Sleeve for an implant screw and implant screw with a sleeve

Abstract

Disclosed are a sleeve (2) for a body (6) of an implant screw (1), particularly for spinal surgery, and an implant screw (1) with a body / tulip (6) onto which the sleeve (2) can be placed and secured, for example, by means of a snap connection. The sleeve (2) serves as a defined attachment (16, 20) for a compression instrument or for a distraction instrument, or the sleeve (2) has at least one such attachment (16, 20). According to a first principle, four nose-shaped attachments (16) and further attachments (20) spaced apart along a central axis can be provided. Or, according to a second principle, the sleeve (2) has inclined, e.g., flattened regions (19), so that free spaces are created on the outer circumference of the sleeve (2), which allow the forceps (12) to approach the central axis (11) of the sleeve (2) and the body (6) in an inclined position.

Description

Technical area

[0001] The present disclosure relates to a (mounting) sleeve for placement on a (pivoting) connecting part, referred to as the body / tulip, of a polyaxial implant screw / pedicle screw, in particular for a spinal stabilization system. In particular, the present disclosure relates to a sleeve-shaped mounting aid which, according to an independent aspect of the disclosure, is intended and configured to be placed / snapped / screwed onto the tulip of a pedicle screw (in a rotationally and / or tilt-proof manner), for example, during an open or minimally invasive surgery, in order to facilitate (manual) alignment of the tulip and to ensure the secure insertion / screwing of a grub screw (setscrew) into the tulip to fix its position and lock a connecting / coupling rod already inserted into the tulip.

[0002] Furthermore, according to another independent aspect of the disclosure, the (assembly) sleeve or the sleeve-shaped assembly aid is provided and designed so that the tulip aligns itself (automatically pivoting) relative to the pedicle screw, in particular during distraction and / or compression maneuvers of two adjacent vertebrae (K / D) by means of a distraction and / or compression instrument, for which purpose the assembly aid is provided or designed with at least one defined contact point / contact area for the distraction and / or compression instrument, which is placed on the assembly aid in such a way that the introduction of a (radial) force, for example a distraction or compression force, into the sleeve-shaped assembly aid there creates (forces) a pivoting / tilting of the tulip (together with the assembly aid) with respect to the screw shaft. Background of the invention

[0003] Spinal stabilization systems are primarily used for dorsal stabilization of the spine, for example, in cases of fractures, tumors, inflammation, deformities, and degenerative instabilities using transpedicular screw fixation. Pedicle screws, for example, are placed (screwed) into the pedicles of adjacent vertebrae, creating an angle-stable connection between the pedicle screws of two adjacent vertebrae via a coupling rod extending along the spine. The pedicle screws and the coupling rod thus form a vertebral stabilization system (rigid framework). Implant screws for a spinal stabilization system can also be used in the sacrum or ilium region.

[0004] Pedicle screws are inserted by a surgeon into the pedicle canal of a vertebra and anchored by screwing. The surgeon aligns the pedicle screws individually for each patient based on the orientation of the pedicle canal. Once the pedicle screws are in place, the aforementioned coupling rod of the correct length is selected and, if necessary, its curvature is adjusted to suit the pedicle screws and their respective positions. However, since the pedicle screws are aligned differently depending on the respective pedicle canal, they usually have a pivoting tulip on the head of the pedicle screw into which the coupling rod is inserted. The tulip can be pivoted to adjust the orientation. State of the art

[0005] A basic distinction is made between monoaxial and polyaxial implant screws (pedicle screws). In the case of a monoaxial implant screw, the externally threaded shaft and the tulip (hereinafter also referred to as the body) are firmly connected or formed as a single piece. However, these monoaxial implant screws have the disadvantage that the coupling rod is difficult to insert into the rigid tulips or bodies of the implant screws to be coupled and can be held securely there.

[0006] The polyaxial implant screw concerned by the invention, however, has a mostly spherical or (semi-)spherical joint head on its externally threaded shaft / pedicle screw shaft, which is encompassed by the (hollow cylindrical) body or tulip, manufactured as a separate component, in a relatively pivotable manner and which is engaged behind in the transition area between the shaft head and the externally threaded shaft. This forms a ball or hinge joint between the externally threaded shaft and the body / tulip. The body / tulip also has a U-shaped longitudinal slot into which the coupling rod can be inserted transversely to the tulip's central axis. Due to the joint between the pedicle screw shaft and the tulip, the body / tulip can, for example,In the pedicle canal of a vertebra or in the ilium or sacrum, it can be pivoted and / or rotated relative to the stem head to achieve a desired position and orientation of the U-shaped longitudinal slot, essentially independent of the orientation of the externally threaded shaft. The undercut on the tulip prevents the body / tulip, and thus the coupling rod held to it or inserted into the longitudinal slot, from being pulled (axially) off the stem head. Finally, the tulip has an internal thread on the inside into which a grub screw is screwed, which rests against the inserted coupling rod.

[0007] Such polyaxial implant screws facilitate the surgeon's insertion / introduction / implantation of the coupling rod into the body. Once the surgeon is satisfied with the position of the coupling rod and the body, the body is fixed in position to the stem head using a setscrew / grub screw with the coupling rod positioned between them as a screw force transmission element (single-screw principle) or with an additional screw / nut between the body and the coupling rod (multi-screw principle).

[0008] DE 10 2016 108 504 A1, which originates from the applicant, discloses a polyaxial pedicle screw whose body / tulip, which can pivot relative to the externally threaded shaft, has two diametrically opposed, axially extending body sections (or flanks, or tulip petals) that form the U-shaped longitudinal slot between them, into which the coupling rod is inserted. On the inside of the (hollow-cylindrical) body, or on the inside of the opposing flanks, an internal thread is formed, into which the setscrew is screwed after the coupling rod has been inserted and positioned together with the body. More precisely, the setscrew is designed as a grub screw that is screwed into the body by means of two partial threads of the two body sections.

[0009] However, inserting the set screw carries the risk of it being placed at an angle and jamming, which at best wastes time and at worst damages the internal thread in the body / tulip. In the latter case, the entire implant screw must be replaced.

[0010] It is therefore already known from the state of the art to perform open or minimally invasive surgery using (assembly) sleeves that are placed on the bodies / tulips in axial extension. Such (assembly) sleeves serve to simplify the alignment of the bodies and can facilitate the insertion / screwing in of the setscrew, as they already specify the screw axis and thus guide the setscrew externally. The sleeves can also serve as an axial counterholder by temporarily locking themselves to the body / tulip, at least in the axial direction, and simultaneously generating a clamping force between the stem head and the tulip via an internal screw mechanism, whereby the body / tulip can be provisionally (pre-)fixed to the stem head. The assembly sleeves can also support the body during compression or distraction maneuvers with appropriate forceps, but allow no or only limited angulation of the tulip relative to the forceps.

[0011] Another disadvantage is that the mounting sleeves of the state of the art must have a certain size due to the internal screw mechanism and therefore block / restrict the view of the implant screws and restrict the working area, e.g. when placing a cage between two vertebrae.

[0012] When distracting and compressing the bodies / tulips of two adjacent implant screws or implant screws of two adjacent vertebrae with forceps without additional assembly aids, situations can arise in which the body / tulip can no longer fit properly (firmly) against the coupling rod or is so inclined relative to the coupling rod that the forces required to correct the misalignment of the tulip cannot be applied by the setscrew. If the tulip is incorrectly aligned with the coupling rod, there is also the possibility that the setscrew will experience a tilting moment during tightening. In other words, the alignment (angular position) of the tulip in relation to the already inserted coupling rod can change during the process of distraction or compression of two adjacent vertebrae. If the grub screw is tightened in this state, it may press.at an oblique angle (i.e., off-center) against the coupling rod. This places a one-sided load on the internal thread in the tulip. This can lead to reduced locking force or even failure of the thread between the setscrew and the body, or to deformation of the body sections / flanks of the body and the setscrew popping out of the internal thread. Brief description of the invention

[0013] The object of the present disclosure is to create a mounting sleeve or sleeve-shaped mounting aid for an implant screw, in particular of a spinal stabilization system, which is / can be temporarily placed on the body (tulip) of the implant screw during surgery and which, in particular during distraction and compression processes (pushing apart or contracting two adjacent vertebrae), simultaneously effects (improved) alignment of the body (tulip) with respect to an already inserted coupling rod by means of appropriate forceps. Furthermore, another object of the present disclosure is to create a mounting sleeve or sleeve-shaped mounting aid for an implant screw, in particular of a spinal stabilization system, which can be easily and quickly mounted on the body (tulip) of the (polyaxial) implant screw.

[0014] This object is achieved by a mounting sleeve or sleeve-shaped mounting aid with the combination of features of claim 1 and / or by an arrangement / an implant screw set with such a mounting sleeve and with an implant screw, in particular for a spinal stabilization system(s), with the combination of features of claim 14.

[0015] According to one aspect of the present disclosure, the mounting sleeve according to the present disclosure is designed and configured for (frontal) placement or attachment and for fastening via an axial undercut, e.g., by snapping or using a bayonet lock, onto a pivoting body (tulip) of a polyaxial implant screw. For this purpose, the mounting sleeve has a coupling section for the (quickly) detachable coupling of the mounting sleeve to the body / tulip, e.g., in the form of a (sleeve-side) snap-in or click-in device, which is configured and designed for the detachable fixation of the sleeve to the body. The mounting sleeve according to the disclosure thus offers the advantage over the sleeves of the prior art that it can be quickly and easily placed on the body and fixed there (without tools and automatically locking), while requiring little space for the coupling section. This leaves more space for further surgical procedures, such as, for example,placing a cage between two adjacent vertebrae.

[0016] The mounting sleeve is designed to sit firmly on the body (tulip) until the connection is released (e.g. by actuating or moving the snap or click device on the sleeve side) and can also transmit larger leverage forces, such as the radial forces of a distraction or compression instrument acting on the tulip or the mounting sleeve, to the body without undesired relative movement of the mounting sleeve to the body.

[0017] According to another aspect of the disclosure, a predefined contact area (contact elevation), preferably in the form of at least one pair of contact projections or stops, e.g. for a distraction instrument and / or for a compression instrument, is formed or arranged on a sleeve jacket outer side of the mounting sleeve. In other words, the mounting sleeve has a predetermined, overlapping axial and circumferential area which projects / projects outwards in the radial direction beyond the sleeve jacket outer circumference (at (all) other areas of the mounting sleeve). The circumferential position of the contact area on the mounting sleeve is preferably selected such that the contact area (when the mounting sleeve is attached to the tulip) points in the longitudinal direction of the inserted coupling rod (i.e., in the coupling rod insertion direction).Furthermore, the axial position of the contact area on the mounting sleeve is preferably selected such that the contact area, when the mounting sleeve is attached to the tulip, is located in an axial section of the tulip facing the screw head (as close as possible to the screw head of the implant screw) and is preferably located axially between the screw head and the coupling rod.

[0018] According to a first principle, the abutments can each be formed as a projection (e.g., a nose or ledge) projecting radially outward from the outer side of the sleeve casing, and / or, according to a second principle, the abutments are simply formed by a first axial edge (axial front edge facing the screw head) of the mounting sleeve, whereas the outer side of the sleeve casing tapers (conical or pyramidal shape) from the first axial edge along a central axis of the mounting sleeve toward a second axial edge of the mounting sleeve (axial front edge facing away from the screw head). Of course, both principles can also be implemented in combination.

[0019] If, for example, a distraction instrument is applied to an implant screw (e.g. pedicle screw) with the mounting sleeve in place during a distraction procedure, the distraction instrument initially comes into contact with the (radially protruding) contact area of ​​the mounting sleeve due to the basic shape of the mounting sleeve as defined above, and there it introduces a radial force (distraction force) into the mounting sleeve. This force is transferred via the tulip and the implant screw shaft into the associated vertebra, which is consequently spaced apart from its neighboring vertebra. Depending on its original orientation (automatic / self-acting), the tulip undergoes a tilting movement around the screw head towards the distraction instrument, whereby it aligns itself essentially perpendicular to the already inserted coupling rod.Now the grub screw can be tightened and the position of the tulip and coupling rod can be fixed without causing the internal thread of the tulip to fail.

[0020] The aforementioned tilting movement of the tulip toward the distraction instrument results almost inevitably from the translational movement of the corresponding vertebra. This means that if one vertebra is moved away from its neighboring vertebra along the already inserted coupling rod using the distraction instrument, the tulip can pivot around the screw head or align itself with the coupling rod, since the tulip or the mounting sleeve does not rest extensively against the distraction instrument due to the contact area (point-shaped or linear radial projection) designed as disclosed.

[0021] The further (in the first principle) the projections (e.g. noses) protrude radially or the stronger (in the second principle) the taper is, the further the mounting sleeve and thus the body (tulip) can pivot around the screw head towards the distraction or compression instrument.

[0022] In the case of the projection-shaped supports (first principle), the two supports of each pair are preferably arranged at such a circumferential distance from one another and / or protrude so far from the outer surface of the sleeve shell that an imaginary straight line connecting the radially outermost points of the two supports does not intersect the outer surface of the sleeve shell. Furthermore, the mounting sleeve preferably has two diametrically opposed axial slots (corresponding to the axial slots in the tulip for receiving the coupling rod), with the two supports of a pair being positioned circumferentially on either side of one axial slot (i.e., a total of two supports) or on either side of both axial slots (i.e., a total of four supports).

[0023] In the case of the tapering of the sleeve shell outer surface (second principle), the above-mentioned four systems on both sides of both axial slots at the circumferential edge with the largest radius are formed almost inevitably. The mounting sleeve can take the shape of a hat or a cap.

[0024] Particularly in the case of a combination of the two principles described above, the tapering of the mounting sleeve can also be formed only in a circumferential area axially directly above the two (nose-shaped) contact projections, whereas the remaining circumferential areas of the mounting sleeve can deviate from this, e.g., be cylindrical. The tapering or tapered circumferential section can also be conical (i.e., circumferentially curved) or pyramid-shaped (i.e., flat).

[0025] The mounting sleeve usually has the above-mentioned first circumferential end edge, which is intended to face the implant screw or its external thread shaft. The body (tulip) is inserted at least partially into the mounting sleeve through this first edge when the mounting sleeve is placed onto the body. Accordingly, the two preferably U-shaped coupling rod recesses or bulges / axial slots, which are diametrically opposite one another with respect to the central axis and are designed to pass through or receive the coupling rod in a transverse direction to the central axis, are formed on this first edge and extend axially from the first edge. The further this axial extension is, i.e. the deeper these coupling rod recesses or bulges are, the further the body (tulip) can penetrate axially into the mounting sleeve, and the further the first edge can approach the external thread shaft orapproach the screw head of the implant screw when the mounting sleeve is placed on the body (tulip).

[0026] This allows the contact areas of the mounting sleeve to be positioned further toward the screw head, or more precisely, closer to the shaft head. This offers advantages during compression and distraction maneuvers, as the tilting moment of the mounting sleeve and the body firmly connected to it, resulting from the radial force introduction, is reduced relative to the externally threaded shaft.

[0027] In particular, if the at least one pair of attachments is arranged or formed on the first edge of the mounting sleeve, the attachments can be positioned near the externally threaded shaft, or more precisely, near the implant screw head. This offers advantages during compression and distraction maneuvers, as the tilting moment of the mounting sleeve and the body firmly connected to it relative to the externally threaded shaft is reduced.

[0028] Preferably, a pair of abutments or a pair of stops are provided on diametrically opposed circumferential sections of the mounting sleeve, as already indicated above. Then, during the operation, the mounting sleeve can be acted upon by both the distraction instrument and the compression instrument. This development is referred to in this document as a double mounting sleeve.

[0029] In one embodiment of the doubled mounting sleeve, a contact point is provided on the first edge, viewed in the circumferential direction, on each side of the two coupling rod recesses (axial slots) or bulges. The two contact points of each pair preferably limit the respective coupling rod recess or bulge on both sides. This evens out the forces on the mounting sleeve during distraction and / or compression maneuvers with the corresponding forceps.

[0030] In another embodiment of the double mounting sleeve, the contact points of the two contact pairs, and consequently also the first edge along the central axis, are positioned closer to the screw head than the coupling rod. This minimizes the tilting moment of the mounting sleeve and the body (tulip) firmly connected to it relative to the externally threaded shaft.

[0031] In the embodiment of the doubled mounting sleeve with a tapered outer surface of the sleeve shell (second principle), this tapered surface is formed by the outer surface of the sleeve shell having a conical or truncated cone shape. Alternatively, flat sides or axially extending outer bevels are provided or formed on two regions of the outer surface of the sleeve shell that are diametrically opposed to each other with respect to the central axis, which preferably result in a trapezoidal shape when viewed in a longitudinal section of the mounting sleeve.

[0032] The flat sides or external slopes (second principle) can extend from the first edge and / or from the respective pair of attachments.

[0033] In the embodiment of the doubled mounting sleeve, the flat sides or outer bevels extend to a second front edge which is axially opposite the first edge, wherein the flat sides or outer bevels converge towards each other in the direction of the second front edge and thereby form the taper.

[0034] Further preferably, each abutment / the abutment arrangement (the abutment) is shaped depending on the pliers used and, in the first principle, forms a radially outwardly extending, preferably nose-shaped projection which projects furthest radially in the region of the tulip-facing end face of the sleeve and has an axial nose bridge running continuously back to the outside of the sleeve.

[0035] In one particularly preferred embodiment, a pair of attachments is provided on each of the sleeve regions opposite one another with respect to a central axis (double mounting sleeve). If these attachment pairs are identical on the two diametrically opposed circumferential regions of the mounting sleeve, the sleeve offers the advantage of a similarly reduced risk of slipping in two different positions rotated 180 degrees to one another. However, if these two attachment pairs or attachment arrangements are unequal on the two diametrically opposed regions of the sleeve, one circumferential region of the sleeve can be designed and optimized for a distraction instrument, while the other circumferential region can be designed and optimized for a compression instrument.

[0036] Preferably, at least one abutment is provided or formed on a first edge of the sleeve which runs around a central axis of the sleeve and faces the implant screw or its external thread shaft.

[0037] In one embodiment of the mounting sleeve, the two coupling rod recesses already mentioned, which are diametrically opposite one another with respect to the central axis (preferably arcuate, e.g. semicircular), are provided on the first edge. In this case, the sleeve can be pushed / slid onto the body comparatively far along or in the direction of the central axis, so that, for example, a secure hold is created. Furthermore, this makes it possible for the attachments to be moved far towards the implant screw head or ultimately to be positioned and fixed close to the screw head. By pushing or sliding the sleeve onto the body / tulip in this way, a large-area support system is possible between the outer walls of the tulip sections and the inner supporting walls of the sleeve, in order to mechanically support the body sections.

[0038] If, in the second principle, conical outer wall sections or outer bevels are provided on two areas of the outer side of the sleeve jacket that are opposite one another with respect to the central axis and extend to a second edge that is axially opposite the first edge, the sleeve can have a cap-like or hat-like shape. The sleeve can therefore also be referred to as a cap. In other words, the outer side or the sleeve jacket can have trapezoidal flat sides that taper towards one another. This makes it easier to bend the sleeve and thus the body / tulip towards the coupling rod and / or the pliers. For this purpose, the body / tulip can tilt with the sleeve, whereby the adjacent conical outer wall section or the adjacent outer bevel or the adjacent flat side of the corresponding pliers approaches and can even come into contact with it.

[0039] In other words, in the second principle, the sleeve preferably has inclined and preferably flattened areas, so that free spaces are created on the outer circumference of the sleeve, which allow the pliers to approach the central axis of the sleeve and the body / tulip in an inclined position and, in a borderline case, come into contact with all the systems of the system arrangement.

[0040] In order to define the pivoting between the pliers and the mounting sleeve, it is particularly preferred if at least one additional pair of abutments for the pliers is formed or arranged in the region of the second (small-diameter) edge (opposite the first, large-diameter edge). This allows at least two axially opposite abutment arrangements to be created, each having one or two pairs of abutments.

[0041] An axially extending instrument opening for the passage of a screwdriver for a setscrew (setscrewdriver) and / or a counterholder can be provided on a region of the sleeve opposite the first edge and / or facing away from the externally threaded shaft. The instrument opening can be enclosed by the second edge.

[0042] On the second edge of the mounting sleeve, which can also be referred to as the edge facing away from the implant screw or its externally threaded shaft, preferably conical (funnel-shaped) insertion sections or (internal) insertion chamfers for the setscrew are formed. Alternatively or additionally, guide surfaces, preferably as partial circular cylindrical surfaces, for the setscrew can be formed on an inner side of the mounting sleeve. Both designs facilitate or enforce coaxial insertion of the setscrew along the central axis of the mounting sleeve, which coincides with the central axis of an internal thread of the body / tulip for the setscrew when the mounting sleeve is placed on the tulip.

[0043] In a simple manufacturing design, a sleeve-side snap-in device is formed by at least one spring tab / spring tongue (preferably two opposing spring tabs). In a specific design, one or both spring tabs extend axially from the second edge (spring tongue root) toward the first edge (free spring tongue tip).

[0044] The spring tab(s) can be arranged in a space-saving manner in a (respective) through-hole of the mounting sleeve, which then preferably extends together with the spring tab from the second edge in the direction of the first edge.

[0045] A contact / locking engagement surface for engaging behind the body / tulip is preferably arranged or formed on a free end portion of the at least one spring tab. A spring tab actuating portion (on the spring tab), for example in the form of radially inwardly projecting projections, can be arranged or formed between the second edge and the contact surface. The spring tab can be forced outward away from the central axis, for example by axially inserting an expanding wedge into the sleeve, in order to release the released mounting sleeve from the body.

[0046] To release the snap connection of the mounting sleeve from the body, a groove can alternatively be provided on the inside of the sleeve, which extends in the circumferential direction of the sleeve and opens into the through-hole. The groove opens into the through-hole, viewed along a central axis of the sleeve, in the axial position or location that corresponds to that of the actuating section. The counterholder can then be rotated, with its at least one lug arranged on the outer circumference being moved through each groove and finally pressing against the actuating section from the inside. This forces the spring tab outwards, thus releasing or unlocking the sleeve from the body.

[0047] In a design that is simple in terms of manufacturing and application technology, the sleeve is rotationally symmetrical to the central axis and / or mirror-symmetrical to a central plane.

[0048] In particular, in the case of the above-mentioned symmetry, two coupling rod recesses for the coupling rod and / or two pairs of systems and / or two conical outer wall sections or outer bevels can be provided on opposite sides of the sleeve.

[0049] In particular, in the case of the above-mentioned symmetry, two spring tabs (preferably with respective through-holes) can be provided on opposite sides of the sleeve.

[0050] Particularly in the case of the above-mentioned symmetry, two grooves can be provided on opposite inner areas of the sleeve, into which the counter-holder with two opposing lugs can be screwed in a bayonet-like manner in order to release the sleeve from the body.

[0051] The assembly / implant screw set according to the disclosure has at least one implant screw with a body (tulip) that can pivot relative to an externally threaded shaft. The body has two opposing body sections (tulip petals), between which a coupling rod insertion opening is provided for receiving a coupling rod. Furthermore, the assembly / implant screw set has at least one previously described mounting sleeve, which can be temporarily or detachably fastened to the body / tulip (preferably by means of its snap-in device) and which at least partially encompasses the two body sections (tulip petals) on the outside. The design of the snap-in or click-in device and the shape of the body and the mounting sleeve are preferably coordinated such that the fixation of the sleeve to the body is effective in all six spatial axes.

[0052] Since at least one pair of attachments for a medical instrument, in particular for a distraction instrument and / or for a compression instrument, is preferably formed or arranged on the outside of the mounting sleeve, the body temporarily acquires an external shape for the duration of the sleeve being applied, particularly for distraction or compression maneuvers, which provides an optimized attachment arrangement for the corresponding forceps type or preferably both forceps types. This attachment arrangement, in interaction with the forceps, is metastable or stable, or even so form-fitting that slipping of the forceps relative to the body is prevented.

[0053] If the outer walls of the body / tulip sections and the inner support walls of the mounting sleeve are part-circular cylindrical and can be placed against each other or are in contact with each other, the sleeve is further developed into a support and stabilization sleeve. This prevents the two body tulip sections (tulip petals) from being forced apart radially outward, even when the setscrew is tightened / screwed against the coupling rod.

[0054] Preferably, respective recesses are formed on the mutually opposite outer walls of the body sections (tulip petals), into which a respective spring tab of the snap-in device of the sleeve can be or is snapped at least partially (in particular with its end section).

[0055] To ensure that the spring tab(s) can be pushed on and subsequently snapped into place as easily as possible, a clamping bevel is preferably provided for the associated spring tab, particularly for its end section. The respective clamping bevel is formed on the outer wall of the body section between a front side of the body section that is immersed or can be immersed into the sleeve and the recess of the body section.

[0056] The recess may (viewed along the center axis of the body) have a body-side contact surface axially adjacent to the clamping bevel, which is perpendicular to the center axis of the body.

[0057] The end section of the at least one spring tab can have an inner contact surface on the sleeve side, which is also perpendicular to the sleeve's central axis. This prevents the sleeve from being detached from the body without an instrument (e.g., the nose of the counterholder).

[0058] Alternatively, the end section of at least one spring tab has a sleeve-side contact surface that is angled to the center axis of the sleeve. Depending on the angle of this contact surface and the spring force of the spring tab, the sleeve can then be released from the body without the need for an additional instrument / tool.

[0059] The clamping slope and the recess of each body section can be formed in pairs, whereby a so-called male indentation can be formed on the outer wall of each body section, for example according to DE 10 2016 108 504 A1 mentioned in the introduction.

[0060] The central axis of the body coincides with the central axis of the sleeve when the sleeve is placed on the body and is at least temporarily fixed by means of the snap-in device.

[0061] The implant screw can be a pedicle screw, an ilium screw, a sacrum screw or an iliosacral screw, i.e. suitable for screwing into a pedicle, in the sacrum or ilium region. Short description of the characters Fig. 1 is a partial view of an assembly comprising a pedicle screw and a sleeve according to an embodiment of the present disclosure; Fig. 2 is the pedicle screw with the sleeve made of Fig. 1 with a coupling rod and with a pair of pliers shown only schematically in a first relative position; Fig. 3 is the pedicle screw with the sleeve with the coupling rod and with the only roughly schematically shown forceps made of Fig. 2 in a second relative position; Fig. 4 is a sectional view of the pedicle screw with the sleeve; Fig. 5 the pedicle screw with the sleeve is shown in Fig. 4 with a counterholder; Fig. 6 is the pedicle screw with the sleeve from the previous figures in a view of an instrument opening; Fig. 7 is a body of the pedicle screw with the sleeve from the previous figures in a view with a setscrew; and Fig. Figure 8 is a cross-section through the body and sleeve from the previous figures. Description of the embodiments

[0062] Hereinafter, an embodiment of the present disclosure will be described based on the accompanying figures.

[0063] Fig. 1 is a section of an implant screw designed as a pedicle screw 1 for a spinal stabilization system with a sleeve 2 according to an embodiment of the present disclosure in a view.

[0064] A pedicle screw 1 has a (only partially shown) externally threaded shaft 4, which extends along a (not shown) screw longitudinal axis and at the end shown a (in the Fig. 4 and Fig. 5) is formed, to which a body (tulip) 6 is mounted. The joint head 22 forms a joint with the body 6, so that the body 6 can pivot relative to the externally threaded shaft 4.

[0065] The body 6 forms a coupling rod insertion opening 8, which is designed to receive a coupling rod insertion opening 8 which is arranged transversely to a central axis 11 of the body 6 (in the Fig. 2 and Fig. 3) to receive and fix the coupling rod 10. The rod insertion opening 8 extends transversely to the central axis 11 through the body 6 and opens on both diametrically opposite sides of the body 6. Specifically, the body 6 is hollow-cylindrical with a peripheral wall that is longitudinally slit at diametrically opposite angular positions, resulting in the aforementioned insertion opening 8 extending transversely to the longitudinal direction of the body.

[0066] The rod insertion opening 8 is directed towards a point facing away from the external threaded shaft 4 (in Fig. 1) face of the body 6, so that the coupling rod 10 can be inserted into the rod insertion opening 8 from one face. In other words, the body 6 forms two notches / longitudinal slots in its peripheral wall, which are diametrically opposite with respect to the central axis 11 and extend from the face of the body 6 facing away from the externally threaded shaft 4 in the direction of the externally threaded shaft 4 to form the rod insertion opening 8.

[0067] The mounting sleeve 2 is compatible with the polyaxial pedicle screw 1 shown, which is known per se from the prior art. For this purpose, the sleeve 2 is precisely fitted or placed onto the pivoting body (tulip) 6 and secured to the body 6 with a detachable coupling, preferably a snap connection (but also a bayonet lock, screw connection, etc.), which in the preferred embodiment is formed by two diametrically opposed spring tabs 9, of which in Fig. 1 only one spring tab 9 is visible.

[0068] The bodies 6 and the sleeve 2 have a common central axis 11 when properly fitted and secured with the spring tabs 9.

[0069] The sleeve 2 has on its first (frontal) edge 13 facing the external thread shaft 4 two arcuate, preferably semicircular coupling rod recesses (longitudinal slots) 14, of which Fig. 1 only one coupling rod recess 14 is shown.

[0070] On the first edge 13, on both sides of each coupling rod recess 14, there is a nose-shaped installation 16 for a (in Fig. 2 and Fig. 3) is provided, wherein the two (forming a pair) attachments 16 are arranged on both sides of the coupling rod recess 14 along the (in Fig. 2 and Fig. 3) already inserted coupling rod 10. Since two diametrically opposed axial slots 14 are located on the first edge 13 in order to accommodate the coupling rod 10 transversely to the body 6 and thus transversely to the mounting sleeve 2, a pair of attachments 16 according to the above explanations are preferably arranged on each of the two axial slots 14.

[0071] Starting from a pair of attachments 16 or from the first edge 13 of the mounting sleeve, a respective outer bevel 19 extends axially to a second edge 18 of the mounting sleeve 2, which can also be referred to as the edge 18 facing away from the externally threaded shaft 4. These two outer bevels 19, which are diametrically opposite one another with respect to the central axis 11, can also be referred to as flattened portions on the outer circumference of the (cylindrical) mounting sleeve 2. The outer bevels 19 are inclined (tapering in a trapezoidal shape) in such a way that they converge toward the second edge 18.

[0072] In the area of ​​the second edge 18, two further abutments (contact surfaces / contact edges) 20 are provided on each outer bevel 19. The two further contact pairs 20 are not formed as lugs, but rather coincide with the respective outer bevels 19 and are delimited by a respective V-shape of the second edge 18. In other words, the contact pairs 20 form a substantially V-shaped notch on each outer bevel 19, which tapers to a point from the second edge 18 toward the first edge 13.

[0073] Fig. 2 and Fig. 3 show the pedicle screw 1 with the sleeve 2 and with the coupling rod 10 and with a forceps 12 (shown only schematically) in two different relative positions of the forceps 12 to the sleeve 2 and thus to the body 6. The sleeve 2 offers at least one pair of defined attachments 16 for both forceps types in both relative positions. If the forceps 12 (shown only schematically) is a compression instrument, Fig. 2 and Fig. 3 on the left side, another similar pedicle screw 1 with sleeve 2 is provided, which is inserted into the Fig. 2 and Fig. 3 is to be moved to the left in the direction of the shown pedicle screw 1. If the forceps 12 shown is a distraction instrument, Fig. 2 and Fig. 3 on the right side, another similar pedicle screw 1 with sleeve 2 is provided, which is inserted into the Fig. 2 and Fig. 3 should be moved to the right in the direction away from the shown pedicle screw 1.

[0074] At the first relative position according to Fig. 2, the forceps 12 transmits its force from right to left via initially only the pair of nose-shaped attachments 16, of which Fig. 2 only one attachment 16 is visible. This means that the vertebra (not shown) into which the implant screw 4 is screwed is Fig. 2 is shifted to the left. This results in a lateral displacement of the screw head or the joint 22 formed by the screw head, from which Fig. 2 and Fig. 3 only the pivot / screw head center axis is shown. The body 6 pivots together with the mounting sleeve 2 relative to the screw shaft 4 in order to automatically align itself essentially perpendicular to the inserted coupling rod 10. More precisely, the axis facing away from the external thread shaft 4 (in the Fig. 2 and Fig. 3 upper) end section of the mounting sleeve 2 against the shown branch of the affected forceps 12, if the (not shown) vertebra including the implant screw screwed into it is removed according to Fig. 2 is pressed to the left and a setscrew 24 already loosely screwed into the body 6 slides along the coupling rod 10.

[0075] In the second relative position according to Fig. 3, the pliers 12 transmit their force from right to left via the pair of nose-shaped attachments 16, whereby a tilting of the body 6 towards the pliers 12 is possible until the pair of further attachments 20 on the second edge 18 of the mounting sleeve 2 come into contact with the branch of the pliers 12.

[0076] When comparing the two relative positions of the Fig. 2 and Fig. 3 shows that when force is applied by means of the pliers 12, the central axis 11 of the sleeve 2, which corresponds to the central axis 11 of the body 6 when attached, can tilt with the body 6 relative to the externally threaded shaft 4. The pair of additional attachments 20 can engage the pliers 12, ultimately resulting in a stable engagement between the pliers 12 and the sleeve 2, allowing the necessary high forces to be transmitted without the pliers 12 slipping off the sleeve 2.

[0077] The spring tabs 9 extend from the second edge 18 in the direction of the external thread shaft 4 and are arranged in respective through recesses 26 of the sleeve 2.

[0078] Fig. Figure 4 shows the joint / screw head 22, designed as a spherical head and forming a joint with the body 6, together with the sleeve 2 in a longitudinal section. It can be seen that the body 6 has two body sections (tulip wings) 6a, which form the rod insertion opening 8 of the body 6. Sections of an internal thread are formed on the inner circumferential walls of the body sections 6a. The internal thread is suitable for screwing in a grub screw, referred to as a setscrew 24, and is intended to fix the inserted coupling rod 10 in the body 6 and to clamp the body 6 against the joint head 22 in order to fix their position relative to one another.

[0079] The body 6 is designed on the outside for detachable and thus temporary / temporary fastening of the mounting sleeve 2 by means of the spring tabs 9. The cutting plane according to the Fig. 4 is placed through the spring tabs 9, revealing their shape. The spring tabs 9 have an inwardly curved / arched / protruding actuating portion 28 and, in contrast, a free end portion 30 located radially further outward, on which an inner contact / locking surface 32 is formed, thus facing the body 6. When the sleeve 2 is placed on the body 6, this engages behind a recess 34 on the outer wall of the body 6. In the illustrated embodiment, this recess 34 is part of a so-called male indentation.

[0080] To ensure that the two spring tabs 9 can be pushed on and subsequently snapped into place as easily as possible, clamping bevels 36 are formed for the end sections 30 of the associated spring tabs 9, which bend the spring tabs 9 radially outward as they slide over the locking / contact surfaces (locking hooks) 32. In the illustrated embodiment, these clamping bevels 36 are also part of the respective male indentations. The respective clamping bevel 36 is formed on the outer wall of the body 6 between the end face of the body 6 that is immersed in the mounting sleeve 2 and the recess 34 of the body 6.

[0081] In the illustrated embodiment, the two sleeve-side contact surfaces 32 are inclined to the central axis 11 of the sleeve 2, i.e., toward the first edge 13. Depending on the inclination of these contact surfaces 32 and the spring force of the spring tab 9, it is then also possible to detach the sleeve 2 from the body 6 without an instrument / tool.

[0082] The inclination of the two sleeve-side contact surfaces 32 at an angle to the central axis 11 and the shape of the outer side of the body 6 and the inner side of the sleeve 2 are coordinated in such a way that the fixation of the sleeve 2 on the body 6 acts in all six spatial axes (three translational and three rotational). For this purpose, the spring tabs 9 also tension an inner edge of the sleeve 2 axially in the direction of the body 6 (in Fig. 4 downwards) against the front side of the body 6.

[0083] The actuating portion 28 is arranged or formed between the second edge 18 and the end portion 30 of the spring tab 9 (on which the contact surfaces / locking projections 32 are formed), via which the spring tab 9 can be pushed outward away from the central axis 11, thus releasing the sleeve 2 and detaching it from the body 6. In a space-saving design, the end portion 30 is arranged radially further outward than the actuating portion 28.

[0084] To release the spring tabs 9 of the sleeve 2 from the body 6, a groove 38 is provided on the inside of the sleeve 2, which extends in the circumferential direction of the sleeve 2 and which in the (in the Fig. 2 and Fig. 3) through-hole 26. The groove opens into the through-hole 26 as viewed along the central axis 11 of the sleeve 2 (in Fig. 4 vertically) in the axial position or location corresponding to that of the actuating section 28.

[0085] Then a Fig. 5 shown counterholder 40 in Fig. 5 are inserted from above through a central, axial through-channel 44 of the sleeve 2 into the upper part of the latter in a bayonet-like manner and rotated. Two lugs 42 arranged on the outer circumference of the counter-holder 40 are each moved through a groove 38 and finally against the actuating section 28 of each spring tab 9. Two further lugs 42 are simultaneously moved into the groove 38. The first two lugs 42 force the two spring tabs 9 outwards, thereby unlocking the sleeve 2 from the body 6. The two further lugs 42 then allow the sleeve 2 to be pulled off the body 6 together with the counter-holder 40.

[0086] Fig. 6 shows the pedicle screw 1 with the mounting sleeve 2 in a view of the axial through-channel 44 of the sleeve 2. Herein, one of the two body sections 6a of the body 6 is provided with the corresponding internal thread section for the (In Fig. 7). On the sleeve 2, a respective insertion bevel 46 for the setscrew 24 is provided on the second edge 18 adjacent to the two spring tabs 9. These two insertion bevels 46 can be located on a common cone and serve to axially align the setscrew 24 during its axial insertion into the mounting sleeve 2.

[0087] On the inner circumference of the sleeve 2, between the two body sections 6a, a respective guide surface 48 for the setscrew 24 is provided. The two guide surfaces 48 lie on a common circular cylinder and align the setscrew 24 along the central axis 11 so that it can be screwed into the internal thread formed by the body 6 without jamming.

[0088] Fig. 7 shows a part of the body 6 with the sleeve 2 with a setscrew 24, before it is aligned with the central axis 11 by the insertion aids, more precisely first by the two insertion bevels 46 and then by the two guide surfaces 48.

[0089] Fig. Figure 8 is a cross-section through the body 6 and the sleeve 2. Since the outer walls 50 of the body sections 6a and the inner support walls 52 of the sleeve 2 are part-circular cylindrical and fit snugly against each other, the sleeve 2 is further developed into a radially acting support and stabilizing sleeve (cuff). This prevents the two body sections 6a from being forced apart, even when the coupling rod 10 (see Fig. 2 and Fig. 3) and the setscrew 24 (see Fig. 7) are clamped or pressed between them.

[0090] Also in the rotational direction around the central axis 11 (see Fig. 7) an anti-rotation device 54 is provided, which prevents relative rotation of the two components 2, 6 about the central axis 11. Furthermore, the anti-rotation device 54 allows the sleeve 2 to be placed on the body 6 only in two different rotational positions, which are rotated 180° relative to each other.

[0091] The first edge 13 can also be referred to as the edge of the sleeve 2 facing the externally threaded shaft 4. The second edge 18 can also be referred to as the edge of the sleeve 2 facing away from the externally threaded shaft 4. Both edges 13, 18 extend around the central axis 11. In the illustrated embodiment, the central axis 11 is an axis of symmetry.

[0092] The sleeve 2 and / or a combination instrument, of which Fig. 6 only the counterholder 40 is shown, can be manufactured using an additive process.

[0093] Disclosed are a sleeve 2 for a body 6 of an implant screw 1, particularly for spinal surgery, and an implant screw 1 with a body 6 onto which the sleeve 2 can be fitted and secured by a snap connection. The sleeve 2 serves as a defined attachment 16, 20 for a compression instrument or for a distraction instrument, or the sleeve 2 has at least one such attachment 16, 20. Four nose-shaped attachments 16 and further attachments 20 spaced along a central axis can be provided.

[0094] The sleeve 2 preferably has inclined and flattened regions 19, so that free spaces are created on the outer circumference of the sleeve 2, which allow the pliers 12 to approach the central axis 11 of the sleeve 2 and the body 6 in an inclined position. List of reference symbols: 1 implant screw 2 sleeves 4 external thread shaft 6 bodies 6a Body section 8 Rod insertion opening (of the body) 9 spring tab 10 coupling rod 11 Central axis 12 pliers 13 first edge 14 Coupling rod recess (of the sleeve) 16 Appendix 18 second edge 19 External slope 20 additional facilities 22 Joint (head) 24 setscrew 26 Through recess (of the sleeve) 28 Operating section 30 final section 32 contact surface 34 Deepening 36 clamping bevel 38 grooves 40 Counterholder / actuating plunger 42 Nose 44 Instrument opening 46 Insertion bevel (on the second edge) 48 guide surface 50 exterior wall 52 retaining wall 54 Anti-twist device QUOTES CONTAINED IN THE DESCRIPTION

[0000] This list of documents submitted by the applicant was generated automatically and is included solely for the convenience of the reader. This list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions. Cited patent literature

[0000] DE 10 2016 108 504 A1 [0008, 0059]

Claims

[1] Mounting sleeve (2) which is designed and arranged to be plugged onto and detachably fastened to a tulip (6) of a polyaxial implant screw (1), for which purpose the mounting sleeve (2) has, in an axial section facing the tulip (6), two diametrically opposed, axially extending wall slots which together define a coupling rod receiving recess (14) extending transversely to the sleeve central axis characterized by that on a sleeve outer side of the mounting sleeve (2) in the axial section facing the tulip (6) at least one overlapping axial and circumferential position is defined, in which a contact and force introduction area for a distraction and / or compression instrument (12) is formed, projecting outwards in the radial direction beyond the remaining sleeve outer circumference. [2] Mounting sleeve (2) according to claim 1, characterized bythat the circumferential position of the contact and force introduction area on the mounting sleeve is selected such that the contact and force introduction area points in the longitudinal direction of the receiving recess (14). [3] Mounting sleeve (2) according to claim 2, characterized by in that a pair of attachments (16) for a distraction instrument (12) and / or for a compression instrument (12) is formed or arranged in the at least one attachment and force introduction region, wherein the attachments (16) are each formed as a projection projecting radially outwards from the sleeve shell outer side, and / or wherein the sleeve shell outer side tapers, starting from the attachment and force introduction region, along a central axis (11) of the mounting sleeve (2) towards the central axis (11). [4] Mounting sleeve (2) according to one of the preceding claims 1 to 3, characterized bya first circumferential end-face edge (13) which is intended to face the implant screw (1) or its externally threaded shaft (4), wherein on the first edge (13) the two preferably U-shaped wall slots or bulges which are diametrically opposite one another with respect to the central axis (11) are provided for passing through or receiving a coupling rod (10) in the transverse direction to the central axis (11), which extend axially starting from the first edge (13). [5] Mounting sleeve (2) according to claim 4, characterized by that the at least one contact and force introduction area is arranged or formed on the first edge (13). [6] Mounting sleeve (2) according to one of the preceding claims 1 to 5 characterized by that two diametrically opposed contact and force introduction areas are provided. [7] Mounting sleeve (2) according to claim 3, characterized bythat in the at least one contact and force introduction area, seen in the circumferential direction, a contact (16) is provided on both sides of the two wall slots or bulges defining the coupling rod receiving recess (14), wherein the two contacts (16) of each pair delimit the respective coupling rod recess (14) or bulge on both sides. [8] Mounting sleeve (2) according to claim 3 characterized by that the taper of the sleeve jacket outer side is formed in that the sleeve jacket outer side has a conical or truncated cone shape, or in that trapezoidal flat sides (19) are provided or formed in the two circumferential regions of the diametrically opposite wall slots, which converge towards one another. [9] Mounting sleeve (2) according to claim 8, characterized bythat the flat sides (19) extend to a second end edge (18) which is opposite the first edge (13), the flat sides (19) converging towards each other in the direction of the second end edge (18). [10] Mounting sleeve (2) according to claim 8, characterized by that on both flat sides (19) adjacent to the second edge (18) two further abutments (20) are formed or arranged, which are preferably formed in that the second edge (18) forms an axially extending, preferably V-shaped notch as a boundary of the flat sides or outer bevels (19). [11] Mounting sleeve (2) according to claim 8, 9 or 10, characterized by that funnel-like insertion bevels (46) for a setscrew (24) are formed on the second edge (18), and / or that partially cylindrical guide surfaces (48) for a setscrew (24) are formed on an inner side of the sleeve jacket. [12] Mounting sleeve (2) according to one of the preceding claims 1 to 11, characterized by a sleeve-side snap device which is designed and configured for releasably fixing the mounting sleeve (2) on the tulip (6) and which is formed by at least one spring tab (9), preferably two diametrically opposed spring tabs (9). [13] Mounting sleeve (2) according to claim 12, characterized by that a contact surface (32) or a radially inwardly projecting locking projection for engaging behind the tulip (6) is arranged or formed on a free end section (30) of the at least one spring tab (9), wherein an actuating section (28) is arranged or formed on the spring tab (9), via which actuating section the spring tab (9) can be moved radially outwards away from the central axis (11). [14] Mounting sleeve (2) according to claim 13, characterized bythat the at least one spring tab (9) is arranged in a respective slot-shaped recess or a through-hole (26) of the mounting sleeve (2) such that the actuating section (28) of the spring tab (9) in question projects radially inwards over an inner side of the sleeve casing in its design position, whereby the at least one spring tab (9) can be elastically pressed outwards radially. [15] Mounting system of or for a polyaxial implant screw (1), which has a tulip (6) which can be pivoted relative to an externally threaded shaft (4), which has two opposing body sections (6a) or flanks, between which two U-shaped rod insertion openings (8) are formed for receiving a coupling rod (10), with a mounting sleeve (2) according to one of claims 1 to 14, which can be temporarily fastened to the tulip (6) by means of a snap device in such a way that the two body sections (6a) or flanks of the tulip (6) are at least partially circumferentially supported or encompassed, and with a counter-holder (40) which is designed to be inserted into the mounting sleeve (2) in order to press the at least one spring tab (9) radially outwards. [16] Implant screw set comprising: - at least one implant screw (1) with a tulip (6) which can be pivoted relative to an externally threaded shaft (4) and which has or forms at least one locking engagement profile on its outer side, and - at least one mounting system according to claim 15, which is adapted so that the sleeve-side snap device of its mounting sleeve (2) comes into locking engagement with the locking engagement profile of the body (6), wherein the snap device of the mounting sleeve (2) and the locking engagement profile of the tulip (6) are adapted to one another in such a way that when they come into engagement, an axial locking engagement force is generated between the mounting sleeve (2) and the tulip (6), which axial locking engagement force pulls the mounting sleeve (2) axially against the tulip (6), wherein this axial locking engagement force is preferably achieved by an inclined position of the contact surface (32) or the locking projection of the sleeve-side snap device with respect to the central axis (11) and / or by an inclined position of the locking engagement profile of the tulip (6) with respect to its longitudinal axis.

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