Convex apical reducer and method of using same

Abstract

A convex apical reducer for use in straightening a spine and method of use is described herein. The convex apical reducer includes a handle coupled to a fulcrum arm, a pusher telescoping arm extendably coupled to the fulcrum arm, and a selectively rotational screw pivot coupled to the pusher telescoping arm, the selectively rotational screw pivot coupling the pusher telescoping arm to a screw arm, the selectively rotational screw pivot for rotating the screw arm about a central axis relative to the pusher telescoping arm. The reducer further includes an apical pusher arm pivotally coupled to the screw arm via a selectively rotational pusher pivot. A linear portion of the apical pusher is coupled to a T-bar that is perpendicular to the fulcrum arm, the apical pusher at least partially coated in a friction coating, the T-bar for interacting with an apex of a convex area of a bent spine.

Description

CONVEX APICAL REDUCER AND METHOD OF USING SAME CROSS REFERENCES TO RELATED APPLICATIONS

[0001] The following application claims priority under 35 U.S.C. § 119 (e) to U.S. Provisional Patent Application Serial No. 63 / 746,459 filed January 17, 2025 entitled CONVEX APICAL REDUCER AND METHOD OF USING SAME. The above-identified application is incorporated herein by reference in its entirety for all purposes.TECHNICAL FIELD

[0002] The present disclosure generally relates to a convex apical reducer and method of using same, and more particularly to an adjustable convex apical reducer and method of using same.BACKGROUND

[0003] During spinal surgery, towers 210, 220 are often attached to pedicle screws 214, 224 to allow access to a pedicle screw tulip head 216. 226 (see FIGS. 4-5). The towers 210, 220 helps eliminate any challenges that may occur in placing rods 218, 228 into a surgical exposure to engage with the pedicle screw tulip heads 216, 226. The towers 210, 220 and tulip and screws 212, 222 are especially important in deeper wounds with minimal exposure as well as deformity correction surgery, such as scoliosis surgery.

[0004] Providers do not know what causes common types of scoliosis. While less common types of scoliosis may be caused by neuromuscular conditions, such as cerebral palsy or muscular dystrophy, birth defects, certain childhood or infant surgeries, injuries to or infections of the spine, and / or spinal cord irregularities.Page 1 of 25NCH-032841.F WO ORD

[0005] Scoliosis is an abnormal lateral LAT curvature of the spine. In persons with scoliosis curvature of the spine occurs in at least one of a lumbar region, a thoracic region and / or a thoracic region of the spine 202. In an abnormal lateral LAT curvature of the spine, the curve has an apex of a convex portion, known as the convex apical area 204 of the spine. This convex apical area 204 is an appropriate target to apply pressure or force to straighten the convex portion prior to affixing the rods 218, 228 to the tulip and screws 212, 222. As illustrated in the prior art example of FIG. 1, a bent bar 10 having a handle 12 at a first end coupled to a curved bar 16 via a straight bar 14, wherein the curved bar 16 terminates at a second end, is currently utilized to straighten curved spines.SUMMARY

[0006] One aspect of the present disclosure comprises a convex apical reducer for use in straightening a spine and method of use is described herein. The convex apical reducer includes a handle coupled to a fulcrum arm, the handle and the fulcrum arm extending along an x-axis, a pusher telescoping arm extendably coupled to the fulcrum arm, wherein the pusher telescoping arm extends along the x-axis, a selectively rotational pivot coupled to the pusher telescoping arm, the selectively rotational pivot coupling the pusher telescoping arm to a linear portion, wherein the linear portion extends along the x-axis, the selectively rotational pivot for rotating the linear portion about a central axis relative to the pusher telescoping arm, and a T-bar coupled to the linear portion, the T-bar is perpendicular to the x-axis.

[0007] Another aspect of the present disclosure comprises a convex apical reducer. The convex apical reducer includes a handle coupled to a fulcrum arm, the handle and the fulcrum arm extending along an x-axis, a pusher telescoping arm extendably coupled to the fulcrum arm, wherein the pusher telescoping arm extends along the x-axis, a selectively rotational pivotPage 2 of 25NCH-032841.F WO ORDcoupled to the pusher telescoping arm, the selectively rotational pivot coupling the pusher telescoping arm to a linear portion, wherein the linear portion extends along the x-axis, the selectively rotational pivot for rotating the linear portion about a central axis relative to the pusher telescoping arm. The convex apical reducer includes a T-bar coupled to the linear portion, the T-bar is perpendicular to the x-axis, a tower arm removably couplable to the fulcrum arm, a tower arm coupled to a selectively rotational arm pivot, the selectively rotational arm pivot coupling the tower arm to the fulcrum arm, further wherein the selectively rotational arm pivot is for rotating the tower arm about a central axis relative to the fulcrum arm, wherein the tower arm extends along the x-axis, and a tower retainer coupled to the tower arm via a selectively rotational tower pivot, the selectively rotational tower pivot for rotating the tower retainer about a central axis relative to the tower arm.

[0008] Y et another aspect of the present disclosure comprises a convex apical reducer for use in straightening a spine and method of use is described herein. The convex apical reducer includes a handle coupled to a fulcrum arm, the handle and the fulcrum arm extending along an x-axis, a pusher telescoping arm extendably coupled to the fulcrum arm, wherein the pusher telescoping arm extends along the x-axis, a selectively rotational screw pivot coupled to the pusher telescoping arm, the selectively rotational screw pivot coupling the pusher telescoping arm to a screw arm, wherein the screw arm extends along the x-axis, the selectively rotational screw pivot for rotating the screw arm about a central axis relative to the pusher telescoping arm. The convex apical reducer further includes an apical pusher arm pivotally coupled to the screw arm via a selectively rotational pusher pivot, the apical pusher arm comprising a linear portion extending along the x-axis, the linear portion coupled to a T-bar that is perpendicular to the x-axis, the apical pusher at least partially coated in a friction coating, the T-bar for interacting with an apex of a convex area of a bent spine, a tower arm removably couplable to the fulcrum arm ,Page 3 of 25NCH-032841.F WO ORDwherein the tower arm is coupled to a selectively rotational arm pivot, the selectively rotational arm pivot coupling the tower arm to the fulcrum arm, the selectively rotational arm pivot t for rotating the tower arm about a central axis relative to the fulcrum arm, wherein the tower arm extends along the x-axis, and a tower retainer coupled to the tower arm via a selectively rotational tower pivot, the selectively rotational tower pivot for rotating the tower retainer about a central axis relative to the tower arm.BRIEF DESCRIPTION OF THE DRAWINGS

[0009] The foregoing and other features and advantages of the present disclosure will become apparent to one skilled in the art to which the present disclosure relates upon consideration of the following description of the disclosure with reference to the accompanying drawings, wherein like reference numerals, unless otherwise described refer to like parts throughout the drawings and in which:

[0010] FIG. 1 is a prior art example of a bent bar;

[0011] FIG. 2 illustrates a rear perspective view of a convex apical pusher, in accordance with one example embodiment of the present disclosure;

[0012] FIG. 3 illustrates a rear perspective view of a convex apical pusher, in accordance with a second example embodiment of the present disclosure;

[0013] FIG. 4 is a top view of a convex apical pusher in contact with a spine, in accordance with one example embodiment of the present disclosure;

[0014] FIG. 5 is a top perspective view of a convex apical pusher in contact with a portion of a spine, in accordance with one example embodiment of the present disclosure;

[0015] FIG. 6 illustrates a front perspective view of a convex apical pusher andPage 4 of 25NCH-032841.F WO ORDadditional selectively removable and attachable apical pusher arms and tower retainers, in accordance with a second example embodiment of the present disclosure;

[0016] FIG. 7 is a perspective view of a convex apical pusher in accordance with one example embodiment of the present disclosure;

[0017] FIG. 8 is a top perspective view of FIG 7;

[0018] FIG. 9 is a bottom perspective view of FIG 7;

[0019] FIG. 10 is atop right perspective view of FIG 7;

[0020] FIG. 11 is a top plan view of FIG 7;

[0021] FIG. 12 is a bottom plan view of FIG 7;

[0022] FIG. 13 is a right elevation view of FIG 7;

[0023] FIG. 14 is a left elevation view of FIG 7;

[0024] FIG. 15 is a front elevation view of FIG 7;

[0025] FIG. 16 is a rear elevation view of FIG 7;

[0026] FIG. 17 is front perspective view a convex apical pusher in accordance with one example embodiment of the present disclosure;

[0027] FIG. 18 is rear perspective view' a convex apical pusher in accordance with one example embodiment of the present disclosure;

[0028] FIG. 19 is a left perspective view of FIG 18;

[0029] FIG. 20 is a top perspective view of FIG 18;

[0030] FIG. 21 is a top plan view of FIG 18;

[0031] FIG. 22 is a bottom plan view of FIG 18;

[0032] FIG. 23 is a left side elevation view of FIG 18;Page 5 of 25NCH-032841.F WO ORD

[0033] FIG. 24 is a right side elevation view of FIG 18;

[0034] FIG. 25 is a front elevation view of FIG 18; and

[0035] FIG. 26 is a rear elevation view of FIG 18.

[0036] Skilled artisans will appreciate that elements in the figures are illustrated for simplicity and clarity and have not necessarily been drawn to scale. For example, the dimensions of some of the elements in the figures may be exaggerated relative to other elements to help to improve understanding of embodiments of the present disclosure.

[0037] The apparatus and method components have been represented where appropriate by conventional symbols in the drawings, showing only those specific details that are pertinent to understanding the embodiments of the present disclosure so as not to obscure the disclosure with details that will be readily apparent to those of ordinary skill in the art having the benefit of the description herein.DETAILED DESCRIPTION

[0038] Referring now to the figures generally wherein like numbered features shown therein refer to like elements throughout unless otherwise noted. The present disclosure generally relates to a convex apical reducer and method of using same, and more particularly to an adjustable convex apical reducer and method of using same.

[0039] FIGS. 2 and 3 illustrates a convex apical reducer 100, in accordance with one or more example embodiments of the disclosure. In one example embodiment, the convex apical reducer 100 includes a handle 102 coupled to a fulcrum arm 104, the handle and the fulcrum arm extending along an x-axis. The fulcrum arm 104 is extendably coupled to a pusher telescoping arm 122, wherein the telescoping arm is coupled to a selectively rotationalPage 6 of 25NCH-032841.F WO ORDscrew pivot 126, the selectively rotational screw pivot couples the pusher telescoping arm 122 to a screw arm 128. The screw arm 128 is pivotably coupled to an apical pusher arm 140 via a selectively rotational pusher pivot 132.

[0040] In scoliosis treatments, convexity of a patient's spine is addressed and treated. The target region for this treatment is at the apex of the patient’s spinal convexity. Advantageously, the convex apical reducer 100 is used to manipulate a patient’s spine toward the spinal midline by applying direct force to convex apical anchors including rods 218, 228 (see FIG. 4). In a typical method of operation, the convex apical reducer 100 is in contact with both the operator’s abdomen and the patient’s spine, with the operator applying midline directed force on rods 218, 228. The fulcrum arm 104 is then used to de-rotate the patient’s spine out of its original mal-rotated position and manually translate the apex of the scoliosis toward midline of the patient’s spine. The convex apical reducer 100 also acts as a fulcrum to push and de-rotate the patient’s spine around the axis of the convex apical reducer 100.

[0041] In one example embodiment, the handle 102 terminates in circumferentially expanded area 102a. In one example embodiment, the circumferentially expanded area 102a extends beyond the thickness of the handle 102 along a y and z axis. In one example embodiment, the circumferentially expanded area 102a is one of rounded, polygonal, or rectangular. In one example embodiment, the handle 102 comprises one of rubber, silicone, and / or other autoclavable materials. In one example embodiment, the handle 102 has a handle length that is between 20% to about 50% of a total length of the convex apical reducer 100. In another example embodiment, the handle is between 8cm to about 15cm.

[0042] In one example embodiment, the fulcrum arm 104 extends from the handle 102. In this example embodiment, the fulcrum arm 104 supports a portion of the pusherPage 7 of 25NCH-032841.F WO ORDtelescoping arm 122 within the fulcrum arm, such that as the pusher telescoping arm 122 is telescoped away from the fulcrum arm, the pusher telescoping arm extends a total length of the convex apical reducer 100 while still partially residing within the fulcrum arm. In one example embodiment, the pusher telescoping arm 122 telescopes into and out of the fulcrum arm 104 along the x-axis. In one example embodiment, the fulcrum arm 104 is substantially hollow and defines an inner diameter. In this example embodiment, the pusher telescoping arm 122 defines an outer diameter, wherein the outer diameter is greater than the inner diameter. In one example embodiment, the inner diameter is between 1mm to about 5mm less than the outer diameter. In one example embodiment, the pusher telescoping arm 122 is a same or lesser length than the fulcrum arm 204. In one example embodiment, the pusher telescoping arm 122 is between 25 cm to about 60 cm. In another example embodiment, the fulcrum arm 104 is between 20 cm to about 50 cm.

[0043] In one example embodiment, the pusher telescoping arm 122 and the fulcrum arm 104 define a series of complementary openings into which a pin, screw, or other object may reside to fix the pusher telescoping arm 122 at a desired length. In another example embodiment, the pusher telescoping arm 122 extends from the fulcrum arm 104 responsive to an activation of an adjustment handle or button, a ratcheting mechanism, or the like. In this example embodiment, the pusher telescoping arm 122 extends linearly from the fulcrum arm 104. Advantageously, the adjustability of the pusher telescoping arm 122 allows a user to adjust to various distances between the user and the spine 202 of the patient.

[0044] In this example embodiment, the fulcrum arm 104, the pusher telescoping arm 122, and the screw arm 128 extend along the x-axis wherein, the selectively rotational screw pivot 126 pivots the screw arm 128 along the y-axis while maintaining the screw arm along the x-axis. In one example embodiment, the selectively rotational screw pivot 126 pivotsPage 8 of 25NCH-032841.F WO ORDabout an axis of rotation defined by a central element 126a, such that the screw arm 126 rotates in a circular arc relative to the pusher telescoping arm 122. In this example embodiment, the screw arm 128 is selectively rotatable about the selectively rotational screw pivot 126 in a first direction 124a a second direction 124b. In one example embodiment, the screw arm 128 rotates responsive to a force applied in the first or second direction 124a, 124b and responsive to an activation of an adjustment handle or button, a ratcheting mechanism, or the like, wherein said activation allows the rotation. In one example embodiment, the screw7arm 128 is a screw angle 124 from the pusher telescoping arm 122. In one example embodiment, the screw angle 124 is adjustable via rotation between about 10° to about 180°. In another example embodiment, the screw7angle 124 is limited by the selectively rotational screw pivot 126 to betw een about 90° to about 120°. In one example embodiment, the screws arm 128 is betw een 10 cm to about 15 cm. In another example embodiment, the screw arm 128 is one of 11 cm, 12 cm, 13 cm, or 14 cm.

[0045] In one example embodiment, fulcrum arm 104, the pusher telescoping arm 122, the screw7arm 128, and a linear portion 142 of the apical pusher arm 140 extend along the x-axis wherein, the selectively rotational pusher pivot 132 pivots the apical pusher arm 140 along the y-axis while maintaining the screw arm along the x-axis. In one example embodiment, the fulcrum arm 104, the pusher telescoping arm 122, and the screw arm 128, and the apical pusher arm 140 comprise one of stainless steel, titanium, and / or high durometer plastic. It would be understood by one of ordinary skill in the art, that the various arms, pivots and portions may comprise a same or different material.

[0046] In the illustrated example embodiment of FIGS. 3 and 4, the linear portion 142 of the apical pusher arm 140 terminates in a T bar 144. In one example embodiment, the T-bar 144 interacts with the screw 224 or tulip 226 during use (see, for example, FIG. 5). InPage 9 of 25NCH-032841.F WO ORDone example embodiment, the T-bar 144 extends from the linear portion 142 along the z-axis. In one example embodiment, the T-bar 144 is substantially perpendicular to the linear portion 142. In one example embodiment, the T-bar 144 is coated in a friction coating, such as autoclavable rubber, silicone or the like. In one example embodiment the friction coating is between 0.5mm to about 2mm thick. In another example embodiment, at least some or all of the apical pusher arm 140 is coated in the friction coating. In one example embodiment, the T-bar 144 defines a screw contact surface 146. In one example embodiment, the screw contact surface 146 is defined on a leading surface of the T-bar 144 (e.g., a surface facing opposite the handle 102). As illustrated in FIG. 6, the apical pusher arm 140 is selectively removable from the screw arm 128, and first and / or second apical pusher arms 140a, 140b are selectively attachable to the screw arm. In this example embodiment, the first and second apical pusher arms 140a, 140b have different lengths of the linear portion 142 and / or T bar 144 as compared to each other and the apical pusher arm 140.

[0047] In one example embodiment, the selectively rotational pusher pivot 132 pivots about an axis of rotation defined by a central element 132a, such that the apical pusher arm 140 rotates in a circular arc relative to the screw arm 128. In this example embodiment, the apical pusher arm 140 is selectively rotatable about the selectively rotational pusher pivot 132 in a first direction 130a and a second direction 130b. In one example embodiment, the apical pusher arm 140 rotates responsive to a force applied in the first or second direction 130a, 130b and responsive to an activation of an adjustment handle or button, a ratcheting mechanism, or the like, wherein said activation allows the rotation.

[0048] In one example embodiment, the linear portion 142 of the apical pusher arm 140 is a pusher angle 130 from the screw arm 128. In one example embodiment, the pusher angle 130 is adjustable via rotation between about 20° to about 180°. In another examplePage 10 of 25NCH-032841.F WO ORDembodiment, the pusher angle 130 is limited by the selectively rotational pusher pivot 132 to between about 20° to about 180°. In one example embodiment, the linear portion 142 is between 5 cm to about 15 cm. In another example embodiment, the linear portion 142 is between 5 cm to about 15 cm.

[0049] As illustrated in the example embodiments of FIGS. 4 and 5, towers 210, 220 are often attached to pedicle screws 214, 224, having screw heads 224a and threads 224b to allow access to a pedicle screw tulip head 216, 226. The towers 210, 220 help with placement of the rods 218, 228, wherein the towers 210, 220 engage with the pedicle screw tulip head 212, 222 on left and right sides of the spine 202, respectively. In FIG. 5, some of towers 220 have been omitted for simplicity. In this example embodiment, the screw contact surface 146 of the apical pusher arm 140 is put into contact with one or more pedicle screw tulip head 216, 226 at an apex of a convex area 204 of a bent spine 202, allow ing the user to apply direct correction force to the convex apex of the curve in the spine 202.

[0050] Advantageously, the altering the angle of approach of the apical pusher arm 140, via the selectively rotational screw pivot 126, the selectively rotational pusher pivot 132 or both allows for ideal force application to the spine 202. Further, the T-bar 144 of the apical pusher arm 140 can spread the direct force over one or more pedicle screw' tulip head 222b, 222c. Additionally, the ability' to lengthen or shorten the convex apical reducer 100 increases user comfort and efficiency.

[0051] As illustrated in FIGS. 2 and 3, the fulcrum arm 104 is removably couplable to a tower arm 152, wherein the tower arm 152 is coupled to a selectively rotational arm pivot 108, the selectively rotational arm pivot 154 coupling the tower arm 152 to the fulcrum arm. The tower arm 152 is further coupled to a tower retainer 158 via a selectively rotational towerPage 11 of 25NCH-032841.F WO ORDpivot 154. It would be understood by one of ordinary skill in the art, that the tower arm 152 is removable.

[0052] In this example embodiment, fulcrum arm 104 and the tower arm 152 extend along the x-axis and wherein, the selectively rotational arm pivot 108 pivots the tower arm 152 along the y-axis while maintaining the tower arm along the x-axis. In one example embodiment, the selectively rotational arm pivot 108 pivots about an axis of rotation defined by a central element, such that the tower arm 152 rotates in a circular arc relative to the fulcrum arm 104. In this example embodiment, the tower arm 152 is selectively rotatable about the selectively rotational arm pivot 108 in a first direction 112a and a second direction 112b. In one example embodiment, the tower arm 152 rotates responsive to a force applied in the first or second direction 112a, 112b and responsive to an activation of an adjustment handle 108a (see FIG. 3) or a button 156 (see FIG. 2), a ratcheting mechanism, or the like, wherein said activation allows the rotation. In one example embodiment, the tower arm 152 is a tower angle 110 from the fulcrum arm 104. In one example embodiment, the tower angle 110 is adjustable via rotation between about 0° to about 90°. In another example embodiment, the tower angle 110 is limited by the selectively rotational arm pivot 108 to between about 10° to about 60°. In one example embodiment, the tower arm 152 is between 10 cm to about 15 cm. In another example embodiment, the tower arm 152 is between 10 cm to about 30 cm.

[0053] In one example embodiment, an extender portion 162 of the tower retainer 158 extends parallel to the x-axis on which the fulcrum arm 104 and the tower arm 152 reside. Further wherein, the selectively rotational tower pivot 154 pivots the tower retainer 158 along the y-axis. In one example embodiment, the tower retainer 158, the tower arm 152, and the selectively rotational tower and arm pivots 108, 154 comprise one of stainless steel, titanium,Page 12 of 25NCH-032841.F WO ORDand / or high durometer plastic.

[0054] In the illustrated example embodiment of FIGS. 2 and 3, the tower retainer 158 defines a c-shape. wherein a first extender bar 160 is coupled to a second extender bar 164 by the extender portion 162. In one example embodiment, the second extender bar 164 interacts with the towers 210, 220 during use. In one example embodiment, the first and second extender bars 160, 164 extend along the z-axis. In one example embodiment, the first and second extender bars 160, 164 are substantially perpendicular to the extender portion 162 and / or the tower bar 152. As illustrated in FIG. 6, the tower retainer 158 is selectively removable from the tower arm 152, and first and / or second tower retainers 158a, 158b are selectively attachable to the tower arm. In this example embodiment, the first and second tower retainers 158a, 158b have different lengths of the first extender bar 160, the second extender bar 164 and / or the extender portion 162 as compared to each other and the tower retainer 158.

[0055] In one example embodiment, the second extender bar 164 is coated in a friction coating, such as autoclavable rubber, silicone or the like. In another example embodiment, at least some or all of the tower retainer 158 is coated in the friction coating. In one example embodiment, the second extender bar 164 defines a tower contact surface 166. In one example embodiment, the tower contact surface 166 is defined on an interior surface of the second extender bar 164 (e.g., a surface facing the handle 102).

[0056] In one example embodiment, the selectively rotational tower pivot 154 pivots about an axis of rotation defined by a central element (not shown), such that the tower retainer 158 rotates in a circular arc relative to the tower arm 152. In this example embodiment, the tower retainer 158 is selectively rotatable about the selectively rotationalPage 13 of 25NCH-032841.F WO ORDtower pivot 154 in a first direction 155a and a second direction 155b. In one example embodiment, the tower retainer 158 rotates responsive to a force applied in the first or second direction 155a, 155b and responsive to an activation of an adjustment handle 156a (see FIG.3) or button 156, a ratcheting mechanism, or the like, wherein said activation allows the rotation.

[0057] In one example embodiment, the extender portion 162 and the second extender bar 160 of the tower retainer 158 are a tower angle 168 from the tower arm 152 (a dashed line has been added FIG. 2 to indicate the tower arm for clarity). In one example embodiment, the tower angle 168 is adjustable via rotation between about -900° to about 90°. In another example embodiment, the tower angle 168 is limited by the selectively rotational tower pivot 154 to between about 40° to about 150°. In one example embodiment, the second extender bar 164 is longer than the first extender bar 160. In one example embodiment, the extender portion 162 is between 8 cm to about 12 cm. In another example embodiment, the extender portion 162 is between 9 cm to about 11 cm. In one example embodiment, the first extender bar 160 is between 2 cm to about 8 cm and the second extender bar 164 is between 5 cm to about 15 cm. In another example embodiment, the first extender bar 160 is 5 cm and the second extender bar 164 is between 7 cm to about 11cm.

[0058] In the example embodiments of FIGS. 17-26, a convex apical reducer 300 having a second configuration is illustrated. The elements of the convex apical reducer 300 illustrated in FIGS. 17-26 are substantially the same as the elements in FIGS. 1-16, except where indicated, and increased by 200. In the example convex apical reducer 300 illustrated in FIGS. 17-26. the screw arm 128 and selectively rotational pusher pivot 132 are omitted, and the fulcrum arm 104 connect directly to the selectively rotational pusher pivot 326.Page 14 of 25NCH-032841.F WO ORD

[0059] In this example embodiment, the handle 302 terminates in circumferentially expanded area 302a. and substantially the same as the handle 102 described above. In one example embodiment, the fulcrum arm 304 extends from the handle 302. In this example embodiment, the fulcrum arm 304 supports a portion of the pusher telescoping arm 322 within the fulcrum arm, such that as the pusher telescoping arm 322 is telescoped away from the fulcrum arm, the pusher telescoping arm extends a total length of the convex apical reducer 300 while still partially residing within the fulcrum arm. In this example embodiment, the fulcrum arm 304 and pusher telescoping arm 322 are substantially the same as the fulcrum arm 104 and pusher telescoping arm 122 described above.

[0060] In this example embodiment, the fulcrum arm 304, the pusher telescoping arm 322, a linear portion 342 of the apical pusher arm 340 extend along the x-axis wherein, the selectively rotational pusher pivot 326 pivots the apical pusher arm 340 along the y-axis while maintaining the pusher telescoping arm 322 along the x-axis. In one example embodiment, the pusher telescoping arm 322, connects directly to the apical pusher arm 340.

[0061] In this example embodiment, the fulcrum arm 304, the pusher telescoping arm 322, and the linear portion 342 extend along the x-axis wherein, the selectively rotational pivot 326 pivots the linear portion 342 along the y-axis while maintaining the linear portion 342 along the x-axis. In one example embodiment, the selectively rotational pivot 326 pivots about an axis of rotation defined by a central element 326a, such that the linear portion 342 rotates in a circular arc relative to the pusher telescoping arm 322. In this example embodiment, the linear portion 342 is selectively rotatable about the selectively rotational pivot 326 in a first direction 324a and a second direction 324b. In one example embodiment, the linear portion 342 rotates responsive to a force applied in the first or second directionPage 15 of 25NCH-032841.F WO ORD324a, 324b and responsive to an activation of an adjustment handle or button, a ratcheting mechanism, or the like, wherein said activation allows the rotation. In one example embodiment, the linear portion 342 is a T-bar angle 324 from the pusher telescoping arm 322. In one example embodiment, the T-bar angle 324 is adjustable via rotation between about 10° to about 180°. In another example embodiment, the T-bar angle 324 is limited by the selectively rotational pivot 326 to between about 90° to about 120°.

[0062] In this example embodiment, the linear portion 342 of the apical pusher arm 340 terminates in a T bar 344. In this example embodiment, the T-bar 344 extends from the linear portion 342 along the z-axis. In this example embodiment, the linear portion 342 and the T-bar 344 are substantially the same as the linear portion 142 and the T-bar 144 described above with regard to FIGS. 1-16. In one example embodiment, the linear portion 342 has a linear length 342a extending between the selectively rotational pusher pivot 326 and the T-bar 344. In this example embodiment, the linear length 342a extends between 50 mm to about 300 mm. In another example embodiment, the linear length 342a is 100 mm. In this example embodiment, the tower arm 352 and the tower retainer 358 are substantially the same as the tower arm 152 and the tower retainer 158 as described above with regard to FIGS. 1-16.

[0063] Advantageously, the adjustability of the tower arm 152, 352 and the tower retainer 158, 358 allows for a fulcrum action with regard to the towers 210, 220 for elongation and derotation of the spine 202. The convex apical reducer 100, 300 allows for force to be applied to the convexity (e.g., via the apical pusher 140, 340) while the spine is simultaneously reduced to the contralateral concave rod (<?.g., via the tower retainer 158, 358).Page 16 of 25NCH-032841.F WO ORD

[0064] In the foregoing specification, specific embodiments have been described. However, one of ordinary skill in the art appreciates that various modifications and changes can be made without departing from the scope of the disclosure as set forth in the claims below. Accordingly, the specification and figures are to be regarded in an illustrative rather than a restrictive sense, and all such modifications are intended to be included within the scope of present teachings.

[0065] The benefits, advantages, solutions to problems, and any element(s) that may cause any benefit, advantage, or solution to occur or become more pronounced are not to be construed as a critical, required, or essential features or elements of any or all the claims. The disclosure is defined solely by the appended claims including any amendments made during the pendency of this application and all equivalents of those claims as issued.

[0066] Moreover in this document, relational terms such as first and second, top and bottom, and the like may be used solely to distinguish one entity or action from another entity or action without necessarily requiring or implying any actual such relationship or order between such entities or actions. The terms "comprises," "comprising," “has”, “having,” “includes”, “including,” “contains”, “containing” or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises, has, includes, contains a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or apparatus. An element proceeded by “comprises ... a”, “has ... a”, “includes ... a”, “contains ...a” does not, without more constraints, preclude the existence of additional identical elements in the process, method, article, or apparatus that comprises, has, includes, contains the element. The terms “a” and “an” are defined as one or more unless explicitlyPage 17 of 25NCH-032841.F WO ORDstated otherwise herein. The terms "substantially", “essentially”, “approximately”, “about” or any other version thereof, are defined as being close to as understood by one of ordinary skill in the art. In one non-limiting embodiment the terms are defined to be within for example 100%, in another possible embodiment within 5%, in another possible embodiment within 1%, and in another possible embodiment within 0.5%. The term “coupled” as used herein is defined as connected or in contact either temporarily or permanently, although not necessarily directly and not necessarily mechanically. A device or structure that is “configured” in a certain way is configured in at least that way, but may also be configured in ways that are not listed.

[0067] To the extent that the materials for any of the foregoing embodiments or components thereof are not specified, it is to be appreciated that suitable materials would be known by one of ordinary' skill in the art for the intended purposes.

[0068] The Abstract of the Disclosure is provided to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. In addition, in the foregoing Detailed Description, it can be seen that various features are grouped together in various embodiments for the purpose of streamlining the disclosure. This method of disclosure is not to be interpreted as reflecting an intention that the claimed embodiments require more features than are expressly recited in each claim. Rather, as the following claims reflect, inventive subject matter lies in less than all features of a single disclosed embodiment. Thus the following claims are hereby incorporated into the Detailed Description, with each claim standing on its own as a separately claimed subject matter.Page 18 of 25NCH-032841.F WO ORD

Claims

CLAIMSWhat is claimed is:

1. A convex apical reducer for use in straightening a spine, the convex apical reducer comprising:a handle coupled to a fulcrum arm, the handle and the fulcrum arm extending along an x-axis;a pusher telescoping arm extendably coupled to the fulcrum arm, wherein the pusher telescoping arm extends along the x-axis;a selectively rotational pivot coupled to the pusher telescoping arm, the selectively rotational pivot coupling the pusher telescoping arm to a linear portion, wherein the linear portion extends along the x-axis. the selectively rotational pivot for rotating the linear portion about a central axis relative to the pusher telescoping arm; anda T-bar coupled to the linear portion, the T-bar is perpendicular to the x-axis.

2. The convex apical reducer of claim 1 further wherein, the apical pusher at least partially coated in a friction coating, the T-bar for interacting with an apex of a convex area of a bent spine.

3. A convex apical reducer of claim 1, wherein the linear portion is coupled to the pusher telescoping arm via a selectively rotational screw pivot rotationally coupled to a screw arm, the selectively rotational screw pivot coupling the pusher telescoping arm to the screw arm, wherein the screw' arm extends along the x-axis, the selectively rotational screw pivotPage 19 of 25NCH-032841.F WO ORDfor rotating the screw arm about the central axis relative to the pusher telescoping arm.

4. The convex apical reducer of claim 3, wherein the selectively rotational screw pivot pivots about an axis of rotation defined by a central element, such that the screw arm rotates in a circular arc relative to the pusher telescoping arm.

5. The convex apical reducer of claim 1, further comprising a tower arm removably couplable to the fulcrum arm.

6. The convex apical reducer of claim 5, wherein the tower arm is coupled to a selectively rotational arm pivot, the selectively rotational arm pivot coupling the tower arm to the fulcrum arm.

7. The convex apical reducer of claim 6, further wherein the selectively rotational arm pivot is for rotating the tower arm about a central axis relative to the fulcrum arm, wherein the tower arm extends along the x-axis.

8. The convex apical reducer of claim 1, further comprising a tower retainer coupled to the tower arm via a selectively rotational tower pivot, the selectively rotational tower pivot for rotating the tower retainer about a central axis relative to the tower arm.

9. The convex apical reducer of claim 8, wherein, the tower retainer rotates responsive to one of a force applied to the tower retainer in a first or second direction, wherein the first direction is opposite the second direction, an activation of an adjustment handle coupled toPage 20 of 25NCH-032841.F WO ORDthe selectively rotational tower pivot, or an actuation of a button coupled to the selectively rotational tower pivot.

10. The convex apical reducer of claim 8, the tower retainer defining a c-shape, wherein the tower retainer comprises a first extender bar coupled to a second extender bar by an extender portion, wherein the first and second extender bars extend along the z-axis and the extender portion extends parallel to the x-axis, the tower retainer for interacting with a tower coupled to an apex of a convex area of the bent spine.

11. The convex apical reducer of claim 10, further wherein, the tower retainer is at least partially coated in a friction coating.

12. The convex apical reducer of claim 1, wherein the apical pusher arm is selectively rotatable about the selectively rotational pusher pivot in a first direction and a second direction, the first direction opposite the second direction.

13. The convex apical reducer of claim 1, wherein, the apical pusher arm rotates responsive to one of a force applied in the first or second direction to the apical pusher arm, an activation of an adjustment handle, or an actuation of a button.

14. A convex apical reducer for use in straightening a spine, the convex apical reducer comprising:a handle coupled to a fulcrum arm, the handle and the fulcrum arm extending along an x-axis;Page 21 of 25NCH-032841.F WO ORDa pusher telescoping arm extendably coupled to the fulcrum arm, wherein the pusher telescoping arm extends along the x-axis;a selectively rotational pivot coupled to the pusher telescoping arm, the selectively rotational pivot coupling the pusher telescoping arm to a linear portion, wherein the linear portion extends along the x-axis, the selectively rotational pivot for rotating the linear portion about a central axis relative to the pusher telescoping arm;a T-bar coupled to the linear portion, the T-bar is perpendicular to the x-axis; further comprising a tower arm removably couplable to the fulcrum arm;a tower arm coupled to a selectively rotational arm pivot, the selectively rotational arm pivot coupling the tower arm to the fulcrum arm, further wherein the selectively rotational arm pivot is for rotating the tower arm about a central axis relative to the fulcrum arm, wherein the tower arm extends along the x-axis; anda tower retainer coupled to the tower arm via a selectively rotational tower pivot, the selectively rotational tower pivot for rotating the tower retainer about a central axis relative to the tower arm.

15. The convex apical reducer of claim 14, the tower retainer defining a c-shape, wherein the tower retainer comprises a first extender bar coupled to a second extender bar by an extender portion, wherein the first and second extender bars extend along the z-axis and the extender portion extends parallel to the x-axis, the tower retainer for interacting with a tower coupled to an apex of a convex area of the bent spine.

16. The convex apical reducer of claim 14, further wherein, the tower retainer and the T-bar are at least partially coated in a friction coating.Page 22 of 25NCH-032841.F WO ORD17. The convex apical reducer of claim 14, wherein the linear portion is coupled to the pusher telescoping arm via a selectively rotational screw pivot rotationally coupled to a screw arm, the selectively rotational screw pivot coupling the pusher telescoping arm to the screw arm, wherein the screw arm extends along the x-axis, the selectively rotational screw pivot for rotating the screw arm about the central axis relative to the pusher telescoping arm, wherein the selectively rotational screw pivot pivots about an axis of rotation defined by a central element, such that the screw arm rotates in a circular arc relative to the pusher telescoping arm.

18. The convex apical reducer of claim 14, wherein the handle terminates in a circumferentially expanded area, wherein the circumferentially expanded area extends beyond a thickness of the handle along a y and z axis.

19. A convex apical reducer for use in straightening a spine, the convex apical reducer comprising:a handle coupled to a fulcrum arm, the handle and the fulcrum arm extending along an x-axis;a pusher telescoping arm extendably coupled to the fulcrum arm, wherein the pusher telescoping arm extends along the x-axis;a selectively rotational screw pivot coupled to the pusher telescoping arm, the selectively rotational screw pivot coupling the pusher telescoping arm to a screw arm, wherein the screw arm extends along the x-axis. the selectively rotational screw pivot for rotating the screw arm about a central axis relative to the pusher telescoping arm;Page 23 of 25NCH-032841.F WO ORDan apical pusher arm pivotally coupled to the screw arm via a selectively rotational pusher pivot; the apical pusher arm comprising a linear portion extending along the x-axis, the linear portion coupled to a T-bar that is perpendicular to the x-axis, the apical pusher at least partially coated in a friction coating, the T-bar for interacting with an apex of a convex area of a bent spine;a tower arm removably couplable to the fulcrum arm , wherein the tower arm is coupled to a selectively rotational arm pivot, the selectively rotational arm pivot coupling the tower arm to the fulcrum arm, the selectively rotational arm pivot t for rotating the tower arm about a central axis relative to the fulcrum arm, wherein the tower arm extends along the x-axis; anda tower retainer coupled to the tower arm via a selectively rotational tower pivot, the selectively rotational tower pivot for rotating the tower retainer about a central axis relative to the tower arm.

20. The convex apical reducer of claim 19, wherein the tower retainer defining a c-shape, wherein the tower retainer comprises a first extender bar coupled to a second extender bar by an extender portion, wherein the first and second extender bars extend along the z-axis and the extender portion extends parallel to the x-axis, the tower retainer for interacting with a tow er coupled to a apex of a convex area of the bent spine.Page 24 of 25NCH-032841.F WO ORD

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