disclosure, the first bottom end plate 120x, the second bottom end plate 120y, and the third bottom end plate 120z can replace the end plates 120, 120a, and 120c. The first top end plate 110x and the first bottom end plate 120x may have a length of about 32 mm and a width of about 25 mm. The second top end plate 110y and the second bottom end plate 120y may have a length of about 37 mm and a width of about 29 mm. The third top end plate 110z and the third bottom end plate 120z may have a length of about 42 mm and a width of about 32 mm. It should be understood that the first top end plate 110x and the first bottom end plate 110y are applicable to patients with smaller vertebrae, the second top end plate 110y and the second bottom end plate 110y are applicable to patients with relatively larger vertebrae than the previous examples, and the third top end plate 110z and the third bottom end plate 110z are applicable to patients with relatively larger vertebrae than the previous two examples. In this way, spinal implant 100,200 and 300 can be configured to have any exemplary occupied space size explained above according to the vertebral anatomy of a specific patient. For example, as a part of initial assessment, a surgeon can assess which available occupied space size is most suitable for the vertebral anatomy of a specific patient. It should be understood that the above exemplary occupied space size is a non-limiting exemplary embodiment, and other occupied area sizes can be used for any one of spinal implant 100,200,300, as long as the selected occupied area size is suitable for the anatomical structure of a specific patient. However, the three exemplary occupied space sizes explained above are generally applicable to most patients.

[0157] Figure 84 is a perspective view of an embodiment of an expandable spinal implant system 1000 according to the principles of the present disclosure. The first surgical tool 400 includes a handle 402, a shaft 404, a tip 406, a locking mechanism 408, and an adjustment knob 452. The tip 406 is configured to be inserted into the guide hole 107 and is operably connected to the spinal implant 100. The first surgical tool 400 is configured to perform a variety of functions for operably manipulating the spinal implant 100. For example, the first surgical tool 400 is configured to be operably engaged with the spinal implant 100 by a fixed connection, so that the spinal implant 100 can be inserted between the vertebral bodies of the patient according to anterior surgical techniques, oblique surgical techniques, and lateral surgical techniques. In addition, the first surgical tool 400 is configured to be operably engaged with the spinal implant 100 to adjust the spinal implant 100 from a contracted position to an expanded position, and vice versa. In addition, the first surgical tool 400 is configured to operably engage the spinal implant 100 to adjust the inclination angle between the end plates 110, 120. In addition, after the spinal implant 100 is inserted into the patient, the spinal implant 100 can be adjusted in situ between the vertebral bodies. Additional attributes of the surgical tool will be referred to below. FIG. 18A to FIG. 19B public.

[0158] Fig.9A is a cutaway perspective view showing the first surgical tool 400 in a first adjusted position, wherein the spinal implant 100 is in a collapsed position, and Fig. 9B 1 is a cutaway perspective view showing a first surgical tool 400 in a first adjustment position after adjusting the spinal implant 100 from a contracted position to a first expanded position. As shown, a tip 406 is inserted through a guide hole 107 and enters a moving mechanism 250. The moving mechanism 250 includes a first fixing screw 252 and a second fixing screw 254 having respective lumens configured to operably receive the tip 406. In some embodiments, the first fixing screw 252 may be referred to as a front screw and the second fixing screw 254 may be referred to as a rear screw. The first fixing screw 252 and the second fixing screw 254 have a helical pitch corresponding to a key-type protrusion of a first push portion 256 and a second push portion 258, respectively. In an exemplary embodiment, the second fixing screw 254 has an opposite pitch and a shorter length than the first fixing screw 252. In some embodiments, the pitch may be an M6 pitch, however other embodiments may have other pitches.

[0159] Each inner cavity of the set screws 252, 254 includes an inner circumferential surface that is keyed to the outer circumferential surface 456 of the tip 406 of the first surgical tool 400. For example, the outer circumferential surface 456 can be similar to the geometry of the tip of a Phillips screwdriver, a hexagonal screwdriver, etc., and the inner circumferential surface of the first set screw 252 and the second set screw 254 can be similar to the geometry of the cavity of the head of a Phillips screw, a hexagonal screw, etc. In some embodiments, the inner circumferential surface of the first set screw 252 and the second set screw 254 can be configured for a Phillips T20 screwdriver, etc., but the size of other embodiments can be different. In other embodiments, the connection between the outer circumferential surface 456 and the inner circumferential surface of the first set screw 252 and the second set screw 254 may include a variety of drive interfaces, including but not limited to: a multi-leaf drive; a six-leaf drive; a cross or Phillips head drive; a straight or "flat head" drive; a square or other polygonal drive; and / or a combination thereof. It should be appreciated that any suitable geometry or surface contour may be used with the exemplary embodiments disclosed herein, so long as the outer circumferential surface 456 is operably keyed to engage with the inner circumferential surfaces of the first set screw 252 and the second set screw 254 .

[0160] In an exemplary embodiment, the outer circumferential surface 456 engages both the first fixing screw 252 and the second fixing screw 254, and when the first surgical tool 400 is rotated in a first direction (clockwise), the outer circumferential surface 456 translates the two fixing screws 252, 254, thereby causing the first push portion 256 and the second push portion 258 to move away from each other in opposite directions. In turn, the first push portion 256 and the second push portion 258 cause the top and bottom end plates 110, 120 to be equally separated from each other in the expansion direction indicated by the arrow. The expansion direction can be a generally vertical direction protruding away from and perpendicular to the generally horizontal direction of the rotation axis of the moving mechanism. Similarly, when the first surgical tool 400 is rotated in a second direction (counterclockwise), the outer circumferential surface 456 translates the two fixing screws 252, 254, thereby causing the first push portion 256 and the second push portion 258 to move toward each other (not shown). Furthermore, the first pusher 256 and the second pusher 258 push the top and bottom end plates 110, 120 to move toward each other by equal amounts in a contraction direction (not shown). The contraction direction may be a generally vertical direction protruding toward and perpendicular to a generally horizontal direction of the rotation axis of the moving mechanism. In summary, when the first surgical tool 400 is positioned at a first position and the first surgical tool 400 is rotated in a first direction or a second direction, the moving mechanism 250 is operable to adjust the spacing between the top and bottom end plates by simultaneously rotating the first fixing screw 252 and the second fixing screw 254 along the rotation axis.

[0161] Fig. 10Ais a cutaway perspective view showing the first surgical tool 400 in a second adjustment position, wherein the spinal implant 100 is in Fig. 9B . As shown in the figure, the first surgical tool 400 is retracted from the moving mechanism 250 so that the outer circumferential surface 456 is only engaged with the first fixing screw 252, that is, the first surgical tool 400 is in the second position. When the first surgical tool 400 is in the second position and rotates in the first direction (clockwise), the outer circumferential surface 456 only translates the first fixing screw 252, thereby only moving the first push portion 256 toward the proximal end 101 of the spinal implant 100 and allowing the second push portion 258 to remain stationary in place. Furthermore, the first push portion 256 pushes the proximal ends 101 of the top and bottom end plates 110, 120, thereby causing the top and bottom end plates 110, 120 to move away from each other in the direction indicated by the arrow at the proximal end 101, thereby increasing the inclination angle between the top and bottom end plates 110, 120. Likewise, when the first surgical tool 400 is in the second position and rotated in the second direction (counterclockwise), the outer circumferential surface 456 translates only the first fixing screw 252, thereby moving the first push portion 256 toward the stationary second pushing portion 258. In practice, the top and bottom end plates 110, 120 move toward each other at the proximal end 101 (not shown), thereby reducing the tilt angle between the top and bottom end plates 110, 120. In summary, when the first surgical tool 400 is positioned in the second position and the first surgical tool 400 is rotated in the first direction or the second direction, the moving mechanism 250 is operable to adjust the tilt angle between the top and bottom end plates 110, 120 while rotating the first fixing screw along the rotation axis.

[0162] Fig.11A and Fig. 11B 25 and 26. The mobile mechanism 250 is a perspective view of the mobile mechanism 250 in the retracted position and the expanded position, respectively. The mobile mechanism 250 is applicable to any exemplary embodiment disclosed herein. As shown, the mobile mechanism 250 includes a screw guide housing 105a and a central support block 257 connected to the screw guide end plate 105 (not shown). The screw guide housing 105a can operably retain the first screw 252 and the second screw 254 therein, thereby defining the rotation axis of the mobile mechanism 250 protruding in its longitudinal direction. The first push portion 256 and the second push portion 258 are operably connected to the first fixing screw 252 and the second fixing screw 254, and are also configured to move along the outer surface of the screw guide housing 105a when the first fixing screw 252 and the second fixing screw 254 rotate.

[0163] The first push portion 256 includes a first oblique side 256a and a second oblique side 256b opposite to the first oblique side 256a, and the first oblique side 256a and the second oblique side 256b are arranged on opposite sides of the rotation axis of the moving mechanism 250. The second push portion 258 includes a third oblique side 258a and a fourth oblique side 258b (not shown) opposite to the third oblique side 258a, and the third oblique side 258a and the fourth oblique side 258b are arranged on opposite sides of the rotation axis of the moving mechanism 250. In addition, the first push portion 256 has a first side surface and a second side surface opposite to the first side surface, and the first side surface and the second side surface are located on opposite sides of the rotation axis of the moving mechanism 250. Similarly, the second push portion 256 has a third side surface and a fourth side surface opposite to the third side surface, and the third side surface and the fourth side surface are located on opposite sides of the rotation axis of the moving mechanism 250. Furthermore, the support block 257 has a seventh side surface and an eighth side surface opposite to the seventh side surface, and the seventh side surface and the eighth side surface are located on opposite sides of the rotation axis of the moving mechanism 250 .

[0164] The first push part 256 includes a plurality of first protrusions 256c, the second push part 258 includes a plurality of second protrusions 258c, and the support block 257 includes a plurality of third protrusions 257c. In an exemplary embodiment, the first push part 256 has two protrusions 256c protruding vertically from the first side surface and two protrusions 256c protruding vertically from the second side surface. Similarly, the second push part 258 has two protrusions 258c protruding vertically from the third side surface and two protrusions 258c protruding vertically from the fourth side. In addition, the support block 257 has two protrusions 257c protruding vertically from the seventh side surface and two protrusions 258c protruding vertically from the eighth side surface. For example, the plurality of first protrusions 256c and the plurality of second protrusions 258c can be conical protrusions having a dome-shaped shape or a hemispherical shape. In a non-limiting exemplary embodiment, each of the plurality of first protrusions 256c and the plurality of second protrusions 258c comprises a hemispherical protrusion having a flat surface that coincides with a corresponding surface of one of the first to fourth hypotenuses 256a, 256b, 258a, 258b. However, other embodiments may have other shapes and / or surface profiles that may be consistent with the disclosure herein.

[0165] The first push portion 256 includes a plurality of first wedges 256d and the second push portion 258 includes a plurality of second wedges 258d. For example, the first push portion 256 includes a first wedge 256d protruding away from the first side surface in the lateral direction of the moving mechanism 250 and a second wedge 256d protruding away from the second side surface in the lateral direction of the moving mechanism. Similarly, the second push portion 258 includes a third wedge 258d protruding away from the third side surface in the lateral direction of the moving mechanism 250 and a fourth wedge 258d protruding away from the fourth side surface in the lateral direction of the moving mechanism. In an exemplary embodiment, each of the plurality of first wedges 256d includes a corresponding upper contact surface 256e and a corresponding lower contact surface 256f, and each corresponding upper contact surface 256e meets the corresponding lower contact surface 256f at a vertex (not marked). Likewise, each of the plurality of second wedges 258d includes a corresponding upper contact surface 258e and a corresponding lower contact surface 258f, and each corresponding upper contact surface 258e meets the corresponding lower contact surface 258f at a vertex (not labeled). In an exemplary embodiment, each upper contact surface 256e, 258e and each lower contact surface 256f, 258f has a curved surface profile. For example, each upper contact surface 256e, 258e is concave relative to the corresponding vertex, and each lower contact surface 256f, 258f is convex relative to the corresponding vertex.

[0166] Fig. 12A and Fig. 12B are in the contracted and expanded positions respectively. Fig.11A and Fig. 11B A perspective view of a movement mechanism 250 is shown having an exemplary bottom end plate 120 . Fig.13A and Fig. 13B are in the contracted and expanded positions respectively. Fig. 12A and Fig. 12B 250, which has a top end plate 110 and a bottom end plate 120. It should be understood that FIG. 12A to FIG. 13B The moving mechanism 250 is schematically shown, with some internal components being illustrated or simplified and other components being omitted for ease of explanation. FIG. 12A to FIG. 13B It is shown schematically only to help explain the operational nature of movement mechanism 250 . Fig. 12A and Fig. 12BThe bottom end plate 120 is shown, which has a pair of second proximal bevels 124 and a pair of second distal bevels 126 disposed opposite to the pair of second proximal bevels 124. Each bevel of the second proximal bevels 124 may include a first inclined contact surface 124a extending away from the support block 257 and inclined relative to the inner surface 122 of the end plate 120. Similarly, each bevel of the second distal bevels 126 may include a second inclined contact surface 126a extending away from the support block 257 and inclined relative to the inner surface 122 of the end plate 120. In an exemplary embodiment, the first inclined contact surface extends a first length (first distance) and the second inclined contact surface extends a second length (second distance) and the first length is greater than the second length.

[0167] Fig.13A and Fig. 13B The top end plate 110 is shown having a pair of first proximal chamfers 114 and a pair of first distal chamfers 116 disposed opposite the first proximal chamfers 114. Each of the first proximal chamfers 114 may include a third inclined contact surface 114a extending away from the support block 257 and inclined relative to the inner surface 112 of the end plate 110. Similarly, each of the first distal chamfers 116 may include a fourth inclined contact surface 116a extending away from the support block 257 and inclined relative to the inner surface 112 of the end plate 110. In an exemplary embodiment, the third inclined contact surface extends a third length (third distance) and the fourth inclined contact surface extends a fourth length (fourth distance) and the third length is greater than the fourth length.

[0168] Each of the inclined surfaces 114, 116, 124, 126 may have an inner surface disposed adjacent to and facing the rotation axis of the moving mechanism 250 and an outer surface opposite to the inner surface and facing away from the rotation axis of the moving mechanism 250. In addition, each of the inclined surfaces 114, 116, 124, 126 may include a corresponding guide wall 130, which is disposed at Fig. 12A and Fig.17 Each guide wall 130 may extend along the inner surface of the corresponding inclined surface in a direction parallel to the corresponding contact surface. FIG. 12A to FIG. 13B , the guide wall 130 extends along the inner surface of the proximal slope 124 in a direction substantially parallel to the first inclined contact surface 124a. FIG. 12A to FIG. 12B As can be best understood, each bottom-most protrusion 256c of the first push portion 256 is disposed inside the corresponding guide wall 130 of the second proximal ramp 124. Similarly, each bottom-most protrusion 258c of the second push portion 258 is disposed inside the corresponding guide wall 130 of the second distal ramp 126. Similarly, although not directly visible, FIG. 13A to FIG. 13BIn the embodiment, each topmost protrusion 256 c of the first push portion 256 is disposed inside the corresponding guide wall 130 of the first proximal slope 114 . Similarly, each topmost protrusion 258 c of the second push portion 258 is disposed inside the corresponding guide wall 130 of the first distal slope 116 .

[0169] refer to Fig.13A and Fig. 13B , when the first surgical tool 400 is in the first position and the first screw 252 and the second screw 254 are translated in the first direction, the first pusher 256 and the second pusher 258 are moved away from each other in opposite directions and as the spinal implant 100 expands, the top end plate 110 and the bottom end plate 120 move away from each other. For example, in some embodiments, the beveled edges 256a, 256b of the first pusher 256 act on the end plates 110, 120 at their proximal ends 101 and the plurality of first wedges 256d contact and slide along the corresponding bevels of the first and second first proximal bevels 114, 124. However, in other embodiments, 256e and 256f may act on the inclined contact surface 124a instead of providing beveled edges 256a, 256b. In some embodiments, the beveled edges 258a, 258b of the second push portion 258 act on the end plates 110, 120 at its distal end 102 and the plurality of second wedges 258d contact and slide along the corresponding bevels of the first and second first distal bevels 116, 126. However, in other embodiments, 258e and 258f may push against the inclined contact surface 126a instead of providing beveled edges 256a, 256b. In addition, each protrusion 256c of the first push portion 256 slides along the corresponding guide walls 130 of the first and second first proximal bevels 114, 124, and each protrusion 258c of the second push portion 258 slides along the corresponding guide walls 130 of the first and second distal bevels 116, 126. In addition, during expansion of the spinal implant 100, each protrusion 257c of the support block 257 may slide against the corresponding vertical guide walls 130a (see Fig.17 ) vertically slides in the . In this way, the spinal implant 100 moves from the collapsed position to the expanded position. It should be understood that the movement of the spinal implant from the expanded position to the collapsed position occurs in substantially the same manner.

[0170] When the first surgical tool 400 is in the second position and only the first screw 252 is translated in the first direction, the first pusher 256 moves away from the support block 257 and the stationary second pusher 258, and the inclination angle between the top end plate 110 and the bottom end plate 120 increases. For example, the bevel 256c of the first pusher 256 can push the end plates 110, 120 at its proximal end 101 and / or as described above, the plurality of first wedges 256d can contact and slide along the corresponding bevels of the first and second first proximal bevels 114, 124. In addition, as described above, each protrusion 256c of the first pusher 256 slides along the corresponding guide wall 130 of the first and second first proximal bevels 114, 124. The second push portion 258 remains stationary, the beveled edges 258a, 258b remain in contact with the end plates 110, 120 at its distal end 102, and the plurality of second wedges 258d remain in contact with the corresponding bevels of the first and second distal bevels 116, 126. As the first push portion 256 acts on the end plates 110, 120 by moving away from the support block 127 and the second push portion 258 remains stationary, the plurality of second wedges 258d pivot along the corresponding bevels of the first and second distal bevels 116, 126 and each protrusion 258c of the second push portion 258 pivots and / or slides incrementally along the corresponding guide walls 130 of the first and second first distal bevels 116, 126. In addition, during expansion of the spinal implant 100, each protrusion 257c of the support block 257 can be moved along the corresponding vertical guide walls 130a of the top end plate 110 and the bottom end plate 120 as needed (see Fig.17 ) slides vertically up and down in the proximal end 101. In this way, the distance between the end plates 110, 120 at the proximal end 101 increases and the distance between the end plates 110, 120 at the distal end 102 decreases slightly, thereby adjusting the tilt angle between the top end plate 110 and the bottom end plate 120. Those skilled in the art will understand that in the disclosed exemplary embodiment, the first fixing screw 252 is longer than the second fixing screw 254, thereby providing a larger space for the travel of the first pusher 256, so that the first pusher 256 can achieve a larger travel distance at the proximal end 101 between the end plates 110, 120 than the second pusher 258 at the distal end 102.

[0171] Fig.14A and Fig. 14B 2 is a cross-sectional view of the moving mechanism 250 relative to the top end plate 110. As shown in the figure, the moving mechanism 250 includes a rotation axis R1 protruding along its longitudinal direction and extending in the transverse direction (from the proximal side 101 to the distal side 102) of the end plate 110. The rotation axis R1 passes through the center of the fixing screws 252 and 254. The moving mechanism 250 includes a transverse axis T1, which intersects the center of the rotation axis and protrudes perpendicularly to the rotation axis R1 through the support block 257.

[0172] Fig.15 A cross section of the moving mechanism 250 taken along the rotation axis R1 is shown. As shown, the first fixing screw 252 is operably coupled to the first push portion 256 by a plurality of keyed protrusions 256k (threaded pattern) corresponding to the pitch pattern of the first fixing screw 252. The second fixing screw 254 is operably coupled to the second push portion 258 by a plurality of keyed protrusions 258k (threaded pattern). The first fixing screw 252 includes a first inner circumferential surface 252a and the second fixing screw 254 includes a second inner circumferential surface. The support block 257 includes an internal retaining cavity 257b, in which the first retaining portion 252r of the first fixing screw 252 and the second retaining portion 254r of the second fixing screw 254 are retained. The internal holding cavity 257 b may be an internal cavity spanning the inner circumference of the support block 257 and configured to allow the first and second fixing screws 252 and 254 to rotate freely along the rotation axis R1 while preventing the first and second fixing screws 252 and 254 from traveling in the longitudinal direction of the moving mechanism 250 .

[0173] Fig.16 is a perspective view of the top end plate 110 and the bottom end plate 120 of the spinal implant 100, Fig.17 yes Fig.16 10 and the bottom end plate 120. In an exemplary embodiment, when the spinal implant 100 is in the closed position, the inner surface 112 of the top end plate 110 and the inner surface 124 of the bottom end plate 120 are nested or partially nested relative to each other. For example, Fig.16 The first proximal bevel 114 of the top end plate 110 is shown inserted from the second proximal bevel 124 of the bottom end plate 120. In addition, the top end plate 110 includes a plurality of first grooves 110n that allow corresponding components of the bottom end plate 120a to be nested therein when the spinal implant 100 is in the collapsed position. For example, Fig.16 The second proximal bevel 124 is shown nested within the recess 110n. In some embodiments, for ease of explanation, the groove 110n may be referred to as a nested groove.

[0174] The top end plate 110 and / or the bottom end plate 120 may optionally include at least one anchor hole 129. In an exemplary embodiment, the top end plate 110 includes a pair of top anchor holes 129a, 129b that pass through the top end plate 110 at an oblique angle relative to the outer surface 111 of the top end plate 110. Similarly, the bottom end plate 120 includes a pair of bottom anchor holes 129c, 129d that pass through the bottom end plate 120 at an oblique angle relative to the outer surface 121 of the end plate 120. Each anchor hole 129 of the plurality of anchor holes 129a-129d is disposed adjacent to the outer surface of the corresponding inclined surface 114, 116, however, the exemplary embodiment is not limited thereto. Fig.17 The specific location shown in .

[0175] FIG. 18A to FIG. 18B is a perspective view of a first surgical tool 400 of an adjustable spinal implant system in accordance with the principles of the present disclosure. FIG. 19A to FIG. 19B 4 is a side view of a first surgical tool 400 and a corresponding adjustment rod 450 configured for insertion into the interior of the first surgical tool 400. The tip 406 is configured to connect to the spinal implant 100 so that the spinal implant 100 is securely attached to the first surgical tool 400 by engaging the locking mechanism 408. Similarly, the tip 406 is configured to disconnect from the spinal implant 100 so that the spinal implant 100 is no longer securely attached to the first surgical tool 400 by disengaging the locking mechanism 408. For example, Fig.19A The tip 406 is shown in a first locked position, wherein the tip gripping portion 406a is expanded to grip onto the spinal implant 100, Fig.19B The tip 406 is shown in a second locked position with the tip grip 406a retracted. The locking mechanism 408 is configured to switch between a first locked position and a second locked position. In some embodiments, when the locking mechanism 408 is engaged in the first locked position, the spinal implant 100 is fixedly coupled to the first surgical tool 400 so that it does not rotate. This may be advantageous for the initial positioning of the spinal implant 100 between vertebral bodies during surgery. In addition, the first surgical tool 400 includes a positioning mechanism 410, which is configured to position the adjustment rod 450 in the first position and the second position (see Fig.19A The first surgical tool 400 may further include a button 420 to switch the positioning adjustment rod 450 between a first position engaging both the first set screw 252 and the second set screw 254 and a second position to engage only the first set screw 252 (see Fig.18B). In addition, in some embodiments, the first surgical tool 400 may include a window 421 to identify whether both the first fixation screw 252 and the second fixation screw 254 are engaged for parallel expansion / contraction of the spinal implant 100 or whether only the first fixation screw 252 is engaged to adjust the inclination angle of the spinal implant 100.

[0176] In an exemplary embodiment, the first surgical tool 400 includes a central shaft hole 409 extending through the handle 402, the shaft 404, and the tip 406. The central shaft hole 409 is configured to receive an adjustment rod 450 therein so that an adjustment knob 452 can rotate therein and at least partially protrude from both ends. The adjustment rod 450 includes an adjustment knob 452, a first positioning surface 453 and a second positioning surface 454, and a keyed circumferential surface 456. When the adjustment rod 450 is positioned in the central shaft hole 409, the adjustment knob 452 protrudes from one end and the keyed circumferential surface 456 protrudes from the other end (see FIG. 14). As the adjustment rod 450 is inserted into the central shaft hole 409, the positioning mechanism 410 can extend and retract the adjustment rod 450 in the longitudinal direction of the shaft 409. As described above with respect to Fig.13A and Fig. 13B As explained, when the first surgical tool 400 is in the first position, the keyed circumferential surface 456 can rotate the first set screw 252 and the second set screw 254 along the rotation axis, and when the first surgical tool 400 is in the second position, the keyed circumferential surface 456 can rotate only the first set screw 252 along the rotation axis. In some embodiments, the positioning mechanism 410 is configured to switch between a first position and a second position, wherein it can act on the positioning surfaces 453, 454 to extend and retract the adjustment rod 450 in the longitudinal direction of the shaft 409. For example, in the first position, the positioning mechanism 410 can extend the adjustment rod 450 from the tip 406 to an extended position, in which the circumferential surface 456 can engage with the inner circumferential surfaces of the first set screw 252 and the second set screw 254. In the second position, the positioning mechanism 410 can retract the adjustment rod 450 through the tip 406 to a partially retracted position, in which the circumferential surface 456 can engage with only the inner circumferential surface of the first set screw 252. The internal gear arrangement of the positioning mechanism 410 may include internal locking pins and surfaces that act on the positioning surfaces 453, 454, so that when the exposed knob of the positioning mechanism 410 is rotated to a specific position, the internal locking pins and surfaces act on the inclined and recessed surfaces of the positioning surfaces 453, 454.

[0177] Additionally, in some embodiments, the first surgical tool 400 can be configured to receive adjustment rods 450 of different lengths having different outer circumferential surfaces 456 and positioning surfaces 453, 454. For example, the first surgical tool 400 can be configured to receive a first relatively short adjustment rod 450 that is optimized for use with a 6A to 7C The first surgical tool 400 may be configured to receive a second relatively long adjustment rod 450 that is optimized for use with the relatively short end plates 110x, 120x. 6A to 7C The spinal implant 100 includes a correspondingly relatively larger endplates 110z, 120z and receives a correspondingly larger translation mechanism 250 having a relatively longer longitudinal axis that is optimized for such relatively longer endplates 110z, 120z.

[0178] Additionally, in some embodiments, the first surgical tool 400 can be configured to receive multiple types of adjustment rods 450. In at least one embodiment, the first surgical tool 400 can receive a first adjustment rod 450 having an outer circumferential surface 456 that is configured to (1) engage both the first set screw 252 and the second set screw 254 simultaneously and (2) engage the first set screw 252. For example, the first adjustment rod 450 can be switched between (1) a first position in which the outer circumferential surface 456 is fully extended and configured to engage both the first set screw 252 and the second set screw 254 and (2) a second position in which the outer circumferential surface 456 is partially extended (and / or partially retracted) to engage only the first set screw 252. In an alternative embodiment, the first surgical tool 400 can receive a second adjustment rod 450 having an outer circumferential surface 456 that is configured to engage only one set screw 252, 254 at a time. For example, the outer circumferential surface 456 may have an engagement surface with a longitudinal length corresponding to a single set screw 252, 254, so that it engages only a single set screw 252, 254 at a time. For example, the second adjustment rod 450 may be switched between (1) a first position in which the outer circumferential surface 456 is fully extended and configured to engage the second set screw 254 independently of the first set screw 252 and (2) a second position in which the outer circumferential surface 456 is partially extended (and / or partially retracted) to engage only the first set screw 252. At least one advantage of having the first surgical tool 400 configured to receive multiple types of adjustment rods 450 of different lengths and having outer circumferential surfaces of different lengths is that the surgeon can quickly and easily select the appropriate adjustment rod 450. For example, the surgeon can select the first adjustment rod 450 to expand / contract the spacing between the end plates 110, 120 by the same or substantially the same amount while maintaining the tilt angle between the end plates 110, 120, i.e., by engaging both the first set screw 252 and the second set screw 254. In addition, the surgeon can select the second adjustment rod 450 to selectively increase / decrease the tilt angle between the end plates of the spinal implant 100 at the proximal side 101 and the distal side 102 independently, i.e., by engaging only one of the first fixation screw 252 and the second fixation screw 254 at a time. For another example, the second adjustment rod 450 can be configured to adjust the spinal implant 100 so that achieving anterior expansion is independent of achieving posterior expansion, which enables the spinal implant 100 to be placed in kyphosis, which is consistent with the embodiment explained above.

[0179] In addition, in some embodiments, the first surgical tool 400 is configured to operate in three modes. In the first mode, the tip grip 406a is firmly connected to the spinal implant 100. In the second mode, the adjustment rod 450 can be positioned in the first position so that the spacing between the end plates 110, 120 is selectively increased / decreased in small increments when the adjustment knob 452 is selectively rotated. For example, by rotating each of the first fixing screw 252 and the second fixing screw 254. In the third mode, the adjustment rod 450 can be positioned in the second position so that the inclination angle between the end plates 110, 120 can be selectively increased / decreased in small increments when the adjustment knob 452 is selectively rotated. For example, by rotating only the first fixing screw 252, the inclination angle between the end plates 110, 120 can be increased / decreased by moving one side of the end plates 110, 120 toward / away from each other and moving the opposite side of the end plates 110, 120 in the opposite direction. In some embodiments, this can also be achieved by rotating only the second fixing screw 254. For example, the first surgical tool 400 may have a relatively short circumferential engagement surface 456 that engages only one of the inner circumferential surfaces of the first set screw 252 or the second set screw 254 at a time.

[0180] Fig. 20 A perspective view of an embodiment of an expandable spinal implant 100 including a plurality of anchor screws 510 is shown. In some embodiments, the anchor screws 510 may be referred to as bone screws. In the exemplary spinal implant 100, the top end plate 110 includes a first anchor screw 510a and a second anchor screw 510b opposite to the first anchor screw 510a, each of which extends through a corresponding hole. For example, the first anchor screw 510a and the second anchor screw 510b pass through corresponding holes of the top end plate 110, which are configured to orient them at an oblique angle relative to the outer surface 111 of the top end plate 110. Similarly, the bottom end plate 120 includes a third anchor screw 510c and a fourth anchor screw 510d, each of which extends through a corresponding hole. The anchor screws 510c, 510d protrude from the proximal end 101 of the spinal implant 100 at an oblique angle toward the distal end 102. For example, the third anchor screw 510c and the fourth anchor screw 510d pass through corresponding holes of the bottom end plate 120, which are configured to orient them at an oblique angle relative to the outer surface 121 of the bottom end plate 120. However, it should be understood that in other embodiments, consistent with the disclosure herein, at least one hole can orient the corresponding anchor screw 510a, 510b, 510c, 510d at any angle relative to the corresponding end plate 110, 120. The anchor screws 510a-510d are configured to anchor into the corresponding adjacent vertebral bodies.

[0181] FIG. 21A to FIG. 21BShown respectively the lateral side view and the front side view of an embodiment of expandable spinal implant system, wherein anchoring screw 510a-510d is anchored in adjacent vertebral body.As shown in the figure, anchoring screw 510a, 510b is outstanding from the top end plate 110 of spinal implant 100 with the angle of inclination towards distal end 102 from near end 101, thereby is anchored in top vertebral body V1.Similarly, anchoring screw 510a, 510b is outstanding from the bottom end plate 120 of spinal implant 100 with the angle of inclination towards distal end 102 from near end 101, thereby is anchored in bottom vertebral body V2.As used herein, a pair of vertebral bodies, adjacent vertebral bodies and / or the first vertebral body and the second vertebral body can refer to for example top vertebral body V1 and bottom vertebral body V2.

[0182] Fig.22A is a side view of a second surgical tool 500 suitable for use with the embodiments and systems disclosed herein, such as for driving anchor screws 510a - 510d . Fig. 22B yes Fig.22A5. The exemplary second surgical tool 500 includes a ratchet drive shaft 555, a positioning handle 520, a tip portion 530, a drive shaft housing 540, and a trigger 550. The ratchet drive shaft 555 can be configured to connect and disconnect with a ratchet handle (not shown) and rotate within the ratchet drive shaft housing 540. For example, the drivable connection may include a variety of drive interfaces, including but not limited to: a multi-leaf drive; a six-leaf drive; a cross or Phillips head drive; a straight or "flat head" drive; a square or other polygonal drive; and / or a combination thereof. The positioning handle 520 can be configured to help maintain and control the second surgical tool 500, for example, in view of the torque transmitted through the ratchet drive shaft 555. The tip portion 530 is angled at β degrees relative to the longitudinal direction of the drive shaft housing 540. In some embodiments, the tip portion 530 is angled so that the degree β corresponds to the inclination of the anchor screws 510a-510d and the inclination of the anchor hole 129. For example, the anchoring hole 129 can be inclined about 30°-50°, and more specifically about 40°, relative to the outer surfaces 111, 121 of the end plates 110, 120. This arrangement may be advantageous for driving the anchoring screws 510a-510d when the spinal implant 100 is positioned between adjacent vertebral bodies. The tip portion 530 can fix the anchoring screw 510 in the inner cavity therein so that the anchoring screw 510 does not break during the initial positioning of the anchoring screw 510. For example, the tip portion 530 can have a flexible elastic member configured to firmly hold the head of the anchoring screw 510. However, when the anchoring screw is sufficiently anchored into an anatomical feature such as a vertebra, the tip portion 530 can release the anchoring screw 510. This feature is particularly advantageous for retaining the anchor screw 510 in the tip portion 530 during surgery so that when the anchor screw 510 is initially positioned in an anchor hole (e.g., anchor hole 129), the anchor screw 510 does not disengage from the tip portion 530. Additionally, in some embodiments, the tip portion 530 is operably coupled to the trigger 550 so that when the anchor screw 510 is installed, the trigger 550 can disconnect the anchor screw 510. In some embodiments, the trigger 550 may not be necessary because the tip portion 530 can self-release the anchor screw 510 after installation.

[0183] FIG. 23A to FIG. 23C are various perspective views of an exemplary anchor screw suitable for use with embodiments disclosed herein in conjunction with a second surgical tool 500 . Fig.23A Trocar tip anchor screw 510e is shown. Fig. 23B A grooved or grooved tip anchor screw 510f is shown, Fig.23CSpeed ​​anchor screw 510g is shown. Each anchor screw 510e-510g may have a pitch and size corresponding to the size of the anchoring orifice 129. Trocar tip anchor screw 510e includes an angled tip portion 510e-1 and a thread pattern including threads 510e-2. Threads 510e-2 may be spaced rearwardly from the angled tip portion 510e-1, which may facilitate aligning the anchor screw 510e with the anchoring hole 129. For example, in some embodiments, threads 510e-2 are spaced rearwardly from the angled tip portion 510e-1 by about 3 mm. Grooved tip anchor screw 510f includes a cutting tip 510f-1 and a thread pattern including threads 510f-2. The cutting tip 510f-1 can extend a relatively long distance from the starting point of the thread 510f-2 so that the cutting tip 510f-1 can be pre-drilled into the adjacent vertebral body before the thread 510f-2 engages with the anchor hole 129. For example, in some embodiments, the thread 510f-2 is spaced about 8 mm from the cutting tip 510f-1. The speed anchor screw 510g includes a tapered tip 510g-1 and a thread pattern including the thread 510g-2. Unlike the trocar tip anchor screw 510e and the grooved tip anchor screw 510f, the thread 510g-2 of the speed anchor screw 510g can start adjacent to the tapered tip 510g-1.

[0184] FIG. 24A to FIG. 24D are various side and top views of exemplary bone graft regions according to the principles of the present disclosure. Fig.24A In the side view of the , a first region R1 and a second region R2 are shown, in which bone growth material can be implanted and / or bone growth promoting material can be used. Fig. 24B In the top view of the embodiment, the third region R3 and the fourth region R4 are shown, where bone growth material can be implanted and / or bone growth promoting material can be used. In some embodiments, the third region R3 and the fourth region R4 overlap vertically with the first region R1 and the second region R2. Fig.24C and Fig.24D , an exemplary graft portion GS is shown. The graft portion GS can be grafted to the end plates 110, 120. In some embodiments, the graft portion GS can be filled with a bone growth material having a bone growth material ranging from about 140 mm 2 to about 180 mm and more specifically about 160 mm 2 For example, the bone growth material can extend three-dimensionally through the graft portion GS and have a surface area ranging from about 140 mm 2 To about 180mm 2 And more specifically about 160mm 2of the corresponding surface area. Consistent with the embodiments disclosed herein, the open arrangement of the spinal implant 100 and the end plates 110, 120 is particularly conducive to direct segmental fusion techniques. For example, the upper and lower vertebral end plates allow the creation of fusion bone bridges to solidify the segments. In addition, the expandable and contractible properties of the spinal implant 100 contribute to bone filling techniques after positioning and adjusting the spinal implant 100 between the vertebral bodies. For example, after the spinal implant 100 is positioned between adjacent vertebral bodies, the spinal implant 100 can be filled with bone material in situ. In some embodiments, the end plate 110 can be considered as a direct upper vertebral end plate, and the end plate 120 can be considered as a lower vertebral end plate, wherein these end plates are configured to allow a fusion bone bridge to pass therethrough to solidify the segments.

[0185] In some embodiments, spinal implant system comprises medicament, includes but not limited to bone growth promoting material as herein described, and this medicament can be placed, filled, coated or layered in parts and / or surface of spinal implant system, on or around.In some embodiments, bone growth promotes material and can be pre-loaded in the inside of spinal implant 100, and / or can be filled by pipe, sleeve tube, syringe or these or other combination of entering apparatus during implant implantation or afterwards.In addition, bone growth promotes material and can be further tamped in spinal implant 100 before, during or afterwards implantation.In some embodiments, bone growth promotes material and / or the material of direct transplantation can strengthen the fixing of spinal implant 100 and adjacent bone structure.In some embodiments, medicament can comprise one or more therapeutic agents and / or pharmacological agents for release (comprising sustained release), to treat for example pain, inflammation and degeneration.

[0186] Fig.25A and Fig.25B The spin implant 100 is shown in a first bent position and a second bent position, respectively. Fig.25A The spinal implant 100 is shown with the top endplate 110 curved relative to the bottom endplate 120 in a first lateral direction. Fig.25B Spinal implant 100 is shown, wherein top end plate 110 is bent in the second transverse direction opposite to the first transverse direction relative to bottom end plate 120. As explained in more detail above, various disclosed protrusions, guide walls, cavities, recesses, etc. are configured so that spinal implant 100 can allow transverse bending to a certain predetermined degree. For example, protrusions 256c, 257c, 258c can be laterally pivoted in guide walls 130 to adapt to a certain degree of transverse bending. In this way, top end plate 110 and bottom end plate 120 can be configured to bend transversely relative to each other in a first direction and a second direction. However, in other embodiments, it may be desired that spinal implant 100 is rigid in the transverse direction and does not allow transverse bending.

[0187] Figure 26 to Figure 28 The left side view, right side view and anterior side view of the installed expandable spinal implant 100 positioned between adjacent vertebral bodies according to various surgical techniques, such as anterior technique, oblique technique, lateral technique, are respectively shown. Figure 26 to Figure 28 The spinal implant 100 is shown after installation in accordance with an anterior lumbar interbody fusion (ALIF) technique.

[0188] Spinal implant system of the present disclosure can be used with surgical arthrodesis surgery, for example, used for treating the affected section of spinal column and the adjacent area in body (for example, the intervertebral disc space between adjacent vertebrae) and the interbody fusion of applicable condition or damage together, and used together with other surgical procedure and method.In some embodiments, spinal implant system can comprise intervertebral implant, and described intervertebral implant can be inserted between adjacent vertebrae, to space the articular joint surface (articular joint surface), to provide support and maximize the stability of vertebrae for vertebrae.In some embodiments, spinal implant system can be used together with one or more vertebrae.

[0189] In accordance with the embodiments disclosed herein, medical practitioners can enter the surgical site including vertebrae, for example, by cutting and retracting tissue. The spinal implant system of the present invention can be used for any existing surgical method or technology (comprising incision surgery, small incision surgery, minimally invasive surgery and percutaneous surgery implantation), thereby entering the vertebrae through a small incision, a retractor, a tube or a cannula, wherein the micro-incision, the retractor, the tube or the cannula provide a protected passage for this region, comprising for example a kind of expandable retractor, wherein the cannula is formed by a plurality of parts, these parts can be separated and moved or moved together, and can be inserted in the case of these parts being closed or together, and then expanded to allow insertion of an implant of a larger size than the closed cross section of the unexpanded retractor part. In one embodiment, the components of the spinal implant system are delivered to the surgical site along the surgical approach by the surgical path to enter the intervertebral disc space between the vertebrae. Various surgical approaches and paths can be used.

[0190] As will be appreciated by those skilled in the art, a preparation instrument (not shown) can be used to remove intervertebral disc tissue, fluid, adjacent tissue and / or bone, and scrape and / or remove tissue from the end plate surface of the first vertebra and / or the end plate surface of the second vertebra, thereby preparing for or as a part of the surgery utilizing the system of the present disclosure. In some embodiments, the occupied space of the spinal implant 100 is selected after testing using a trial instrument (not shown) that can be similar to the size and structure of the spinal implant 100. In some embodiments, the size of this trial can be fixed and / or equipped with a mobile mechanism 250 similar to the embodiment described herein. In some embodiments, the spinal implant 100 can be visualized by fluoroscopy and is oriented before being introduced into the intervertebral disc space. In addition, the first surgical tool 400 and the second surgical tool 500 and the spinal implant 100 can be equipped with a reference mark to enable the use of image-guided surgical navigation before and / or during surgery.

[0191] The parts of spinal implant system of the present disclosure can be delivered or implanted as pre-assembled device, or can be assembled in situ.In one embodiment, spinal implant 100 is made of single piece structure, can not disassemble this structure when not destroying device.In other embodiments, spinal implant 100 can comprise removable part.Comprise that the parts of spinal implant system of implant 10,20,30 can in situ expansion, contraction, modify, remove or replace wholly or in part.In some embodiments, spinal implant 100 can be delivered to surgical site by mechanical manipulation and / or freehand technique (free hand technique).

[0192] In addition, the parts of spinal implant 100 may include radiopaque materials, such as polymers. Radiopaque markers may be included for identification under x-rays, fluoroscopy, CT or other imaging techniques. In addition, the first surgical tool 400 and the second surgical tool 500 may be radiopaque and may optionally include a mark added to its tip portion to allow them to be seen on fluoroscopy / X-rays when advancing into the patient. At least one advantage of having spinal implant 100 is that a medical practitioner can verify the positioning of spinal implant 100 relative to adjacent vertebral bodies, and further adjust the spacing between end plates 110, 120, the inclination angle between end plates 110, 120 and the overall positioning of the device in the patient. In this way, spinal implant 100 can correct the alignment of the patient's spine in the sagittal plane.

[0193] Fig.29A2 is a perspective view of a second embodiment of an expandable spinal implant 200 according to the principles of the present disclosure. Aspects of the second spinal implant 100 can be the same, substantially the same, or similar to spinal implant 100. In addition, the second spinal implant 200 can be used in the previously disclosed systems and methods. Therefore, repeated description thereof will be omitted.

[0194] Fig.29B is an exploded view illustrating the second spinal implant 200. The second spinal implant 200 includes a top end plate 110 (first end plate) and a bottom end plate 120 (second end plate) and a moving mechanism 2500, which will be described in more detail below. The proximal end 101 includes a screw guide end plate 1050 arranged between the end plates 110 and 120. In some embodiments, the screw guide end plate 1050 can be pivoted left and right and up and down to accommodate the insertion of the first surgical tool 400 from an angled position. For example, the screw guide end plate 1050 can accommodate surgical tools inserted at an angle (axial misalignment) of about 1° to 20° in the horizontal and vertical directions, more specifically about 1° to 15°. At least one advantage of this arrangement is that the first surgical tool 400 can be inserted at an angle relative to the guide hole 107 of the spinal implant 200.

[0195] In an exemplary embodiment, the moving mechanism 2500 is operably coupled to the top end plate 110 and the bottom end plate 120, similar to what was explained above. The moving mechanism 2500 differs from the moving mechanism 250 in that the moving mechanism 2500 can be misaligned, for example, by about 5°, 10°, 15°, or 20° compared to the moving mechanism 250 of the first embodiment. In at least one embodiment, the moving mechanism 2500 is misaligned by about 15° to facilitate insertion and rearward adjustment by reconnecting to the rear. In an exemplary embodiment, the moving mechanism 2500 operates by the same principle as the moving mechanism 250, although the internal profiles of the top end plate 110 and the bottom end plate 120 are moved to allow the moving mechanism 2500 to be misaligned.

[0196] Fig. 30A 2 is a top view of the spinal implant 200 in contrast to an embodiment in which the moving mechanism 2500 is misaligned. As shown, the spinal implant 200 has a first reference axis B1 and a second reference axis B2. The first reference axis B1 can be understood as a projection of the moving mechanism 2500 when it is not misaligned and the moving mechanism 2500 is in a centered position. The second reference axis B2 can be understood as a projection of the moving mechanism 2500 through the central portion of the guide hole 107 when the moving mechanism 2500 is misaligned to an eccentric position inside the end plates 110, 120.

[0197] General reference FIG. 30B to FIG. 30F, discloses a modified embodiment of spinal implant 200, wherein mobile mechanism 2500 is misaligned. In the disclosed embodiment, mobile mechanism 2500 has the same components as mobile mechanism 250 and operates under the same principle as previously explained. In the disclosed embodiment, mobile mechanism 2500 is misaligned by about 15° compared to mobile mechanism 250 of spinal implant 100. In other embodiments, mobile mechanism 2500 can be misaligned in any suitable range, for example from about 5° to 25°. Fig. 30C yes Fig. 30B 1, with the top end plate 110 removed for ease of understanding. As shown, the movement mechanism 2500 is misaligned and the top and bottom end plates 110, 120 have different geometries to accommodate the misaligned movement mechanism 2500. The top and bottom end plates 110, 120 can have the same or substantially the same features as previously disclosed. Fig.30D yes Fig. 30B An alternative perspective view of an embodiment of , with the top end plate 110 removed for ease of understanding. Fig.30E is with Fig. 30B A top view of an exemplary top end plate 110 for use with an embodiment of the present invention. Fig.30F is with Fig. 30B A top view of an exemplary bottom end plate 120 for use with embodiments of the present invention.

[0198] Fig.31 is a perspective view of the spinal implant 200 in an installed position between three alternating positions of a vertebral body and a first surgical tool 400. Fig.31 1 shows how the first surgical tool 400 can be inserted into the guide hole 107 at an angle relative to the first reference axis B1. The reference ring RR represents the range of feasible offset positions in which the first surgical tool 400 can be operably inserted into the guide hole 107. In some embodiments, the first surgical tool 400 can be bent at 15° in the middle region to enable the surgeon to adjust the spinal implant 200 in a manner that avoids anatomical features and organs (e.g., pelvic ring and iliac crest). In addition, when a misalignment movement mechanism 2500 of, for example, about 15° is used, this advantage is further expanded. Therefore, the system of the disclosed spinal implant 200 can be manipulated by the surgeon through the surgical tool 400 in the combined total angle range of the movement mechanism 2500 offset and the angle range of the surgical tool bending. In at least one embodiment, since the movement mechanism 2500 is offset by about 15° and the surgical tool 400 is bent by about 15°, the total angle range is about 30°.

[0199] Fig.32A is a top view of a third embodiment of an expandable spinal implant 300 in accordance with the principles of the present disclosure. Fig.32BThe spinal implant 300 is shown in a perspective view. Aspects of the spinal implant 300 may be the same, substantially the same, or similar to the spinal implant 100. In addition, the spinal implant 300 may be used in previously disclosed systems and methods. Therefore, repeated description thereof will be omitted.

[0200] In some embodiments, the size and orientation of the top and bottom end plates 110, 120 and the size and orientation of the mobile mechanism 250d are particularly advantageous for the lateral insertion technique. The spinal implant 300 includes a first reference axis C1 and a second reference axis C2. Different from the previous embodiments, the first reference axis C1 can span the longitudinal length of the spinal implant 300 and directly pass through the rotation axis of the mobile mechanism 250d. The second reference axis C2 can pass through the center of the spinal implant to divide the spinal implant 300 into two. In addition, the second reference axis C2 can intersect the first reference axis C1 and protrude through the center of the support block 257.

[0201] The spinal implant 300 may include a top end plate 110d and a bottom end plate 120d and a moving mechanism 250, which may be the same or substantially the same as described above. The spinal implant 300 includes a proximal end 101 and a distal end 102 opposite to the proximal end 101, and a first side end 103 and a second side end 104 opposite to the first side end 103. The first side end 103 and the second side end 104 extend between the proximal end 101 and the distal end 102. The proximal end 101 includes an exposed screw guide end plate 105, which defines a corresponding screw guide hole 107, which is disposed between the end plates 110d and 120d. The screw guide end plate 105 and the guide hole 107 may be the same or substantially the same as described above.

[0202] The top end plate 110 may include a first outer surface 111d and a first inner surface 112d opposite to the first outer surface 111d. Similarly, the bottom end plate 120d may include a second outer surface 121d and a second inner surface 122d. The outer surfaces 111d, 121d may be configured to be located between and / or contact the vertebral bodies in the patient's spine and have various surface features similar to those described above with reference to the spinal implant 100. In some embodiments, the outer surfaces 111d and 122d may have a substantially linear surface profile across the face of its textured surface. In other embodiments, the outer surfaces 111d and 122d may have a curved surface profile across the face of its textured surface. Further details of the end plates 110d, 120d will be described in more detail below.

[0203] The inner surfaces 111d, 122d can surround the movement mechanism 250 and have various contours, guides, cavities and other operable features that facilitate movement and / or provide mechanical advantages to other operable and movable corresponding components to facilitate retraction, angular adjustment, lateral bending, compression forces, absorption of shear forces, etc., as will be explained in more detail below.

[0204] In an exemplary embodiment, the top end plate 110d includes a pair of first proximal bevels 114d and a pair of first distal bevels 116d opposite the first proximal bevels 114d. Each bevel of the first proximal bevels 114d includes an inclined surface extending away from the inner surface 112d and the moving mechanism 250d. Similarly, each bevel of the first distal bevels 116d includes an inclined surface extending away from the inner surface 112d and the moving mechanism 250d. The bottom end plate 120d includes a pair of second proximal bevels 124d and a pair of second distal bevels 126d opposite the second proximal bevels 124d. Each bevel of the second proximal bevels 124d includes an inclined surface extending away from the inner surface 122d and the moving mechanism 250d. Similarly, each bevel of the second distal bevels 126d includes an inclined surface extending away from the inner surface 11d1 and the moving mechanism 250d.

[0205] Exemplary spinal implant 300 includes a mobile mechanism 250d operably coupled to top end plate 110d and bottom end plate 120d, similar to that explained above with reference to spinal implant 100. Therefore, repetitive description will not be repeated. The first functional feature of mobile mechanism 250d is that it is also configured to increase and reduce the spacing between top and bottom end plates 110d, 120d when first fixing screw 252 and second fixing screw 254 rotate simultaneously in clockwise and counterclockwise directions respectively. The second functional feature of mobile mechanism 250d is that it is also configured to increase and reduce the inclination angle between top and bottom end plates 110d, 120d when first fixing screw 252 rotates in clockwise and counterclockwise directions respectively.

[0206] Fig.33A is a perspective view of a spinal implant 300 in a collapsed position, Fig.33B is a perspective view of a spinal implant 300 in an expanded position. Fig.33A In the retracted position, the top end plate 110d and the bottom end plate 120d are retracted to the fully closed position. Fig.33B In the expanded position, the top end plate 110d and the bottom end plate 120d expand by the same amount. FIG. 9A to FIG. 9BAs explained above, when the first surgical tool 400 is inserted into the guide hole 107 at the first position and rotated in the first direction (clockwise), the first pusher 256 and the second pusher 258 move away from each other by an equal amount in opposite directions. In turn, the first pusher 256 and the second pusher 258 move the top and bottom end plates 110d, 120d away from each other by an equal amount. Similarly, when the first surgical tool 400 is rotated in the second direction (counterclockwise), the first pusher 256 and the second pusher 258 move the top and bottom end plates 110d, 120d toward each other by an equal amount in the contraction direction (not shown). In summary, when the first surgical tool 400 is positioned at the first position and the first surgical tool 400 is rotated in the first direction or the second direction, the moving mechanism 250d is operable to adjust the spacing between the top and bottom end plates 110d, 120d. Fig.33C is a perspective view of spinal implant 300 in a first angled position, and Fig.33D 300 is a perspective view of the spinal implant 300 in a second angled position. The spinal implant 300 may have the same or similar features as explained above with respect to the spinal implants 100, 200. The spinal implant 300 is capable of (1) expanding / contracting the proximal end while the distal end remains stationary, (2) expanding / contracting the distal end while the proximal end remains stationary, and (3) expanding / contracting the proximal end and the distal end simultaneously. FIG. 10A to FIG. 10B As explained above, when the first surgical tool 400 is inserted into the guide hole 107 at the second position and rotated in the first direction (clockwise), the first pusher 256 moves away from the proximal end 101 of the spinal implant 100, while the second pusher 258 remains stationary in place. In practice, the top and bottom end plates 110d, 120d move toward each other at the distal end 102 (not shown) and move away from each other at the proximal end 101, thereby reducing the tilt angle between the top and bottom end plates 110, 120.

[0207] Likewise, when the first surgical tool 400 is in the second position and rotated in the second direction (counterclockwise), the first pusher 256 moves toward the stationary second pusher 258. In practice, the top and bottom end plates 110d, 120d move toward each other at the proximal end 101 (not shown), thereby reducing the tilt angle between the top and bottom end plates 110d, 120d. In summary, when the first surgical tool 400 is positioned in the second position and the first surgical tool 400 is rotated in the first direction or the second direction, the moving mechanism 250 is operable to adjust the tilt angle between the top and bottom end plates 110, 120 while rotating the first fixing screw along the rotation axis.

[0208] exist Fig.33AIn the retracted position, the first height between the top end plate 110d and the bottom end plate 120d on the proximal side 101 and the distal side 102 is about 9 mm. Fig.33B In the first expanded position, the second height of the spinal implant 300 between the top end plate 110d and the bottom end plate 120d on the proximal side 101 and the distal side 102 is about 9 mm. Fig.33B In the first expanded position, the top end plate 110d is parallel to the bottom end plate 110d. Fig.33C In the first angled position, the top and bottom end plates 110d, 120d contact each other at the distal side 102 and are spaced apart from each other at the proximal side 101. For example, at the distal side 102, the height between the top end plate 110d and the bottom end plate 120d is about 9 mm. For another example, at the proximal side 101, the height between the top end plate 110d and the bottom end plate 120d is about 16 mm. Therefore, the inclination angle between the top end plate 110d and the bottom end plate 120d at the distal side 101 is about 11°. Fig.33D In the second angled position of the top and bottom end plates 110d, 120d, the top and bottom end plates 110d, 120d contact each other at the proximal side 102 and are spaced apart from each other at the distal side 101. For example, at the proximal side 102, the height between the top end plate 110d and the bottom end plate 120d is about 9 mm. For another example, at the distal side 101, the height between the top end plate 110d and the bottom end plate 120d is about 16 mm. Therefore, the inclination angle between the top end plate 110d and the bottom end plate 120d at the proximal side 101 is about 11°.

[0209] In some embodiments, the spinal implant 300 may include a three-position internal drive shaft (not shown) that complements or replaces the components of the moving mechanism 250. The three-position internal drive shaft can enable the first set screw 252 and the second set screw 254 to be adjusted independently of each other, and can adjust the first set screw 252 and the second set screw 254 in parallel or simultaneously. For example, the first surgical tool 400 may have a relatively short circumferential surface 456 that engages only one of the inner circumferential surfaces of the first set screw 252 or the second set screw 254 at a time. For another example, another first surgical tool 400 having a relatively long circumferential surface 456 can engage the inner circumferential surfaces of the first set screw 252 and the second set screw 254 at the same time. Consistent with the disclosed embodiments, the surgeon can use the first surgical tool 400 having a relatively short circumferential surface 456 to perform an angle adjustment of the spinal implant 300, and then use the first surgical tool 400 having a relatively long circumferential surface 456 to perform a height adjustment of the spinal implant 300. In other embodiments, the spinal implant 300 can include screw guide holes 107 on both sides of the spinal implant 300 to provide access to the first fixation screw 252 independently of the second fixation screw 254 .

[0210] Fig.34 400 is a perspective view of a spinal implant system using a spinal implant 300 and a first surgical tool 400. In an exemplary system, the spinal implant 300 is positioned in an installation position between the vertebral bodies by the first surgical tool 400 according to the lateral insertion technique explained in more detail above. The first surgical tool 400 can operably adjust the spinal implant 300 in situ between the vertebral bodies, as explained in more detail above. For example, the first surgical tool 400 can operably expand the spinal implant 300 at the proximal 101 and / or distal 102 of the spinal implant. In this way, the spinal implant 300 can correct the alignment of the patient's spine in the coronal plane.

[0211] Fig.353 is a perspective view of a spinal implant system utilizing a spinal implant 300, highlighting how the first surgical tool 400 can manipulate the spinal implant 300 from different angles. For example, the spinal implant 300 may include components identical, substantially identical, or similar to the moving mechanism 2500 described above. In an exemplary embodiment, the first surgical tool 400 may be inserted into the guide hole 107 at an angle relative to the first reference axis B1. The reference ring RR represents the range of feasible offset positions at which the first surgical tool 400 can be operably inserted into the guide hole 107. In some embodiments, the first surgical tool 400 may be bent at 15° in the middle region (not shown) to enable the surgeon to adjust the spinal implant 300 in a manner that avoids anatomical features and organs (e.g., the pelvic ring and the iliac crest).

[0212] General reference Figures 36 to 39B , an additional expandable spinal implant 600 is disclosed. The expandable spinal implant 600 may have the same, substantially the same and / or similar components and properties as the spinal implants 100, 200 and 300, including general applicability with other related systems and surgical tools disclosed above. The spinal implant 600 may include a screw guide end plate 6150 having at least one hole 610 configured to receive an anchor screw 510 therein. The length of the screw guide end plate 6150 may be relatively longer than the length of the screw guide end plate 150 discussed above, and the screw guide end plate 6150 may be operably connected to the movement mechanism 250, similar to the above explanation of spinal implants 100, 200 and 300.

[0213] In the illustrated embodiment, the top end plate 110 and the bottom end plate 120 can each have a receiving portion 630 having a size and geometry corresponding to the end portion of the screw guide end plate 6150, so that when the spinal implant 600 is in the fully collapsed position, the end position of the screw guide end plate 6150 does not increase the relative height of the implant 600 in the fully collapsed position. For example, the end plates 110, 120 can be completely closed without being affected by the screw guide end plate 6150 and thus maintaining a relatively compact size.

[0214] Fig.38A and Fig.38BFront and rear perspective views of an exemplary screw guide end plate 6150 are shown, which has at least one hole 610 configured to receive an anchor screw 510 therein. In the illustrated embodiment, two holes 610 are shown, although embodiments according to the principles of the present disclosure may have any number of holes 610. As shown, each hole 610 can be configured to selectively receive a corresponding anchor screw therein. The external entrance of each hole 610 can define two alternating guide paths. For example, a first guide path can be defined by an entrance and a first exit hole 610a of the hole 610, and a second guide path can be defined by an entrance and a second exit hole 610b of the hole 610. In this way, the hole 610 can be configured to orient a corresponding anchor screw 510 at a time in either a first orientation or a second orientation.

[0215] The corresponding exemplary first and second orientations are Fig.37 , which shows a first anchor screw 510 (right anchor screw) oriented upward at an oblique angle relative to the top end plate 110 and a second anchor screw 510 (left anchor screw) oriented downward at an oblique angle relative to the bottom end plate 120. In addition, the first orientation can align the corresponding anchor screw 510 so that it protrudes through the corresponding slotted hole 640 of the first end plate 110 (see Fig.36 and Fig.39A ). Similarly, the second orientation can align the corresponding anchor screw 510 so that it protrudes through the corresponding slotted hole 640 of the second end plate 120 (see Fig.36 and Fig.39B ).

[0216] At least one advantage of the disclosed spinal implant 600 is that the screw guide end plate 6150 and the moving mechanism 250 can be configured so that the moving mechanism 250 can selectively adjust the spacing between the first end plate 110 and the second end plate 120 and adjust the inclination angle between the first end plate and the second end plate while anchoring at least one corresponding anchor screw 510 in the corresponding vertebra. For example, the surgeon can initially position the spinal implant 600 between adjacent vertebrae of the patient and install the corresponding first anchor screw 510 in a first orientation through the slotted hole 640 of the first end plate 110, and install the corresponding second anchor screw 510 in a second orientation through the slotted hole 640 of the second end plate 120. Next, the surgeon can continue to adjust the spacing and / or inclination angle between the end plates 110, 120 until the end plates 110, 120 are in the desired position. This is possible, at least in part, because the relative position of the screw guide end plates 6150 remains fixed due to the anchored anchor screws 510, and the first and second end plates can freely expand / contract and / or tilt / drop by the movement mechanism 250 as the anchor screws 510 extend through the slotted holes 640 (whose geometry is such that the anchored anchor screws 510 do not interfere with the movement of the end plates 110, 120). For example, the end plates 110, 120 can freely move while the anchor screws 510 remain anchored in place in the corresponding vertebrae while changing their relative positioning relative to the slotted holes 640 due to the movement of the end plates 110, 120.

[0217] General reference Figures 40 to 44B , an additional expandable spinal implant 700 is disclosed. The expandable spinal implant 700 may have the same, substantially the same and / or similar components and properties as spinal implants 100, 200, 300 and 600, including general applicability with other related systems and surgical tools disclosed above. The spinal implant 700 may include a screw guide end plate 7150 having at least one hole 710 configured to receive an anchor screw 510 therein. The length of the screw guide end plate 7150 may be relatively longer than the length of the screw guide end plate 150 discussed above, and the screw guide end plate 7150 may be operably connected to the movement mechanism 250, similar to the above explanation of spinal implants 100, 200 and 300.

[0218] In the illustrated embodiment, the top end plate 110 and the bottom end plate 120 may each have a receiving portion 730 having a size and geometry corresponding to the end portion of the screw guide end plate 7150, so that when the spinal implant 700 is in the fully collapsed position, the end position of the screw guide end plate 7150 does not increase the relative height of the implant 700 in the fully collapsed position. For example, the end plates 110, 120 can be completely closed without being affected by the screw guide end plate 7150, thereby maintaining a relatively compact size.

[0219] Fig.42A and Fig.42B An exemplary screw guiding end plate 7150 is shown with and without a corresponding anchor screw 510, respectively. Fig.43A and Fig.43B Front and rear perspective views of an exemplary screw guide end plate 7150 are shown having at least one hole 710 configured to receive an anchor screw 510 therein. In the illustrated embodiment, four holes 710 are shown, although embodiments in accordance with the principles of the present disclosure may have any number of holes 710.

[0220] As shown, each hole 710 can be configured to selectively receive a corresponding anchor screw 510 therein. The outer entrance of each hole 710 can define a guide path that is configured to orient the corresponding anchor screw 510 in an inclined position extending away from the proximal side of the corresponding end plate 110 or 120. For example, the screw guide end plate 7150 may include a total of four holes 710, and the four holes 710 may include two topmost holes 710 and two bottommost holes 710. In the disclosed embodiment, the two topmost orifices 710 can be configured to tilt the corresponding anchor screw 510 relative to the top end plate 110 extending from the proximal side of the implant 700 to the distal side of the implant 700. Similarly, the two bottommost orifices 710 can be configured to tilt the corresponding anchor screw 510 relative to the bottom end plate 120 extending from the proximal side of the implant 700 to the distal side of the implant 700. The corresponding orientation in Fig.40 , Fig.41 and Fig.42B, which shows two top anchor screws 510 oriented upward at an oblique angle relative to the top end plate 110 and two bottom anchor screws 510 oriented downward at an oblique angle relative to the bottom end plate 120. Alternatively, the screw holes in the plate can be arranged and numbered in a variety of alternative designs, including providing a single hole in the center or on one or the other side of the top and bottom instead of two holes at the top and bottom, or two holes on one of the top or bottom and one hole on the opposite side of the top or bottom. These screw holes may also include protrusions, threads or other features to control, guide and / or hold the screws in place, or include features such as retaining clips, springs or covers to hold the screws in place after the screws are inserted. The screw holes can be a variety of shapes, including cylindrical, conical, or designed to receive a bulbous or spherical screw head.

[0221] For ease of explanation, Fig.44A and Fig.44B The top end plate 110 and the bottom end plate 120 can be shown separately, having an anchor screw 510 in one corresponding hole 710 and not having an anchor screw 510 in the other corresponding hole 710. As shown, the top end plate 110 can include at least one anchor screw 510 such that it extends through or passes through a corresponding recess 740 of the first end plate 110. Similarly, the bottom end plate 120 can include at least one anchor screw 510 such that it extends through or passes through a corresponding recess 740 of the first end plate 110.

[0222] At least one advantage of the disclosed spinal implant 700 is that the screw guide end plate 7150 and the moving mechanism 250 can be configured so that the moving mechanism 250 can selectively adjust the spacing between the first end plate 110 and the second end plate 120 and adjust the inclination angle between the first end plate and the second end plate while anchoring at least one corresponding anchor screw 510 in the corresponding vertebra. For example, the surgeon can initially position the spinal implant 700 between adjacent vertebrae of the patient and install at least one corresponding anchor screw 510 in a first orientation extending through or through the corresponding recess 740 of the first end plate 110, and install at least one corresponding anchor screw 510 in a second orientation extending through or through the recess 740 of the second end plate 120. Next, the surgeon can continue to adjust the spacing and / or inclination angle between the end plates 110, 120 until the end plates 110, 120 are in the desired position. This is possible, at least in part, because the relative positions of the screw guide end plates 7150 remain fixed due to the anchored anchor screws 510, and the first and second end plates can freely expand / contract and / or tilt / drop by the movement mechanism 250 as the anchor screws 510 extend through or through the slotted holes 740 (whose geometry is such that the anchored anchor screws 510 do not interfere with the movement of the end plates 110, 120). For example, the end plates 110, 120 can move freely while the anchor screws 510 remain anchored in place in the corresponding vertebrae.

[0223] Fig.45 and Fig.46 8 is a perspective view of an additional embodiment of an expandable spinal implant 800 according to the principles of the present disclosure including a front end plate 810. In some embodiments, the front end plate 810 may be referred to as a third end plate, or may be referred to as a medial, lateral, or rear end plate, depending on the orientation or method used, and the specific configuration and shape of the implant, and the location, side, or end to which the third plate is attached or positioned. Fig.47 According to the principles of this disclosure Fig.45 . The expandable spinal implant 800 may include features that are the same, substantially the same, and / or similar to the various embodiments disclosed above. For example, the movement mechanism 250 may operate in the same, substantially the same, and / or similar manner as described above. However, the implant 800 may include a front end plate 810, a top end plate 820 (upper end plate), and a bottom end plate 830 (lower end plate) having different characteristics, as will be explained in further detail below.

[0224] For example, implant 800 may include a front side 800a, a rear side 800p and two opposite lateral sides 800l. In addition, for example, the outer contour of implant 800 may include a top end plate 820 (upper end plate), a bottom end plate 830 (lower end plate) and a front end plate 810 (front end plate). In various embodiments, the top end plate 820 and the bottom end plate 830 may jointly define the rear side 800p (rear side) of implant 800. For example, the front end plate 810 may include a plurality of circular bone screw holes 801. In the exemplary embodiment, four circular bone screw holes 801 are disclosed, but in other embodiments, the number of bone screw holes 801 may be more or less. For example, in some embodiments, there may be an additional 5th bone screw hole and a 6th bone screw hole in the middle position of the front end plate 810. In other embodiments, there may be a total of two bone screw holes 801 , including a left bone screw hole 801 protruding diagonally on the top end plate 820 and a right bone screw hole 801 protruding diagonally on the bottom end plate 820 .

[0225] In various embodiments, each bone screw hole 801 may include at least one annular portion 801a that facilitates insertion of the bone screw 511 (see Fig.52 ) and / or facilitate the alignment of a drill bit (e.g., as disclosed above in the surgical tool 500) in a coaxial relationship. For example, the ring portion 801a can define a bearing surface for seating, for example, the inclined surface 512 of the outer recessed track 513 of the head portion of the bone screw 511. In various embodiments, the ring portion 801a can have a size and shape that generally corresponds to the size and shape of the inclined surface 512, and define an inner diameter that is smaller than the cross-sectional diameter of the outer recessed track 513. In addition, in various embodiments, for example, due to the inclined surface 512, the ring portion 801a of the bone screw hole 801 can allow approximately + / - 10° of freedom for the corresponding bone screw 511, and in some embodiments, approximately + / - 5° of freedom.

[0226] The front end plate 810 may include at least one bone screw lock 803 for preventing the bone screw 511 from being withdrawn. For example, the bone screw lock 803 may be a rotatable lock that can be rotated, for example, about 90° between an open position and a closed position to prevent the bone screw 511 from being withdrawn. In various embodiments, the front end plate 810 may include at least one attachment point 805 for connecting the implant 800 to a surgical tool. In the disclosed embodiment, a plurality of attachment points 805 are distributed around the screw guide hole 807. In the disclosed embodiment, six attachment points 805 are radially distributed around the screw guide hole 807, although other embodiments may have more or fewer attachment points, such as 2, 3, 4, 5, 7, or 8.

[0227] As reference Fig.47As best understood, the front end plate 810, the top end plate 820, and the bottom end plate 830 can be operably coupled to the mobile mechanism 250. For example, the mobile mechanism 250 serves as a central attachment location for each of the end plates 810, 820, 830, and each of the end plates 810, 820, 830 can, for example, independently interact with the mobile mechanism 250. In the disclosed embodiment, the front end plate 810 can be operably coupled to the mobile mechanism 250 by inserting the post 855 into the corresponding post retaining hole 255, the size and shape of the post retaining hole being configured to securely couple the two together. In various embodiments, the post 855 can extend from the inner surface of the front end plate 810 in a direction toward the rear side 800p of the implant 800 and toward the mobile mechanism 250. In this way, the front end plate 810 is independently fixed to the mobile mechanism 250, for example, from the top end plate 820 and the bottom end plate 830.

[0228] Fig.48A and Fig.48B 830 of a spinal implant 800. In various embodiments, the bottom end plate 830 and the top end plate 820 may include the same, substantially the same, and / or similar features. In the example illustration, the bottom end plate 830 may include a bone screw release 832 for each corresponding bone screw hole 801. For example, the bone screw release 832 includes an arcuate channel and / or a tapered channel that defines a portion of the outer surface of the end plate 830. In some embodiments, the number of bone screw releases 832 may be greater or less. For example, a single bone screw release 832 or three bone screw releases 832. In some embodiments, the top end plate 820 may include a first bone screw release 822, and the bottom end plate 830 may include a second bone screw release 832 that protrudes relative to each other in diametrically opposed directions. Additionally, in Fig.48A and Fig.48B In the top view of FIG. 8 , a gap 840 (void space) is shown between the front end plate 810 and the bottom end plate 830. The gap 840 between the front end plate 810 and the end plates 820, 830 may exist in both the expanded position and the retracted position. For example, Fig.48C As shown, implant 800 is in an expanded position and there is a gap 840 between front end plate 810, top end plate 820, and bottom end plate 830. Still for example, gap 840 can define a continuous interruption between the rear side of front end plate 810 and the front sides of top and bottom end plates 820, 830.

[0229] Fig.49800 in an expanded configuration, including a plurality of bone screws 511 extending over corresponding bone screw holes 801. In an exemplary embodiment, when the implant 800 is in a fully expanded position, the trajectory of the bone screws 511 is not affected by the top end plate 820 and / or the bottom end plate 830. For example, the bone screw releases 822, 832 allow the implant 800 to fully expand without interfering with the bone screws 511. Still for example, the bone screws 511 can be fixed to the bone surface and the implant 800 is anchored only via the bone screw holes 801 of the front end plate 810.

[0230] Fig.50 The invention comprises a plurality of bone screws 511. Fig.45 An alternative perspective view of an embodiment of the present invention, wherein the plurality of bone screws are prevented and / or inhibited from withdrawing due to the bone screw lock 803. By rotating the bone screw lock 803 by approximately 90°, the bone screw lock 803 can be Fig.49 The unlocked position shown is the same as Fig.50 In operation, an end user (such as a surgeon) can place a bone screw 511 through the bone screw hole 801 after the implant 800 expands to a desired height and inclination. Thereafter, the surgeon can move the bone screw lock 803 from the unlocked position to the locked position to prevent the bone screw 511 from being withdrawn. In various embodiments, the surgeon can drive the bone screw 511 even after the bone screw lock 803 is engaged in the locked position. Fig.51 is a rear perspective view of implant 800 including a plurality of bone screws 511.

[0231] Fig.52 FIG. 5 is an exemplary side view of a bone screw 511. Fig.52 , the bone screw 511 may include an inclined surface 512 that extends around the circumference of the bone screw 511 and terminates in a ring portion 513. In various embodiments, for example, the ring portion 513 may have a size and shape that generally corresponds to the size and shape of the annular portion 801a of the bone screw hole 801. In addition, in various embodiments, the cooperation between the annular portion 801a, the inclined surface 512, and the ring portion 513 may allow, for example, approximately + / - 5° of freedom for the corresponding bone screw 511.

[0232] Fig.53 are reference diagrams illustrating various cardinal directions and planes relative to a patient in which the various spinal implants disclosed herein may be manipulated, adjusted, and / or moved in accordance with the principles of the present disclosure.

[0233] Additional plate / expandable plate implementation scheme

[0234] General reference Figures 54 to 69, various plates are disclosed, including expandable plate embodiments for coupling to various spinal implants. Figure 54 to Figure 61 An embodiment of a first expandable panel 1500 is illustrated; Figure 62 to Figure 67 An embodiment of a second expandable plate 1600 is illustrated, and Figures 68 to 73 An embodiment of a third expandable plate 1700 is shown. The various expandable plates 1500, 1600, 1700 may have the same, similar and / or substantially the same components and functions, unless the context clearly indicates otherwise. For example, the various expandable plates 1500, 1600 and 1700 may each be designed to be connected and / or coupled to the various spinal implants disclosed herein, and may be used in combination with, for example, the front end plate 810. However, the principles of the disclosed expandable plates 1500, 1600, 1700 are not necessarily limited to the specific implants disclosed herein, and may certainly be coupled and / or connected to other implants in the same, similar and / or substantially the same manner.

[0235] Figure 54 to Figure 55 1 is a perspective view of an embodiment of a first expandable plate 1500 for coupling to a disclosed spinal implant. The expandable plate 1500 may include, for example, an upper portion 1505 (also referred to as an upper plate) and a lower portion 1503 (also referred to as a lower plate) that can expand and contract relative to each other. For example, the upper portion 1505 may include a first bone screw hole 1502a for supporting a first bone screw 1504a in a target trajectory, and the lower portion 1503 may include a second bone screw hole 1502b for supporting a second bone screw 1504b in a target trajectory. The expandable plate 1500 may include an end cap 1501 that can rotate between locking positions, in which the first bone screw hole 1502a and the second bone screw hole 1502b are covered so as to prevent and / or inhibit the first bone screw 1504a and the second bone screw 1504b from withdrawing. The expandable plate 1500 may include a fixing screw 1507 for fixing the upper portion 1505 and the lower portion 1503 at a specific position relative to each other. For example, upper portion 1505 and lower portion 1503 can be expanded away from each other in a vertical direction, and set screw 1507 can lock upper portion 1505 and lower portion 1503 at any of a variety of expanded positions.

[0236] Fig.56is a front view of the first expandable plate 1500, showing various axes and reference directions. For example, the expandable plate 1500 may extend in a length direction along axis YY (which may also be referred to as a vertical direction, depending on the orientation). In various embodiments, the expandable plate 1500 may be generally considered to be symmetrical on either side of the axis YY and / or symmetrical at least because the bone screw holes 1502a and 1502b are vertically aligned. Additionally, for example, the expandable plate 1500 may extend in a width direction along axis XX (which may also be referred to as a lateral direction, depending on the orientation). In various embodiments, the thickness of the expandable plate 1500 may extend in a proximal to distal direction. For example, as Fig.54 As shown, the thickness may be measured in a proximal to distal direction from a proximal side 1500p to a distal side 1500d.

[0237] Figure 57 to Figure 59 15 is a view of various exploded components of the first expandable plate 1500. In an exemplary embodiment, a set screw 1507 is shown extending in a proximal to distal direction and including a thread pattern 1507a on an outer circumferential surface at a distal end and a head portion 1507b at a proximal end, the head portion being relatively larger than, for example, a maximum diameter of the thread pattern 1507a. In various embodiments, the set screw 1507 may include a hollow interior so that a rotary instrument (such as a driver) may extend through the set screw 1507 in a proximal to distal direction. For example, the set screw 1507 may extend through the hole 1501a of the cap 1501, the hole 1503a of the lower portion 1503, the hole 1505a of the upper portion 1505, and be screwed into the threaded hole 1509a of the nut 1509. Additionally, in various embodiments, the head portion 1507b can be nested and / or seated within the circumferential recess 1501b such that, for example, the outer surface of the head portion 1507b is flush and / or substantially flush with the outer portion of the end cap 1501. Additionally, the upper portion 1505 can include a lip 1505d that protrudes from the distal side of the upper portion 1505 and extends in the width direction. For example, in various embodiments, the lip 1505d can be positioned to sit on the apophyseal ring of an adjacent vertebra and be used to determine the proper expansion setting of the upper portion 1505 relative to the lower portion 1503.

[0238] like Fig.58As best seen in the figure, the lower portion 1503 may include a receiving cavity 1503c having a size and shape corresponding to the lower end of the upper portion 1505, for example. The receiving cavity 1503c may have a size and shape that generally corresponds to the size and shape of the lower end of the upper portion 1505. For example, the lower portion 1503 may include a rack portion 1503b that includes a plurality of raised tracks and recessed grooves extending in a width direction. In various embodiments, the rack portion 1503b may be disposed within the cavity 1503c proximal to the hole 1503a and on both sides of the hole. In addition, the rack portion 1503b may face in a proximal direction of the expandable plate 1500. As shown in FIG. Fig.57 As best seen in FIG. 1 , for example, the upper portion 1505 may include a rack portion 1505b that includes a plurality of raised tracks and recessed grooves extending in a width direction. In various embodiments, the rack portion 1505b may be disposed on the distal end of the upper portion 1505 such that, for example, when the upper portion 1505 is inserted into the receiving cavity 1503c, the rack portion 1505b faces the rack portion 1503b. In this manner, for example, the rack portion 1505b may engage with the rack portion 1503b in any of a plurality of various positions defined by the plurality of raised tracks and recessed grooves.

[0239] In various embodiments, the upper portion 1505 can move up and down in the vertical direction in the receiving cavity 1503c so that the expandable plate 1500 can selectively expand and contract. In addition, for example, the nut 1509 can be nested in the channel 1503e of the lower portion 1503. In an exemplary embodiment, the channel 1503e can be understood as a slotted channel that extends a distance greater than the diameter of the nut 1509 in the vertical direction and extends a distance close to the width of the nut 1509 in the width direction. For example, the nut 1509 may include a planar side surface 1509b, and the distance in the width direction of the channel 1503e may correspond to the distance between the two planar side surfaces 1509b. In addition, the planar side surface 1509b can prevent the nut 1509 from rotating when the fixing screw 1507 is tightened to the nut 1509. Thus, an end user (such as a surgeon) can expand the top portion 1505 relative to the bottom portion 1503 (or vice versa) and tighten the set screw 1507 to the nut 1509 so that the rack portions 1505b and 1503b are pushed together and / or directly engage each other. In this way, the end user can securely couple the top portion 1505 to the bottom portion 1503 in any of a variety of possible expanded positions.

[0240] refer to Fig.59 and Fig.61, for example, the fixing screw 1507 may include a tapered portion 1507c disposed between a proximal circumferential recess 1507d and the threaded portion 1507a. In some embodiments, for example, the tapered portion 1507c may be referred to as a conical tapered portion. For example, the tapered portion 1507c may be widest at the proximal end of the screw 1507 and narrowest at its end closest to the distal end and before and / or adjacent to the threaded portion 1507a. In various embodiments, the engagement surfaces of the tapered portion 1507c (in various embodiments), the upper portion 1505, and / or the lower portion 1503 may be disposed within the circumferential recess 1507d (see Fig.61 ). Additionally, in various embodiments, the tapered portion 1507c can interfere with the hole 1505a so that, for example, the set screw 1507 can rotate therein while also remaining coupled to the nut 1509. Additionally, the tapered portion 1507c can facilitate and / or allow the upper portion 1505 and the lower portion 1503 to expand and contract while also allowing the cover 1501 to rotate. For example, the cover 1501 can rotate about the tapered portion 1507c between a locked position and an unlocked position.

[0241] Fig.60 is a front view of an embodiment of a first expandable plate 1500 coupled to an end plate 810 of a spinal implant 800, and Fig.61 yes Fig.60 . In an exemplary embodiment, the distal side of the expandable plate 1500 is shown in contact with the proximal side of the end plate 810. In addition, the first fixing screw 252 and the second fixing screw 254 of the moving mechanism 250 are shown to be accessible through the hole of the fixing screw 1507 of the expandable plate 1500. In addition, the target trajectory of the first bone screw 1504a and the second bone screw 1504b is shown to extend substantially perpendicular to the face of the expandable plate 1500 in a direction from the proximal to the distal side. For example, the first bone screw 1504a and the second bone screw 1504b extend straight back from the proximal end toward the distal end in a plane close to the centerline of the implant 800 and the expandable plate 1500. In addition, in various embodiments, the first bone screw hole 1502a and the second bone screw hole 1502b can be conical, tapered and / or cylindrical, with or without a retaining lip, and can also allow approximately + / -9 degrees of relative freedom of movement. In various embodiments, in the retracted position, the vertical distance between the first bone screw hole 1502a and the second bone screw hole 1502b can be, for example, about 15 mm to about 25 mm, and in some embodiments, about 21.5 mm. In various embodiments, in the expanded position, the vertical distance between the first bone screw hole 1502a and the second bone screw hole 1502b can be, for example, about 20 mm to about 35 mm, and in some embodiments, about 27.5 mm.

[0242] Figure 62 to Figure 63 1 are various perspective views of an embodiment of a second expandable plate 1600 for coupling to a disclosed spinal implant. The expandable plate 1600 may include, for example, an upper portion 1605 (also referred to as an upper plate) and a lower portion 1603 (also referred to as a lower plate) that can expand and contract relative to each other. For example, the upper portion 1605 may include a first bone screw hole 1602a for supporting a first bone screw 1604a in a target trajectory and a second bone screw hole 1602b for supporting a second bone screw 1604b in a target trajectory. In addition, for example, the lower portion 1603 may include a third bone screw hole 1602c for supporting a third bone screw 1604c in a target trajectory. The expandable plate 1600 may include an end cap 1601 that can rotate between locking positions, in which the first bone screw hole 1602a, the second bone screw hole 1602b, and the third bone screw hole 1602c are covered so as to prevent and / or inhibit the first bone screw 1604a, the second bone screw 1604b, and the third bone screw 1604c from withdrawing. The expandable plate 1600 may include a fixing screw 1607 for fixing the upper portion 1605 and the lower portion 1603 at a specific position relative to each other. For example, the upper portion 1605 and the lower portion 1603 can expand away from each other in the vertical direction, and the fixing screw 1607 can lock the upper portion 1605 and the lower portion 1603 in any one of the various expanded positions, as will be explained in further detail below.

[0243] Fig.64 is a front view of the second expandable plate 1600, showing various axes and reference directions. For example, the expandable plate 1600 may extend in a length direction along axis YY (which may also be referred to as a vertical direction, depending on the orientation). In various embodiments, the expandable plate 1600 may be generally considered to be symmetrical on either side of the axis YY. For example, the left side of the expandable plate 1700 may be symmetrical relative to the right side of the expandable plate 1700. Additionally, for example, the expandable plate 1600 may extend in a width direction along axis XX (which may also be referred to as a lateral direction, depending on the orientation). In various embodiments, the thickness of the expandable plate 1600 may extend in a proximal to distal direction. For example, as Fig.62 As shown, the thickness may be measured in a proximal to distal direction from a proximal side 1600p to a distal side 1600d.

[0244] Fig.6516 is an exploded component view of the second expandable plate 1600. In an exemplary embodiment, a set screw 1607 is shown extending in a proximal to distal direction and including a thread pattern 1607a on an outer circumferential surface at a distal end and a head portion 1607b at a proximal end, the head portion being relatively larger than, for example, the maximum diameter of the thread pattern 1607a. For example, the set screw 1607 may extend through the hole 1601a of the cap 1601, the hole 1603a of the lower portion 1603, the hole 1605a of the upper portion 1605, and be screwed into the threaded hole 1609a of the nut 1609. In various embodiments, the set screw 1607 may include a hollow interior so that a rotational instrument (such as a driver) may extend through the set screw 1607 in a proximal to distal direction. Additionally, in various embodiments, the head portion 1607b can be nested and / or seated within the circumferential recess 1601b such that, for example, the outer surface of the head portion 1607b is flush and / or substantially flush with the outer portion of the end cap 1601. Additionally, the upper portion 1605 can include a lip 1605d protruding from the distal side of the upper portion 1605 and extending in the width direction. Similarly, the lower portion 1603 can include a lip 1603d protruding from the distal side of the lower portion 1603 and extending in the width direction. For example, in various embodiments, the lips 1605d, 1603d can be positioned to sit on the apophyseal rings of adjacent vertebrae, respectively, and used to determine the appropriate expansion setting of the upper portion 1605 relative to the lower portion 1603. For example, an end user (such as a surgeon) can position the lip 1605d to sit and / or contact the apophyseal ring of the upper vertebra and position the lip 1603d to sit and / or contact the apophyseal ring of the lower vertebra. In doing so, the proper expansion and / or relative height of the expandable panel 1600 may be established.

[0245] like Fig.65 As best seen in , the upper portion 1605 may include a receiving cavity 1605c having a size and shape corresponding to, for example, the upper end of the lower portion 1603. The receiving cavity 1605c may have a size and shape that generally corresponds to the size and shape of the upper end of the lower portion 1603. For example, the upper portion 1605 may include a rack portion 1605b that includes a plurality of raised tracks and recessed grooves extending in a width direction. In various embodiments, the rack portion 1605b may be disposed within the cavity 1605c proximal to the hole 1605a and on both sides of the hole. In addition, the rack portion 1605b may face in a proximal direction of the expandable plate 1600. As shown in FIG. Fig.65 and Fig.675a, for example, the lower portion 1603 may include a rack portion 1603b including a plurality of raised tracks and recessed grooves extending in a width direction. In various embodiments, the rack portion 1603b may be disposed on the distal end of the lower portion 1603 such that, for example, when the lower portion 1603 is inserted into the receiving cavity 1605c, the rack portion 1603b faces the rack portion 1605b. In this manner, for example, the rack portion 1603b may engage with the rack portion 1605b in any of a plurality of various positions defined by the plurality of raised tracks and recessed grooves.

[0246] In various embodiments, the lower portion 1603 can move up and down in the vertical direction within the receiving cavity 1605c, so that the expandable plate 1600 can be selectively expanded and contracted. In addition, the nut 1609 can be nested in the channel 1605e of the upper portion 1605, for example Fig.67 1605e. In an exemplary embodiment, channel 1605e may be understood as a slotted channel that extends in the vertical direction a distance greater than the diameter of nut 1609 and in the width direction a distance close to the width of nut 1609. For example, nut 1609 may include planar side surfaces 1609b, and the distance in the width direction of channel 1605e may correspond to the distance between two planar side surfaces 1609b. In addition, planar side surfaces 1609b may prevent nut 1609 from rotating when set screw 1607 is tightened to nut 1609. Thus, an end user (such as a surgeon) may expand bottom portion 1603 with respect to top portion 1605 (or vice versa) and tighten set screw 1607 to nut 1609, so that rack portions 1605b and 1603b are pushed together and / or directly engage with each other. In this way, an end user may securely couple top portion 1605 to bottom portion 1603 in any of a variety of possible expanded positions.

[0247] Fig.66 and Fig.671600 is a perspective view of an embodiment of a second expandable plate 1600 in an expanded position. Although not illustrated, the second expandable plate 1600 can be connected to the implant and / or end plate 810 in the same, substantially the same and / or similar manner as explained above with reference to the first expandable plate 1500. Therefore, repeated description will be omitted. In the exemplary embodiment, the first bone screw 1604a, the second bone screw 1604b and the third bone screw 1604c are shown extending from the proximal end toward the distal end in a divergent pattern. In addition, in various embodiments, the first bone screw and the second bone screw may at least partially converge toward each other. In addition, in various embodiments, the first bone screw hole 1602a, the second bone screw hole 1602b and the third bone screw hole 1602c can be conical, tapered and / or cylindrical, with or without a retaining lip, and can also allow about + / -9 degrees of relative freedom of movement. In various embodiments, in the collapsed position, the vertical distance between the first bone screw hole 1602a and the second bone screw hole 1602b can be, for example, about 16 mm to about 25 mm, and in some embodiments, about 21.5 mm. In various embodiments, in the expanded position, the vertical distance between the first bone screw hole 1602a and the second bone screw hole 1602b can be, for example, about 20 mm to about 35 mm, and in some embodiments, about 27.5 mm.

[0248] Figures 68 to 73 are various perspective views of an embodiment of a third expandable plate 1700 for coupling to the disclosed spinal implant. Fig.68 and Fig.69, the expandable plate 1700 may include, for example, an upper portion 1705 (also referred to as an upper plate) and a lower portion 1703 (also referred to as a lower plate) that can expand and contract relative to each other. For example, the upper portion 1705 may include a first bone screw hole 1702a for supporting a first bone screw 1704a in a target trajectory and a second bone screw hole 1702b for supporting a second bone screw 1704b in a target trajectory. In addition, for example, the lower portion 1703 may include a third bone screw hole 1702c for supporting a third bone screw 1704c in a target trajectory and a fourth bone screw hole 1702d for supporting a fourth bone screw 1704d. The expandable plate 1700 may include an end cap 1701 that can be rotated between locking positions, in which the first bone screw hole 1702a, the second bone screw hole 1702b, the third bone screw hole 1702c, and the fourth bone screw hole 1702d are covered so as to prevent and / or inhibit the first bone screw 1704a, the second bone screw 1704b, the third bone screw 1704c, and the fourth bone screw 1702d from withdrawing. The expandable plate 1700 may include a fixing screw 1707 for fixing the upper portion 1705 and the lower portion 1703 at a specific position relative to each other. For example, the upper portion 1705 and the lower portion 1703 can be expanded away from each other in a vertical direction, and the fixing screw 1707 can lock the upper portion 1705 and the lower portion 1703 in any of a variety of expanded positions, as will be explained in further detail below.

[0249] Fig.70 is a front view of the third expandable plate 1700, showing various axes and reference directions. For example, the expandable plate 1700 may extend in a length direction along axis YY (which may also be referred to as a vertical direction, depending on the orientation). In various embodiments, the expandable plate 1700 may be generally considered to be symmetrical on either side of the axis YY. For example, the left side of the expandable plate 1700 may be symmetrical relative to the right side of the expandable plate 1700. Additionally, for example, the expandable plate 1700 may extend in a width direction along axis XX (which may also be referred to as a lateral direction, depending on the orientation). In various embodiments, the thickness of the expandable plate 1700 may extend in a proximal to distal direction. For example, as Fig.68 As shown, the thickness may be measured in a proximal to distal direction from a proximal side 1700p to a distal side 1700d.

[0250] Fig.711700. It is an exploded component view of the third expandable plate 1700. In an exemplary embodiment, a set screw 1707 is shown extending in a proximal to distal direction and including a thread pattern 1707a on an outer circumferential surface at the distal end and a head portion 1707b at the proximal end, the head portion being relatively larger than, for example, the maximum diameter of the thread pattern 1707a. For example, the set screw 1707 may extend through the hole 1701a of the cap 1701, the hole 1703a of the lower portion 1703, the hole 1705a of the upper portion 1705, and be screwed into the threaded hole 1709a of the nut 1709. In various embodiments, the set screw 1707 may include a hollow interior so that a rotational instrument (such as a driver) may extend through the set screw 1707 in a proximal to distal direction. Additionally, in various embodiments, the head portion 1707b can be nested and / or seated within the circumferential recess 1701b such that, for example, the outer surface of the head portion 1707b is flush and / or substantially flush with the outer portion of the end cap 1701. Additionally, the upper portion 1705 can include a lip 1705d protruding from the distal side of the upper portion 1705 and extending in the width direction. Similarly, the lower portion 1703 can include a lip 1703d protruding from the distal side of the lower portion 1703 and extending in the width direction. For example, in various embodiments, the lips 1705d, 1703d can be positioned to sit on the apophyseal rings of adjacent vertebrae, respectively, and used to determine the appropriate expansion setting of the upper portion 1705 relative to the lower portion 1703. For example, an end user (such as a surgeon) can position the lip 1705d to sit and / or contact the apophyseal ring of the upper vertebra and position the lip 1703d to sit and / or contact the apophyseal ring of the lower vertebra. In doing so, the proper expansion and / or relative height of the expandable panel 1700 may be established.

[0251] like Fig.71 As best seen in , the upper portion 1705 may include a receiving cavity 1705c having a size and shape corresponding to the upper end of the lower portion 1703, for example. The receiving cavity 1705c may have a size and shape that generally corresponds to the size and shape of the lower end of the upper portion 1705. For example, the upper portion 1705 may include a rack portion 1705b that includes a plurality of raised tracks and recessed grooves extending in a width direction. In various embodiments, the rack portion 1705b may be disposed within the cavity 1705c proximal to the hole 1705a and on both sides of the hole. In addition, the rack portion 1705b may face in a proximal direction of the expandable plate 1700. As shown in FIG. Fig.715a, for example, the lower portion 1703 may include a rack portion 1703b including a plurality of raised tracks and recessed grooves extending in a width direction. In various embodiments, the rack portion 1703b may be disposed on the distal end of the lower portion 1703 such that, for example, when the lower portion 1703 is inserted into the receiving cavity 1705c, the rack portion 1703b faces the rack portion 1705b. In this manner, for example, the rack portion 1703b may engage with the rack portion 1705b in any of a plurality of various positions defined by the plurality of raised tracks and recessed grooves.

[0252] In various embodiments, the lower portion 1703 can move up and down in the vertical direction within the receiving cavity 1705c so that the expandable plate 1700 can be selectively expanded and contracted. In addition, the nut 1709 can be nested in the channel 1705e of the upper portion 1705, for example Fig.73 As shown. In an exemplary embodiment, channel 1705e can be understood as a slotted channel that extends a distance greater than the diameter of nut 1709 in the vertical direction and a distance close to the width of nut 1709 in the width direction. For example, nut 1709 may include a planar side surface 1709b, and the distance in the width direction of channel 1705e may correspond to the distance between two planar side surfaces 1709b. In addition, planar side surface 1709b can prevent nut 1709 from rotating when fixing screw 1707 is tightened to nut 1709. Therefore, an end user (such as a surgeon) can expand bottom portion 1703 for top portion 1705 (or vice versa) and tighten fixing screw 1707 to nut 1709, so that rack portions 1705b and 1703b are pushed together and / or directly engaged with each other. In this way, an end user can securely couple top portion 1705 to bottom portion 1703 in any of a variety of feasible expansion positions.

[0253] Fig.72 and Fig.731700 are various perspective views of an embodiment of the third expandable plate 1700 in an expanded position. Although not illustrated, the third expandable plate 1700 can be connected to the implant and / or end plate 810 in the same, substantially the same and / or similar manner as explained above with reference to the first expandable plate 1500. Therefore, repeated description will be omitted. In the exemplary embodiment, the first bone screw 1704a, the second bone screw 1704b, the third bone screw 1704c and the fourth bone screw 1704d are shown extending from the proximal end toward the distal end in a converging pattern. In addition, in various embodiments, the first bone screw hole 1702a, the second bone screw hole 1702b, the third bone screw hole 1702c and the fourth bone screw hole 1702d can be conical, tapered and / or cylindrical, with or without a retaining lip, and can also allow approximately + / -9 degrees of relative freedom of movement. In various embodiments, in the retracted position, the vertical distance between the first bone screw hole 1702a and the third bone screw hole 1702b can be, for example, about 17 mm to about 25 mm, and in some embodiments, about 21.5 mm. Similarly, in various embodiments, in the retracted position, the vertical distance between the second bone screw hole 1702b and the fourth bone screw hole 1702d can be, for example, about 17 mm to about 25 mm, and in some embodiments, about 21.5 mm. In various embodiments, in the expanded position, the vertical distance between the first bone screw hole 1702a and the third bone screw hole 1702c can be, for example, about 20 mm to about 35 mm, and in some embodiments, about 27.5 mm. Similarly, in various embodiments, in the expanded position, the vertical distance between the second bone screw hole 1702b and the fourth bone screw hole 1702d can be, for example, about 20 mm to about 35 mm, and in some embodiments, about 27.5 mm.

[0254] Fig.74 1800 is a flow chart of an operating method 1800 for installing an expandable plate and an expandable implant between adjacent vertebrae of a patient. The various method steps below may be explained in the context of the various disclosed expandable plates 1500, 1600, and 1700. Although the various expandable plates 1500, 1600, 1700 and various spinal implants disclosed herein may be used to perform the operating method 18000, the operating method is not limited to the embodiments disclosed herein. In addition, the following steps need not be performed in order and may be performed in any alternating order with or without all of the disclosed method steps.

[0255] At step 1802, for example, an expandable plate and / or an expandable spinal implant may be provided. At step 1804, the end user may prepare the space between adjacent bone structures by removing and / or cleaning the space. For example, the end user may remove a degenerated intervertebral disc between an upper vertebra and a lower vertebra. At step 1806, the end user may insert a spinal implant between an upper vertebra and a lower vertebra. In some embodiments, the spinal implant and the expandable plate may be inserted into the patient's anatomical structure at the same time, although the spinal implant may be inserted into the intervertebral disc space between the upper vertebra and the lower vertebra, while the expandable plate remains on the outside of the intervertebral disc space. At step 1808, the end user may install at least one bone screw in the bone structure. For example, the end user may install a bone screw extending through the upper and / or lower portions of the expandable plate. In various embodiments, at least one bone screw may be partially installed, i.e., one screw may not be completely tightened into the patient's anatomical structure. At step 1810, the end user may expand the expandable plate and / or spinal implant. For example, the end user can insert the insert through the fixing screw of the expandable plate and activate the expansion mechanism inside the spinal implant to achieve the expansion of the spinal implant in the intervertebral disc space. In addition, the end user can move the upper part and / or the lower part to expand the expandable plate outside the intervertebral disc space. At step 1812, the end user can position a part of the expandable plate against the condyle ring. For example, the end user can ensure that the lip portion of at least one of the upper part and / or the lower part abuts the condyle ring of the corresponding vertebra. At step 1814, the end user can fully tighten any remaining bone screws to be installed. For example, the end user can tighten any remaining bone screws of the expandable plate and / or any remaining bone screws of the spinal implant.

[0256] Additional Expandable Embodiments

[0257] General reference Figures 75 to 90 , expandable spinal implants 310, 320, 330, and 340 are disclosed. Implants 310, 320, 330, and 340 may include the same, similar, and / or substantially the same components and functionality as other previously disclosed implant embodiments. Spinal implants 310, 320, 330, and 340 may also be used in combination with or as a substitute for any previously disclosed systems and methods. In many embodiments, implants 310, 320, 330, and 340 may include components and functionality that are the same, similar, and / or substantially the same as other previously disclosed implant embodiments. FIG. 32A to FIG. 35 In various embodiments, implants 310, 320, 330, and 340 can be configured for lateral, oblique, anterior-lateral, and other insertion techniques, although those skilled in the art will readily recognize that implants 310, 320, 330, and 340 can also be optimized and used for other surgical techniques.

[0258] Fig.75 is a front perspective view of expandable spinal implant 310, and Fig.76 310 is a rear perspective view of an expandable spinal implant 310. In an exemplary embodiment, the implant 310 may include a first end plate 110 (an upper end plate or a head side end plate) and a second end plate 120 (an lower end plate or a tail side end plate) that can be moved relative to each other via a moving mechanism 250. In some embodiments, the outer surfaces of the end plates 110 and 120 may have a substantially linear surface profile across the exposed surface of the end plates, and in other embodiments, the end plates 110 and 120 may have a curved surface profile across the surface of a textured, micro-textured or non-textured surface. Similar to what was previously explained, the implant 310 may include various profiles, guides, cavities, and other operable features that cooperate with the moving mechanism 250 to facilitate movement and / or provide mechanical advantages to other corresponding parts to facilitate expansion, contraction, angular adjustment, lateral bending, absorption of compression forces, shear forces, etc.

[0259] In an exemplary embodiment, the implant 310 can extend from the proximal end 101 to the distal end 102 in a proximal to distal direction. Similarly, for example, the implant 310 can extend in a width direction between the first lateral end 103 and the second lateral end 104. In various embodiments, the proximal end 101 can include an exposed screw guide end plate 105 that defines a corresponding screw guide hole 107 that is disposed between the end plates 110 and 120. The screw guide end plate 105 and the guide hole 107 can be the same or substantially the same as described above. Return to Reference Fig.53 , when the implant 310 is inserted into the intervertebral disc space, the implant 310 can extend, for example, in a coronal plane in a direction from the proximal side to the distal side. Therefore, in some embodiments, the implant 310 can be referred to as a "coronary expandable implant."

[0260] Fig.77 is a first exploded component view of implant 310, and Fig.78310 from an alternative and substantially opposite perspective. In an exemplary embodiment, the first end plate 110 may include a pair of first proximal chamfers 114 and a pair of first distal chamfers 116 opposite the first proximal chamfers 114. Each chamfer of the first proximal chamfers 114 may include an inclined surface extending away from the inner surface of the first end plate 110 and the moving mechanism 250. Although the exemplary embodiment illustrates a corresponding "pair" of proximal chamfers 114 and distal chamfers 116, other embodiments may include at least one proximal chamfer 114 and at least one distal chamfer 116, such as a single proximal chamfer 114 and a single distal chamfer 116. Each chamfer of the first distal chamfer 116 may include an inclined surface extending away from the inner surface of the first end plate 110 and the moving mechanism 250. Similarly, the second end plate 120 may include a pair of second proximal chamfers 124 and a pair of second distal chamfers 126 opposite the second proximal chamfers 124. Each of the second proximal bevels 124 may include an inclined surface extending away from the inner surface of the second end plate 120 and the moving mechanism 250. Each of the second distal bevels 126 may include an inclined surface extending away from the inner surface of the second end plate 120 and the moving mechanism 250. Although the example embodiment illustrates a corresponding "pair" of proximal bevels 124 and distal bevels 126, other embodiments may include at least one proximal bevel 124 and at least one distal bevel 126, such as a single proximal bevel 124 and a single distal bevel 126. In various embodiments, the bevels 116, 114 of the upper end plate 110 may not (or may not) be vertically aligned with the bevels 126, 124 of the lower end plate 120.

[0261] As previously described, the moving mechanism 250 can be operably coupled to the top end plate 110 and the bottom end plate 120 in any suitable manner. In the illustrated embodiment, the moving mechanism 250 may include a support block 257 that rotatably supports the first and second fixing screws 252 and 254 that are threadably coupled to the first and second pushing portions 256 and 258, respectively. In an exemplary embodiment, the first and second pushing portions 256 and 258 may include an inclined surface 260. In various embodiments, the inclined surface 260 may be a lateral protrusion having a shape similar to a chamfered diamond that may simultaneously push against and / or directly contact the corresponding inclined surfaces of the first and second end plates 110 and 120. In an exemplary embodiment, the first and second pushing portions 256 and 258 may each include at least one grasping surface 261 in the form of an inclined protrusion that may be disposed within a corresponding guide wall 130 (also referred to as a channel 130). At least one advantage of this configuration may be that the gripping surface 261 and the guide wall 130 may facilitate the closure of the implant 310, i.e., reduce the vertical distance between the first end plate 110 and the second end plate 210. In an exemplary embodiment, each side end of the first push portion 256 and the second push portion 258 includes an upper gripping surface 261 and a lower gripping surface 261. In addition, in this embodiment, for example, since the lateral protrusion 259 is disposed in the vertical slot 359 of the end plates 110, 120, the support block 257 may be constrained and cannot move in the direction from the proximal side to the distal side. In this way, when the implant 310 expands and contracts, the support block 257 can slide vertically up and down in the vertical slot 359. In addition, in some embodiments, since the vertical slot 359 has a gap space and / or a chamfered end, the support block 257 can be tiltable during the expansion of the implant 310. In some embodiments, the screw guide housing 105 may include a support tang 106 that extends through an opening of the second push portion 258 and is coupled to the support block 257. In this way, movement of the second push portion 258 may not interfere with the position of the screw guide housing 105, and the screw guide housing 105 may be rigidly coupled to the support block 257, for example.

[0262] The first functional feature of the example moving mechanism 250 is that it can be further configured to equally increase and decrease the spacing between the top end plate 110 and the bottom end plate 120 at the proximal end 101 and the distal end 102 when the first set screw 252 and the second set screw 254 are rotated simultaneously. This type of expansion can be referred to as "parallel" expansion and / or "parallel" dispersion. The second functional feature of the moving mechanism 250 is that it can be further configured to increase and decrease the tilt angle between the top end plate 110 and the bottom end plate 120 at the proximal end 101 when the first set screw 252 is rotated in the clockwise direction and the counterclockwise direction, respectively. The third functional feature of the moving mechanism 250 is that it can be further configured to increase and decrease the tilt angle between the top end plate 110 and the bottom end plate 120 at the distal end 102 when the second set screw 254 is rotated in the clockwise direction and the counterclockwise direction, respectively. Therefore, the moving mechanism 250 can be considered to have at least three different expansion modes, and each mode can be executed independently of the other modes.

[0263] Fig.79 is a top view showing various cross-sectional lines taken through the implant 310. Cross-sectional line A1 may extend lengthwise through the center of the implant 310 in a proximal to distal direction. In some embodiments, cross-sectional line A1 may be coextensive and / or coaxial with the axis of rotation of the first set screw 252 and the second set screw 254. Cross-sectional line A3 may extend lengthwise through a first side portion of the implant 310 corresponding to the location of the inclined surfaces 114, 116 in a proximal to distal direction. Similarly, cross-sectional line A4 may extend lengthwise through a second side portion of the implant 310 corresponding to the location of the inclined surfaces 124, 126 in a proximal to distal direction.

[0264] Fig.80 is through Fig.79 14. In the example embodiment, the inclined surface 260 of the push portion 256 is similar to a chamfered diamond that can act on the corresponding inclined surface of the inclined surface 116. Similarly, the inclined surface 260 of the push portion 258 is similar to a chamfered diamond that can act on the corresponding inclined surface of the inclined surface 114. In addition, the grasping surface 261 is slidably disposed in the guide wall 130. In addition, the lateral protrusion 259 can be disposed in the vertical slot 359.

[0265] Fig.81 is through Fig.7925. In an example embodiment, the first set screw 252 and the second set screw 254 are rotatably coupled to the support block 257 so that the first set screw 252 and the second set screw 254 can be constrained from moving in the proximal to distal direction. In this way, the rotation of the set screw 252 can independently move the pusher 256, and the rotation of the set screw 242 can independently move the pusher 258.

[0266] Fig.82 is through Fig.79 In an exemplary embodiment, the first distance between section A4 and section A1 may be slightly smaller than the second distance between section A3 and section A1. Fig.82 The cross-sectional view shows the upper gripping surface 261 (rather than Fig.80 The lower gripping surface 261 shown in FIG. Fig.80 The chamfered diamond portion shown is a portion of the inclined protrusion 260 having a different cross-sectional shape. However, it should be understood that in various embodiments, the geometry of the inclined surface 260 of each pusher 256, 258 may include a geometry corresponding to both sections A4 and A3 or to either section A4 or A3. Fig.82 , the upper end of the inclined surface 260 of the push portion 256 may act on the corresponding inclined lower surface of the inclined surface 126. Similarly, the upper end of the inclined surface 260 of the push portion 258 may act on the corresponding inclined lower surface of the inclined surface 124. In addition, the upper catch surface 261 may be slidably disposed in the guide wall 130. In addition, the lateral protrusion 259 may be disposed in the vertical slot 359.

[0267] Fig.83850 is a front perspective view of an expandable spinal implant 320 including a proximal plate 850. The implant 320 may have the same, similar and / or substantially the same features and functions as described above with respect to the implant 310. Therefore, repeated descriptions will be omitted or only briefly described. In an exemplary embodiment, the implant 320 may include a proximal plate 850 that replaces the screw guide end plate 105. The proximal plate 850 may be coupled to the support block 257 in the same, similar and / or substantially the same manner as explained above with respect to the screw guide end plate 105. In some embodiments, the proximal plate 850 may be rigidly coupled to the support block 257, and in other embodiments, the proximal plate 850 may be pivotally coupled to the support block 257 to allow some lateral movement and / or vertical movement. In addition, in some embodiments, the proximal plate 850 may be rotatably coupled to the support block 257 to allow relative movement of approximately + / -10 degrees in any direction. In addition, in various embodiments, the proximal plate 850 may not be directly coupled (directly contacted) to the end plates 110, 120. In this embodiment, the proximal plate 850 may include an upper bone screw hole 852 and a lower bone screw hole 851. In various embodiments, each bone screw hole 852, 851 may be configured to orient and support a bone screw in a target trajectory while allowing a certain angular deviation of the corresponding bone screw of about + / -5 degrees of relative movement in any direction. In an exemplary embodiment, the upper bone screw hole 852 and the lower bone screw hole 851 are vertically aligned and directed to a lateral side of the proximal plate 850. For example, the upper bone screw hole 852 and the lower bone screw hole 851 are offset toward the lateral side of the implant 320 relative to the rotation axis of the first fixing screw 252 and the second fixing screw 254.

[0268] In addition, each end plate 110, 120 may include a bone screw cutout 822 so that the target bone screw trajectory of the corresponding bone screw hole 851, 852 can prevent the corresponding bone screw from contacting the corresponding end plate 110, 120. In addition, the proximal plate 850 may include at least one bone screw lock 803. In an exemplary embodiment, the bone screw lock 803 can be rotated between an unlocked position, in which each of the bone screw holes 851, 852 is freely exposed, and a locked position, in which each of the bone screw holes 851, 852 is blocked (or at least partially blocked). In this embodiment, in the locked position, the bone screw lock 803 can be configured to simultaneously lock a first bone screw disposed in the upper bone screw hole 852 and a second bone screw disposed in the lower bone screw hole 851. For example, the bone screw lock 803 includes a first wing 804 and a second wing 805 opposite the first wing 804. In addition, in some embodiments, the wings 804, 805 can be at least partially flared outward in a direction from the proximal side to the distal side. At least one advantage of this configuration may be that such geometry of the wings 804, 805 provides a stop surface (or face) that extends in a direction substantially perpendicular to the target trajectory of the corresponding bone screw holes 852, 851. For example, the rear surface defined by the wing 804 may extend or at least partially extend in a first plane substantially perpendicular to the bone screw trajectory defined by the upper bone screw trajectory 852. Similarly, the rear surface defined by the wing 806 may extend or at least partially extend in a second plane substantially perpendicular to the bone screw trajectory defined by the lower bone screw trajectory 851. However, in other embodiments, the proximal plate 850 may include a first bone screw lock 803 configured to lock a first bone screw disposed in the upper bone screw hole 852 and a second bone screw lock 803 configured to lock a second bone screw (not illustrated) disposed in the lower bone screw hole 851. In addition, in various embodiments, the bone screw lock 803 may include a drive feature 809 disposed between the first wing 804 and the second wing 806. Thus, the end user can utilize any corresponding drive tool (e.g., hexagonal, torx, torx, square, polygonal, etc.) to rotate the bone screw lock 803. In at least one embodiment, the drive feature 809 can be driven by the same drive tool that rotates the set screws 252, 254.

[0269] Fig.84 is in the partially expanded first position Fig.83 . In the exemplary configuration, it can be seen that the distal end 102 is expanded and the proximal end 101 is collapsed. For example, the pusher 256 has moved distally to expand the distal end 102, while the pusher 258 has remained stationary and / or substantially stationary.

[0270] Fig.85is in a partially expanded second position Fig.83 . In the exemplary configuration, it can be seen that the proximal end 101 is expanded and the distal end 102 is collapsed and / or semi-collapsed. For example, the pusher 258 has moved proximally to expand the proximal end 101, while the pusher 256 has remained stationary and / or substantially stationary.

[0271] Fig.86 is in the fully expanded position Figure 83 to Figure 85 Front perspective view of an embodiment of the present invention. Fig.87 yes Fig.86 100 is a partial component diagram of an embodiment of the present invention, wherein the upper end plate 110 is removed for ease of understanding. In the example configuration, it can be seen that the proximal end 101 and the distal end 102 are each expanded. For example, the pusher 258 has been moved proximally to expand the proximal end 101, and the pusher 256 has been moved distally to expand the distal end 102.

[0272] Fig.88 and Fig.89 3 are various front perspective views of an expandable spinal implant 330. The spinal implant 330 may have the same, similar and / or substantially the same components and functions as described above with respect to the spinal implant 310. Therefore, repeated descriptions will be omitted. In an exemplary embodiment, it can be seen that a first height H1 between the outer surface of the upper end plate 110 and the outer surface of the lower end plate 120 on the first lateral side 103 is greater than a second height H2 between the outer surface of the upper end plate 110 and the outer surface of the lower end plate 120 on the second lateral side 104. At least one advantage of this configuration may be that when the implant 330 is inserted into the intervertebral disc space from a lateral angle, it can provide additional correction of the intervertebral disc space. For example, depending on the selected insertion side, the implant 330 can provide additional kyphosis correction or lordosis correction.

[0273] Fig.90310 is a top view comparison diagram of expandable spinal implant 340 and expandable spinal implant 310. Spinal implant 340 may have the same, similar and / or substantially the same parts and functions as described above with respect to spinal implant 310. Therefore, repeated description will be omitted. In the exemplary embodiment, it can be seen that the first length L1 of implant 340 in the direction from the proximal to the distal side may be relatively greater than the second length L2 of implant 310. Therefore, it should be understood that various implants according to the principles of this specification may have various lengths, widths, heights, etc. to be suitable for the anatomical structure of a specific patient in view of any specific surgical technique. For example, some lateral embodiments may be relatively long to accommodate different parts of the spine and / or patients of different sizes. It should also be understood that the various parts, features and functions of any specific implant embodiment disclosed herein may be substituted, modified and / or replaced with any other parts, features or functionality of any other specific implant embodiment, unless the context clearly indicates otherwise.

Claims

1. An expandable implant, the expandable implant being movable between a collapsed position and an expanded position, the expandable implant comprising: an expandable body having a length extending from a proximal end to a distal end in a proximal-to-distal direction, a width extending from a first lateral side to a second lateral side in a width direction, and a height extending from an upper end to a lower end in a vertical direction, the height being greater than the width; An upper end plate, the upper end plate comprising a first outer surface and a first inner surface opposite to the first outer surface, the first inner surface comprising a first proximal inclined surface and a first distal inclined surface arranged opposite to the first proximal inclined surface; A lower end plate, the lower end plate comprising a second outer surface and a second inner surface opposite to the second outer surface, the second inner surface comprising a second proximal inclined surface and a second distal inclined surface arranged opposite to the second proximal inclined surface; A moving mechanism for expanding the upper end plate and the lower end plate, the moving mechanism comprising: a support block coupled to the upper end plate and the lower end plate, the support block rotatably supporting a proximal fixation screw and a distal fixation screw along a rotation axis extending parallel to the proximal-to-distal direction; a proximal push portion movably coupled to the proximal set screw, the proximal push portion comprising a first upper inclined surface and a first lower inclined surface; and a distal push portion movably coupled to the distal fixation screw, the distal push portion comprising a second upper inclined surface and a second lower inclined surface; in: In the retracted position, the proximal push portion and the distal push portion are disposed in an intermediate position within the expandable body, In the first expanded position, the proximal push portion is disposed proximal to the expandable body, and a spacing between the upper end plate and the lower end plate at the proximal end is greater than a spacing between the upper end plate and the lower end plate at the proximal end in the collapsed position, In the second expanded position, a spacing between the upper and lower end plates at the distal end is greater than a spacing between the upper and lower end plates at the distal end in the collapsed position.

2. The expandable implant of claim 1, wherein the support block further comprises a first lateral protrusion movably disposed in the first slot of the upper end plate.

3. The expandable implant of claim 2, wherein the support block further comprises a second lateral protrusion movably disposed in a second slot of the inferior end plate.

4. The expandable implant of claim 3, wherein the first post and the second post extend in substantially opposite directions.

5. The expandable implant of claim 1, wherein: The first inner surface of the upper end plate further includes at least one guide wall; The proximal pushing portion includes at least one grasping surface, and each grasping surface of the proximal pushing portion is respectively disposed in the guide wall.

6. The expandable implant of claim 5, wherein: The second inner surface of the lower end plate further comprises at least one guide wall; The distal pushing portion includes at least one grasping surface, and each grasping surface of the distal pushing portion is respectively disposed in the guide wall.

7. The expandable implant of claim 1, wherein: The first inner surface of the upper end plate further includes a proximal guide wall and a distal guide wall, The proximal guide wall is adjacent to the first proximal ramp and is inclined in substantially the same orientation as the first proximal ramp, and The distal guide wall is adjacent to the first distal bevel and is inclined in substantially the same orientation as the first distal bevel.

8. The expandable implant of claim 1, wherein in the first expanded position, the proximal push portion contacts the first proximal chamfer and the second proximal chamfer and is disposed proximate to the proximal side.

9. The expandable implant of claim 8, wherein in the second expanded position, the distal push portion contacts the first distal bevel and the second distal bevel and is disposed proximate to the distal side relative to the intermediate position.

10. The expandable implant of claim 1, wherein: The proximal set screw and the distal set screw are coaxially aligned in the proximal to distal direction along the length of the expandable body, and A screw adjustment hole extends through the proximal push portion, the proximal set screw, the support block, and the distal set screw.

11. The expandable implant of claim 1 , further comprising a proximal plate including at least one bone screw hole defining a bone screw trajectory.

12. The expandable implant of claim 11, wherein the proximal plate further comprises at least one rotatable bone screw lock having at least one wing, each wing comprising a surface extending in a plane substantially perpendicular to a corresponding bone screw trajectory.

13. The expandable implant of claim 12, wherein at least one of the superior endplate and the inferior endplate includes at least one bone screw release.

14. The expandable spinal implant of claim 1, further comprising a proximal plate including a first bone screw hole and a second bone screw hole.

15. The expandable spinal implant of claim 14, wherein the proximal plate includes a bone screw lock configured to at least partially block the first bone screw hole and the second bone screw hole.

16. The expandable spinal implant of claim 15, wherein the superior end plate includes a first bone screw release and the inferior end plate includes a second bone screw release.

17. The expandable spinal implant of claim 1, wherein at least one of the superior endplate and the inferior endplate is concave in the proximal to distal direction.

18. The expandable spinal implant of claim 1, wherein at least one of the superior endplate and the inferior endplate is concave in the width direction.

19. A spinal implant capable of being inserted laterally, the spinal implant comprising: an expandable body having a length extending from a proximal end to a distal end in a proximal-to-distal direction, a width extending from a first lateral side to a second lateral side in a width direction, and a height extending from an upper end to a lower end in a vertical direction, the height being greater than the width; The upper end plate comprises a first outer surface and a first inner surface opposite to the first outer surface, the first inner surface comprises a first proximal inclined surface and a first distal inclined surface arranged opposite to the first proximal inclined surface; The lower end plate comprises a second outer surface and a second inner surface opposite to the second outer surface, the second inner surface comprises a second proximal inclined surface and a second distal inclined surface arranged opposite to the second proximal inclined surface; a support block coupled to the upper and lower end plates, the support block having a proximal screw guide and a distal screw guide opposite the proximal screw guide, the proximal screw guide defining a first rotation axis and the distal screw guide defining a second rotation axis, the first and second rotation axes extending in the proximal-to-distal direction; a proximal set screw and a distal set screw, the proximal set screw being rotatably supported by the proximal screw guide and the distal set screw being rotatably supported by the distal screw guide; a proximal push portion and a distal push portion, the proximal push portion being coupled to the proximal fixation screw and comprising a first upper inclined surface and a first lower inclined surface, the distal push portion being coupled to the distal fixation screw and comprising a second upper inclined surface and a second lower inclined surface, in: The proximal pushing portion is coupled to the proximal fixing screw and is movable toward and away from the proximal end of the expandable body in the proximal-to-distal direction by rotation of the proximal fixing screw along the first rotation axis, and the distal pushing portion is coupled to the distal fixing screw and is movable toward and away from the distal end of the expandable body in the proximal-to-distal direction by rotation of the distal fixing screw along the second rotation axis, wherein the proximal pushing portion and the distal pushing portion are configured to simultaneously disperse the upper end plate and the lower end plate in a parallel manner when the proximal fixing screw and the distal fixing screw are simultaneously rotated in a first direction, and to simultaneously contract the upper end plate and the lower end plate in a parallel manner when the proximal fixing screw and the distal fixing screw are simultaneously rotated in a second direction opposite to the first direction, wherein the proximal fixing screw is configured to push the proximal pushing portion toward the proximal end of the expandable body in the direction from proximal to distal when the proximal fixing screw is independently rotated in the first direction, thereby dispersing the upper end plate and the lower end plate at the proximal end of the expandable body, and wherein the distal fixing screw is configured to push the distal pushing portion toward the distal end of the expandable body in the direction from proximal to distal when the distal fixing screw is independently rotated in the first direction, thereby dispersing the upper end plate and the lower end plate at the distal end of the expandable body.

20. A spinal implant configured for a lateral insertion surgical technique, the spinal implant comprising: an upper end plate and a lower end plate, the upper end plate and the lower end plate extending in a proximal to distal direction, the upper end plate comprising: a first outer surface and a first inner surface opposite the first outer surface, the first outer surface including at least one bone screw release, and the first inner surface including a plurality of first guide walls, a first proximal end and a first distal end opposite the first proximal end, a first proximal chamfer and a first distal chamfer disposed opposite the first proximal chamfer, and a first lateral surface and a second lateral surface opposite the first lateral surface, the first lateral surface and the second lateral surface extending between the first proximal end and the first distal end; A lower end plate, the lower end plate comprising: a second outer surface and a second inner surface opposite the second outer surface, the second outer surface including at least one bone screw release, and the second inner surface including a plurality of second guide walls, a second proximal end and a second distal end opposite the second proximal end, a second proximal chamfer and a second distal chamfer disposed opposite the second proximal chamfer, and a third lateral surface and a fourth lateral surface opposite the third lateral surface, the third lateral surface and the fourth lateral surface extending between the second proximal end and the second distal end; a proximal plate comprising a plurality of bone screw holes and a central hole; a moving mechanism operably coupled to the proximal plate, the upper end plate, and the lower end plate, the moving mechanism comprising: a support block and a first push portion and a second push portion disposed on opposite sides of the support block, a rotatable first set screw and a rotatable second set screw opposite to the first set screw, the first set screw and the second set screw being configured to rotate in a first rotational direction and a second rotational direction about a rotational axis protruding in a direction substantially parallel to the length of the expandable body, wherein the proximal plate is directly connected to the support block; wherein the first pushing portion is operably coupled to the first fixing screw and is movable toward and away from the support block in the proximal-to-distal direction by rotation of the first fixing screw along the rotation axis, and the second pushing portion is operably coupled to the second fixing screw and is movable toward and away from the support block in the proximal-to-distal direction by rotation of the second fixing screw along the rotation axis, wherein the first pushing portion includes a first side surface and a second side surface opposite to the first side surface and has a plurality of first protrusions protruding from the first side surface and the second side surface, and the second pushing portion includes a third side surface and a fourth side surface opposite to the third side surface and has a plurality of second protrusions protruding from the third side surface and the fourth side surface, wherein the plurality of first protrusions and the plurality of second protrusions correspond to the cross-sectional shapes of the plurality of first guide walls and the plurality of second guide walls and are operably coupled thereto, respectively, so that the plurality of first protrusions and the plurality of second protrusions move along the plurality of first guide walls and the plurality of second guide walls, respectively, wherein the moving mechanism is configured to operably adjust the spacing between the upper end plate and the lower end plate when the first fixing screw and the second fixing screw are rotated simultaneously along the rotation axis, and The moving mechanism is configured to operably adjust an inclination angle between the upper end plate and the lower end plate when either the first fixing screw or the second fixing screw is rotated along the rotation axis.

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