Expandable intervertebral implants with conical screw elements and systems

Abstract

1. An expandable implant having an insertion direction for placement within an intervertebral space, the expandable implant including: a first section having a first bone-engaging surface; a second section having a second bone-engaging surface disposed opposite the first section, the second section being disposed such that the first and second bone-engaging surfaces are generally parallel to the insertion direction; an interconnecting structure interconnecting the first and second sections, at least a portion of the interconnecting structure being deformable to allow for a change in distance and / or orientation between the first and second sections; and a first partial internal cylindrical thread structure disposed between the first and second sections, the first partial internal cylindrical thread structure having a thread axis, the thread axis being oblique to the insertion direction by a first angle α1.

Description

[Technical field]

[0001]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims priority to International Patent Application No. PCT / IB2022 / 053530, filed April 14, 2022, the entire contents of which are incorporated herein by reference. This application also claims priority to International Patent Application No. PCT / IB2022 / 057789, filed August 19, 2022, the entire contents of which are incorporated herein by reference.

[0002]

[0002] The present disclosure relates to surgical procedures for spinal surgery, and devices and systems for treating spinal disorders. In particular, various embodiments relate to expandable and adjustable intervertebral implants or cages, and surgical instruments, systems, and methods for inserting and manipulating the expandable and adjustable intervertebral implants. More particularly, the present disclosure relates to devices, systems, and methods for correcting lordosis and / or other spinal abnormalities. [Background technology]

[0003]

[0003] Several intervertebral implants, spacers, spinal cages, or spinal fixation devices have been proposed which can be expanded, for example to increase their thickness, or which can change the orientation of an upper vertebral engaging surface relative to a lower vertebral engaging surface, for example to change the lordotic angle between adjacent vertebrae.

[0004] For example, U.S. Patent No. 9,839,528 describes an expandable fixation device having a first endplate and a second endplate, and also including a first ramp and a second ramp configured to mate with both the first endplate and the second endplate. The first ramp has a mating feature having a first angle with respect to a vertical axis, and the second ramp has a mating feature having a second angle with respect to the vertical axis, such that the first angle is different from the second angle. In particular, the first and second ramps may be configured to provide symmetrical expansion of the first and second endplates of the expandable fixation device.

[0005]

[0005] As another example, US Patent Application Publication No. 2021 / 0085486 describes an implant device including an expandable housing, a first drive mechanism, and a second drive mechanism, the first drive mechanism including a first pair of cam members and a first shaft that engages with the first pair of cam members. The second drive mechanism may include a second pair of cam members and a second shaft that engages with the second pair of cam members. Also, the first pair of cam members and the second pair of cam members may each include a helical male thread having a thickness configured to fit into a gap between adjacent respective riser members.

[0006]

[0006] However, all current state of the art expandable intervertebral implants require complex manufacturing, rely on relatively complex mechanical mechanisms for expansion and angular orientation change, and require several complex components. Therefore, in light of these shortcomings of the current state of the art, greatly improved intervertebral implants are highly desirable in order to simplify their design and operation, and reduce their complexity and manufacturing costs. Summary of the Invention

[0007] According to one aspect of the present invention, there is provided an expandable implant having an insertion direction (ID) for placement in an intervertebral space. Preferably, the expandable implant includes a first section having a first bone-engaging surface, a second section having a second bone-engaging surface disposed opposite the first section, the first and second bone-engaging surfaces being disposed parallel or substantially parallel to the insertion direction, an interconnect structure interconnecting the first and second sections, at least a portion of the interconnect structure being deformable to allow for a change in distance and / or orientation between the first and second sections, and a first partial internal cylindrical thread structure disposed between the first and second sections, the first partial internal cylindrical thread structure having a first thread axis, the first thread being oblique to the insertion direction by a first angle.

[0008]

[0008] The expandable implant may further include a first inclined surface facing the open segment of the first partial internal cylindrical thread structure and disposed between the first section and the second section, wherein the distance between the first inclined surface and the first partial internal cylindrical thread structure decreases along the insertion direction, measured in a direction perpendicular to the first and second bone-engaging surfaces.

[0009] The first inclined surface may form a cylinder segment surface having a cylinder axis that is oblique to the insertion direction by a second angle α2.

[0010]

[0010] The expandable implant may further comprise a second partial internal cylindrical thread structure disposed between the first section and the second section, arranged to face the first partial internal cylindrical thread structure so that a first thread pitch of the first partial internal cylindrical thread structure matches a second thread pitch of the second partial internal cylindrical thread structure, the second partial internal cylindrical thread structure having a second thread axis, the second thread axis being oblique to the insertion direction by a second angle α2.

[0011]

[0011] The expandable implant may further include a third partial internal cylindrical thread structure disposed between the first section and the second section and extending adjacent to the first partial internal cylindrical thread structure, the third partial internal cylindrical thread structure having a third thread axis, the third thread axis being oblique to the insertion direction by a third angle.

[0012]

[0012] The expandable implant may further include a second inclined surface facing the open segment of the third partial internal cylindrical thread structure and disposed between the first section and the second section, wherein the distance between the second inclined surface and the third partial internal cylindrical thread structure decreases along the insertion direction, measured in a direction perpendicular to the first and second bone-engaging surfaces.

[0013] The second inclined surface may define a cylindrical segment surface having a cylinder axis that is oblique to the insertion direction by a fourth angle.

[0014]

[0014] The expandable implant may further include a fourth partial internal cylindrical thread structure disposed between the first section and the second section, and positioned facing the third partial internal cylindrical thread structure so that a third thread pitch of the third partial internal cylindrical thread structure matches a fourth thread pitch of the fourth partial internal cylindrical thread structure, the fourth partial internal cylindrical thread structure having a fourth thread axis, the fourth thread axis being oblique to the insertion direction by a fourth angle.

[0015]

[0015] The interconnect structure may be deformably attached to the upper section to form a first hinge element, and the interconnect structure is deformably attached to the lower section to form a second hinge element.

[0016]

[0016] The expandable implant may further comprise a first conically shaped screw element having a first external thread configured to threadably mate (engage by threaded engagement) with the first partial internal cylindrical thread structure.

[0017]

[0017] The expandable implant may further comprise a second cone-shaped screw element having second external threads configured to threadably mate with the third partial internal cylindrical thread structure (50).

[0018]

[0018] Upon threading or engagement of the first conical screw element with the first partially internal cylindrical thread structure, a first distance between the first section and the second section increases by pushing the first and second sections apart due to deformation of at least one portion of the interconnecting structure.

[0019]

[0019] The interconnecting structure can be positioned diagonally between the first section and the second section, with the first and second hinge elements being positioned on opposing side edges of the first and second sections, respectively, or the interconnecting structure includes a plurality of spring elements positioned between the first partial internal cylindrical thread structure and the third partial internal cylindrical thread structure.

[0020] A first partial internal cylindrical thread structure may be formed in a surface of the interconnect structure facing the first section.

[0021] A third partial internal cylindrical thread structure may be formed in a surface of the interconnect structure facing the second section.

[0022]

[0022] The interconnection structure may include a plurality of first elastic interconnection elements arranged between the first section and the second section on one side adjacent to the first partial internal cylindrical thread structure, and a plurality of second elastic interconnection elements arranged between the upper section and the lower section on another side adjacent to the first partial internal cylindrical thread structure.

[0023]

[0023] At least one of the plurality of first elastic interconnection elements and at least one of the plurality of second elastic interconnection elements may include a first tab having a first diagonal direction and a second tab having a second diagonal direction, the first and second diagonal directions being different.

[0024]

[0024] The interconnecting structure may be deformable to allow for expansion of the distance between the upper section and the lower section upon threaded engagement of the conical screw element with the first partial internal cylindrical thread structure.

[0025]

[0025] The plurality of first elastic interconnection elements and the plurality of second elastic interconnection elements may be deformable to change the relative angle between the first diagonal direction and the second diagonal direction to enable expansion of the distance between the upper section and the lower section upon engagement of the conical screw element with the first internal thread.

[0026]

[0026] The expandable implant may further comprise an expansion mechanism configured for linear displacement relative to the implant, the expansion mechanism may include at least one wedge element for engaging at least one slope surface of one or both of the first and second sections, and the expansion mechanism may be rotatably connected to the first conical screw element such that threading of the first conical screw element with the first partial internal cylindrical thread structure linearly displaces the expansion mechanism.

[0027] According to another aspect of the present invention, there is provided an expandable implant having an insertion direction (ID) for placement within an intervertebral space. The expandable implant preferably includes a first element for engaging a first vertebra, a second element for engaging a second vertebra, a flexible means interconnecting the first and second elements, the flexible means allowing for variation of a distance D between the first and second elements, and a means for increasing the distance D between the first and second elements by applying at least one of an expansion or bending force to the flexible means.

[0028] The means for increasing the distance may be configured to convert the rotational threading motion into a translational motion to vary the distance D by deforming at least a portion of the flexible means.

[0029]

[0029] The means for increasing distance may be configured to perform the translation without the use of a linear slidable engagement, or a device that performs a linear translation without rotation.

[0030]

[0030] The means for increasing the distance may include a conical shaped screw element and an at least partial internal cylindrical thread.

[0031] According to yet another aspect of the present invention, there is provided an expandable implant for placement within an intervertebral space, preferably comprising four corner elements extending parallel to an insertion direction and four sets of a plurality of deformable interconnecting elements, each elastic interconnecting element being disposed between two adjacent corner elements, at least one corner element including a partial internal cylindrical thread, the at least one partial internal cylindrical thread forming a discontinuous thread with a thread axis oblique to the insertion direction, the discontinuous thread being configured to threadably receive a conical screw element.

[0032] At least two of the four corner elements may include partial internal cylindrical threads.

[0033]

[0033] The deformable interconnecting element may be deformable so as to enable an expansion of the distance between the upper and lower sections of the two corner elements and at the same time an expansion of the distance between the left and right sections of the two corner elements when the conical screw element is screwed with the discontinuous thread.

[0034]

[0034] At least one of the deformable interconnection elements may include a first tab having a first diagonal direction and a second tab having a second diagonal direction, the first and second diagonal directions being different.

[0035]

[0035] According to yet another aspect of the present invention, a three-dimensional printing method for manufacturing an expandable implant is provided for producing an implant body and a cone-shaped screw element.

[0036] According to yet another aspect of the present invention, there is provided an expandable implant system including an intervertebral implant and an implant handling device.Preferably, the implant handling device includes a holder having a dual function for removably holding the implant and guiding and injecting a bone graft into the implant, a pusher insertable into the holder and having a dual function for acting like or as a piston for pushing the bone graft into the implant by the holder and disengaging the holder from releasable engagement with the implant, one or more screwdrivers, and a screwdriver guide that may be attached to or formed integrally with the holder, the screwdriver having at least one guide bore extending in an insertion direction ID for guiding the one or more screwdrivers for engagement and rotation with the one or more cone-shaped screw elements, respectively.

[0037]

[0037] According to yet another aspect of the present invention, a spinal implant system is provided. The spinal implant system may include a spinal plate or device and an interconnecting screw for attaching the spinal plate or device to the implant by a connection interface of the implant. The spinal plate or device is configured to receive one or more bone screws for implantation into the spine or vertebrae to provide support for retention within the spine or between the vertebrae after implantation of the implant. The spinal implant system may also include one or more bone screws.

[0038] According to yet another aspect of the present invention, there is provided a spinal implant system that may include one or more of an implant holding instrument, a screwdriver, a removable bone graft inserter, an injection syringe, and a slap hammer.

[0039]

[0039] The implant holding device may be a straight implant holding device or an angled implant holding device.

[0040]

[0040] According to yet another aspect of the present invention there is provided an implant holding instrument, which may be a straight implant holding instrument or an angled implant holding instrument.

[0041] The implant holding instrument may include an elongate body with a handle portion at a proximal end and an implant interface head disposed at a distal end. The body may include a shaft extending between the handle portion and the implant interface head. The body may include a central channel configured to receive and hold a tubular implant connector.

[0042]

[0042] The tubular implant connector may comprise a shaft comprising an elongated hollow tube and an implant interface device disposed at a distal end of the shaft. The tubular implant connector and the implant interface device include a hollow tubular coupling element comprising male threads configured to mate or engage with the implant for attachment to the implant.

[0043]

[0043] The tubular implant connector may be positioned within the implant holding instrument such that the shaft is received in the central channel, and the implant interface device may be received inside the implant interface head, with the coupling element extending outwardly from the implant interface head and protruding through its central orifice to connect with the implant and attach the implant to the tubular implant connector.

[0044]

[0044] The tubular implant connector may be arranged to rotate inside the central channel and the implant interface head.

[0045]

[0045] The implant holding instrument may further include a first screwdriver guide channel extending from the proximal end to the distal end and a second screwdriver guide channel extending from the proximal end to the distal end. The first screwdriver guide channel may be a partially closed channel formed by a proximal surround section included in the handle portion and a distal surround section included in the implant interface head, and may also include an open support extending between the proximal and distal surround sections. The second screwdriver guide channel may similarly include an open support extending between the proximal and distal surround sections.

[0046]

[0046] A tubular implant connector may include such a bendable interconnect. The bendable interconnect may include a body with a plurality of stripes and a plurality of slots where body material is absent or removed. The stripes may be located between the slots. The plurality of stripes and the slots may be arranged such that a distal end of the implant holding device is resiliently bent away from a central axis of the implant holding device.

[0047]

[0047] The above and other objects, features and advantages of the present invention, as well as the manner in which they are achieved, will become more apparent, and the invention itself will be best understood, from a consideration of the following description in conjunction with the accompanying drawings showing several preferred embodiments of the present invention.

[0048]

[0048] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate presently preferred embodiments of the invention and, together with the general description above and the detailed description below, serve to explain features of the invention. [Brief description of the drawings]

[0049] [Figure 1A] FIG. 1 is a top perspective view of an intervertebral implant 100 according to a first embodiment of the present invention having one partial internal cylindrical thread structure 40 for threading with a conical screw element 60, the implant 100 having a conical screw element 60 threaded thereto. [Figure 1B] FIG. 1 is a perspective cross-sectional view of an intervertebral implant 100 taken at a vertical cut location along the central axis thereof. [Figure 1C] FIG. 1 is a perspective cross-sectional view of an intervertebral implant 100 taken at a horizontal cut location along the central axis thereof. [Figure 1D] FIG. [Figure 1E] FIG. 1 is a side view of an intervertebral implant 100. [Figure 1F] FIG. 1 is a side cross-sectional view of an intervertebral implant 100. [Figure 1G] FIG. 1D is a side cross-sectional view of what is shown in FIG. 1C, also showing two additional cross-sectional views through cut locations A and B oriented perpendicular to the insertion direction ID. [Figure 2A] FIG. 1 is a top perspective view of an intervertebral implant 200 according to a second embodiment of the present invention having two partial internal cylindrical thread structures 40, 46 facing each other and having aligned and matching thread pitches for threading with a conical screw element 60; [Figure 2B]FIG. 2 is a perspective cross-sectional view of an intervertebral implant 200 taken at a vertical cut location along the central axis thereof. [Figure 2C] FIG. 2 is a perspective cross-sectional view of an intervertebral implant 200 taken at a horizontal cut location along the central axis thereof. [Figure 2D] FIG. [Figure 2E] FIG. 2 is a side view of the intervertebral implant 200. [Figure 2F] FIG. [Figure 2G] FIG. [Figure 3A] FIG. 13 is a rear perspective view of an intervertebral implant 300 according to a third embodiment of the present invention having two partial internal cylindrical thread structures 40, 50 arranged next to each other, each of which extends substantially with an angular offset in the insertion direction (ID) and each of which is configured to threadably engage with a cone-shaped screw element 60, 70; [Figure 3B] FIG. 1 is a rear perspective view of an implant 300 with screw elements 60, 70 threaded into partial internal cylindrical thread features 40, 50. [Figure 3C] FIG. 3 is a rear view of the implant 300 without the screw elements 60, 70. [Figure 3D] FIG. 2 is a rear view of implant 300 in a non-expanded or non-extended state with screw elements 60, 70 threaded into partial internal cylindrical thread features 40, 50. [Figure 3E] A side cross-sectional view cut along a vertical plane aligned to coincide with the third thread axis TA3 of the partial internal cylindrical thread structure 50, showing the implant 300 without the screw element 70. [Figure 3F] FIG. 2 is a side cross-sectional view taken along a vertical plane coinciding with the first thread axis TA1 of the partial internal cylindrical thread structure 40, showing the implant 300 without the screw element 70. [Figure 3G] FIG. 2 is a side cross-sectional view showing an implant 300 having a screw element 70. [Figure 3H]FIG. 3 is a top view of the implant 300 without the cone-shaped screw elements 60, 70. [Figure 3I] FIG. 3 is a top view of an implant 300 having screw-cone shaped elements 60, 70. [Figure 3J] A front view of the implant 300 in a partially expanded state using the conical screw element 60 expanded to a distance D1, with the bone engaging surfaces 12, 22 disposed at an angle β1 and the first section 10 pivoted about the first hinge element 15 as a deformable part of the interconnect structure 30. [Figure 3K] FIG. 2 is a side cross-sectional view of an implant 300 in which a conical screw element 60 is fully threaded onto the end of a partial internal cylindrical thread structure 40. [Figure 3L] FIG. 1 is a top perspective view of an implant 300 with a conical screw element 60 fully threaded into the end of a partial internal cylindrical thread structure 40, as seen through a transverse opening TO. [Figure 3M] FIG. 1 is a front view of an implant 300 in a fully expanded state using cone-shaped screw elements 60, 70 fully threaded into partial internal cylindrical thread structures 40, 50, respectively, causing pivoting of the first section 10 and the second section 20 by the first hinge element 15 and the second hinge element 25 relative to the interconnecting section 30. [Figure 3N] FIG. 2 is a top perspective view of the implant 300. [Figure 4A] FIG. 13 is an exemplary top perspective view of an intervertebral implant 400 according to a fourth embodiment of the present invention having four corner elements 110, 120, 130, 140 extending longitudinally in an insertion direction ID, in which the implant body 5 is expanded in both the z direction to have a variable dimension of distance D1 and in the y direction to have a variable dimension of distance D2 due to engagement of a conical screw element 60 with an internal thread disposed in one or more of the four corner elements 110, 120, 130, 140, thereby expanding in height and width. [Figure 4B]1 is a perspective cross-sectional view with a cutting plane arranged horizontally along the insertion direction through the center of the body 5 and the cone-shaped screw element 60. FIG. [Figure 4C] FIG. [Figure 4D] FIG. [Figure 4E] FIG. [Figure 4F] FIG. [Diagram 5] FIG. 5 is a top perspective view of a spinal implant system according to yet another embodiment of the present invention, showing an exemplary intervertebral implant 300 that can be removably interconnected to an implant handling device 505 that includes a holder 530, exemplarily formed by a hollow cylinder, having a dual function for removably holding the implant 300 and for guiding and injecting a bone graft into the implant 300, and a pusher 510 that can be inserted into the hollow body of the holder 530, having a piston-like structure for pushing the bone graft into the implant 300 by the holder 530. and having a dual function for acting on and disengaging the holder 530 from releasable engagement with the implant 300; one or more screwdrivers 540 each having a torque instrument 544; and a screwdriver guide 520 which may be attached to the holder 530 or formed integrally therewith, the screwdriver guide having at least one guide bore extending in the insertion direction ID for guiding the one or more screwdrivers 540 for engagement with and rotation with the one or more cone-shaped screw elements 60, 70, respectively. [Figure 6A] FIG. 5 is a top cross-sectional view of an implant 300 and a holder 530 having a hollow body, e.g., a cylindrical shaped element, in a disengaged state of the implant 300 and the holder 530 from the z-direction as referred to in FIG. 5, also showing an exemplary flexible coupling 534 having two symmetrically arranged flexible clips 336, 338 that can be part of or formed with the interconnect structure 30 of the implant. [Figure 6B]FIG. 13 is a side cross-sectional view in the y direction of the implant 300 and holder 530 in a disengaged state. [Figure 6C] FIG. 1 is a cross-sectional side view in the z-direction of the implant 300 and holder 530 in an engaged state, with clips 336, 338 engaged with corresponding locking cavities or holes 536, 538 located in the side wall of the holder 530, and also shows the distal end of the holder 530 forming a bone graft discharge port 532 reaching into the body 5 of the implant 300, which leads to a transverse opening TO for injecting bone graft into the opening TO, and the distal end of the holder 530 also has a slot 534 to allow insertion into the implant 300, forming a flexible connection. [Figure 6D] FIG. 13 is a side cross-sectional view in the y direction of the implant 300 and holder 530 in an engaged state. [Figure 7A] An intervertebral implant 600 according to a fifth embodiment of the present invention, the implant 600 employs two conical screw elements 660, 670, each having two conical screw sections 664, 666 and 674, 676 located at the distal and proximal ends of the respective screw elements 660, 670, the implant body 5 having two pairs of partial internal cylindrical thread arrangements 644, 646 and 654, 656, which are threaded by a screw element 660 having two conical screw sections 664, 666 and a corresponding internal cylindrical thread arrangement 644, 646 on one side of the implant 600, and a screw element 660 having two conical screw sections 664, 666 and a corresponding internal cylindrical thread arrangement 644, 646 on the other .... On the other side of the implant 600, a screw element 670 having two conical screw sections 674, 676 is positioned to individually enable threaded engagement with the corresponding internal cylindrical thread features 654, 656, thereby providing improved pressure and weight distribution to the body 5 when pressurized or loaded along the z-direction, with the four conical screw sections 664, 666, 674, 676 and corresponding partial internal cylindrical thread features 644, 646, 654, 656 being positioned at the corners of the implant 600 when viewed in the z-direction. [Figure 7B] FIG. 1 is a side cross-sectional axial view of a cone-shaped screw element 660 having front and rear conical screw sections 664, 666 interconnected to one another by a bold face or shaft 662 in an unexpanded state. [Figure 7C] FIG. 6 is a top cross-sectional view of an implant 600. [Figure 7D] FIG. 6 is a top perspective view of an implant 600. [Figure 8A] FIG. 13 is a front view of an intervertebral implant 700 according to a sixth embodiment of the present invention, the implant 700 having an implant body 5 having an interconnecting structure 730 formed by a plurality of spring elements 732.1-732.6, in an exemplary variant six spring elements 732.1-732.6, arranged along a central section of the body 5, at least partially disposed within a transverse opening TO, the spring elements 732 interconnecting the first and second sections 10, 20 and arranged along the insertion direction ID between two openings having two partial internal cylindrical thread structures 40, 50 respectively. [Figure 8B] FIG. [Figure 8C] FIG. 7 is a top view of the implant 700. [Figure 9A] FIG. 13 is a front top perspective view of an intervertebral implant 800 according to a seventh embodiment of the present invention. [Figure 9B] FIG. 13 is another front top perspective view from a different angle of view. [Figure 9C] FIG. 8 is a front view of the implant 800 in an unexpanded state. [Figure 9D] FIG. 8 is a front view of the implant 800 in a fully expanded state. [Figure 9E] FIG. 8 shows the implant 800 in a partially expanded state with an oblique angle between the first section 10 and the second section 20 of the implant 800. [Figure 10A] FIG. 13 is a simplified top view of an intervertebral implant 900 according to an eighth embodiment of the present invention, showing a top view of the expansion mechanism and a symbolic layout of the body 5 in a non-expanded state. [Figure 10B] FIG. 13 is another top view of the expansion mechanism in an expanded state, preferably for transforaminal lumbar interbody fusion (TLIF) applications. [Figure 11A] FIG. 10 is a top perspective view showing an embodiment of an intervertebral implant 1000 according to a ninth embodiment of the present invention. [Figure 11B] FIG. 10 is a top perspective see-through view to show different elements of the implant 1000. [Figure 11C] 1 is a cross-sectional view defined by a cutting plane coinciding with the axis of rotation of a rotatable expansion mechanism 1060. FIG. [Figure 11D] FIG. 13 is a top view of an implant 1000 that uses an expansion mechanism that combines an embodiment using a conical screw section 1064 with an embodiment using linear sliding of one or more wedges 1072, 1074 against sloping surfaces 1014, 1024 and 1016, 1026, respectively. [Figure 12A] FIG. 11 is a top perspective view showing an aspect of an intervertebral implant 1100 according to a tenth embodiment of the present invention. [Figure 12B] 1A-1C are top perspective views in different directions. [Figure 12C] 1 is a cross-sectional view defined by a cutting plane coinciding with the two axes of rotation of the rotatable expansion mechanisms 1160, 1170. [Figure 12D] FIG. 11 is a top view of an implant 1100 placed within an intervertebral space. [Figure 13A] FIG. 12 is a top perspective view showing an aspect of an intervertebral implant 1200 according to an eleventh embodiment of the present invention. [Figure 13B] 13C is a front view relative to the insertion direction ID to show the distal end DE of the intervertebral implant 1200, and also shows a cross-sectional view of the section plane AA shown in FIG. 13C. [Figure 13C] FIG. 12 is a top view of an intervertebral implant 1200. [Figure 13D] 11A and 11B are a side view and a cross-sectional view taken along a cutting plane BB, and the eleventh embodiment is a modification of the fifth embodiment shown in FIGS. 7A to 7D. [Figure 14A]FIG. 14 is a top perspective view illustrating an aspect of an intervertebral implant 1400 according to a twelfth embodiment of the present disclosure. [Figure 14B] 14 is a cross-sectional side perspective view of an intervertebral implant 1400. FIG. [Figure 14C] FIG. 14 is a side view of an implant 1400 in an unexpanded state. [Figure 14D] FIG. 14 is a side view of an implant 1400 in an expanded state. [Figure 14E] FIG. 14 is a side cross-sectional view of an implant 1400. [Figure 14F] FIG. 12 is a side cross-sectional view of an implant 1400 and a screw element 1470, the twelfth embodiment being a variation of the fifth embodiment shown in FIGS. 7A-7D and the eleventh embodiment shown in FIGS. 13A-13D. [Figure 15A] FIG. 15 is a perspective view of a spinal implant system 1500 according to yet another aspect of the present disclosure, showing an exemplary intervertebral implant 1400 that can be attached or connected to a spinal plate or device 1501 by interconnecting screws 1505, the spinal plate or device 1500 being configured to accept bone screws 1510, 1515 for implantation within the spine to provide support for retention within or between the vertebrae after implantation of the implant 1400. [Figure 15B] FIG. 15 is a partial cross-sectional side view of a spinal implant system 1500. [Figure 16A] FIG. 16 is a perspective view of another spinal implant system 1600 according to yet another embodiment of the present disclosure, showing an exemplary intervertebral implant 1400, an implant holding instrument 1605, a screwdriver 1610, a removable bone graft inserter 1615, an injection syringe 1620, and a slap hammer 1625. [Figure 16B] FIG. 16B is an enlarged perspective view of the implant holding device 1605 shown in FIG. 16A. [Figure 16C] FIG. 16 is a top view of an implant holding device 1605. [Figure 16D] A cross-sectional view taken along BB of the cage holder 1605. [Figure 16E] FIG. 16B is an enlarged perspective view of the screwdriver 1610, removable bone graft inserter 1615, injection syringe 1620 and slap hammer 1625 shown in FIG. 16A. [Figure 17A] FIG. 17 is a perspective view of another spinal implant system 1700 according to yet another aspect of the present disclosure, showing an exemplary intervertebral implant 1400, an angled implant holding instrument 1705, a screwdriver 1710, a removable bone graft inserter 1715, an injection syringe 1720, and a slap hammer 1725. [Figure 17B] FIG. 17B is a close-up perspective view of the angled implant holding tool 1705 shown in FIG. 17A. [Figure 17C] FIG. 17B is an enlarged perspective view of the screwdriver 1710, removable bone graft inserter 1715, injection syringe 1720 and slap hammer 1725 shown in FIG. 17A. [Figure 17D] 17A-17C are enlarged perspective and top views of the angled implant holding device 1705. [Figure 17E] 17A is another close-up perspective view and close-up top view of the angled implant holding device 1705. FIG. [Figure 17F] 17A is another close-up perspective view and close-up top view of the angled implant holding device 1705. FIG. [Figure 17G] FIG. 17 is a detailed view of the distal end of the tubular implant connector of the implant holding device 1705. [Figure 17H] FIG. 17 illustrates an angled implant holding instrument 1705. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0050]

[0066] Wherever possible, the same reference numbers are used herein to designate identical elements common to the figures, and images may be simplified for illustrative purposes and not drawn to scale.

[0051]

[0067] According to a first embodiment of the present invention, an expandable implant 100 is provided, as exemplarily shown in Figures 1A-1G. The expandable implant 100 has or comprises an implant body 5 forming an insertion direction ID, which is a direction in which the implant 100 is inserted into an intervertebral or interbody space, for example for a lateral lumbar interbody fusion (LLIF) for insertion between two adjacent vertebrae of a living body's spinal column. The expandable implant 100 forms an implant body 5 having an insertion or distal end DE pointing towards the intervertebral space during insertion and a handling or proximal end PE from which the implant 100 can be held, and includes a first or upper section 10 having a first bone-engaging surface 12 and a second or lower section 20 having a second bone-engaging surface 22, the second section 20 being disposed opposite the first section 10. The first and second sections 10, 20 can be implemented in different ways to form, for example, first and second plates, discs, or other types of planar structures that are disposed generally parallel to one another, at least prior to insertion into the intervertebral space, and that have porous, trabecular, or other types of surface or body structuring on the bone-engaging surfaces 12, 22 that can facilitate attachment and fixation with a bone structure, for example with a bone surface of a vertebra. The first and second sections 10, 20 can extend in a plane that is parallel or generally parallel to the insertion direction ID, for example within a certain angular tolerance range of less than ±5°, more preferably less than ±2.5°.

[0052]

[0068] In one variation, the bone-facing and engaging surfaces 12, 22 can have structuring to increase friction between the implant 100 and the bone structure with which it engages, for example, but not limited to, ripples, ridges, cones, hooks, knobs, tabs, ramps, spheres, peaks. For example, ridges, rails, or other types of longitudinal structures can be formed on the surfaces 12, 22 arranged parallel to the insertion direction ID to provide some guidance while the implant 100 is being inserted into the intervertebral space. Furthermore, the surfaces 12, 22 can be not completely flat, but can have convex structures, for example in the form of domes or bumps, which can match the endplate surfaces of two adjacently arranged vertebrae, the endplate surfaces facing each other. For example, the surfaces 12, 22 can be manufactured in detail by three-dimensional printing to a patient-specific configuration to provide a complementary shape with the existing endplate surfaces. The bone-engaging surfaces 12, 22 of the first section 10 and the second section 20 may also include one or more openings, such as an opening leading to an internal hollow volume of the implant 100, not shown in this embodiment, that may be filled with bone graft and bone fusion promoters to secure the adjacent vertebrae to the implant 100. Preferably, when viewed from the top or bottom, the first and second sections 10, 20 have rounded, smooth corners to prevent damage and to facilitate insertion of the implant into the intervertebral space. The distal end DE of the implant 100 may also be shaped to be rounded or spherical, or to have a cylindrical curvature, or may be pointed, to facilitate insertion.

[0053]

[0069] Furthermore, the implant 100 is provided with an interconnect structure 30 interconnecting the first section 10 and the second section 20, at least a portion of which is deformable to allow a change in the distance and / or orientation between the first section 10 and the second section 20. In the first embodiment shown in Figs. 1A-1G, only a change in the distance D between the first section 10 and the second section 20 is possible to expand the distance D between the sections 10, 20. The distance D between the first section 10 and the second section 20 can be, for example, the distance between the outer surface of the first section 10 and the outer surface of the second section 20, as in the example shown in Fig. 1E. However, the distance D can be measured, for example, between any first position on the first section 10 and any second position on the second section 20 that are subjected to a relative displacement by the interconnect structure 30. Typically, the interconnecting structure or element 30 can have a geometry, material properties or characteristics, structuring or other arrangement that allows deformation to the interconnecting structure or element 30 when an expansion force is applied, such as a force that moves the sections 10, 20 outward from each other. Also, the interconnecting structure 30 can allow the reduction of the distance D by an elastic force that brings the sections 10, 20 closer together, such that at least a portion of the interconnecting structure or element 30 has elastic properties. In this regard, when the distance D is expanded to a higher value, a tension can be exerted by the interconnecting structure or element 30 that can allow the contraction or reduction of the distance D when the expansion force is released. In a variant, it is also possible that at least a portion of the interconnecting structure 30 has plastic properties and that when deformed to increase the distance between the sections 10, 20, there is no or only little tension for contraction exerted by the interconnecting structure or element 30.

[0054]

[0070] In the illustrated variant, the interconnecting structure or element 30 is formed as a plurality of first elastic interconnecting elements 32 arranged on a first side 100 of the implant and as a plurality of second elastic interconnecting elements 34 arranged on the other, second side of the implant body 5, the first side being opposite the second side and interconnecting the first and second sections 10, 20, for example interconnecting the edge post or pillar 14 of the first section 10 to the edge post or pillar 24 of the second section 20 on the first side and interconnecting the edge post or pillar 16 of the first section 10 to the edge post or pillar 26 of the second section 20 on the other, second side, thereby forming two laterally arranged elastic interconnecting elements 32. For example, at least one of the first elastic interconnection element 32 and the second elastic interconnection element 34 can include a first tab, bar, post, support, pillar, plate or column 36 arranged in a first diagonal direction relative to the insertion direction ID, and a second tab, bar, post, support, pillar, plate or column 38 connected to the first tab 36 having a second diagonal direction relative to the insertion direction ID, where the first and second diagonal directions are different. Thereby, the first tab 36 and the second tab 38 are arranged to form a V-shape that can open the V-angle to increase the distance D between the sections 10, 20, and the first and second diagonal angles between the tabs 36, 38 and the insertion direction can be, but are not limited to, an angle range of 30° to 60°. Additionally, the first elastic interconnection element 32 and the second elastic interconnection element 34 may be embodied in a variety of different structural arrangements that allow deformation to increase the distance D, such as a circle, an ellipse, a diamond, an arc, or other shapes that allow deformation of the interconnection elements 32, 34 to increase the distance D between the sections 10, 20.

[0055]

[0071] It is also possible that the interconnecting structure 30 can be configured such that expansion of the implant body 5 in the z-direction is facilitated, and more specifically, deformation of the interconnecting structure 30 to expand in the z-direction is facilitated, while deformation in another direction, e.g., resulting in a displacement of the first section 10 relative to the second section 20 relative to or along the insertion direction ID, or a displacement of the sections 10, 20 relative to the y-direction, transverse or lateral direction, or an angular displacement of the sections 10, 20 about the z-direction, is substantially prevented or reduced. For example, in the variant shown in Figures 1A and 1D, this is exemplarily done by an arrangement of V-shaped elements that can bend to provide for expansion as well as contraction in the z-direction, but where the width of the tab-like elements 36, 38 is substantially greater than the thickness of the tab-like elements 36, 38, e.g., in a ratio of 1 to 3, or even 1 to 5.

[0056]

[0072] Furthermore, the implant body 5 includes a first partial internal cylindrical thread structure 40 disposed between the first section 10 and the second section 20. As shown in Fig. 1B and Fig. 1C, in the illustrated variant, the partial internal cylindrical thread structure 40 has a partial internal thread formed on the surface of a cylindrical segment, where the rotation axis of the cylinder coincides with the first thread axis TA1 of the partial internal cylindrical thread structure 40 and can be machined, formed or otherwise provided on the inner surface of the second section 20, i.e., the second section 20 formed as a rectangular plate. The first thread axis TA1 or rotation axis of the cylinder extends substantially in the insertion direction ID, but is oblique to the insertion direction ID by a small angle defined as the first angle α1. Preferably, the first angle α1 is within an angle range between 1° and 30°, more preferably between 1° and 15°, and even more preferably between 3° and 15° with respect to the insertion direction. Also, the first thread axis TA1 of the thread structure 40 preferably lies substantially in a plane oriented parallel to the insertion direction ID, which plane is located between the first and second side walls of the implant body 5, e.g. midway between the first and second interconnecting elements 32 and 34 of the interconnecting structure 30, e.g. substantially midway between the first and second interconnecting elements 32 and 34 of the interconnecting structure 30. This allows the partial internal cylindrical thread structure 40 to be located between and substantially midway between the interconnecting elements 32, 34 and to extend between the interconnecting elements at a small oblique first angle α1 with respect to the insertion direction ID. As shown in the variant of Figures 1B and 1C, the partial internal cylindrical thread structure 40 can extend from the proximal end PE to the distal end DE, with the first thread axis TA1 obliquely disposed at an oblique first angle α1 to decrease the width of the hollow or concave cavity of the cylindrical segment from the proximal end PE to the distal end DE, as measured from the inner surface of the second section 20 in a direction perpendicular to the insertion direction.

[0057]

[0073] Additionally, the implant 100 may further include a screw element 60, e.g., a cone-shaped screw element 60, defining a front insertion side IS and a rear operating side OS, having a length L, including an external thread 62 configured to threadably engage the partial internal cylindrical thread structure 40 of the implant body 5, and a torque application structure 64. Preferably, the torque application structure 64 is disposed on the operating side OS of the screw element 60 for releasable engagement with a torque tool, as will be further described below, e.g., but not limited to, a Torx socket head, a hex socket head, a Phillips-type socket head, or other type of torque application structure. In the illustrated variation, the screw element 60 is hollow and traversed by a bore, e.g., a cone-shaped bore narrowing toward the insertion direction, although it may also be solid. The external thread 62 has a thread radius or diameter that decreases from the operating side OS toward the insertion side IS of the screw element 60, thereby forming a conical or tapered shape and a conical thread. The thread diameter is, for example, the distance from the external thread on one side of the screw element 60 to the external thread on the other opposite side, or, for example, the larger diameter. The thread radius is half the value of the thread diameter. Preferably, the maximum thread radius of the external thread 62 on the operation side is such that the thread radius of the screw element 60 decreases constantly linearly from the operation side OS to the insertion side IS, while corresponding to or matching the constant thread radius of the partial internal cylindrical thread structure 40 to allow threading with the partial internal cylindrical thread structure 40. In contrast, the thread radius of the cylindrical thread structure 40 is constant, e.g., the structure 40 has a constant effective thread radius or diameter. In this respect, the maximum section of the screw element 60 can fully thread with the cylindrical thread structure 40, but due to the tapered or conical nature of the screw element 60, in the narrower portion near the front or insertion side IS of the screw element 60, only partial thread contact occurs between the thread 62 and the thread structure 40, which is shown in the cross-sectional views of Figures 1C and 1G.In this regard, Figure 1G shows two additional cross-sectional views with cutting planes AA and BB arranged perpendicular to the insertion direction ID, one showing a cross-sectional view of the screw element 60 and body 5 near the opening 80, where the outer radius of the screw element 60 is only slightly smaller than the radius of the cylindrical thread structure 40, and to the right of that, a cross-sectional view of the screw element 60 and body 5 near the midpoint between the proximal end PE and the distal end DE, where the outer radius of the screw element 60 is approximately half the radius of the cylindrical thread structure 40. This also allows for threaded displacement of the cone-shaped screw element 60 along the axis of the cylindrical thread structure 40, which is generally parallel to the insertion direction ID.

[0058]

[0074] With regard to the internal and external threads, the thread pitch may preferably range between 0.5 mm and 5 mm, may have rounded, square, trapezoidal, triangular or other shapes, and may have thread forms as sharp V, metric, buttress, integral, square, Whiteworth, Acme, knuckle or Dalet threads. In the illustrated variant, there is only one thread, but it is also possible to have two or more threads for the external thread 62 and the internal thread structure 40, for example double start, triple start or more threads, in order to modify the torque transmission between the screw element 60 and the implant body 5.

[0059]

[0075] Moreover, preferably, the taper angle, apex angle or cone angle of the conical screw element 60 and the external thread 62 is substantially the same as the oblique first angle α1 of the cylindrical thread structure 40, as shown in Figures 1B and 1F. Also, the conical screw element 60 can be such that it is removable from the implant 100, for example, by threading the external thread 62 with the thread structure 40 and removing and inserting it through an opening 80 provided at the proximal end PE. In the illustrated example, the circular opening has a radius larger than the maximum outer diameter of the screw element 60. In one variant, the conical screw element 60 cannot be removed from the implant, for example, by selecting an opening 80 that prevents removal of the screw element 60, for example, but not limited to, an opening 80 smaller than the maximum cross section of the screw element 60 as seen in the insertion direction ID. Furthermore, the length L of the cone-shaped screw element 60 is shorter than the length of the extension of the internal cylindrical thread structure 40 in the insertion direction ID or the entire length of the implant 100, so that the screw element 60 can be threadably displaced relative to the partially internal cylindrical thread structure 40 and the implant 100 within a certain range and still be located completely inside the implant 100. In the illustrated variant, the length L is about 50% of the length of the implant 100. Preferably, for good support of the first and second sections 10, 20 by direct or indirect contact with the outer surface of the screw element 60 between the first and second sections 10, 20, the cone-shaped screw element 60 is not less than 30% of the entire length of the implant body 5 or the length of the extension of the internal cylindrical thread structure 40 in the insertion direction ID.

[0060]

[0076] As mentioned above, the implant 100 is configured in various sizes, and in this embodiment, the interaction between the cone-shaped screw element 60 and the internal cylindrical thread structure 40, in combination with the deformability of the interconnecting structure 30, allows the distance D between the first section 10 and the second section 20 to be varied. For example, FIGS. 1B, 1C, 1F, and 1G show the screw element 60 in a first initial position after being inserted into the implant 100. Thereafter, the first cone-shaped screw element 60 can be threadably rotated, e.g., in a clockwise direction, e.g., using a torque instrument removably attached to the torque application structure 64, to threadably engage the first cone-shaped screw element 60 with the first partial internal cylindrical thread structure 40, and then linearly advanced in a linear direction corresponding to the insertion direction ID toward the distal end DE of the implant 100. The screw element 60 thereby acts as a wedge or tapered element that moves gradually along the insertion direction and exerts an expansion force on the first and second sections 10, 20 forcing the expansion of these elements away from each other. In other words, this threadable rotation and linear advancement of the element 60 creates an expansive force toward the first and second sections 10, 20 that urges the first and second sections 10, 20 apart and increases the first distance D between the first and second sections 10, 20 by deformation of at least a portion of the interconnecting structure 30, e.g., increasing the V-angle between the tabs 36, 38 of the interconnecting elements 32, 34 by bending. In this regard, the interconnecting structure 30 can provide a counter force to the expansive force that can maintain the first and second sections 10, 20 in operative direct or indirect contact with the cone-shaped screw element 60.

[0061]

[0077] Furthermore, to further aid in the expansion of the sections 10, 20 by the threaded engagement of the conical screw element 60 with the partial internal cylindrical thread structure 40, an inclined surface 44 can be optionally provided facing the open segment of the first partial internal cylindrical thread structure 40, the inclined surface 44 being disposed between the first section 10 and the second section 20. In the variant shown in FIG. 1B, the inclined surface 44 forms part of the inner surface of the first upper section 10, and the thread structure 40 is formed on the inner surface of the second lower section 20, although this arrangement can be reversed (see, for example, FIG. 1F). The angle of orientation of the plane defining the inclined surface 44 relative to the insertion direction ID can be defined as a second angle α2, preferably the absolute value of the second angle α2 being equal or substantially equal to the first angle α1, but having an opposite sense or a different sign value. This allows multiple contact points CP of the apex of the external thread 62 to contact the inclined surface 44 to provide an expansion force to the second section 20 as shown in FIG. 1F or to the first section 10 as shown in FIG. 1B. In this arrangement, the distance between the inclined surface 44 and the partial internal cylindrical thread structure 40 measured in a direction perpendicular to the first and second bone-engaging surfaces 12, 22 decreases along the insertion direction ID to form a hollow portion that narrows toward the distal end DE and has an opening angle that is approximately twice the first angle α1. The inclined surface 40 can be a continuous surface, or a medium cross-section with an opening, or a narrow incline that extends only a limited width, to reduce implant material usage, and can be located substantially in the center of the implant 100 and positioned to ensure contact between the apex of the thread of the cone-shaped screw element 60 and the contact point CP.

[0062]

[0078] In this respect, the engagement and advancement of the conical screw element 60 into the narrowed opening by the inclined surface 44 and the first partial internal cylindrical thread structure 40 exerts an expansion force on the first and second sections 10, 20 for the expansion and increase of the distance D. The inclined surface 44 can be flat, but in order to increase the surface area of ​​the contact point CP, preferably the inclined surface 44 is a segment of a cylindrical surface, the cylinder having a radius at the operating side OS corresponding to, equal to or slightly larger than the maximum external thread radius of the conical screw element 60. Also, preferably, the cylindrical axis of the cylindrical segment of the inclined surface 44 is oblique to the insertion direction ID by a second angle α2 with a cylindrical axis CA, which can coincide with the thread axis TA1 in the region of or around the opening 80, as shown in FIG. 1F, for example.

[0063]

[0079] With the implant 100, a simplified design for intervertebral or interbody implants or spinal cages is provided, allowing for a reduction in parts used and reducing complexity. In the above-illustrated variant, only two parts are required, the implant body 5 and the cone-shaped screw element 60 of the implant 100, and the adjustability of the implant design can be maintained without the need for complex components and multiple moving parts. This can prevent operational failures and reduce manufacturing costs. In a preferred embodiment, the implant body 5, the cone-shaped screw element 60, or both, can be manufactured by three-dimensional printing, for example by using an electron melting beam 3D printer system and by using biocompatible Ti6Al4V metal powder. Other types of 3D printing techniques can be used, such as metal powder bed fusion, direct metal laser sintering (DMLS), selective laser melting (SLM), electron beam melting (EBM), metal binder jetting, or mold jetting.

[0064]

[0080] With regard to the manufacturing method using 3D printing technology, it is possible to print the implant body 5 and the one or more cone-shaped screw elements 60, 70 simultaneously by a 3D printing process, for example by assembling the body 5 and the one or more cone-shaped screw elements 60, 70 together layer by layer. The implant may, for example, comprise or consist of titanium, or may comprise or consist of plastic, for example polyetheretherketone (PEEK). The implant may be manufactured by 3D printing technology, for example, comprise or consist of titanium, or may comprise or consist of plastic, for example polyetheretherketone (PEEK). It is then possible to carry out one or more heat and / or surface treatment steps in order to obtain the required specific surface and core material properties. For example, once the body 5 and the one or more screw elements 60, 70 are formed, a hot isostatic pressing (HIP) treatment step can be carried out at high pressure using a heating chamber of a furnace to improve the mechanical properties, for example to improve the elasticity and deformability of the material, provide isotropy of the material, densify the material and thereby provide better fatigue resistance. Next, a pickling step can be performed for surface treatment, for example using a gas mixture of fluorine-hydrogen (HF) and nitric acid (HNO3), which can improve the surface properties of the body 5 and the one or more cone-shaped screw elements 60, 70 to reduce friction for screwing. Furthermore, after the pickling step, it is possible to perform an anodizing step, for example a type 3 titanium color anodizing step, to improve the usability and, optionally, to further reduce the friction surface properties or improve the lubricity. Optionally, the anodizing step can also include a type 2 titanium anodizing step for reducing friction or lubricity of the surface.Preferably, no additional machining steps are required of the implant body 5 and the one or more conically shaped screw elements 60, 70, e.g. by milling or lathe, and no additional assembly steps are required, as the body 5 and the one or more screw elements 60, 70 are the only parts of the implant described herein.

[0065]

[0081] Three-dimensional printing allows complex trabecular or porous structures to be created at low cost, in shorter manufacturing times, and with reduced material usage. Additionally, it is possible to fabricate complex elements for the deformable interconnect structure 30, such as a certain number of tabs 36, 38 arranged adjacent to each other, for example, to form two rows of interconnect elements 32, 34 on each lateral side. Also, by providing areas or volumes of the interconnect structure 30 or other elements with a degree of porosity, a degree of cavities, a degree of hollow volume, or by providing thinned walls, tabs, rods, etc., certain areas or volumes can be designated as deformable or bendable areas or volumes of the interconnect structure 30, as will be further described below. For example, in the context of the first embodiment of Figures 1A-1F, the volume where tab 38 contacts the first upper section 10, the volume where tabs 36, 38 interconnect, and the volume where tab 36 contacts the second lower section 20 can be made thinner or with some porosity to favor deformation or bending in these areas.

[0066]

[0082] Additionally, the interconnect structure 30 can be characterized as a device that, due to its mechanical deformation characteristics, can enable a change in the distance D between a first element or device 10, 12 for engaging a first vertebra and a second element 20, 22 for engaging a second vertebra, and the partial internal cylindrical thread structure 40 and the conical shaped screw element 60 cooperate to form a device, apparatus, or system that can increase the distance D between the first element 10, 12 and the second element 20, 22 by applying an expansion force to the interconnect structure 30, e.g., an expansion force applied by the first element 10, 12 and the second element 20, 22. In this regard, the device, subassembly, apparatus or system capable of increasing the distance D between the first element 10, 12 and the second element 20, 22, embodied by the structure 40 and the element 60, is configured to convert the rotational screwing motion of the cone-shaped screw element 60 relative to the screw structure 40 into a translational motion along the z-direction in order to vary the distance D by deforming at least a portion of the interconnect structure 30. Furthermore, the device, subassembly, apparatus or system capable of increasing the distance D between the first element 10, 12 and the second element 20, 22 can be configured to perform a conversion from a rotational screw motion to a translational motion without performing a linear slidable engagement of two obliquely arranged surfaces, e.g., a slidable linear engagement of two oblique structures without rotation of the oblique structures, or a slidable linear engagement of other types of slidable linear elements, e.g., having different types of cam and screw combinations. Also, for example, by using two different sections along the cylindrical shaft with left and right screws, no threaded cylindrical shaft is needed to move the cam member or tilt structure along the insertion direction, an arrangement that requires multiple moving parts.

[0067]

[0083] 2A-2G show a second exemplary embodiment of the present invention, in which an expandable implant 200 having a body 5 and one cone-shaped screw element 60 is provided. The expandable implant 200 and its body 5 form an insertion direction ID, which is an insertion direction of the implant 200. In contrast to the first embodiment, in which the first inclined surface 40 is provided in the form of either a plane or a cylindrical segment surface, a second partial internal cylindrical thread structure 46 is provided and arranged between the first upper section 10 and the second lower section 20. Furthermore, the second partial internal cylindrical thread structure 46 is arranged to face the first partial internal cylindrical thread structure 40 such that the first thread pitch of the first partial internal cylindrical thread structure 40 and the second thread pitch of the second partial internal cylindrical thread structure 46 match, allowing the cone-shaped screw element 60 to simultaneously screw into both the first partial internal cylindrical thread structure 40 and the second partial internal cylindrical thread structure 46 having the upper and lower sections 10, 20, respectively. Preferably, the first and second partial internal cylindrical thread structures 40, 46 can be separated by an expandable gap that expands due to the threading engagement of the conical screw element 60 with the partial thread structures 40, 46, as exemplarily shown in FIG. 2A. Furthermore, the second partial internal cylindrical thread structure 46 has a second thread axis TA2, which is arranged obliquely to the insertion direction (ID) by a second angle α2, preferably the absolute value of the second angle α2 is equal to the first angle α1, but is arranged in the opposite direction or is of a different sign value. The thread axes TA1 and TA2 are configured to intersect at an angle α1+α2 between the axes TA1 and TA2 in a position to provide a coincident thread. Thereby, there is a mirror-symmetric arrangement of cylindrical segments forming the first and second partial internal cylindrical thread structures 40, 46. In this embodiment, the contact surface of the contact point CP can be further increased and can also provide a more symmetrical application of the expansion force in view of the symmetry provided between the two partial thread structures 40, 46, and can also provide a smoother threaded engagement.Additionally, simultaneous threading of the first upper section 10 and the second lower section 20 can prevent displacement of the sections 10, 20 relative to one another in the insertion direction ID or in a direction lateral to the insertion direction.

[0068]

[0084] In this embodiment, the first and second sections 10, 20 can also be interconnected with each other with a tearable or releasable structure, which can be, for example, an additional part of the interconnect structure 30, or can be another separate part, such as an interconnection that can be torn or untied upon expansion of the sections 10, 20, for example, when a force is established by the threaded engagement of the cone-shaped screw element 60 with both the first and second partial internal cylindrical thread structures 40, 46 of the implant body 5 and the expansion of the sections 10, 20. The tearable structure can be, for example, but not limited to, a tearable layer, such as a porous or other weakened interconnect layer, a tearable adhesive, or an adhesive between the contact surfaces of the sections 10, 20 that face each other. In such an embodiment, both the first and second partial internal cylindrical thread structures 40, 46 can be initially interconnected without a gap between the first section 10 and the second section 20 at the interface before the expansion of the first section 10 and the second section 20 occurs.

[0069]

[0085] 3A-3N show an intervertebral implant 300 according to a third embodiment of the invention, the implant 300 having two partial internal cylindrical thread structures 40, 50 arranged adjacent to each other in the body 5, each structure 40, 50 extending substantially with an angular offset in the insertion direction (ID) and each of which is configured to threadably engage with a cone-shaped screw element 60, 70. In the illustrated variant, by using two substantially parallel arranged partial internal cylindrical thread structures 40, 50 in threaded cooperation with two respective cone-shaped screw elements 60, 70, it is possible to expand the body 5 in two different positions to increase the distance D1 at a first side of the implant body 5 and to increase the distance D2 at a second side of the body 5 opposite the first side. The distance D1 at the first side of the body 5 can be, for example, the distance between the outer surface of the first section 10 and the outer surface of the second section 20. However, the distance D1 can be measured, for example, between any first position on the first section 10 and any second position on the second section 20 that are subjected to relative displacement by the screw elements 60, 70. The distance D2 at the second lateral side of the body 5 can be, for example, the distance between an outer surface of the first section 10 and an outer surface of the second section 20. However, the distance D2 can be measured, for example, between any first position on the first section 10 and any second position on the second section 20 that are subjected to relative displacement by the screw elements 60, 70. For example, this allows the angular orientation between the first section 10 and the second section 20 to be changed to an angle β (see, for example, Figures 3J and 3M), for example by increasing the distance D1 on one side by a specific first height by threadingly moving the conical screw element 60 at a specific penetration distance into the body 5 and leaving the distance D2 on the other side unchanged, or by increasing the distance D2 on the other side by a specific second height by threadingly moving the conical screw element 70 at a specific penetration distance into the body 5 and leaving the distance D1 unchanged, or by increasing the distance D1-D2 to different heights at different penetration distances between the screw elements 60, 70.

[0070]

[0086] In this third embodiment, in addition to the partial internal cylindrical thread structure 40, another partial internal cylindrical thread structure 50 is arranged between the first section 10 and the second section 20 and extends adjacent to the partial internal cylindrical thread structure 40, the other or third partial internal cylindrical thread structure 50 forming a third thread axis TA3 shown in FIG. 3E, the third thread axis TA3 being oblique to the insertion direction ID by a third angle α3. The third angle α3 may be, for example, the same or substantially the same as the absolute value of the first angle α1 defined by the first thread axis TA1 of the first partial internal cylindrical thread structure 40, as described with respect to the previous embodiment. Furthermore, a second inclined surface 54 (see, for example, FIGS. 3E and 3G) facing the open segment of the third partial internal cylindrical thread structure 50 may be provided and may be arranged, for example, in a mirror symmetric arrangement, between the first section 10 and the second section 20. This arrangement may be similar to that of the first inclined surface 44, which is aligned facing the open segment of the first partial internal cylindrical thread structure 40. The second inclined surface 54 may be formed as a cylindrical segment surface having a cylinder axis that is oblique to the insertion direction (ID) by a fourth angle α4, and preferably the absolute values ​​of the third angle α3 and the fourth angle α4 are the same or substantially the same. In this regard, the distance between the second inclined surface 54 and the segment of the cylindrical surface of the third partial internal cylindrical thread structure 50 decreases along the insertion direction ID, measured in a direction perpendicular to the first bone-engaging surface 12 and the second bone-engaging surface 22.

[0071]

[0087] In another variant, instead of the second inclined structure 54 without threads, a fourth partial internal cylindrical thread structure 56 (not shown) can be arranged between the first section 10 and the second section 20 and arranged facing the third partial internal cylindrical thread structure 50 such that the third thread pitch of the third partial internal cylindrical thread structure 50 and the fourth thread pitch of the fourth partial internal cylindrical thread structure 56 coincide, for example, by a mirror symmetric arrangement of the structures 50, 56. The fourth partial internal cylindrical thread structure 56 can also define a fourth thread axis TA4, which is arranged to be oblique to the insertion direction (ID) by a fourth angle α4. Again, preferably, the absolute values ​​of the third angle α3 and the fourth angle α4 are the same.

[0072]

[0088] 3C and 3D, the interconnection structure 30 in this embodiment forms a transverse structure, for example in the form of a plate, arranged diagonally between the first section 10 and the second section 20, for example from one side edge of the first section 10 to the opposite side edge of the second section 20, when viewed in the insertion direction ID, and can be deformably attached to the first section 10 at one edge to form the first hinge element 15, and the interconnection structure 30 can be deformably attached to the second section 20 at the other opposite edge to form the second hinge element 25. Also, in this variant, the partial internal cylindrical thread structure 40 can be arranged to extend in a first position on the side of the interconnection structure 30 facing the first section 10, and the inclined surface 44, for example a cylindrical surface, or the second partial internal cylindrical thread structure 46 is arranged to be formed in a part of the first section 10 facing the thread structure 40. Similarly, the partial internal cylindrical thread structure 50 can be arranged to extend to a second location opposite the interconnect structure 30 facing the second section 20, and an inclined surface 54, e.g., a cylindrically shaped surface, or a fourth partial internal cylindrical thread structure 56 is arranged to be formed within a portion of the first section 10 facing the thread structure 40.

[0073]

[0089] Also, the interconnection structure 30 can have two curved curved surface elements 33, 37, which have a substantially cylindrical segment shape, with their cylindrical axes parallel to the insertion direction ID, the surface element 37 being arranged opposite the partial internal cylindrical thread structure 40 of the interconnection structure 30, and the surface element 33 being arranged opposite the partial internal cylindrical thread structure 50. These two surface elements 33, 37 can face two curved surface elements 18, 28 of the first section 10 and the second section 20, respectively, which also have a substantially cylindrical segment shape. In the unexpanded or unextended shape, the two curved surface elements 33, 37 and the two curved surface elements or components 18, 28 can be in contact with each other, or there can be a gap that can be formed between the two curved surface elements 33, 37 and the two curved surface elements 18, 28, respectively.

[0074]

[0090] Furthermore, in the third embodiment, transverse openings or cavities TO are arranged, which may form a first cavity in the central region of the first section 10, a second cavity in the central region of the interconnection structure 30, and a third cavity in the central region of the second section 20, as shown in Figures 3A, 3B, 3G, and 3H. Such transverse openings or cavities TO, which will be located between the structures of the partial internal cylindrical thread structures 40, 50 and the inclined surfaces 44, 54, may be used to fill or otherwise provide bone graft or other functional material therein.

[0075]

[0091] 3J-3N show the implant 300 in two different expanded states to illustrate its operation and different configuration possibilities. For example, FIG. 3J shows a front view of the implant 300 in a partially expanded state by the use of the cone-shaped screw element 60, which is fully threaded into the thread structure 40 to its end located away from the opening 80 at the maximum penetration depth or distance, resulting in an expanded state in which one lateral side is expanded to the maximum value of the distance D1. In contrast, the cone-shaped screw element 70 is still in the initial starting position at the opening 90. This places the bone-engaging surfaces 12, 22 at a first bending angle β1 as the first section 10 is pivoted about the first hinge element 15 as a deformable part of the interconnection structure 30. This maximum threaded penetration depth or distance of the screw element 60 allows the deformation of the interconnection structure 30 by the first hinge element 15 to reach a maximum extension of the distance D1, preferably reaching 50% or more of the initial non-extended distance D1 (e.g., 150% or more of the initial non-extended distance D1). Also, the maximum angle obtained between the surfaces of the bone-engaging surfaces 12, 22 preferably reaches about 12°, more preferably about 18° or more. FIG. 3K shows a top perspective view of the implant 300 with the conical screw element 60 fully threaded into the end of the partial internal cylindrical thread structure 40, using a vertically arranged cut plane passing through TA1, TA2, showing that the conical screw element 60 reaches the end of the partial internal cylindrical thread structure 40 at the tip or apex of the screw element 60, and FIG. 3L shows a top perspective view of the implant 300 with the conical screw element 60 fully threaded into the end of the partial internal cylindrical thread structure 40, as seen through the transverse opening TO.

[0076]

[0092] 3M shows a front view of the implant 300 fully expanded by using both cone-shaped screw elements 60, 70 fully threaded to their ends with the threaded structures 40, 50 at their maximum penetration depth or distance resulting in a fully expanded state with both lateral sides expanded to the maximum of the distances D1, D2, such that the bone engaging surfaces 12, 22 are arranged to be parallel or nearly parallel to each other as the first section 10 is pivoted about the first hinge element 15 as the deformable part of the interconnect structure 30 at the first bend angle β1 and the second section 20 is pivoted about the second hinge element 25 as the deformable part of the interconnect structure 30 at the first bend angle β2 or the second bend angle β2 by the equal penetration depth or distance of the screw elements 60, 70. This maximum threaded penetration depth or distance of the screw elements 60, 70 allows deformation of the first and second hinge elements 15, 25 of the interconnecting structure 30 to reach a maximum extension of both distances D1, D2, again preferably reaching 50% or more of the initial non-extended distance D1, D2 (e.g., 150% or more of the initial non-extended distance, 150% or more of the initial non-extended distance D2). FIG. 3N shows a top perspective view of the fully expanded body 5 of the implant 300.

[0077]

[0093] In the third embodiment, the implant 300 can be adjusted to provide a desired scoliosis, lordosis, or kyphosis angle for correction by allowing an angulation between the first upper section 10 and the second lower section 20, and thereby relative to their bone-engaging surfaces 12, 22. For example, for restoration of coronal balance, the lateral height by the separately adjustable distances D1, D2, and the coronal correction angle can be adjusted within a certain range.

[0078]

[0094] 4A-4F show aspects of a fourth embodiment of the invention illustrating an implant 400 having multiple corner elements, e.g., four corner elements 110, 120, 130, 140, extending longitudinally in an insertion direction ID, where engagement of a cone-shaped screw element 60 with one or more internal threads disposed on one or more of the four corner elements 110, 120, 130, 140, respectively, results in expansion of the implant body 5 in both the z-direction to have a variable dimension relative to a distance D1, and simultaneously in the y-direction to have a variable dimension relative to a distance D2, thereby forming an implant 400 with an expanding height and width. Furthermore, in the illustrated variation, the implant 400 has a somewhat rectangular cross-sectional area when viewed in the insertion direction ID. To allow for expansion in both the z- and y-directions that are perpendicular to each other, the corner elements sharing a side of the implant body 5 are interconnected with a deformable interconnecting structure, thereby having a plurality or four sets of a plurality of deformable interconnecting elements 115, 125, 135, 145, where the interconnecting element 115 is formed between the corner elements 110, 120, the interconnecting element 125 is formed between the corner elements 120, 130, the interconnecting element 135 is formed between the corner elements 130, 140, and the interconnecting element 145 is formed between the corner elements 140, 110. In the illustrated variation, the deformable interconnecting elements 115, 125, 135, 145 include a plurality of links or tabs having a V-shape. For example, each one of the deformable interconnection elements 115, 125, 135, 145 is formed from a pair of tabs or links 117, 119, 127, 129, 137, 139, 147, 149 disposed at different angles.

[0079]

[0095] Additionally, at least one (or more) of the corner elements 110, 120, 130, 140 includes a partial internal cylindrical thread 112, 122, 132, 142, where at least one of the partial internal cylindrical threads 112, 122, 132, 142 forms a discontinuous thread having a thread axis that is oblique to the insertion direction ID, the discontinuous thread being configured to threadably receive the conical screw element 60. In the illustrated variation, each corner element 110, 120, 130, 140 has a corresponding internal cylindrical thread 112, 122, 132, 142, but there is only one, and it is also possible that the other corner element has an inclined surface disposed at an oblique angle to the insertion direction ID, or has a cylindrical segment surface with a cylindrical axis that is oblique to the insertion direction ID, as discussed above. Preferably, at least two corner elements facing each other, such as corner elements 110, 130 or corner elements 120, 140, comprise partial internal cylindrical threads 112, 132 or 122, 142, and the other two corner elements can be equipped with inclined surfaces arranged at an oblique angle to the insertion direction ID or cylindrical segment surfaces arranged at an oblique angle to the insertion direction ID.

[0080]

[0096] The deformable interconnecting elements 115, 125, 135, 145 are deformable to enable the expansion of the distance D1 between the upper and lower sections of the two corner elements 110, 120 and 130, 140 arranged on the same side, and the simultaneous expansion of the distance D2 between the left and right sections of the two corner elements 120, 130 and 110, 140 arranged on the same side, such that when the conical screw element 60 is screwed into the discontinuous thread that may be formed by one or more partial internal cylindrical threads 112, 122, 132, 142, the progressive screwing of the conical screw element 60 advances the conical screw element 60 in the insertion direction to engage with one or more narrower sections of the diagonally arranged internal cylindrical threads 112, 122, 132, 142, widening the four corner elements 110, 120, 130, 140, thereby increasing the distance between adjacent corner elements.

[0081]

[0097] 5 shows a top perspective view of a spinal implant system 500 according to yet another embodiment of the present invention, illustrating an exemplary intervertebral implant 300 that can be removably interconnected to an implant handling device or system 505 to form a spinal implant system 500 having triple functionality, a first function of which is to hold and insert the implant 300 into the intervertebral space between two adjacently located vertebrae, a second function of which is to adjust the implant 300 for expansion and tilting of the first and second sections 10, 20 using two screwdrivers 540 capable of rotating the first cone-shaped screw element 60 and the second cone-shaped screw element 70, and a third function of which is to inject or otherwise provide bone graft into the transverse opening or another type of cavity of the spinal implant 300. The intervertebral implant 300 is merely exemplary, and other intervertebral implants described herein can be used with the implant handling device 505.

[0082]

[0098] The implant handling device or system 505 exemplarily includes a holder 530 formed by a hollow cylinder with a dual function: first, the holder 530 can be used to removably hold the implant 300, and second, the holder 530 can be used to guide and inject a bone graft into the implant 300 through its hollow body. Guiding and injecting the bone graft can be provided by a pusher 510 having a shape complementary to the internal volume of the holder 530, the pusher being configured to slidably engage with the internal volume and displaceable along the insertion direction ID. Furthermore, the pusher 510 itself can have a dual function, the first function being to act like a piston to push the bone graft through the inner volume holder 530 and into the implant 300 through a bone graft discharge opening or port 532 located at the distal end of the holder 530 and leading toward the transverse opening TO of the implant body 5, and the second function being to release the implant by being configured to disengage the holder 530 from the releasable engagement of the flexible coupling (or clip) 334 of the implant body 5 of the implant 300. This may be embodied by a distal end of the pusher 510 having a hollow cylindrical section forming a circular wall which, upon relative slidable engagement of the pusher 510 with respect to the holder 530 in the insertion direction ID, may bend the two clips 336, 338 inwardly to release them from the locking cavities 536, 538 of the holder 530 by engaging with the inclined surfaces 337, 339 (see, e.g., FIG. 6A ) of the clips 336, 338, respectively. Additionally, the front or distal end of the holder 530 further includes locking cavities or openings 536, 538 disposed within the side walls of the holder 530, and the flexible coupler 334 having the two symmetrically disposed flexible clips 336, 338 may be part of or formed with the interconnect structure 30 of the implant 300.

[0083]

[0099] Furthermore, the implant handling device or system 505 may further include one or more screwdrivers 540, each having a torque instrument 544 disposed at its distal end and configured to transmit torque to a corresponding one of the first and second torque application structures 64, 74 of each of the first and second conical screw elements 60, 70, and a screwdriver guide 520 that may be attached to the holder 530 or formed integrally therewith, and in the illustrated variant, has two guide bores 522, 524 extending in the insertion direction ID for guiding the two screwdrivers 540 to engage and rotate with the one or more conical screw elements 60, 70, respectively. The guide bores 522, 524 of the screwdriver guide 520 each have a hollow cylindrical shape dimensioned to accommodate the shaft of the screwdriver 540, and their cylindrical axes are configured to be spaced and positioned so that they coincide with the rotational axes of the conical screw elements 60, 70 disposed within the body 5 of the implant 300.

[0084]

[0100] 6A-6D show different top and side cross-sectional views of a hollow body, an implant 300, and a hollow body, e.g., a holder 530 having a cylindrical shaped element, illustrating the manipulation, i.e., interconnection and release, of the holder 530 from the implant body 5 with the holder 530 and the body 5 in a disengaged state (shown in FIGS. 6A and 6B) and an engaged state (shown in FIGS. 6C and 6D), and show an exemplary flexible coupler 334 of an implant 300 having two symmetrically arranged flexible clips 336, 338 that may be part of or formed with the interconnection structure 30 of the implant, e.g., two clips 336, 338 cut out of a plate forming the interconnection structure 30. Each clip 336, 338 has a sloped or angled surface 337, 339 that is oblique to the insertion direction ID, allowing the clips 336, 338 to bend radially inward by the distal end of the holder 530 for engagement between the holder 530 and the implant 300, and also bend radially inward by engagement with the cylindrical wall of the pusher 510 for disengagement or release of the holder 530 and the implant 300. In this regard, it is noted that the direction of insertion of the implant 300 into the intervertebral space and the direction of insertion of the holder 530 into the implant are substantially the same direction. Also shown is a flexible coupler 534 at the distal end of the holder, having a slotted cylindrical section configured to bend or flex radially away from and toward the central axis of the holder 530, and locking cavities or holes 536, 538 disposed in the sidewalls of the holder 530. 6C shows the implant 300 and holder 530 in an engaged state, where the clips 336, 338 are bent radially inward to engage corresponding locking cavities or holes 536, 538 disposed in the sidewall of the holder 530. The distal end of the holder 530 also forms a bone graft evacuation port 532 accessible within the body 5 of the implant 300, which leads to a transverse opening TO for bone graft injection into the opening TO.This can be accomplished by the pusher 510 acting like a piston within the hollow body or volume of the holder 530 to push the bone graft placed inside the holder 530 through the bone graft ejection port 532 and into the body 5 of the implant 300. Preferably, the interior hollow volume of the holder 530 is cylindrical and the pusher 510 has a corresponding cylindrical shape, although other cross-sectional shapes are possible.

[0085]

[0101] 7A-7D show four different views of an intervertebral implant 600 according to a fifth embodiment of the present invention, using two cone-shaped screw elements 660, 670, each having two conical screw components 664, 666 and 674, 676 arranged at the distal and proximal ends of each screw element 660, 670, the implant body 5 having two pairs of partial internal cylindrical thread structures 644, 646 and 654, 656 arranged to allow threading of the screw element 660 having the two conical screw components 664, 666 with the corresponding partial internal cylindrical thread structures 644, 646 on one side of the implant 600, and the screw element 670 having the two conical screw components 674, 676 with the corresponding partial internal cylindrical thread structures 654, 656 on the other side of the implant 600, the two screw elements 660, 670 being arranged to be approximately parallel to each other. This arrangement can provide improved pressure and weight distribution to the body 5 when pressurized or loaded in the z-direction, and can also provide improved parallelism of the upper and lower sections 10, 20 when the implant 600 is expanded, for example by minimizing deformations that may be caused by expansion with the cone-shaped screw elements 660, 670, for example to ensure that both the upper and lower surfaces 12, 22 remain parallel to the insertion direction ID. In the illustrated variant, there are two cone-shaped screw elements 660, 670, but the implant can also be provided with only one cone-shaped screw element 660 with front and rear cone screw components 664, 666. It is also possible that more than two screw components 664, 666 are provided on one screw element 660 or 670.

[0086]

[0102] In the illustrated variant, the four conical screw components 664, 666, 674, 676 and the corresponding partial internal cylindrical thread arrangements 644, 646, 654, 656 are located at the corners of the implant 300 when viewed in the z-direction to provide improved load-bearing and stabilization of the implant 600, although other configurations can be selected. For example, in one variant, to have three mechanical support positions, it is possible to have two conical screw components 664, 666 or 674, 676 on one side of the implant 600 and one screw element 660 or 670 on the other side with a conical shaped screw element 60 having only one conical screw element, as exemplarily shown in Figures 1A-1G. Such an embodiment also allows to create an implant with a triangular or trapezoidal profile when viewed in the z-direction, for example by having a triangular or trapezoidal first section 10 and a second section 20, where the conical screw element 60 is located at the short base of the trapezoid or at a corner of the triangle, and one longitudinal screw element 660 or 670 is located at or along the long base of the trapezoid or on the opposite side of the triangle. Also, the screw element 660 includes a shaft or bolt 662 with two conical screw components 664, 666 arranged at both ends, and the screw element 670 includes a shaft or bolt 672 with two conical screw components 674, 676 arranged at both ends. The screw elements 660, 670 can be placed in their operative position within the implant 600, as shown in FIG. 7D, by increasing the space between the first section 10 and the second section 20 by substantially extending the interconnect structure 30 in the z-direction to place the screw elements 660, 670 within their respective openings. The interconnect structure 30 may comprise any one of the interconnect structures 30 discussed herein in this disclosure. As described in the previous embodiment, the partial internal cylindrical thread structure 644, 646, 654, 656 may be included within (formed or provided on an inner surface of) the first section 10 or the second section 20.In the illustrated variant of FIG. 7B, the partial internal cylindrical thread structures 644, 646, 654, 656 are included in the first section 10. As previously disclosed in the previous embodiment, each partial internal cylindrical thread structure 644, 646, 654, 656 has a tread axis TA or cylindrical axis of rotation extending in the insertion direction but at an oblique angle αTA to the insertion direction, the oblique angle αTA being the same or substantially the same as the first angle α1, for example. The inclination angle α of each partial internal cylindrical thread structure 644, 646, 654, 656 may be the same or substantially the same. The or each one of the partial internal cylindrical thread structures 644, 646, 654, 656 may have an inclined surface 695, 696, 697, 698 facing it or disposed opposite it. The inclined surfaces 695, 696, 697, 698 are formed, provided and positioned relative to the partial internal cylindrical thread features 644, 646, 654, 656 in the same manner as described in the previous embodiment, and as previously described, each of them has a cylindrical axis that is oblique to the insertion direction ID by an angle αR. The absolute value of the angle αR may be the same or substantially the same as that of the angle αTA of the partial internal cylindrical thread feature positioned opposite (directly) the inclined surface.

[0087]

[0103] Furthermore, in the intervertebral implant 600, cylindrical surface elements 680, 690 can be arranged to engage or mate with a surface of the respective shaft or bolt 662, 672, each having a first cylindrical segment 682, 692 and a second cylindrical segment 684, 694 facing each other to guide the rotation performed by the longitudinal screw element 660, 670, respectively, relative to the implant body 5. The respective radii or diameters of the cylinder segments formed by the surfaces 682, 684 and the surfaces 692, 694 should be selected to be slightly larger than the radii or diameters of the respective shafts or bolts 662, 672 to allow for easy, but guided, rotation. The first cylindrically shaped segment 682, 692 may be integrally formed with, part of, or attachable to the first section 10, and the second cylindrically shaped segment 684, 694 may be integrally formed with, part of, or attachable to the second section 20. In a first unexpanded state or position of the implant 600, the two segments 682, 692 and 684, 694 of the cylindrically shaped surface element 680, 690 may be constructed and arranged such that their cylindrical axes coincide or are shared with the adjacent segments 682, 684 and 692, 694, and may coincide with the rotational axes of the shafts or bolts 662, 672, thereby forming a substantially cylindrical cavity or volume between the adjacent segments 682, 684 and 692, 694. This arrangement allows for improved guidance during rotation of the longitudinal screw elements 660 or 670, especially at the beginning of the expansion of the implant 600. This can prevent blocking of the conical shaped threads, e.g., the conical screw components 664, 666 and 674, 676. Upon expansion of the first and second sections 10, 20, the cavities or volumes between adjacent segments 682, 684 and 692, 694 are elongated and thus are no longer cylindrical, but can still provide some lateral guidance in the y direction.In one variation, the cylindrical surface elements 680, 690 are not two cylindrical surface segments facing each other as described above, but each form a generally cylindrical hole or bore in the block to accommodate the shaft or bolt 662, 672 therein, and may be arranged to be suspended between the first section 10 and the second section 20, for example, by using expandable elements or links arranged between the cylindrical surface elements 680, 690 and the first element 10, and between the cylindrical surface elements 680, 690 and the second element 20. These expandable elements may be part of or be an integral part of the different interconnect structures 30 discussed herein, or may be embedded within the interconnect structures 30, and may be made of similar or identical elements thereof, such as, but not limited to, bendable tabs, links, v-shaped elements, rounded or elliptical shaped elements, w-shaped elements, and combinations thereof. This variant provides cylindrically shaped surface elements 680, 690 suspended between the first element 10 and the second element 20, so that the rotational guidance by the shaft or bolt 662, 672 does not change with increasing expansion and distance between the first element 10 and the second element 20.

[0088]

[0104] 8A-8C show an intervertebral implant 700 according to a sixth embodiment of the invention, which has an implant body 5 with an interconnecting structure 730 formed by a plurality of spring elements 732.1 to 732.6, in an exemplary variant six spring elements 732.1 to 732.6, which are arranged along a central section of the body 5 and at least partially arranged in a transverse opening TO, the spring element 732 being arranged along the insertion direction ID between two openings interconnecting the first section 10 and the second section 20 and each having two partial internal cylindrical thread structures 40, 50. In the variant shown, transverse plate-like elements such as those shown in the embodiment of FIG. 3A are not shown or are not present, the spring elements are shown as deformable structures, for example elastically deformable structures that can extend in the z-direction in the middle or central section of the implant 700, in the variant shown, an M-shaped or W-shaped structure with four legs, each leg being slightly curved. Additionally, the orientation of the M-shaped or W-shaped structures in the transverse or y-direction is selected to alternate for each spring element 732.1-732.6 to provide a substantially symmetrical arrangement for minimizing lateral forces when expanding implant 700 in the z-direction.

[0089]

[0105] 9A-9D show different views of an intervertebral implant 800 according to a seventh embodiment of the present invention, where FIG. 9A shows a front top perspective view, FIG. 9B shows another front top perspective view from a different angle, FIG. 9C shows a front view with implant 800 in an unexpanded state, FIG. 9D shows a front view with implant 800 in a fully expanded state, and FIG. 9E shows implant 800 in a partially expanded state with an oblique angle between first section 10 and second section 20 of implant 800. The implant 800 may include a first section 10 having a first bone-engaging surface 12, e.g., having one or more openings therein, and a second section 20 having a second bone-engaging surface 22, with a transverse intermediate section 830 disposed between the first section 10 and the second section 20, with one end of the transverse intermediate section 830 articulably attached to the first section 10, e.g., along a side edge or end of the first section 10, and the other end of the transverse intermediate section 830 articulably attached to the second section 20, e.g., to a diagonally opposite side edge or end of the second section 20.

[0090]

[0106] Additionally, the implant 800 may further include a first rotatable bolt 860 disposed between the first section 10 and the transverse mid-section 830 and configured to define a first axis of rotation that is preferably parallel or approximately parallel to the insertion direction (ID), and a second rotatable bolt 870 disposed between the transverse mid-section 830 and the second section 20 and having a second axis of rotation that is preferably parallel or approximately parallel to the insertion direction (ID). The outer surfaces 862, 872 of the first and second rotatable bolts 860, 870 formed about their respective rotation axes, the first surface 832 facing the first section 10 of the transverse intermediate section 830, and the second surface 834 facing the second surface 20 are configured to grip or interlock with each other, for example by having a mutual engagement surface structuring such that upon rotation of at least one of the first and second rotatable bolts 860, 870 about the first or second rotation axis, at least one of the first and second rotatable bolts 860, 870 can roll on the first surface 832 or the second surface 834, respectively, with increased grip. The inner surface 19 of the first section 10 may have a flat or other smooth surface that allows the bolt 860 to rotatably slide or slip on the surface 19 when it is rotated and contacts the inner surface 19, and the inner surface 29 of the second section 20 may also have a flat or other smooth surface that allows the bolt 870 to rotatably slide or slip on the surface 29 when it is rotated and contacts the inner surface 19.

[0091]

[0107] In one variation, both the inner surface 19 of the first section 10 and the first surface 832 of the transverse mid-section 830 can have inter-engaging surface structuring for engaging with an outer surface 862 of a first rotatable bolt 860, and similarly, both the inner surface 29 of the second section 20 and the second surface 834 of the transverse mid-section 830 can have inter-engaging surface structuring for engaging with an outer surface 872 of a second rotatable bolt 870. In another variation, the first surface 832 of the transverse mid-section 830 can have a flat or other smooth surface that allows the bolt 860 to rotatably slide or slip over the first surface 832 when rotated and contacting the first surface 832, and the second surface 834 of the transverse mid-section 830 can have a flat or other smooth surface that allows the bolt 870 to rotatably slide or slip over the second surface 834 when rotated and contacting the second surface 834. Thus, in this variation, the inner surface 19 of the first section 10 can have an interengaging surface structuring for engaging with the outer surface 862 of the first rotatable bolt 860, and similarly, the inner surface 29 of the second section 20 can have an interengaging surface structuring for engaging with the outer surface 872 of the second rotatable bolt 870.

[0092]

[0108] In this configuration, by imparting a rotation, for example a clockwise rotation as viewed from the front, to the first rotatable bolt 860, i.e. by engagement of surface 862 of bolt 860 with either or both of surfaces 19, 832, the first rotatable bolt 860 moves in the positive y-direction, thereby exerting an expansion force between the first section 10 and the transverse section 830, thereby also exerting a bending force on the first bendable or pivotable mounting link 836, causing pivoting of the first section 10 relative to the transverse section 830; this transition from a first unextended state to a second extended state is shown in Figures 9C and 9E, which show two states upon rotational displacement of the first rotatable bolt 860. In this regard, the first section 10 and the transverse section 830 can be interconnected to one another by a first bendable or pivotable attachment link 836, e.g., an element of the transverse section 830 that is resiliently bendable to allow pivoting of the first section 10 relative to the transverse section 830. The bendable or pivotable attachment link 836 can be embodied as an edge portion between the transverse section 830 and the first section 10 and can be made of a reversibly bendable material or structural configuration. Due to the reversible bendability of the bendable or pivotable attachment link 836, rotating the first rotatable bolt 860 in a counterclockwise direction can move the first rotatable bolt 860 in the negative y-direction back to the state shown in FIG. 9C and the first section 10 can return to its initial, unextended position.

[0093]

[0109] Similarly, the second section 20 and the transverse section 830 can be interconnected to each other by a second bendable or pivotable attachment link 838 to enable a reversible pivotable interconnection between the second section 20 and the transverse section 30, and in a variant an edge is shown disposed between the transverse section 830 and the second section 20, and a second rotatable bolt 870 can effect reversible pivotal extension between the second section 20 and the transverse section 830, for example, by rotating clockwise for extension and counterclockwise for retraction.

[0094]

[0110] Preferably, the surface structuring of the first surface 862 of the first bolt 860, the second surface 872 of the second bolt 870, and the surface structuring of any one of the first surface 832 of the transverse mid-section 830, the second surface 834 of the transverse mid-section 830, the inner surface 19, and the inner surface 29 may be such as to allow for discrete positions of the first bolt 860 and the second bolt 870 along the y-axis. For example, the first surface 862 and the second surface 872 of the first rotatable bolt 860 and the second rotatable bolt 870 include alternating grooves 864 and ridges 866 (see, for example, FIG. 9C), with the exemplary variation showing three such alternating grooves 864 and ridges 866. The grooves 864 and ridges 866 are arranged to be parallel to the axis of rotation of the first bolt 860. Additionally, the surface structuring of the transverse mid-section 830 can include complementary shaped ridges 836 and grooves 838, whereby the ridges 866 of the bolts 860 can mate with the grooves 838 of the transverse mid-section 830. In the illustrated example, the ridges 866 of the bolts 860 are rounded to engage with the complementary rounded shaped grooves 838 of the transverse mid-section 830. As shown in Figures 9C-9E, in this configuration, the first bolts 860 can assume discrete positions with increased contact surface between the bolts 860 and the transverse mid-section 830, providing higher load bearing ratings and better weight distribution. The bolts 870 and the second surface 834 of the transverse mid-section 830 can be similarly configured with grooves 874 and ridges 876 of the bolts 870, as well as complementary grooves 837 and ridges 835.

[0095]

[0111] In this configuration, the first rotatable bolt 860 and the second rotatable bolt 870 can form a cam-type device, allowing for discrete displacement positions along the y-direction by applying a rotation to each one of the first bolt 860 or the second bolt 870. This provides an expandable implant device 800 that can expand such that the first and second bone engaging surfaces 12, 22 of the first and second sections 10, 20, respectively, remain parallel to one another when the same amount of rotation of both bolts 860, 870 is applied, thereby performing the same amount of linear displacement along the y-direction in opposite directions for the respective bolts 860, 870. This is illustrated in Figures 9C and 9D, where Figure 9C shows the implant 800 in a non-expanded state with both bolts 860, 870 in an initial position located near or on each side of the implant body 5, and Figure 9D shows the implant in a most expanded state with both bolts 860, 870 rotated the same distance in the y direction to their innermost positions on the implant body 5 to provide maximum expansion of the surfaces 12, 22. Furthermore, different angles between the surfaces 12, 22 can be achieved by rotating the first rotatable bolt 860 and the second rotatable bolt 870 to different positions along the y direction, with bolt 860 in its innermost position and bolt 870 in its outermost position as shown in Figure 9E.

[0096]

[0112] For additional load support and weight distribution, the expandable implant device 800 can include a first longitudinal ridge or ridge 815 extending in the insertion direction ID on a first surface 832 of the transverse intermediate portion 830 and a second longitudinal ridge or ridge 825 on a second surface 834 of the transverse intermediate portion 830, also extending in the insertion direction ID. Further, in an unexpanded position, for example as shown in FIG. 9C, the inner surface 19 of the first section 10 can include a corresponding groove 15G for receiving and contacting the first longitudinal ridge or ridge 815, and the inner surface 29 of the second section 20 can include a corresponding groove 25G for receiving and contacting the second longitudinal ridge or ridge 825. Further, for example at their front surfaces, the first and second rotatable bolts 860 and 870 can include a first torque application structure 869 and a second torque application structure 879 that enable removable engagement with a torque instrument, for example a screwdriver or torque tool. Also, the first rotatable bolt 860 and the second rotatable bolt 870 may each include a central transverse or non-transverse drill hole 865, 875 to allow for a tool guide rod or instrument, such as, but not limited to, a K-wire, Kirschner wire, or rod. Preferably, the expandable implant device 800 has two such rotatable bolts 860 and 870 instead of just one to provide various configuration positions of the bone engaging surfaces 12, 22 and also allow for parallel displacement or expansion of the first bone engaging surface 12 and the second bone engaging surface 22. As shown in Figures 9A, 9B, and 9C, in a non-expanded position or state, the surface walls of the first rotatable bolt 860 and the second rotatable bolt 870 may form part of the side wall of the implant device 800 and may contact tissue or bone. As shown, a portion of the outer surfaces 862, 872 of the first rotatable bolt 860 and the second rotatable bolt 870 may be provided with a surface that promotes bone or tissue ingrowth, such as trabecular surface structuring, a porous structure, or other types of surface structuring known to promote bone or tissue ingrowth.

[0097]

[0113] In the context of the seventh embodiment, the implant device 800 includes a flexible assembly or means provided by the first bendable or pivotable attachment link 836, the second bendable or pivotable attachment link 838 and the transverse mid-section 830, which interconnects the first and second elements 10, 20 and allows for a change in the distance D between the first element 10 and the second element 20, and further allows for a change in the angle between the first element 10 and the second element 20. Furthermore, the implant device 800 includes an assembly for increasing the distance D, or in particular a means for increasing the distance D between the first element 10 and the second element 20 by means of a first rotatable bolt 860 and a second rotatable bolt 870, which are configured to apply a bending force to the first bendable or pivotable attachment link 836 and the second bendable or pivotable attachment link 838 to allow reversible expansion.

[0098]

[0114] 10A and 10B show simplified top views of an intervertebral implant 900 according to an eighth embodiment of the present invention, where FIG. 10A shows a top view of an expansion mechanism 960 having two conical screw sections 964, 966 and a symbol layout of the body 905 in an unexpanded state, and FIG. 10B shows another top view of the expansion mechanism 960 in an expanded state, preferably used for transforaminal lumbar interbody fusion (TLIF) applications. However, some or all aspects of this embodiment can also be used for other spinal implant application types. In this embodiment, a conical screw-based expansion mechanism 960 is provided, where the torque application structure 984 of the head portion 980 can only rotate relative to the body 905 of the implant 900 and does not move along the insertion direction ID when rotated. For this variation, a sliding mechanism 970 is provided having a sleeve element 972 having an open inner bore attached to or integrally formed with the rotatable bolt 962, and a sliding shaft 974 configured to be slidably received inside the sleeve element 972 and attached to or integrally formed with a torque application structure 984, for example by another shaft element or interconnector 982. The inner surface of the open inner bore of the sleeve element 972 and the outer surface of the sliding shaft 974 are configured to allow sliding, slipping, or other relative movement along the axis of rotation of the rotatable bolt 962 while preventing relative rotation of the sleeve element 972 with respect to the sliding shaft 974. This prevention of rotation can be achieved by complementary surface structuring on the inner surface of the open inner bore of the sleeve element 972 and the outer surface of the sliding shaft 974, for example with alternating grooves and ridges extending along the axis of rotation, as shown in FIG. The interconnector 982 and the head portion 980 attached to or integrally formed with the sliding shaft 974 can be rotatably positioned within a cylindrical cavity in the proximal end PE of the body 905 of the implant 900, such that a user can insert a torque tool into the torque application structure 984 to expand and retract the implant 900 and the head portion 980 can rotate relative to the cylindrical cavity.Rotation and torque applied to the torque application structure 984 of the head portion 980 is transferred by the sliding mechanism 970 to the rotatable bolt 962, whereby the conical screw sections 964, 966 can be threadedly engaged with corresponding partially internal cylindrical threaded structures, such as those shown in Figures 7B and 7C at reference numbers 644, 646, or similar. The sliding mechanism 970 prevents the head portion 980 from being subjected to linear translation in the direction of the axis of rotation relative to the body 905. This engagement of the conical screw sections 964, 966 with the threaded structures expands the first and second sections 10, 20 of the body 905.

[0099]

[0115] 11A-11D show an embodiment of an intervertebral implant 1000 according to a ninth embodiment of the present invention, in which FIG. 11A shows a top perspective view thereof, FIG. 11B shows a top perspective view thereof and a see-through view thereof to show different elements of the implant 1000, FIG. 11C shows a cross-sectional view defined by a cutting plane coinciding with the axis of rotation of a rotatable expansion mechanism 1060, and FIG. 11D shows a top view thereof, the implant 1000 using an expansion mechanism that combines an embodiment using a cone-shaped screw element 1064 with linear sliding of one or more wedges 1072, 1074 against the sloped surfaces 1014, 1024 and the sloped surfaces 1016, 1026, respectively. The implant 1000 can be used for anterior lumbar interbody fusion (ALIF) applications. However, some or all aspects of this embodiment can also be used for other spinal implant application types.

[0100]

[0116] 11B, an expansion mechanism is provided that includes a rotating expansion mechanism 1060 rotatably interconnected or attached to a translation expansion mechanism 1070 disposed between a first section 1010 and a second section 1020 having bone engaging surfaces 1012, 1022. The rotating expansion mechanism 1060 can include a head portion having a torque application structure 1084, a cone-shaped screw element 1064 configured to threadably mate with one or more partial internal cylindrical thread structures 1044 that can be disposed inside the first section 1010, the second section 1020, or both the first section 1010 and the second section 1020, a shaft or bolt 1062, and a rotatable attachment mechanism 1077 configured to rotatably attach the rotating expansion mechanism 1060 to the translation expansion mechanism 1070. The rotatable mounting mechanism 1077 may be embodied by a recess or groove circularly arranged around a portion 1069 of the shaft or bolt 1062 disposed inside the cylindrical bore or hole 1079 of the translational expansion mechanism 1070, and a closure cap or plate 1068, such that the rotatable mounting mechanism 1077 or portion 1069 remains securely inside the cylindrical bore or hole 1079 even as the rotational expansion mechanism 1060 moves linearly back and forth along its rotational axis or along the insertion direction ID for expansion and contraction of the implant 1000.

[0101]

[0117] The translational expansion mechanism 1070 can include one or more wedge elements 1072, 1074, and in the illustrated variation, two wedge elements 1072, 1074 are disposed at the distal end of a transverse bar or beam 1078 that is rotatably attached at its center to the shaft or bolt 1062 of the rotational expansion mechanism 1060, for example by use of a transverse cylindrical bore or hole 1079. Additional wedge elements can also be disposed along the transverse bar 1078. The first and second sections 1010, 1020 are interconnected to one another with a resilient interconnect structure 1030, which is shown having one or more resilient interconnect elements 1031, 1032, 1033, 1034, 1035, and 1036, with the exemplary variation shown in the top view of FIG. 11D having six resilient interconnect elements that can resiliently hold the first section 1010 and the second section 1020 together to allow expansion and retraction of the implant 1000. In the variation shown, the resilient interconnect elements 1031-1036 are formed as wavy spring elements, but can have different shapes, as discussed above with respect to the different structures that can be used for the interconnect structure 1030 of the various embodiments described herein.

[0102]

[0118] The wedge elements 1072, 1074 can be urged against the first and second pairs of sloped surfaces 1014, 1024 (e.g., the top surface 1014 of the first section 1010 and the opposing bottom surface 1024 of the second section 1020) and sloped surfaces 1016, 1026 (e.g., the top surface 1016 of the first section 1010 and the opposing bottom surface 1026 of the second section 1020) of the first and second sections 1010, 1020, respectively, upon linear movement in the insertion direction ID, which can be initiated by threading and rotating the rotating expansion mechanism 1060, for example by applying torque to the torque application structure 1084 using a torque tool, thereby generating two expansion forces or pressure regions that urge the first and second sections 1010, 1020 of the implant body 1005 to expand or separate. This is due to the rotatable interconnection of the rotatable mounting mechanism 1077 between the rotational extension mechanism 1060 and the translational extension mechanism 1070. Preferably, the sloped surfaces 1014, 1024, 1016, 1026 are treated, coated, or otherwise manufactured to have a low coefficient of friction (COF) between them. Also, in the illustrated variant, both mutually facing surfaces 1014, 1024 and 1016, 1026 are sloped, meaning that they are oblique to the insertion direction ID. However, it is also possible that only one of the surfaces 1014, 1024, and 1016, 1026 is sloped, whereby one or more wedge elements 1072, 1074 also have only one corresponding sloped surface. These expansion forces or pressures then urge the first and second sections 1010, 1020 to expand away from one another increasing the distance therebetween and against the contraction forces exerted by the interconnecting structure 1030. At the same time, the rotational threaded engagement of the cone-shaped screw element 1064 of the rotational expansion mechanism 1060 with the one or more partial internal cylindrical thread structures 1044 also creates an expansion force or pressure field to urge the first and second sections 1010, 1020 of the implant body 1005 to expand or separate.When the rotating expansion mechanism 1060 is released from the threaded and counter-rotating rotation, the wedge elements 1072, 1074 are pulled back in the opposite direction of the insertion direction ID, thereby allowing the force exerted by the interconnecting structure 1030 to pull the first and second sections 1010, 1020 together for retraction, and at the same time, the cone-shaped screw element 1064 is threadably rotated to move against the insertion direction ID to reduce the distance between the first section 1010 and the second section 1020, again to be retracted by the force exerted by the interconnecting structure 1030. The combination of two expansion mechanisms, one linear with the wedge elements 1072, 1074 and one rotating using the cone-shaped screw element 1064, allows for less mechanical resistance to the expansion process of the sections 1010, 1020.

[0103]

[0119] For example, an implant 1000 for an ALIF procedure may be provided with only one access point for torque application, thereby still having at least three expansion force or pressure areas for expanding the sections 1010, 1020, and may have a torque application structure 1084 centrally located at the proximal end of the implant 1000, thereby providing a device that can be more easily used within a surgical environment without the need for several access points for the implant configuration. The rotating expansion mechanism 1060 may further include a bore or hole coincident with its rotation axis to removably accommodate a guide wire, e.g., a K-wire, Kirschner wire, or other guiding structure for guiding a torque tool during surgery. Herein, the implant 1000 is shown as having a rectangular profile when viewed from the top or z-direction. However, since this exemplary implant 1000 has three or more expansion force or pressure areas due to the two wedge elements 1072, 1074 arranged in a triangle and one of the cone-shaped screw elements 1064, the implant 1000 may be designed to have a triangular, trapezoidal, or other shape.

[0104]

[0120] 12A-12D show aspects of an intervertebral implant 1100 according to a tenth embodiment of the present invention, where FIG. 12A shows a top perspective view of the implant 1100, FIG. 12B shows a top perspective view in a different orientation, FIG. 12C shows a cross-sectional view defined by a horizontally disposed cutting plane coinciding with two rotation axes of the rotatable expansion mechanisms 1160, 1170, and FIG. 12D shows a top view of the implant 1100 positioned in the intervertebral space above a vertebra V. The implant 1100 can be used for lateral approach open incision spinal surgery (OLIF) applications. However, some or all aspects of this embodiment can be used for other spinal implant application types.

[0105]

[0121] The implant 1100 uses two parallel arranged rotating expansion mechanisms 1160, 1170 similar to those shown in Figures 3A-3N, but having different lengths, with their rotation axes arranged generally parallel to each other, and with cone-shaped screw elements 1164 and 1174 respectively arranged at first and second diametrically opposed corners of the implant body 1105. The first, longer rotating expansion mechanism 1160 has a first torque application structure 1184 at a proximal end PE accessible by a torque tool, with the first cone-shaped screw element 1164 arranged at the other distal end DE to form a first force or pressure area 1161 at a first corner of the body 1105. The torque application structure 1184 and the cone-shaped screw element 1164 are interconnected to each other by a bolt or shaft 1162. Additionally, the second, shorter, rotary expansion mechanism 1170 has a second torque application structure 1194 at the proximal end PE, but also a second cone-shaped screw element 1174 disposed at a second corner of the proximal end PE to create a second force or pressure area 1171 (see, for example, FIG. 12D) at a second corner of the body 1105 that is disposed diagonally opposite with respect to the first corner shown in FIG. 12D. With this arrangement, the proximal face of the implant 1100 has two torque application structures 1184, 1194 disposed adjacent to each other, but allows the implant body 1105 having first and second sections 1110, 1120 to expand with first and second pressure areas or zones 1161, 1171 at two opposing corners of the body 1105. The elastic interconnect structure 1130 can be arranged between the first section 1110 and the second section 1120, for example, by means of an elastic interconnect element 1135 arranged, for example, in the form of a V-shaped connecting link, in an extension region of the rotation axis of the second, shorter rotating expansion mechanism 1170. A plurality of interconnect elements 1135B can also be included, for example, between the first rotating expansion mechanism 1105 and the second rotating expansion mechanism 1170.Also, diagonally shaped transverse openings TO are disposed in the first and second sections 1110, 1120 and extend along an imaginary line extending halfway between the first and second pressure regions or zones 1161, 1171 and also extend diagonally between the first and second opposed corners of the implant body 1105. At each of the first and second diagonally disposed corners, first and second partial internal cylindrical thread features 1144 and 1154 are disposed on either the inner surface of the first section 1110, the inner surface of the second section 1120, or both to permit engagement of one of the first and second cone-shaped screw elements 1164 and 1174 to create an expansive force in the regions 1161, 1171, respectively.

[0106]

[0122] Figures 13A to 13D show different aspects of an intervertebral implant 1200 according to an eleventh embodiment of the present invention, where Figure 13A shows a top oblique view thereof, Figure 13B shows a front view relative to insertion direction ID to show its distal end DE, and also shows a cross-sectional view at section plane AA shown in Figure 13C, Figure 13C shows a top view thereof, and Figure 13D shows a side view and cross-sectional view at section plane BB, this eleventh embodiment being a modification of the fifth embodiment shown in Figures 7A to 7D. In this variation, the elastic interconnection structure 1230 elastically interconnecting the first and second sections 10, 20 includes a plurality of spring elements 1232, for example three different spring elements, where the first and second spring elements 1232.1, 1232.2 are arranged around the shaft or bolt 1262, 1272 of one of the cone-shaped screw elements 1260, 1270, respectively, and the third spring element 1232.3 is arranged at the distal end DE substantially midway between the two sides of the implant 1200. Also shown in this embodiment is a lateral opening TO having a cavity or volume for receiving and holding a bone graft, arranged between the screw elements 1260, 1270, and having a filling port FP at the proximal end. The filling port FP can have a transverse opening, such as a bore or hole, leading from the external environment to the cavity of the transverse opening TO and allowing the filling of the TO with an implant, for example with a tool, such as the embodiment shown in FIG. 5, having a flexible coupling mechanism 334, 534 configured to removably interconnect the implant 1200 with a tool, such as the implant handling device or system 505 shown in FIG. 5, the details of which and its operation are shown in FIGS. 6A-6D. As shown in the cross-sectional view of FIG. 13B, the first and second spring elements 1232.1, 1232.2 include open loops disposed around the bolts or shafts 1262, 1272 of the cone-shaped screw elements 1260, 1270, respectively, each of which also has two bent or curved arms interconnecting the ends of the open loop with the upper and lower sections 10, 20, respectively. The central third spring element 1232.3 is formed as a wave or wavy structure that interconnects the first and second sections 10,20.The upper and lower sections 10, 20 and the spring elements 1232.1, 1232.2, 1232.3 may be integrally formed by three dimensional printing.

[0107]

[0123] 14A-14F show different aspects of an intervertebral implant 1400 according to a twelfth embodiment of the present disclosure, where FIG. 14A shows a top perspective view thereof, FIG. 14B shows a side perspective view thereof and a cross-sectional view thereof, FIG. 14C shows a side view of the implant 1400 in an unexpanded state, FIG. 14D shows a side view of the implant 1400 in an expanded state, FIG. 14E shows a side view and a cross-sectional view of the implant 1400, and FIG. 14F shows a side view and a cross-sectional view of the implant 1400 and the screw element 1470, the twelfth embodiment being a variation of the fifth embodiment shown in FIGS. 7A-7D and the eleventh embodiment shown in FIGS. 13A-13D.

[0108]

[0124] In this variation, like the variations described above, particularly the variation of the fifth embodiment shown in Figures 7A to 7D and the variation of the twelfth embodiment shown in Figures 13A to 13D, the implant 1400 comprises a first section 10 having a first bone-engaging surface 12, a second section 20 disposed opposite the first section 10 and having a second bone-engaging surface 22, and an interconnecting structure 1430 interconnecting the first section 10 and the second section 20 and being deformable to enable a change in the distance and / or orientation between the first section 10 and the second section 20. The elastic interconnection structure 1230, which elastically interconnects the first and second sections 10, 20, similarly includes one or more spring elements 1432, e.g., three different spring elements, where the first and second spring elements 1432.1, 1432.2 are arranged around the shaft or bolt 1462, 1472 of one of the conical screw elements 1460, 1470, respectively, and the third spring element 1432.3 is arranged at a distal end DE between the two sides of the implant 1400, e.g., midway or substantially midway between the two sides of the implant 1400.

[0109]

[0125] As in the eleventh embodiment of Figures 13A-13D, the first and second spring elements 1432.1, 1432.2 may include an open loop disposed around the bolt or shaft 1462, 1472 of the cone-shaped screw element 1460, 1470, each of which also has two bent or curved arms interconnecting the ends of the open loop to the upper and lower sections 10, 20, respectively (see, for example, the cross-sectional view of Figure 13B). The central third spring element 1432.3 is formed as a wave-shaped or wavy structure interconnecting the first and second sections 10, 20. The upper and lower sections 10, 20 and the spring elements 1232.1, 1232.2, 1232.3 can be integrally formed by three-dimensional printing. The interconnect structure 1430 may alternatively comprise or consist of the interconnect structure previously disclosed in the fifth embodiment shown in Figures 7A-7D.

[0110]

[0126] Other features of the fifth embodiment shown in FIGS. 7A-7D and / or the eleventh embodiment of FIGS. 13A-13D may be included in this embodiment as well.

[0111]

[0127] The implant 1400 includes a transverse opening TO that includes or defines a cavity or volume for receiving and holding a bone graft, the cavity or volume being disposed between the screw elements 1460, 1470 and having a fill port FP at the proximal end PE. The fill port FP can have a transverse opening, such as a bore or hole leading from the external environment to the cavity of the transverse opening TO, allowing the graft to be filled into the transverse opening TO and cavity with a tool, for example, as shown in the system of the embodiment shown in Figures 16A and 16C, which will be described in more detail below. Compared to the previous embodiment, in this twelfth embodiment, the fill port FP includes an internal thread 1450 on the inner surface of the implant 1400, defining or delimiting a bore or hole leading from the external environment to the cavity of the transverse opening TO. The internal threads 1450 are configured to mate or engage with external threads provided on the interconnecting screw 1505 for connection to a spinal plate (shown in FIGS. 15A and 15B) or on the distal end of a tubular implant connector of a holding instrument or tool as described in more detail below in connection with the embodiment systems 1600, 1700 shown in FIGS. 16A and 16C and 17A and 17B. The first section 10 or the second section 20 includes a fill port FP, and in the illustrated variation, the second section 20 includes a fill port FP.

[0112]

[0128] In this variation, a plurality of implant partial internal cylindrical thread structures 1444, 1446, 1454, 1456 provided in the or each of the first or second sections 10, 20 have opposing partial internal cylindrical thread structures 1495, 1496, 1497, 1498 facing or disposed opposite thereto (instead of an inclined structure) to provide a dual-thread screw guide SG for each of the conical screw components 1464, 1466, 1474, 1476 disposed at the distal and proximal ends of the respective cone-shaped screw elements 1460, 1470. Thus, a plurality of dual-thread screw guides SG are provided, making it possible to ensure a more stable expansion of the implant 1400.

[0113]

[0129] Each opposing partial internal cylindrical thread structure 1495, 1496, 1497, 1498 is formed or provided within an inner surface of the first section 10 or the second section 20, and the implant partial internal cylindrical thread structure 1444, 1446, 1454, 1456 and the opposing partial internal cylindrical thread structures 1495, 1496, 1497, 1498 are ... 44, 1446, 1454, 1456 and the thread pitch of the opposing partial internal cylindrical thread structures 1495, 1496, 1497, 1498 are positioned to face the implant partial internal cylindrical thread structures 1444, 1446, 1454, 1456 of the dual thread screw guide SG so as to match or allow mating with the conical screw components 1464, 1466, 1474, 1476.

[0114] Each opposing partial internal cylindrical thread feature 1495, 1496, 1497, 1498 may define a thread axis TA that is obliquely disposed relative to the insertion direction ID by an angle αTA. The absolute value of the angle αTA of each opposing partial internal cylindrical thread feature 1495, 1496, 1497, 1498 may be the same as or substantially the same as the angle αTA of the oppositely (directly) disposed implant partial internal cylindrical thread feature 1444, 1446, 1454, 1456.

[0115]

[0130] Thus, the conical screw components 1464 , 1466 , 1474 , 1476 disposed at the distal and proximal ends of the respective cone-shaped screw elements 1460 , 1470 are guided by the resulting double-threaded screw guide SG to provide a more stable expansion of the implant 1400 .

[0116]

[0131] The implant 1400 of this variation may also include at least one or more elongated fixation elements or pins 1475 to improve fixation to the spinal endplate. However, multiple elongated fixation elements 1475 may also be included within the implant of any one of the embodiments of the present disclosure. The elongated fixation pins 1475 are attached to the first bone-engaging surface 12 and / or the second bone-engaging surface 22, and the pins 1475 extend away from the bone-engaging surface in a direction away from or opposite the insertion direction ID to facilitate insertion of the implant and in a direction that helps prevent removal of the implant after implantation. The elongated fixation pins 1475 (or each elongated fixation pin 1475) may include or define an elongated tapered structure that tapers to a reduced thickness or width in a direction extending away from the bone-engaging surface. The elongated fixation element 1475 may include an outer end with or defining a surface in the form of a hook, the surface including a curved portion facing or oriented toward the distal end DE of the implant 1400 and extending to a captured or jagged surface facing or oriented toward the proximal end PE of the implant 1400. The elongated fixation pin 1475 may extend at an angle from the first bone-engaging surface to define an acute angle Δ with respect to the bone-engaging surface (see, e.g., FIG. 14E ), the acute angle extending between the bone-engaging surface and a lateral wall LW of the pin 1475 that faces the proximal end of the implant 1400.

[0117]

[0132] The implant 1400 of this variation may also include at least one or more lateral guiding or retention tabs / winglets 1486 attached to and extending away from a lateral side LS of the implant 1400 disposed or extending between the first section 10 and the second section 20. A winglet 1486 is preferably disposed on each lateral side LS of the implant 1400.

[0118]

[0133] The first section 10 and / or the second section 20 may include lateral winglets 1486 extending therefrom. The lateral winglets 1486 are positioned on the lateral sides LS of the implant 1400 to be adjacent to or flanking the conical screw components 1464, 1466, 1474, 1476 of the cone-shaped screw elements 1460, 1470 when the implant 1400 is in an expanded state, for example as shown in FIG. 14D, and / or during rotation of the screw elements 1460, 1470 when the screw elements 1460, 1470 are advanced to a deep position inside the implant 1400. The lateral wiglet 1486 extends to at least partially close the lateral spacing between the first section 10 and the second section 20 when the implant 1400 is in an expanded or fully expanded state. Lateral movement of the screw elements 1460, 1470 is compensated for by realigning the screw elements 1460, 1470 so that the lateral wiglet 1486 contacts the conical screw component and advances along the thread axis. The cone-shaped screw elements 1460, 1470 provide additional guidance during advancement within the implant 1400, allowing the screw elements 1460, 1470 to be realigned or remain aligned along their tread axis TA and / or be retained within the implant 1400 to ensure a more stable implant 1400 during deployment to and in the expanded state.

[0119]

[0134] In the illustrated embodiment, as shown in FIG. 14D , the implant 1440 includes an upper or first lateral winglet 1486A that extends angularly away from the first section 10 toward the second section 20 and is positioned adjacent to or on a flank of the conical screw component 1466 of the cone-shaped screw element 1470, and a lower or second lateral winglet 1486B that extends angularly away from the first section 20 toward the first section 10 and is positioned adjacent to or on a flank of the conical screw component 1464 of the cone-shaped screw element 1470. An additional lower lateral winglet 1486C is located below the upper or first lateral winglet 1486A and extends away from the second section 20 away from the first section 10. An additional upper lateral winglet 1486D is located above the lower or second lateral winglet 1486B and extends away from the first section 10 to the second section 20. As shown in FIGS. 14C and 14D, the upper or first lateral winglet 1486A may extend at the same or substantially the same angle as the additional lower lateral winglet 1486C relative to the lateral side LS of the implant 1400, and the lower or second lateral winglet 1486B may extend at the same or substantially the same angle as the additional upper lateral winglet 1486D relative to the lateral side LS of the implant 1400, to facilitate closure of the implant 1400 in an unexpanded state. The lateral winglets 1486 may have or define, for example, a triangular configuration and may include or define a jagged or recessed perimeter surface.

[0120]

[0135] 15A shows a perspective view and FIG. 15B shows a side view and partial cross-sectional view of a spinal implant system 1500 according to yet another aspect of the disclosure. The system 1500 includes a twelfth embodiment vertebral or spinal plate (or device) 1501 and an intervertebral implant 1400 that can be attached or connected to the spinal plate 1501 by an interconnecting screw 1505. The interconnecting screw 1505 includes male threads configured to mate or engage with the internal threads 1450 of the fill port FP of the implant 1400 to attach the implant 1400 to the spinal plate 1501. The interconnecting screw 1505 can include a central transverse portion or be cannulated, thereby allowing a tool guide rod or instrument, such as but not limited to a K-wire, Kirschner wire, or rod, to be received therein and passed through the interconnecting screw 1505. The interconnecting screw 1505, alone or together with the spinal plate 1501, can be slid or displaced along a tool guide rod or instrument to facilitate connection with or capture by the internal threads 1450 of the implant 1400. Similarly, a cannulated screwdriver can be connected to the interconnecting screw 1505, for example, by being slid along a tool guide rod or instrument to be attached to the interconnecting screw 1505, thereby guiding the interconnecting screw 1505 into the internal threads 1450 of the implant 1400 and allowing it to be screwed into the internal threads 1450 of the implant 1400, thus attaching the interconnecting screw 1505 and the spinal plate 1501 to the implant 1400.

[0121]

[0136] The spinal plate 1501 includes a central transverse bore 1520 through which the interconnecting screw 1505 is received and passes to connect to the fill port FP and the implant 1400. The central transverse bore 1520 includes an outer section 1521 of a larger diameter or width than an inner section 1522, the outer section 1521 configured to receive the screw head of the interconnecting screw 1505, the inner section 1522 receiving the shaft of the interconnecting screw 1505. The screw head has a wider diameter than the inner section 1522 of the central transverse bore 1520 to allow the interconnecting screw 1505 to be retained or held by the spinal plate 1501 and the implant 1400 to be attached to the spinal plate 1501. The spinal plate 1501 also includes first and second bone screw transverse bores 1525, 1530 disposed on either or opposite sides of the central transverse bore 1520. The first and second bone screw transverse bores 1525, 1530 are configured to receive bone screws 1510, 1515, respectively, that are inserted into upper and lower or first and second vertebrae disposed on either side of the implant 1400. Each of the bone screw transverse bores 1525, 1530 similarly includes an outer section 1531 and an inner section (not shown), where the outer section 1531 has a larger diameter or width than the inner section. The outer section 1531 is configured to receive the screw head of the bone screw 1510, 1515, where the inner section is configured to receive the shaft of the bone screw 1510, 1515. The screw head has a wider diameter than the inner section of the transverse bores 1525, 1530 to allow each bone screw 1510, 1515 to be held or retained by the spinal plate 1501, and the spinal plate 1501 to be attached or secured to a vertebra or spine. Thus, the spine plate 1500 is configured to accept bone screws 1510, 1515 for implantation within the spine to provide support to hold or retain the implant 1400 within or between vertebrae after implantation.The spinal plate 1500 may also include a flexible blocking element 1550 extending across and / or into the outer section 1531 of the bone screw transverse bore 1525, 1530 to act as an outer stop or abutment to block the bone screw from exiting the plate 1501. The flexible blocking element 1550 may be located, for example, on the outer rim of the outer section 1531 and may comprise a flexible blade or spring that extends in front of the bone screw head to allow contact with the screw head if the bone screw is displaced over time in a direction to exit the plate 1501. The plate 1501 may include a recess 1551, for example, in communication with the outer section 1531 of the bone screw transverse bore or contained within a wall defining the bone screw transverse bore, the recess 1551 including the flexible blocking element 1550 extending therefrom into the outer section 1531. The recess 1551 is configured to receive the flexible blocking element 1550 therein during insertion and rotation of the bone screw so as not to impede implantation of the bone screw. Although FIG. 15A shows one flexible blocking element 1550, the plate 1501 may include at least one flexible blocking element 1550 for each bone screw of the plate 1501, for example. The plate 1501 may be manufactured, for example, by 3D printing. The plate 1501 may be manufactured, for example, by 3D printing and may include or consist of titanium.

[0122]

[0137] FIG. 16A shows a perspective view of another spinal implant system 1600 according to yet another embodiment of the present disclosure. The system 1600 includes an intervertebral implant 1400, an intervertebral implant holding instrument or tool 1605, at least one screwdriver 1610, a removable separate bone graft inserter 1615, an injection syringe 1620, and a slap hammer 1625. FIG. 16B shows an enlarged perspective view of the implant holding instrument 1605 shown in FIG. 16A. FIG. 16C shows a top view of the implant holding instrument 1605, and FIG. 16D shows a cross-sectional view taken along BB of the implant holding instrument 1605. FIG. 16E shows an enlarged perspective view of the screwdriver 1610, the removable bone graft inserter 1615, the injection syringe 1620, and the slap hammer 1625 shown in FIG. 16A.

[0123]

[0138] The implant holding instrument 1605 extends (substantially) linearly or straight from the proximal end PE1 to the distal end DE1 of the instrument. The implant holding instrument 1605 includes an elongated body 1632 with a handle portion 1633 at the proximal end PE1 and an implant interface head 1636 disposed at the distal end DS1. The body 1632 includes a shaft 1638 extending between the handle portion 1633 and the implant interface head 1636. The body 1632 includes a central channel 1640 extending from the proximal end PE1 to the distal end DE1 and configured to receive and hold the tubular implant connector 1630.

[0124]

[0139] The tubular implant connector 1630 comprises a shaft 1642 comprising an elongated hollow tube (i.e., for example, flexible), a knob 1644 at a proximal end, and an implant interface device 1646 disposed at a distal end of the shaft 1642. The tubular implant connector 1630 and the implant interface device 1646 include a hollow tubular coupling element 1634 including male threads configured to mate or engage with internal threads 1450 of a fill port FP of the implant 1400 to attach the implant 1400 to the tubular implant connector 1630.

[0125]

[0140] The hollow tubular coupling element 1634 comprises, for example, a hollow cylindrical rod with an external thread provided on its outer surface for mating with the internal threads 1450 of the fill port FP. The elongated body 1632 includes or defines a cavity 1652 configured to hold the knob 1644. To connect to the internal threads 1450 of the fill port FP of the implant 1400 and attach the implant 1400 to the tubular implant connector 1630, the tubular implant connector 1630 is positioned within the implant holding instrument 1605 such that the knob 1644 is received within the cavity 1652, the shaft 1642 is received within the central channel 1640, and the implant interface device 1646 is received inside the implant interface head 1636 and through its central orifice CO by the coupling element 1634 extending and protruding outwardly from the implant interface head 1636. The tubular implant connector 1630 is arranged to rotate inside the central channel 1640 and implant interface head 1636, for example, by rotation of the knob 1644 about the central axis R, allowing the male threads of the coupling element 1634 to mate or engage with the internal threads 1450 of the fill port FP to attach the implant 1400 to the tubular implant connector 1630. The implant holding instrument 1605 may include a removable cover 1654 that is removable from the proximal end PE1 to allow insertion or replacement of the tubular implant connector 1630. The implant holding instrument 1605 and the removable cover 1654 may be manufactured, for example, by plastic injection molding.

[0126]

[0141] The implant retaining device 1605 is made of, includes, or consists of, for example, plastic or polymer. The implant retaining device 1605 is made of, includes, or consists of, for example, polyvinyl chloride (PVC), polyethylene, polyester, polycarbonate, polyetheretherketone (PEEK), ultra-high molecular weight polyethylene (UHMWPE) or polyacrylamide. The knob 1644 of the tubular implant connector 1630 may be made of, include, or consist of the aforementioned materials, but may also be made of, include, or consist of metals such as stainless steel, or titanium, or tantalum, or platinum, or palladium, or aluminum. The remaining elements of the tubular implant connector 1630 may also be made of, include, or consist of such metals, or may be made of, include, or consist of such plastic / polymer materials.

[0127]

[0142] The implant holding device 1605 extends completely (substantially) linearly or straight from the proximal end PE1 to the distal end DE1 of the device, and the implant 1400 is positioned or attached thereto in alignment with the linear extension direction of the implant holding device 1605.

[0128]

[0143] The implant holding instrument 1605 further includes a first screwdriver guide channel 1656 extending from the proximal end PE1 to the distal end DE1 and a second screwdriver guide channel 1658 extending from the proximal end PE1 to the distal end DE1. The first screwdriver guide channel 1656 is a partially closed channel formed by a proximal surround section 1660A contained within the handle portion 1633, a distal surround section 1662A contained within the implant interface head 1636, and an open support 1664A extending between the proximal surround section 1660A and the distal surround section 1662A. The second screwdriver guide channel 1658 similarly includes an open support 1664B extending between the proximal surround section 1660B and the distal surround section 1662B.

[0129]

[0144] The screwdriver 1610 includes an elongated shaft 1666 (i.e., flexible, for example), a knob 1667 at a proximal end, and an implant interface device 1668 disposed at a distal end. The implant interface device 1668 includes a torque instrument 1669 disposed at the distal end and configured to transmit torque to the torque application structures of the first and second screw elements 1460, 1470 of the implant 1400, which may have any of the torque application structures previously described in connection with the first embodiment of the present disclosure.

[0130]

[0145] The knob 1667 of the screwdriver 1610 may be made of, include, or consist of the plastic / polymeric materials mentioned above. The remaining elements of the screwdriver 1610 may be made of, include, or consist of metals such as stainless steel, or titanium, or tantalum, or platinum, or palladium, or aluminum.

[0131]

[0146] The screwdriver 1610 is received by the implant holding instrument 1605 via the first orifice OF1A, passes through the proximal surround section 1660A of the handle portion 1633, along the open support 1664A, and through the distal surround section 1662A of the implant interface head 1636, such that the torque instrument 1669 exits through the second orifice OF2A of the implant holding instrument 1605 and the implant interface head 1636 to connect to the torque application structure of the screw element 1470. The screwdriver 1610 can be connected to the torque application structure of the screw element 1460 in a similar manner via the third orifice OF1B, the proximal surround section 1660B, the open support 1664B, and the distal surround section 1662B of the handle portion 1633, and the fourth orifice OF2B of the implant interface head 1636.

[0132]

[0147] 16E also shows an enlarged perspective view of the screwdriver 1610, as well as an enlarged perspective view of the removable bone graft inserter 1615, the injection syringe 1620, and the slap hammer 1625. The implant holding instrument 1605 includes a slap hammer attachment mechanism 1670 at its proximal end configured to connect to an attachment mechanism 1671 disposed at a distal end of the slap hammer 1625. The attachment mechanisms 1670, 1671 may be configured to engage one another using, for example, a bayonet attachment or fitting, for example, the attachment mechanism 1670 including a slot configured to receive the pin attachment mechanism 1671. Alternatively, for example, a screw-on attachment may be used.

[0133]

[0148] The independent bone graft inserter 1615 comprises, for example, an elongated flexible hollow tube 1671 and a connection device 1672 including a first connector, for example, a threaded connector 1673 configured to engage or mate with a corresponding threaded connector 1674 of the injection syringe 1620, and an opposing second connector 1674 configured to connect at its proximal end to the attachment mechanism 1670 of the implant holding instrument 1605. The second connector 1674 may include, for example, a bayonet attachment or fitting, or a threaded connection, as described above in connection with the slap hammer 1625. The threaded connector 1673 of the connection device 1672 and the corresponding threaded connector 1674 of the injection syringe 1620 are configured to implement, for example, a Luer lock.

[0134]

[0149] The flexible elongated hollow tube 1671 has a diameter and length such that it can be received inside the central channel 1640 of the implant holding instrument 1605 and extend therethrough into the fill port FP of the implant 1400 for injecting the bone graft into the implant 1400. The central channel 1640 can guide the independent bone graft inserter 1615 into the fill port FP and secure it at its proximal end PE1 to the attachment mechanism 1670 of the implant holding instrument 1605. When attached to the independent bone graft inserter 1615, the injection syringe 1620 allows for the injection of the bone graft or demineralized bone matrix into the implant 1400 through the elongated flexible hollow tube 1671. The independent bone graft inserter 1615 uses the implant holding instrument 1605 as a guide for backfilling the implant 1400 with the bone graft. The injection syringe 1620 and separate bone graft inserter 1615 may be made of, include, or consist of, for example, polyvinyl chloride (PVC), polyethylene, polyester, polycarbonate, polyetheretherketone (PEEK), ultra-high molecular weight polyethylene (UHMWPE), or polyacrylamide. The slap hammer 1625 may also be made of, include, or consist of such materials, or the aforementioned metals.

[0135]

[0150] FIG. 17A shows a perspective view of another spinal implant system 1700 according to yet another embodiment of the present invention, illustrating an exemplary intervertebral implant 1400, an angled implant holding instrument 1705, a screwdriver 1710, a separate removable bone graft inserter 1715, an injection syringe 1720, and a slap hammer 1725. FIG. 17B shows an enlarged perspective view of the angled implant holding instrument 1705 shown in FIG. 17A. FIG. 17C shows an enlarged perspective view of the screwdriver 1710, a separate removable bone graft inserter 1715, an injection syringe 1720, and a slap hammer 1725 shown in FIG. 17A. FIGs. 17D-17F show enlarged perspective and top views of the angled implant holding instrument 1705. FIG. 17G shows details of the distal end of the flexible tube of the cage holder 1705, and FIG. 17H further illustrates the angled implant holding instrument 1705.

[0136]

[0151] The system 1700 is identical to the previously described spinal implant system 1600 of Figures 16A-16E, except that the implant holding instrument is an angled implant holding instrument 1705, as can be seen, for example, in Figures 17B and 17D-17F and 17H. The implant holding instrument does not extend completely linearly or straight from the proximal end PE1 to the distal end DE1 of the instrument. Instead, the angled implant holding instrument 1705 extends first linearly or straight and then curved. The implant interface head 1736 is tilted or angled at an angle θ relative to a central axis R1 that extends in the direction of extension of the proximal section PS of the implant holding instrument 1705. For such purpose, the proximal section PS can be defined to extend between the outermost proximal end or proximal tip PT of the instrument 1705 and a midpoint MD of the instrument 1705, the midpoint MD being located at a distance of half the maximum length value MLV of the instrument 1705 (see, for example, FIG. 17H). The angle θ can be, for example, between 5° and 45°. The implant interface head 1736 has, for example, a first lateral side FLS, which is longer in length than a second lateral side SLS located opposite the first posterior FLS (see, for example, FIG. 17F), thus defining the angular deviation θ of the instrument 1705. The curvature direction of the distal end of the instrument 1705 or the implant interface head 1736 can be lateral, left or right, as shown in FIGS. 17D-17F, relative to the extension direction of the central axis R1, or can be downward or upward relative to the extension direction of the central axis R1. The angled implant holding device 1705 is configured to continuously or permanently maintain an angled orientation.

[0137]

[0152] The tubular implant connector 1730 is identical to the tubular implant connector 1630 described above and includes a shaft 1742 comprising an elongated hollow tube, a knob 1744 at a proximal end, and an implant interface device 1746 disposed at a distal end of the shaft 1742. The tubular implant connector 1730 and the implant interface device 1646 include a hollow tubular coupling element 1734 as previously described. The implant interface device 1746 further includes a bendable interconnector 1790 interconnecting the distal end of the shaft 1742 and the tubular coupling element 1734. The bendable interconnector 1790 may include a hollow body 1791 with a number of stripes 1792 and a number of slots 1792 where material of the body 1791 is absent or removed. Each stripe 1792 is disposed between, for example, two slots 1793. The plurality of stripes 1792 and slots 1792 are arranged to allow the distal end of the implant holding instrument 1705 to bend elastically in all directions away from the central axis CA1 of the implant holding instrument 1705. This allows the distal end of the tubular implant connector 1730 received within the implant interface head 1736 of the implant holding instrument 1705 to bend elastically and guided up to the loading port FP of the implant 1400 and connected thereto, for example, by a threaded connection by rotation of the tubular implant connector 1730, as shown in Figures 17D-17F. The previously described tubular implant connector 1630 may also include such a bendable interconnector 1690, for example, as an option.

[0138]

[0153] Additionally, similar to the screwdriver 1610 previously described with respect to the system 1600, the screwdriver 1710 includes an elongated shaft 1766, a knob 1767 at a proximal end, and an implant interface device 1768 disposed at a distal end. The implant interface device 1768 includes a torque instrument 1769 disposed at the distal end and configured to transmit torque to the torque application structures of the first screw element 1460 and the second screw element 1470 of the implant 1400. The implant interface device 1746 further includes a bendable interconnect 1790 interconnecting the distal end of the shaft 1766 and the torque instrument 1769. The bendable interconnect 1790 may be the same as that of the tubular implant connector 1730 or may be implemented differently. The bendable interconnect 1790 allows the screwdriver 1710 received within the implant interface head 1736 of the implant holding instrument 1705 to bend elastically and the torque instrument 1769 to be guided out through the orifices OF2A, OF2B of the implant holding instrument 1705 and implant interface head 1736 to connect to the torque application structures of the screw elements 1460, 1470. Rotation of the torque application structures by the screwdriver 1710 allows expansion of the implant 1400. The screwdriver 1610 previously described may also, for example, optionally include such a bendable interconnect 1790.

[0139]

[0154] Thus, the spinal implant system 1600, 1700 provides straight and angled disposable implant holding instruments for the lateral, ATP and iliac crest approaches 1705.

[0140]

[0155] Although described with respect to spinal implant systems 1600, 1700, implant holding instruments 1605, 1705, respectively, relate to further independent aspects of the present invention.

[0141]

[0156] Although the present invention has been disclosed with reference to certain preferred embodiments, numerous modifications, variations, and alterations to the described embodiments, as well as equivalents thereof, are possible without departing from the scope and scope of the present invention. For example, aspects of one embodiment may be incorporated into another of several embodiments. As a non-limiting example, it is understood that the sliding mechanism 970 of the eighth embodiment may also be an aspect of other embodiments that use cone-shaped screw elements to maintain the position of the torque application structure in a specific position and avoid linear displacement along the rotational axis defined by the respective cone-shaped screw elements. As another example, the elements of the implant handling device or system 505 of the spinal implant system 500 may also be part or elements of other embodiments of the spinal implant described herein. Also, the manufacturing techniques described herein may be used or applied to any of the embodiments described herein. Thus, the present invention is not limited to the described embodiments, but is intended to be given its broadest reasonable interpretation in accordance with the language of the appended claims.

Claims

1. 1. An expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) having an insertion direction (ID) for placement in an intervertebral space, a first section (10) having a first bone engaging surface (12); a second section (20) having a second bone engaging surface (22) disposed opposite the first section (10), the first and second bone engaging surfaces (12, 22) being oriented generally parallel to the insertion direction (ID); an interconnect structure (30) interconnecting the first section (10) and the second section (20), wherein at least one portion of the interconnect structure (30) is deformable to allow for a change in distance and / or orientation between the first section (10) and the second section (20); a first partial internal cylindrical thread structure (40) disposed between the first section (10) and the second section (20), the first partial internal cylindrical thread structure (40) having a first thread axis (TA1), the first thread axis (TA1) being oblique to the insertion direction (ID) by a first angle α1; 1. An expandable implant comprising:

2. a first inclined surface (44) facing an open segment of said first partial internal cylindrical thread structure (40) and disposed between said first section (10) and said second section (20), wherein a distance between said first inclined surface (44) and said first partial internal cylindrical thread structure (40) decreases along said insertion direction (ID) as measured in a direction perpendicular to said first and second bone engaging surfaces (12, 22).

2. The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 1.

3. 3. The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 2, wherein the first inclined surface (44) forms a cylindrical segment surface having a cylinder axis that is oblique to the insertion direction (ID) by a second angle α2.

4. a second partial internal cylindrical thread structure (46) disposed between the first section (10) and the second section (20), the second partial internal cylindrical thread structure (46) facing the first partial internal cylindrical thread structure (40) such that a first thread pitch of the first partial internal cylindrical thread structure (40) and a second thread pitch of the second partial internal cylindrical thread structure (46) match, the second partial internal cylindrical thread structure (46) having a second thread axis (TA2), the second thread axis (TA2) being oblique to the insertion direction (ID) by a second angle α2; 10. The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 1, further comprising:

5. a third partial internal cylindrical thread structure (50) disposed between the first section (10) and the second section (20) and extending adjacent to the first partial internal cylindrical thread structure (40), the third partial internal cylindrical thread structure (50) having a third thread axis (TA3), the third thread axis (TA3) being oblique to the insertion direction (ID) by a third angle; 10. The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 1, further comprising:

6. a second inclined surface (54) facing an open segment of said third partial internal cylindrical thread structure (50) and disposed between said first section (10) and said second section (20), wherein a distance between said second inclined surface (54) and said third partial internal cylindrical thread structure (50) decreases along said insertion direction (ID) as measured in a direction perpendicular to said first and second bone engaging surfaces (12, 22).

6. The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 5.

7. 7. The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 6, wherein the second inclined surface (54) forms a cylindrical segment surface having a cylindrical axis that is oblique to the insertion direction (ID) by a fourth angle.

8. a fourth partial internal cylindrical thread structure (56) disposed between the first section (10) and the second section (20), the fourth partial internal cylindrical thread structure (56) facing the third partial internal cylindrical thread structure (50) such that a third thread pitch of the third partial internal cylindrical thread structure (50) and a fourth thread pitch of the fourth partial internal cylindrical thread structure (56) match, the fourth partial internal cylindrical thread structure (56) having a fourth thread axis (TA4), the fourth thread axis (TA4) being oblique to the insertion direction (ID) by a fourth angle; The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 5, further comprising:

9. The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 1, wherein the interconnecting structure (30) is deformably attached to the upper section (10) to form a first hinge element (15) and the interconnecting structure (30) is deformably attached to the lower section (20) to form a second hinge element (25).

10. a first cone-shaped screw element (60) having a first external thread (62) configured to mesh with the first partial internal cylindrical thread formation (40); 10. The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 1, further comprising:

11. a second cone-shaped screw element (70) having a second external thread (72) configured to mesh with the third partial internal cylindrical thread formation (50); The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 5, further comprising:

12. The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 10, wherein when the first conical screw element (60) is threadedly engaged with the first partial internal cylindrical thread structure (40), a first distance (D1) between the first section (10) and the second section (20) is increased by pushing the first and second sections (10, 20) apart due to deformation of the at least one portion of the interconnect structure (30).

13. The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 5, wherein the interconnection structure (30) is disposed diagonally between the first section (10) and the second section (20), and the first and second hinge elements (15, 25) are disposed on opposite side edges of the first and second sections (10, 20), respectively, or the interconnection structure (30) includes a plurality of spring elements (632) disposed between the first partial internal cylindrical thread structure (40) and the third partial internal cylindrical thread structure (50).

14. The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 13, wherein the first partial internal cylindrical thread structure (40) is formed in a surface of the interconnect structure (30) facing the first section (10).

15. The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 13, wherein the third partial internal cylindrical thread structure (50) is formed in a surface of the interconnect structure (30) facing the second section (20).

16. The interconnect structure (30) a plurality of first elastic interconnection elements (32) disposed between the first section (10) and the second section (20) on one side adjacent to the first partial internal cylindrical thread structure (40); a plurality of second elastic interconnection elements (34) disposed between the upper section (10) and the lower section (20) on another side adjacent to the first partial internal cylindrical thread structure (40); The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 1, comprising:

17. 17. The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 16, wherein at least one of the plurality of first elastic interconnection elements (32) and at least one of the plurality of second elastic interconnection elements (34) include a first tab (36) having a first diagonal direction and a second tab (38) having a second diagonal direction, the first and second diagonal directions being different.

18. 2. The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 1, wherein the interconnection structure (30) is deformable to allow expansion of a distance D between the upper section (10) and the lower section (20) when a conical screw element (70) is threadedly engaged with the first partial internal cylindrical thread structure (40).

19. 18. The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 17, wherein the plurality of first elastic interconnection elements (32) and the plurality of second elastic interconnection elements (34) are deformable to change the relative angle between the first oblique direction and the second oblique direction to enable expansion of a distance D between the upper section (10) and the lower section (20) upon engagement of a conical screw element (50) with the first internal thread (40).

20. an expansion mechanism (1070) configured for linear displacement relative to said implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400), said expansion mechanism (1070) comprising at least one wedge element (1072, 1074) for engaging at least one slope surface (1014, 1024, 1016, 1026) of one or both of said first and second sections (10, 20), said expansion mechanism (1070) rotatably connected to said first conical shaped screw element (60) such that threaded engagement of said first conical shaped screw element (60) with said first partial internal cylindrical thread structure (40) linearly displaces said expansion mechanism (1070). The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 10, further comprising:

21. An expandable implant (400) for placement in an intervertebral space, comprising: Four corner elements (110, 120, 130, 140) extending parallel to the insertion direction (ID); four sets of a plurality of deformable interconnection elements (115, 125, 135, 145), each elastic interconnection element being disposed between two adjacent corner elements (110, 120), (120, 130), (130, 140), (140, 110); Equipped with at least one corner element (110, 120, 130, 140) includes a partial internal cylindrical thread (112, 122, 132, 142), said at least one partial internal cylindrical thread (112, 122, 132, 142) forming a discontinuous thread with a thread axis oblique to an insertion direction (ID), said discontinuous thread configured to threadably receive a conical screw element (60); Expandable implants.

22. 22. The expandable implant (400) of claim 21, wherein at least two of the four corner elements (110, 120, 130, 140) include partial internal cylindrical threads (112, 122, 132, 142).

23. The expandable implant (400) of claim 21, wherein the deformable interconnecting elements (115, 125, 135, 145) are deformable to enable expansion of a distance D1 between the upper and lower sections of the two corner elements (110, 120) (130, 140) and simultaneously expansion of a distance D2 between the left and right sections of the two corner elements (120, 130) and (110, 140) when the conical screw element (60) is screwed into the discontinuous thread.

24. 22. The expandable implant (400) of claim 21, wherein at least one of the deformable interconnecting elements (115, 125, 135, 145) includes a first tab having a first diagonal direction and a second tab having a second diagonal direction, the first and second diagonal directions being different.

25. 1. An expandable implant (100, 200, 300, 400, 600, 700, 800, 900, 1000, 1100, 1200, 1400) having an insertion direction (ID) for placement within an intervertebral space, a first element (10, 12, 110, 120) for engaging a first vertebra; a second element (20, 22, 130, 140) for engaging a second vertebra; a flexible means (30, 125, 145, 730, 830, 836, 838) interconnecting said first element (10, 12, 110, 120) and said second element (20, 22, 130, 140), said flexible means allowing a change in the distance D between said first element (10, 12, 110, 120) and said second element (20, 22, 130, 140); means (40, 60, 860, 870) for increasing the distance between the first element (10, 12, 110, 120) and the second element (20, 22, 130, 140) by applying at least one of an expanding or bending force to the flexible means (30, 125, 145, 830, 836, 838); 1. An expandable implant comprising:

26. The expandable implant (100, 200, 300, 400, 600, 700, 800, 900, 1000, 1100, 1200, 1400) of claim 25, wherein the means (40, 60) for increasing the distance is configured to convert a rotational threading motion into a translational motion to change the distance D by deforming at least a portion of the flexible means (30, 125, 145, 730).

27. 26. The expandable implant (100, 200, 300, 400, 600, 700, 800, 900, 1000, 1100, 1200, 1400) of claim 25, wherein the means (40, 60) for increasing the distance is configured to perform the translation without the use of a linear slidable engagement or a device that performs linear translation without rotation.

28. 26. The expandable implant (100, 200, 300, 400, 600, 700, 900, 1000, 1100, 1200, 1400) of claim 25, wherein said means (40, 60) for increasing said distance comprises a conical shaped screw element (60) and an at least partial internal cylindrical thread (40).

29. An expandable implant system (500), comprising: Intervertebral implants (100, 200, 300, 400, 600, 700); An implant handling device or system (505); Equipped with The implant handling device or system (500) comprises: a holder (530) having a dual function for releasably holding the implant (100, 200, 300, 400, 600, 700) with couplings (534, 536, 538) and for guiding and injecting a bone graft into the implant (100, 200, 300, 400, 600, 700) through a bone graft ejection port (532); a dual-function pusher (510) insertable into said holder (530) and acting as or like a piston to push a bone graft through the holder (530) and into said implant (100, 200, 300, 400, 600, 700) and to disengage said holder (530) from releasable engagement with said implant (100, 200, 300, 400, 600, 700); A screwdriver (540); a screwdriver guide (520) which can be attached to or formed integrally with said holder (530), the screwdriver guide (520) having a guide bore (522) extending in said insertion direction ID for guiding said screwdriver (540) for engagement and rotation with a cone-shaped screw element (60); Equipped with Expandable implant system.

30. 13. A three-dimensional (3D) printing method for manufacturing the expandable implant of claim 1.

Images