Auxiliary system for mounting a longitudinal support on a pedicle screw and / or for fixing the polyaxiality of the pedicle screw

Abstract

The present invention relates to an auxiliary system (1) for mounting a longitudinal support (2) on a pedicle screw (3) and / or for fixing the polyaxiality of the pedicle screw (3) consisting of a screwed shaft (31) having a shaft head (32) which is surrounded by a receiving sleeve (33), in particular a tulip, in which a plunger element (35) is mounted which can be preloaded against the shaft head (32) by a locking element (34), in particular a grub screw, and the auxiliary means system (1) comprises a pressure component (4), to be pressingly brought into engagement with the plunger element (35), and a tension component (5), which can be moved relative to, preferably counter to, the pressure component (4) in the axial direction thereof, and a latching or hooking means (52) is arranged on each of two holding arms (51) of the tension component (5) and can be brought into tensile engagement with the receiving sleeve (33), preferably on engagement elements (331) of the receiving sleeve (33), and, when the the tension component (5) is connected to the receiving sleeve (33), can be inserted between the holding arms (51) of the longitudinal supports (2) towards the receiving sleeve (33), wherein the pressure component (4) can be moved axially with respect to the tension component (5) by rotational movement of a screw region (41) of the pressure component (4), and, in a locking position (4.VP) of the pressure component (4), the latching or hooking means (52) can be locked, in particular when connected to the receiving sleeve (33), and, at the same time, a force can be generated, in particular on the plunger element (35), by means of the pressure component (4) in the distal direction in order to temporarily fix the polyaxiality of the pedicle screw (3).

Description

[0001] Auxiliary system for mounting a longitudinal beam on a pedicle screw and / or for fixing the polyaxiality of the pedicle screw

[0002] Description

[0003] The present disclosure relates to an auxiliary system for mounting a longitudinal beam on a pedicle screw and / or for fixing the polyaxiality of the pedicle screw according to the preamble of claim 1.

[0004] Background of the Revelation

[0005] Pedicle screws are primarily used for the dorsal stabilization of the spine in cases of fractures, tumors, inflammation, deformities such as scoliosis, and degenerative instabilities via transpedicular screw fixation. Pedicle screws are placed in the pedicles of adjacent vertebrae, creating an angle-stable connection between the axially aligned pedicle screws and a longitudinal support or bar extending axially or along the spine. The pedicle screws and longitudinal support thus form a vertebral stabilization system.

[0006] Pedicle screws consist of a screwed shaft with a head, surrounded by a receiving sleeve, in particular a tulip-shaped one, in which a plunger is mounted that can be preloaded against the shaft head by a locking element, in particular a setscrew. The pedicle screw is thus designed as a so-called polyaxial pedicle screw, in which, after the shaft has been inserted into the pedicle canal of a vertebra by the surgeon, the receiving sleeve can be pivoted and / or rotated relative to the shaft to achieve a desired position and orientation of the receiving sleeve, essentially independent of the orientation of the shaft. An undercut prevents the receiving sleeve from being pulled off the shaft head. When inserting the shaft, the surgeon aligns the pedicle screws individually based on the orientation of the pedicle canal.Once all the necessary pedicle screws are in place, the aforementioned longitudinal beam or web of the correct length is selected and, if necessary, its longitudinal curvature is adjusted to the pedicle screws and their respective positions. The longitudinal beam should then be placed in the receiving sleeves of the pedicle screws. Finally, the longitudinal beams and receiving sleeves are secured by screwing locking elements, in particular screws, into the receiving sleeves. These screws press against the longitudinal beams, thereby simultaneously clamping the receiving sleeves and the pedicle screws against each other.

[0007] The polyaxial pedicle screws are now characterized by the fact that the receiving sleeve / tulip is initially mounted so that it can move freely relative to the screw shaft, allowing the receiving sleeve to assume a different orientation than the shaft. This makes it easier for the surgeon to insert / insert the longitudinal rod laterally into the receiving sleeve. Once the surgeon is satisfied with the position of the longitudinal rod and the receiving sleeve, they lock the pedicle screw using the locking element, preferably a setscrew. Thus, the receiving sleeve is fixed in position at the screw head by means of the locking element, in particular the setscrew, with the longitudinal rod or web positioned between them.

[0008] To enable the transmission of forces from the receiving sleeve into the vertebra during implantation, despite the mobility (joint) between the shaft and the receiving sleeve of the polyaxial pedicle screw, auxiliary systems are known. Transmitting forces from the receiving sleeve into the vertebra is necessary to manipulate it, for example. This is particularly important for repositioning maneuvers in cases of scoliosis, fractures, or spondylolisthesis, and sometimes for compression or distraction procedures. The auxiliary system thus serves to mount the longitudinal support to the pedicle screw and / or to fix the polyaxiality of the pedicle screw.

[0009] Prior Art: Auxiliary systems known in the prior art, e.g. from WO 2013 / 034351 A1, have a pressure component for pressing engagement with the punch and a pull component which is movable relative to, preferably in the opposite direction to, the pressure component in its axial direction and on each of two retaining arms of the pull component a locking or hooking means is arranged which can be brought into pulling engagement with the receiving sleeve, preferably on engagement elements of the receiving sleeve, and in the connected state of the pull component with the receiving sleeve can be inserted between the retaining arms of the longitudinal beams towards the receiving sleeve.

[0010] The polyaxiality of the pedicle screw can initially only be temporarily fixed (frozen) or made stiff using the auxiliary system, in order to lock or restrict the movement of the polyaxiality and the longitudinal beam / web, at least temporarily. In other words, the polyaxiality of the pedicle screw can be fixed or made stiff using the temporarily employed auxiliary system without fixing the longitudinal beam / web. This is achieved by applying a compressive force from the pressure component to the plunger and by applying a tensile force between the receiving sleeve and the tension component. These forces are generated by axially moving the compressive component relative to the tension component.This has the advantage that the polyaxial pedicle screw with the associated auxiliary system is now suitable for transferring correspondingly high forces to the vertebra for manipulation during the implantation process before fixing the longitudinal beam.

[0011] It should be noted here that the term "provisional" does not necessarily refer only to a light engagement / jamming of the stock head, but rather specifically to a locking measure that is applied temporarily and whose achievable locking properties, such as the clamping force on the stock head, etc., are comparable to, or at least closely approximate, a permanent locking mechanism. In other words, the "provisional" locking mechanism should be dimensioned so that it causes the receiving sleeve to clamp onto the stock head in a manner comparable to a permanent locking element. In this case, while subsequent release of the frictional engagement might only be possible with considerable force, in accordance with the prior art, there would at least be the possibility of readjusting the swivel before fixing the longitudinal member.The “provisional” locking mechanism can also be dimensioned in such a way that sufficient adjustment forces can be transferred to the vertebra by means of the polyaxial pedicle screw, whereby the frictional connection achieved between the shaft head and the receiving sleeve can be released again.

[0012] Several assistive devices are arranged in pairs per vertebral body and then at multiple levels on the corresponding pedicle screws during the implantation procedure. Very high forces are exerted when straightening a spine deformed due to scoliosis, which cannot always be absorbed by existing assistive device systems.

[0013] A weak point is the long retaining arms used to connect the traction component to the receiving sleeve. The distance between these arms must be increased for mounting on the receiving sleeve in the area of ​​the locking or hooking mechanism. For example, retaining arms are known that, to increase this distance, are mounted to the traction component by means of a transverse pin, allowing for rotational movement. Such retaining arms must be manually actuated to connect or disconnect them from the receiving sleeve. Furthermore, these transverse pins have play, thus reducing the precision of the retaining arms' movement.

[0014] The existing retaining arms still lack sufficient positional stability. When forces are applied from the retaining arms via the mounting sleeve and the pedicle screw shaft into the swivel, specifically under appropriate leverage, the mounting sleeve can tilt unnoticed relative to the retaining arms. This causes the locking element (grub screw) to be positioned at an angle within the mounting sleeve. In particular, the grub screw is then screwed into the internal thread at an angle. When tightening grub screws, a high tightening torque of, for example, approximately 10 Nm is applied. If the mounting sleeve is tilted, this can damage the internal thread without adequately securing the longitudinal beam / rod.Additionally, the retaining arm can become jammed laterally on the receiving sleeve, particularly due to unwanted movement of the locking and hooking mechanisms relative to the engagement elements, making it difficult to detach the assistive device system. Furthermore, an unfavorable lever arm ratio can cause the (soft) tissue in contact with the receiving sleeve to significantly impede or completely prevent detachment.

[0015] These complications significantly impair the implantation procedure or the corresponding surgery. In the case of a damaged internal thread, the pedicle screw must be painstakingly removed and replaced with a new one. This carries the risk that the second pedicle screw will not achieve the same level of fixation in the vertebral body as the first one.

[0016] Brief description of the Revelation

[0017] The present disclosure is based on the objective of providing an auxiliary system for mounting a longitudinal beam to a pedicle screw and / or for fixing the polyaxiality of the pedicle screw, which reduces or eliminates the problems of the prior art. In particular, the auxiliary system is intended to increase the forces that can be transmitted between the pedicle screw when connected to it.

[0018] This problem is solved by an auxiliary system for mounting a longitudinal beam to a pedicle screw and / or for fixing the polyaxiality of the pedicle screw according to claim 1. Further advantageous embodiments are the subject of the dependent claims.

[0019] More precisely, the problem is solved by making the pressure component axially displaceable relative to the tension component by rotating a screw section of the pressure component. In a locking position of the pressure component, the detent or hooking elements, particularly in their connected state to the receiving sleeve, can be locked. Simultaneously, a force can be generated distally by means of the pressure component, particularly on the plunger, to provisionally fix the polyaxiality of the pedicle screw. Thus, attaching and detaching the assistive device system from the pedicle screw and provisionally fixing the polyaxiality of the pedicle screw can be accomplished by a single "screw operation" using the same operating element. This simplifies the handling of the assistive device system and allows for shorter procedures.The screw actuation, specifically the rotational movement of the screw section of the pressure component, generates a high axial force, enabling the polyaxiality of the pedicle screw to be fixed with high clamping forces. With locked locking or hooking devices, decoupling of the auxiliary system is not possible. The elastic bending of the engagement tongues is then prevented by contact between the locking or hooking devices and the pressure component. With locked locking or hooking devices, varying pressure levels can be applied using the pressure component, thus allowing for different degrees of fixation of the pedicle screw's polyaxiality. This enables levering of the auxiliary system, for example, for vertebral alignment, even when the polyaxiality of the pedicle screw is not fully engaged. This allows for a more flexible surgical procedure and reduces the risk of complications.

[0020] It can be advantageous if a bendable, preferably flexible, engagement tongue is formed on each of the retaining arms, and a locking or hooking means is arranged at the distal end region of the engagement tongue, and the engagement tongues can be bent elastically in opposite directions and relative to the respective remainder of the retaining arm, increasing the distance between the locking or hooking means, in particular to create or release the connection of the tensioning component with the receiving sleeve.

[0021] The tensioning component, with its retaining arms and engagement tongues, is preferably manufactured in one piece, particularly as a one-piece steel sleeve. Manufacturing the tensioning component in one piece allows for a significantly larger stress cross-section (max.

[0022] Material thickness (with compact external dimensions) in the area of ​​the retaining arms and engagement tongues. This ensures maximum stability and high precision during applications such as spinal alignment. In particular, weak points such as cross pins used as connecting elements for highly stressed components to create their mobility are avoided. High forces can be generated between the assistive device system and the pedicle screw's receiving sleeve, especially through a continuous / uninterrupted force flow from the force application point on the assistive device system to the receiving sleeve. The retaining arms exhibit high positional stability. When forces are introduced from the retaining arms via the receiving sleeve into the vertebra, namely with appropriate leverage, unnoticed tilting of the receiving sleeve relative to the retaining arms is successfully prevented.This ensures correct positioning of the locking element in the receiving sleeve. In particular, it ensures correct insertion of the setscrew by preventing axial misalignment and any resulting tilting of the setscrew. This allows for high tightening torques, such as approximately 10 Nm, without damaging the corresponding internal thread on the receiving sleeve. Furthermore, easy coupling and uncoupling of the auxiliary system and the pedicle screw is possible, especially since only minimal deflection of the engagement tongues is required for coupling and uncoupling. The auxiliary system creates a stable connection between the receiving sleeve and the screw head of the pedicle screw.

[0023] Preferably, the engagement tongue is formed by a slot in the respective holding arm with two essentially parallel slot areas and with an arc-shaped slot area connecting these two parallel slot areas at the distal end of the engagement tongue.

[0024] In this context, "essentially parallel slot areas" means that deviations from the parallel arrangement of up to approximately 10° are possible.

[0025] The slots make the tensioning component with its engagement tongues easy to manufacture. For example, the slots could be laser-cut into a steel tensioning component. The slot preferably has a constant width and is preferably oriented perpendicular to the axis of the tensioning component.

[0026] According to a particularly preferred embodiment, the auxiliary system has a rod pusher for positioning the longitudinal beam in a u-shaped slot of the receiving sleeve, and the rod pusher is movable in the longitudinal direction relative to the pressure component and the tension component by rotation using a screwdriver.

[0027] The rod press ensures the longitudinal beam can be securely positioned in the desired location within the U-shaped slot. Simultaneous, precisely controlled force transmission from the auxiliary system to a swivel during insertion of the longitudinal beam into the slot is easily achieved with the rod press.

[0028] Preferably, the rod pusher is designed as a rod pusher inner sleeve arranged within the pressure component with a screw area rotatably held in the pressure component.

[0029] The inner sleeve of the rod pusher allows for a particularly compact design of the auxiliary system. Furthermore, the system is easy to operate, especially since, besides the inner sleeve, there is only one other operating element: the pressure component. This reduces the amount of screwing required when using the auxiliary system.

[0030] The inner sleeve of the rod pusher is preferably designed in at least two parts, wherein the (proximal) part with the screw area is rotatable relative to the pressure component, and wherein the (distal) part intended for contact with the longitudinal beam is only longitudinally movable and not rotatable relative to the pressure component. A threaded connection is preferably formed between the inner sleeve of the rod pusher and the pressure component, such that the connection between the inner sleeve and the pressure component is designed in the manner of a screw drive with a multi-start thread.

[0031] Preferably, the pressure component can be positioned in an insertion position in addition to the locking position, in which the connection of the tension component with the receiving sleeve can be created, and in a removal position in which the connection between the tension component and the receiving sleeve can be released again.

[0032] The pressure component can thus be arranged in three functionally distinct positions relative to the tension component. A rotational movement of the screw area allows for quick and precise positioning, as well as quick and precise transitions between positions. The screw area of ​​the pressure component features a thread for force transmission to the tension component. This thread ensures that all positions remain indefinitely as long as no rotational movement is applied to the screw area by the operator.

[0033] Advantageously, the pressure component protrudes from the tension component at its proximal end. At least one marking is provided on the outer circumference of the pressure component, by means of which the position of the pressure component in its locking, insertion, or removal position is visually identifiable.

[0034] This marking further simplifies the handling of the auxiliary system. The marking could, for example, consist of one, two, or three rings, preferably distinguished by color. Incorrect positioning of the printed component can be reliably prevented by this marking.

[0035] In particular, at least one fork-shaped recess is formed at the distal end of the pressure component, in which a retaining lug of the locking or hooking means engages to lock it when the pressure component is in its locking position.

[0036] The elastic bending of the engagement tongues can be avoided by supporting the retaining lug on the pressure component adjacent to the fork-shaped recess. Force transmission between the pressure component and the tension component is improved via the retaining lug when the pressure component is in its locking position. In particular, multiple locking positions are possible, in which different forces act between the pressure component and the plunger to achieve varying degrees of fixation of the pedicle screw's polyaxiality.

[0037] Preferably, a ramp-shaped projection is provided on the inside of each engagement tongue, which is formed in particular by means of a mushroom-headed pin that projects into a recess of the pressure component arranged in its locking or engagement position. By moving the pressure component into its removal position, the engagement tongue can be bent open by sliding the projection along the pressure component, the projection can be moved out of the recess, and thus, in particular, the locking or hooking means can be moved out of engagement with the engagement element.

[0038] The assistive device can then be easily removed from the pedicle screw with minimal effort. The engagement tongues can be bent open with minimal force by rotating the pressure component, thus easily avoiding any unwanted force being applied to the pedicle screw during this process.

[0039] Preferably, the locking or hooking device has a support surface facing the proximal end of the auxiliary system for contact with the receiving sleeve, particularly in the area of ​​its engagement element. The support surface has an angle of 1° to 3°, particularly 2°, to a plane perpendicular to the longitudinal axis of the tensioning component when not connected. The radially inner end of the support surface projects proximally relative to the radially outer end of the support surface.

[0040] In other words, the support surface forms a negative contour. This support surface prevents the locking or hooking element from slipping out of the receiving sleeve. The effectiveness of preventing slippage increases with the axial force applied to the locking or hooking element.

[0041] According to another preferred embodiment of the auxiliary system, a through-opening is formed along the longitudinal axis of the auxiliary system, into which a screwdriver can be inserted from the proximal end and rotated in the receiving sleeve for mounting the locking element, in particular the setscrew.

[0042] This ensures that the polyaxiality of the pedicle screw can be fixed using the locking element, while the polyaxiality of the pedicle screw is still provisionally fixed using the auxiliary system. This provisional fixation is only released after fixation with the locking element, thus preventing any interim tilting of the receiving sleeve relative to the shaft head.

[0043] According to another preferred embodiment of the auxiliary system, the pressure component is guided in the longitudinal direction in the tension component by at least one dovetail-shaped guide.

[0044] The pressure component is preferably designed in at least two parts, wherein the part with the screw area is rotatable relative to the tension component, and wherein the part with the dovetail-shaped guide is only longitudinally movable and not rotatable relative to the tension component. A threaded connection is preferably formed between the pressure component and the tension component, such that the connection between the pressure component and the tension component is designed in the manner of a screw drive with a multi-start thread. The dovetail-shaped guide prevents tilting between the pressure component and the tension component despite high forces, thus ensuring reliable and precise axial relative movement.

[0045] Preferably, the rod pusher is guided on the pressure component in the longitudinal direction with at least one holding surface lying parallel to the longitudinal axis, in particular a screw-profile-like outer surface, and is thus secured against rotation relative to the pressure component.

[0046] This lateral anti-rotation device for the rod pusher provides additional torsional protection against the pressure component. The positioning of the longitudinal beam / rod in the slot of the receiving sleeve is improved. Only the necessary axial forces act on the longitudinal beam from the rod pusher, and no torsional or rotational forces.

[0047] In summary, such an assistive device system is suitable for a wide range of applications, such as the correction of severely deformed spines (scoliosis). Despite its compact design, the system achieves optimal force transmission, maximum stability, and maximum safety. Brief description of the figures

[0048] Brief description of the characters

[0049] Preferred embodiments are described in more detail below with reference to the accompanying figures.

[0050] Fig. 1 schematically shows an auxiliary system according to the invention in a first embodiment with a pedicle screw in a sectional view along the longitudinal axis.

[0051] Fig. 2 shows separately a train component from Fig. 1.

[0052] Fig. 3 shows separately a printed component from Fig. 1.

[0053] Fig. 4 shows separately a rod pusher from Fig. 1.

[0054] Fig. 5 shows separately a transmission component from Fig. 1.

[0055] Fig. 6 shows the auxiliary system from Fig. 1 after a first assembly step.

[0056] Fig. 7 shows the auxiliary system from Fig. 1 after a second assembly step.

[0057] Fig. 8 shows the auxiliary system from Fig. 1 after a third assembly step.

[0058] Fig. 9 shows the auxiliary system from Fig. 1 with a screwdriver.

[0059] Fig. 10 shows separately a distal end region of the pressure component from Fig. 1.

[0060] Fig. 11 shows a section of the auxiliary system from Fig. 1 with the pressure component in its mounting position. Fig. 12 shows the connection process of the auxiliary system from Fig. 1 with the pedicle screw.

[0061] Fig. 13 shows the auxiliary system from Fig. 1 and the coupled pedicle screw without a locking element.

[0062] Fig. 14 shows the screwdriver in a position corresponding to the locking position of the pressure component.

[0063] Fig. 15 shows the screwdriver enlarged in a position corresponding to the locking position of the pressure component.

[0064] Fig. 16 shows separately the locking or hooking device from Fig. 1.

[0065] Fig. 17 shows a section of the auxiliary system from Fig. 1 with the pressure component in its locking position in a sectional view.

[0066] Fig. 18 shows a section of the auxiliary system from Fig. 1 with the pressure component in its locking position in a sectional view rotated and shifted relative to Fig. 17.

[0067] Fig. 19 shows a section of the auxiliary system from Fig. 1 with the pressure component in its locking position in a three-dimensional view.

[0068] Fig. 20 shows a section of the auxiliary system from Fig. 1 with the pressure component in its locking position in a three-dimensional view and in section through the locking or hooking means parallel to the longitudinal axis.

[0069] Fig. 21 shows separately the locking or hooking device from Fig. 1 and rotated relative to Fig. 16.

[0070] Fig. 22 shows a section of the auxiliary system from Fig. 1 with the pressure component in its locking position and in section through the engagement elements. Fig. 23 shows the auxiliary system from Fig. 1 and the coupled pedicle screw with the pressure component in its locking position in a three-dimensional view without a screwdriver.

[0071] Fig. 24 shows the auxiliary system from Fig. 1 with a longitudinal beam between the support arms.

[0072] Fig. 25 shows the auxiliary system from Fig. 1 with a longitudinal beam positioned in the receiving sleeve in a three-dimensional view.

[0073] Fig. 26 shows the auxiliary system from Fig. 25 in a sectional view.

[0074] Fig. 27 shows the auxiliary system from Fig. 1 with a locking element positioned in the receiving sleeve and the rod pusher in a distal end position in a sectional view.

[0075] Fig. 28 shows the auxiliary system from Fig. 1 with a locking element positioned in the receiving sleeve and the rod pusher in a proximal end position in a sectional view.

[0076] Fig. 29 shows the auxiliary system from Fig. 1 during the movement of the printed component into its removal position in a sectional view.

[0077] Fig. 30 shows a section of the auxiliary system from Fig. 1 with a position of the screwdriver corresponding to the removal position of the printed component.

[0078] Fig. 31 shows the auxiliary system from Fig. 1 with the pressure component in its removal position and thus engagement tongues moved outwards in a side view.

[0079] Fig. 32 shows the auxiliary system from Fig. 31 in a sectional view. AE2107P-WQ-0004

[0080] 15 / 37

[0081] Fig. 33 shows separately a distal end region of the pressure component.

[0082] Fig. 34 shows the auxiliary system from Fig. 1 in a cross-section through the dovetail-shaped guide of the pressure component.

[0083] Fig. 35 shows the auxiliary system from Fig. 1 when being pulled off the pedicle screw.

[0084] Fig. 36 shows a detailed view of the rod pusher outer sleeve of the auxiliary system from Fig. 1 without pedicle screw in a three-dimensional view.

[0085] Fig. 37 shows a detailed view of the assistive device system from Fig. 1 in the distal end region without pedicle screw in a sectional view.

[0086] Fig. 38 shows a detailed view of the auxiliary system from Fig. 1 in the proximal end region of the rod pusher outer sleeve in a sectional view.

[0087] Fig. 39 shows the assistive device system from Fig. 1 with a view of its distal front face.

[0088] Fig. 40 shows the auxiliary system from Fig. 1 without screwdriver in a sectional view.

[0089] Fig. 41 shows a detailed view of the auxiliary system from Fig. 1 in the area of ​​the transmission component in a sectional view.

[0090] Fig. 42 shows a detailed view of the auxiliary system from Fig. 1 in the area of ​​the noses of the transmission component in a sectional view.

[0091] Fig. 43 shows a detailed view of the auxiliary system from Fig. 1 in the area of ​​the transmission component in a cross-sectional view.

[0092] Fig. 44 shows a detailed view of a proximal end region of the elongated hole of the pull component. Fig. 45 shows the auxiliary system from Fig. 1 with a locking element positioned in the receiving sleeve and the rod pusher in a distal end position in a three-dimensional view, with a view of the locking element through the window in the rod pusher outer sleeve.

[0093] Fig. 46 schematically shows an auxiliary system according to a second embodiment of the invention with a pedicle screw in a sectional view along the longitudinal axis.

[0094] Fig. 47 shows separately a train component from Fig. 46.

[0095] Fig. 48 shows separately a printed component from Fig. 46.

[0096] Fig. 49 shows separately a rod pusher from Fig. 46.

[0097] Fig. 50 shows the pressure component inserted into the tension component in its placement position in a three-dimensional view.

[0098] Fig. 51 shows a detailed view of the proximal end region from Fig. 50 in section.

[0099] Fig. 52 shows a sectional view of the situation shown in Fig. 50.

[0100] Fig. 53 shows separately a distal end region of the pressure component from Fig. 46.

[0101] Fig. 54 shows a section of the auxiliary system from Fig. 46 with the pressure component in its placement position.

[0102] Fig. 55 shows the connection process of the auxiliary system from Fig. 46 with the pedicle screw.

[0103] Fig. 56 shows the auxiliary system from Fig. 46 and the coupled pedicle screw without the locking element. Fig. 57 shows the pressure component in its locking position.

[0104] Fig. 58 shows the pressure component enlarged in its locking position.

[0105] Fig. 59 shows separately the locking or hooking device from Fig. 46.

[0106] Fig. 60 shows a section of the auxiliary system from Fig. 1 with the pressure component in its locking position in a sectional view.

[0107] Fig. 61 shows the auxiliary system from Fig. 46 and the coupled pedicle screw with the pressure component in its locking position in a three-dimensional view.

[0108] Fig. 62 shows the auxiliary system from Fig. 46 with a longitudinal beam between the support arms.

[0109] Fig. 63 shows the auxiliary system from Fig. 46 with a longitudinal beam positioned in the receiving sleeve in a three-dimensional view.

[0110] Fig. 64 shows the auxiliary system from Fig. 46 with a locking element positioned in the receiving sleeve and the rod pusher in a distal end position in a sectional view.

[0111] Fig. 65 shows a section of the auxiliary system from Fig. 46 with the pressure component in its removal position.

[0112] Fig. 66 shows the auxiliary system from Fig. 46 with the pressure component in its removal position and thus engagement tongues moved outwards in a side view.

[0113] Fig. 67 shows the auxiliary system from Fig. 66 in a sectional view.

[0114] Fig. 68 shows a distal end region of the pressure component separately. AE2107P-WQ-0004

[0115] 18 / 37

[0116] Fig. 69 shows the auxiliary system from Fig. 46 in a cross-section through the dovetail-shaped guide of the pressure component.

[0117] Fig. 70 shows the auxiliary system from Fig. 46 when being pulled off the pedicle screw.

[0118] Fig. 71 shows the auxiliary system from Fig. 46 with the pedicle screw, without rod pusher and with the pressure component in its locking position in a sectional view.

[0119] Fig. 72 shows the auxiliary system from Fig. 46 with the pedicle screw, without rod pusher and with the pressure component in its removal position and thus engagement tongues moved outwards in a sectional view.

[0120] Fig. 73 shows the auxiliary system from Fig. 46 with the rod pusher in a proximal end position and with the pressure component in its placement position in a sectional view.

[0121] Fig. 74 shows a cross-section of the assistive device system from Fig. 73 through a central area of ​​the assistive device system.

[0122] Fig. 75 shows a spine with several pedicle screws, each of which is coupled to an assistive device system according to its first or second embodiment.

[0123] Description of preferred embodiments

[0124] Figures 1 and 46 each show an auxiliary system 1 for mounting a longitudinal beam 2 to a pedicle screw 3 and / or for fixing the polyaxiality of the pedicle screw 3. The pedicle screw 3 has a screwed shaft 31 with a shaft head 32, which is surrounded by a receiving sleeve 33, in particular a tulip-shaped sleeve, in which a plunger 35 is mounted and can be preloaded against the shaft head 32 by a locking element 34, in particular by a setscrew. The auxiliary system 1 has a pressure component 4, e.g., according to Figures 3 and 48, for the compressive engagement with the plunger 35 and a tension component 5, e.g., according to Figures 4 and 48. 2 and Fig. 47, which is movable relative to, preferably in the opposite direction to, the pressure component 4 in its axial direction and on two retaining arms 51 of the tension component 5 a locking or hooking means 52 is arranged, which can be brought into pulling engagement with the receiving sleeve 33, preferably on engagement elements 331 of the receiving sleeve 33.In the connected state of the train component 5 with the receiving sleeve 33, the longitudinal beam 2 can be inserted between the retaining arms 51 towards the receiving sleeve 33.

[0125] Each of the retaining arms 51 has a bendable, preferably flexible, engagement tongue 53. A locking or hooking element 52 is arranged at the distal end of each engagement tongue 53. The engagement tongues 53 can be bent elastically in opposite directions relative to the respective remaining portion of the retaining arm 51, thereby increasing the distance between the locking or hooking elements 52, particularly for creating or releasing the connection between the tensioning component 5 and the receiving sleeve 33. At their proximal end, the engagement tongues 53 transition into a sleeve-shaped region of the tensioning component 5, which has a closed outer circumference. The retaining arms 51 project distally from this sleeve-shaped region with its closed outer circumference.

[0126] The engagement tongue 53 is formed by a slot 54 in the respective retaining arm 51, comprising two essentially parallel slot regions and an arc-shaped slot region connecting these two parallel slot regions at the distal end DE of the engagement tongue 53. In its two proximal end sections, the slot 54 is arc-shaped, with the gap between the end sections increasing towards the ends of the slot 54. This results in improved force transmission from the engagement tongues 53 to the rest of the tensioning component 5.

[0127] The pressure component 4 is axially displaceable relative to the tension component 5 by a rotational movement of a screw area 41 of the pressure component 4. In a locking position 4.VP of the pressure component 4, the detent or hooking means 52, in particular in their state connected to the receiving sleeve 33, can be locked, and simultaneously a force can be generated by means of the pressure component 4 in a distal direction, in particular on the plunger 35, for the provisional fixation of the polyaxiality of the pedicle screw 3.

[0128] The auxiliary system 1 has a rod pusher 6, e.g., according to Fig. 4 and Fig. 49, for positioning the longitudinal beam 2 in a U-shaped slot 332 of the receiving sleeve 33. The rod pusher 6 can be moved longitudinally relative to the pressure component 4 and the tension component 5 by rotation using a screwdriver 7.

[0129] According to the first embodiment of the auxiliary system 1, the rod pusher 6 is designed as a rod pusher outer sleeve 61 enclosing the pulling component 5. This outer sleeve is displaceable by rotation of a transmission component 8 arranged within the pulling component 5. The transmission component 8 has a screw area 81 rotatably held in the pulling component 5 and at least one lug 82. The lug 82 is rotatable relative to the screw area 81, penetrates a longitudinally oriented elongated hole 55 formed within the pulling component 5, and engages in a recess 661 of the rod pusher outer sleeve 61 for force transmission.

[0130] According to the second embodiment of the auxiliary system 1, the rod pusher 6 is designed as a rod pusher inner sleeve 62 arranged within the pressure component 4 with a screw area 621 rotatably held in the pressure component 4.

[0131] The pressure component 4 can be positioned in an insertion position SP, in which the connection of the pull component 5 with the receiving sleeve 33 can be created, and in a removal position NP, in which the connection between the pull component 5 and the receiving sleeve 33 can be released again, in addition to the locking position 4.VP.

[0132] According to the first embodiment of the auxiliary system 1, at least one marking 9 is arranged on a screwdriver 7 of the auxiliary system 1 for the pressure component 4, by means of which the position of the pressure component 4 in its locking position 4.VP, insertion position 4.SP, or removal position 4.NP is visually identifiable. The marking 9 has, for example, as shown in Fig. 30, in particular two rings, namely a distal, preferably red, and a proximal, preferably black, ring. The pressure component 4 is in its locking position 4.VP when the marking 9 is not visible, in particular when no ring is visible, and this locking position 4.VP is automatically reached when the final position is reached during tightening, for example, with a torque wrench. The pressure component 4 is in its insertion position 4.SP when the proximal, preferably black, ring on the screwdriver 7 is just barely no longer covered by the transmission component 8.The pressure component 4 is in its removal position 4.NP when the distal, preferably red, ring on the screwdriver 7 is just barely no longer covered by the transmission component 8. Other marking configurations are also conceivable.

[0133] According to the second embodiment of the auxiliary system 1, the pressure component 4 projects from the proximal end of the tension component 5. At least one marking 9 is arranged on the outer circumference of the pressure component 4, by means of which the position of the pressure component 4 in its locking position 4.VP, placing position 4.SP or removal position 4.NP is visually identifiable.

[0134] Analogous to the first embodiment, the marking 9 in the second embodiment, e.g., according to Fig. 65, also has, in particular, two rings: a distal, preferably red, and a proximal, preferably black, ring, which here are positioned on the pressure component 4. The proximal edge of the tension component 5 then indicates the current position of the pressure component 4, analogous to how it was described above for the screwdriver.

[0135] At the distal end of the pressure component 4, at least one fork-shaped recess 42 is formed in which a retaining lug 521 of the locking or hooking means 52 engages to lock it when the pressure component 4 is arranged in its locking position 4.VP.

[0136] On the inside of each engagement tongue 53, a ramp-shaped projection 56 is provided, which is formed in particular by means of a mushroom-head pin that projects into a recess 43 of the pressure component 4 in its locking or engagement position 4.VP, 4.SP. By moving the pressure component 4 into its removal position 4.NP, the engagement tongue 53 can be bent open by sliding the projection 56 along the pressure component 4, the projection 56 can be moved out of the recess 43, and thus, in particular, the locking or hooking means 52 can be moved out of engagement with the engagement element 331.

[0137] As shown in Fig. 22, the locking or hooking element 52 has a support surface 522 facing the proximal end of the auxiliary system 1 for contact with the receiving sleeve 33, particularly in the area of ​​its engagement element 331. The support surface 522 has an angle α of 1° to 3°, particularly 2°, to a plane perpendicular to the longitudinal axis L of the tensioning component 5 when not connected. The radially inner end of the support surface 522 projects proximally relative to the radially outer end of the support surface 522.

[0138] It would be conceivable that, for improved force transmission, a corresponding helix angle is also formed on the engagement element of the receiving sleeve. However, as shown, for example, in Fig. 22, the engagement element 331 has a surface oriented perpendicular to the longitudinal axis L for contact with the support surface 522.

[0139] Along the longitudinal axis L of the auxiliary system 1 a through opening 10 is formed, into which a screwdriver can be inserted from the proximal end and rotated in the receiving sleeve 33 for the assembly of the locking element 34, in particular the setscrew.

[0140] The pressure component 4 is guided in the tension component 5 in the longitudinal direction by at least one dovetail-shaped guide 44.

[0141] According to the first embodiment of the auxiliary system 1, the rod pusher 6 is guided longitudinally on the tensioning component 5 by at least one retaining surface lying parallel to the longitudinal axis L, and is thus secured against rotation relative to the tensioning component 5. The rod pusher 6 therefore has a particularly effective anti-rotation device on the outer diameter of the tensioning component 5, which ensures the correct alignment of the radii formed at the distal end of the rod pusher 6 with the longitudinal beam 2.

[0142] The rod pusher outer sleeve 61 is connected / guided to the tensioning component 5 in a rotationally secure manner via guide lugs along its entire range of motion in the proximal area (see Figs. 38 and 39). In combination with the lateral retaining surface adjacent to a window 612 of the rod pusher outer sleeve 61, this results in effective torsional stabilization of the rod pusher outer sleeve 61. Therefore, the window 612 of the rod pusher outer sleeve 61 does not have a stabilizing effect on the transmission of torque to the setscrew.

[0143] According to the second embodiment of the auxiliary system 1, the rod pusher 6 is guided longitudinally on the pressure component 4 with at least one holding surface parallel to the longitudinal axis L, in particular a screw-profile-like outer surface, and is thus secured in particular against rotation to the pressure component 4 (see Figs. 49, 73 and 74).

[0144] The rod pusher 6 thus features a particularly space-saving anti-rotation device, which ensures the correct alignment of the radii formed at the distal end of the rod pusher 6 with the longitudinal beam 2. The compression component 4, which is subject to the most rotation relative to the tension component 5 due to the preferably four-fold dovetail-shaped guide 44, has a profile sleeve that matches the holding surface of the rod pusher 6. The profile sleeve is firmly connected to the rest of the compression component 4, e.g., by bonding, welding, or pressing. The holding surface, in particular a polygonal profile, hardly reduces the wall thickness of the rod pusher 6 and yet enables very effective anti-rotation protection via the profile sleeve, whereby the anti-rotation device is active over the entire axial travel of the rod pusher 6 (see Figs. 73 and 74).

[0145] According to the first embodiment of the auxiliary system 1, a window 612 is formed in the rod pusher outer sleeve 62, which is arranged adjacent to a free space between the two retaining arms 52 when the rod pusher outer sleeve 62 is arranged in a distal end position, in particular to allow a view of the locking element 34, in particular the setscrew, during its assembly in the receiving sleeve 33.

[0146] The following describes the application of the auxiliary system 1 according to its first embodiment. This auxiliary system 1 can be disassembled for cleaning and consists of four main components: the pull component 5, the push component 4, the rod pusher 6, and the transmission component 8. Before use, these main components are completely pre-assembled and are then ready for immediate use. Only two screwdrivers 7 are required for operation, or, for maximum torque, the corresponding torque wrenches. During assembly, the push component 4 is first inserted into the pull component 5 (see Fig. 6). Then, the rod pusher outer sleeve 61 is slid onto it (see Fig. 7). Subsequently, the transmission component 8 is inserted / screwed into the pull component 5 and engaged in the rod pusher outer sleeve 61 in the area of ​​its recess 611 with the lug 82 (see Fig. 8).

[0147] To couple the auxiliary system 1 with the receiving sleeve 33 of a pedicle screw 3 already screwed into a vertebral body, the pressure component 4 is moved into the mounting position 4.SP using the screwdriver 7 provided for this purpose, as shown in Fig. 9. In this mounting position 4.SP, the fork-shaped recess 42 of the pressure component 4 is not yet engaged with the retaining lug 521 (see Fig. 11). The flexible engagement tongues 53 now allow the auxiliary system 1 to be slid onto the pedicle screw 3 and the locking or hooking elements 52 to automatically engage on the receiving sleeve 33 in the area of ​​the engagement elements 331 (see Figs. 12 and 13). The auxiliary system 1 is now connected to the receiving sleeve 33 by the preload force of the flexible engagement tongues 53. The shaft head 32 is still polyaxially mounted in the receiving sleeve 33.

[0148] To provisionally fix the receiving sleeve 33 to the shaft head 32, the pressure element 4 is turned by hand using the screwdriver 7 – or, for maximum holding force, with a torque wrench (not shown) – into the locking position 4.VP, as shown, among other things, in Figures 14 and 15. The fork-shaped recess 42 of the pressure element 4 engages the retaining lug 521 of the locking or hooking element 52 and thus secures the engagement tongues 53 against slipping off the receiving sleeve 33. In particular, the pressure element 4 engages in designated recesses in the area of ​​its fork-shaped recess 42, or engages in the locking or hooking element 52 adjacent to the retaining lug 521 (see Figures 16, 17, and 22). Four points of the pressure component 4 engage in the punch 35 and the axial force from the pressure component 4 on the punch 35 locks the shaft head 32 to the receiving sleeve 33, i.e. the pedic screw 3 is provisionally fixed (see Fig.

[0149] 18). This locking mechanism secures the receiving sleeve 33 in its relative position to the vertebral body and forms a closed "force system" from the receiving sleeve 33 and the auxiliary system 1. This system provides mutual support and enables the transmission of very high forces, such as those that can occur during the subsequent alignment of the vertebral bodies. The force is transmitted via the engagement elements 331 of the receiving sleeve 33 and the locking or hooking means 52, with the engagement tongues 53 being subjected primarily to tensile stress, as symbolized by the arrows in Figures 19 and 20. After the receiving sleeve 33 has been provisionally fixed to the shaft head 32 and the vertebral bodies have been aligned, the screwdriver 7 is removed and the auxiliary system 1 is ready for the insertion of the longitudinal beam 2 / rod (see Figure 1).

[0150] 23). The longitudinal beam 2 / rod is now inserted between the retaining arms 51 (see Fig. 24). The large opening between the retaining arms 51 allows both the insertion of pre-bent longitudinal beams 2 / rods and the compensation of different heights of adjacent vertebral bodies. In the next step, the longitudinal beam 2 is moved into the U-shaped slot 332 of the receiving sleeve 33 using the rod pusher 6. To move the rod pusher 6, a special screwdriver is inserted into a screw area 81 of the transmission component 8 and turned, whereby the rotation of this screw area 81 results in a longitudinal movement of the rod pusher 6 (see Figs. 25 and 26). Since the vertebral bodies are aligned here, high forces occur. These tensile forces add to the already prevailing tensile forces in the retaining arms 51.Once the longitudinal beam 2 is in the U-shaped slot 332, the locking element 34, e.g., a setscrew, can be inserted through the auxiliary system 1 using a special insertion tool (not shown). Such a setscrew is then connected to the AE2107P-WG-0004.

[0151] 26 / 37

[0152] The required torque of 5 Nm to 15 Nm, in particular 10 Nm, is applied to the receiving sleeve 33 (see Fig. 27). This is carried out for each auxiliary system 1 until the longitudinal beam 2, in particular two parallel longitudinal beams 2, are firmly connected with all pedicle screws 3 (see Fig. 75). Finally, the auxiliary system 1 is decoupled from the pedicle screw 3. To do this, the rod pusher 6 is first moved back to the proximal position with the associated screwdriver (see Fig. 28). Now the engagement tongues 53 are (again) free and can be moved outwards for decoupling. For this, the screwdrivers are exchanged, and then the pressure component 4 can be moved longitudinally by rotating its screw area 41 using the appropriate screwdriver 7 (see Fig. 29). The pressure component 4 is moved into its removal position 4.The screwdriver 7 is turned to position NP, the attainment of which is visually indicated by the marking 9, in particular by a preferably red ring, on the screwdriver end. Specifically, the pressure component 4 is in its release position 4.NP when the preferably red ring on the screwdriver 7 is just no longer covered by the transmission component 8 (see Fig. 30). The screwdriver 7 has a torque limiter with a disengagement function in left-hand rotation. Should the user forget to move the push rod 6 to its proximal position, the engagement tongues 53 are blocked by the push rod 6's outer sleeve 61. In this case, the torque limiter disengages and prevents damage to the components. The flexible engagement tongues 53 are moved outwards by retracting the pressure component 4 to its release position 4.NP (see Fig. 31).This is achieved via an inclined ramp of the pressure component 4 adjacent to the recess 43 and the ramp-shaped projections 56 arranged on the inside of the engagement tongues 53, in particular the mushroom-head pins attached here (see Fig. 32).

[0153] Due to the special dovetail-shaped guide 44 of the pressure component 4 in the tension component 5 and the high force transmission between the pressure component 4 and the tension component 5 via a thread, the engagement tongues 53 are reliably moved outwards, especially when fabric is in contact with the retaining arm 51 (see Figs. 33 and 34). The auxiliary system 1 can now be removed from the pedicle screw 3 without additional force (especially without manually holding the retaining arms) (see Fig. 35). Further design features of the auxiliary system 1 are described below.

[0154] The locking or hooking means 52 are designed in particular as separate components. The ramp-shaped projections 56 are also formed in particular by means of separate components, namely so-called mushroom-head pins.

[0155] The locking or engagement elements 52 and the mushroom-head pins are pressed into the pull component 5 from the inside, as shown, for example, in Fig. 2 or 47. This allows for the one-piece manufacturing of the pull component 5 with its engagement tongues 53, and harder materials can be used for the locking or engagement elements 52 and the mushroom-head pins than for the retaining arms 51 of the pull component 5. The locking or engagement elements 52 and the mushroom-head pins are subjected to high frictional loads, so a hard material is advantageous for these elements.

[0156] Figures 40 to 44 illustrate the transmission of the thrust motion from the transmission component 8 to the rod pusher outer sleeve 61, i.e., the transmission of the thrust motion from "inside to outside". Despite the design of the rod pusher 6, the auxiliary system 1 according to the first embodiment is completely disassemblable for cleaning. The auxiliary system 1 comprises the transmission component 8, which is designed in particular with a transmission sleeve, with spring-loaded arms and the lugs 82, in particular self-locking thrust lugs. For disassembly, the transmission component 8 can preferably be turned back by hand via its screw area 81, and an inner contour of the rod pusher outer sleeve 61, via chamfers, ensures automatic decoupling of the transmission component 8 from the rod pusher outer sleeve 61 (see Fig. 42).In the distal end region of the transmission component 8, the spring arms are secured against inward buckling by a special profile shape of the lugs 82 (see Fig. 43). In the proximal end region of the elongated hole 55 in the pull component 5, a release window is provided through which the lugs 82 can retract inward when the rod pusher outer sleeve 61 has reached its proximal end position. This allows the transmission component 8 to be completely pulled out. In the area of ​​the release window, the elongated hole 55 has an increased width transverse to the longitudinal axis L (see Fig. 44).

[0157] The following describes the application of the auxiliary system 1 according to its second embodiment. This auxiliary system 1 can be disassembled for cleaning and consists of three main components: the pull component 5, the pressure component 4 (1st operating element), and the rod pusher 6 (2nd operating element). To couple the auxiliary system 1 with the receiving sleeve 33 of a pedicle screw 3 already screwed into a vertebral body, the pressure component 4 is inserted into the pull component 5 and then brought into its insertion position 4.SP by rotating the screw area 41. As shown in Fig. 51, the marking 9 has, in particular, two rings: a distal, preferably red, and a proximal, preferably black, ring. The pressure component 4 is in its insertion position 4.SP when the proximal, preferably black, ring on the pressure component 4 is just barely no longer covered by the pull component 5.The fork-shaped recess 42 of the pressure component 4 is in this mounting position 4. SP is not yet engaged with the retaining lug 521 (see Figs. 53 and 54). The flexible engagement tongues 53 now allow the auxiliary system 1 to be slid onto the pedicle screw 3 and the locking or hooking means 52 to automatically engage on the receiving sleeve 33 in the area of ​​the engagement elements 331 (see Figs. 55 and 56). The auxiliary system 1 is now connected to the receiving sleeve 33 by the preload force of the flexible engagement tongues 53. The shaft head 32 is still polyaxially supported in the receiving sleeve 33.

[0158] To provisionally fix the receiving sleeve 33 to the shaft head 32, the pressure component 4 is turned, e.g., by hand – or for maximum holding force with a torque wrench (not shown) – into the locking position 4.VP, as shown, among other things, in Figures 57 and 58. The pressure component 4 is in its locking position 4.VP when the marking 9 is not visible, in particular when no ring is visible, and this locking position 4.VP is automatically reached when the final position is reached during tightening, e.g., by hand or with a torque wrench. The fork-shaped recess 42 of the pressure component 4 engages the retaining lug 521 of the locking or hooking means 52 and thus secures the engagement tongues 53 against slipping off the receiving sleeve 33. In particular, the pressure component 4 engages in the area of ​​its fork-shaped recess 42 in recesses provided for this purpose or adjacent to the retaining lug 521 in the locking or hooking means 52 (see figure).Figs. 59 and 60). The further details of the distal end region of the assistive device system 1 and its functions correspond to those of the first embodiment, are designed analogously to Figures 18 to 22 and are therefore not described again here.

[0159] After the receiving sleeve 33 has been provisionally fixed to the shaft head 32 and the vertebral bodies have been aligned, the rod pusher 6, namely the rod pusher inner sleeve 62, is inserted and adjusted by turning its screw section 621 (see Fig. 61). The longitudinal beam 2 / rod is then inserted between the retaining arms 51 (see Fig. 62). The large opening between the retaining arms 51 allows both the insertion of pre-bent longitudinal beams 2 / rods and the compensation of different heights of adjacent vertebral bodies. In the next step, the longitudinal beam 2 with the rod pusher 6 is moved into the U-shaped slot 332 of the receiving sleeve 33. A special screwdriver can be inserted into the screw section 621 and turned to move the rod pusher 6, with the rotation of this screw section 621 resulting in a longitudinal movement of the rod pusher 6. The screw area 621 can also be rotated manually (see Fig. 63).Since the vertebral bodies are aligned here, higher forces occur. These tensile forces add to the already existing tensile forces in the retaining arms 51. As soon as the longitudinal beam 2 is located in the U-shaped slot 332, the locking element 34, e.g., a setscrew, can be inserted through the auxiliary system 1 using a special insertion tool (not shown). Such a setscrew can then be screwed into the receiving sleeve 33 with the required torque of 5 Nm to 15 Nm, in particular 10 Nm (see Fig. 64). This is carried out for each auxiliary system 1 until the longitudinal beam 2, in particular two parallel longitudinal beams 2, are firmly connected with all pedicle screws 3 (see Fig. 75). Finally, the auxiliary system 1 is decoupled from the pedicle screw 3. For this purpose, the pressure component 4 is rotated to its removal position 4.NP (red ring marking).The rod pusher 6 can remain in position and does not need to be turned out beforehand, which saves time AE2107P-WG-0004.

[0160] 30 / 37

[0161] This means, in particular, compared to the handling of the first embodiment. The pressure component 4 is in its removal position 4.NP when the distal, preferably red, ring on the pressure component 4 is just no longer covered by the tension component 5 (see Fig. 65).

[0162] The flexible engagement tongues 53 are moved outwards by retracting the pressure component 4 into its removal position 4.NP (see Fig. 66). This occurs via an inclined ramp on the pressure component 4 and the ramp-shaped projections 56 arranged on the inside of the engagement tongues 53, in particular the mushroom-head pins attached here (see Fig. 67). Due to the special dovetail-shaped guide 44 of the pressure component 4 in the tension component 5 and the high force transmission between the pressure component 4 and the tension component 5 via a thread, the engagement tongues 53 are reliably moved outwards, especially when fabric is in contact with the lever arm 51 (see Figs. 68 and 69). The auxiliary system 1 can now be removed from the pedicle screw 3 without additional force (in particular without manually holding the retaining arms) (see Fig. 70).

[0163] The advantages of the second embodiment over the first include, for example, a slimmer design and the reduction to two operating elements (pressure component 4, rod pusher inner sleeve 62), each of which can be operated manually or with screwdrivers, thus reducing the amount of screwing required when using the second embodiment. (Reference symbol list)

[0164] 1 Assistive device system

[0165] 2 longitudinal beams

[0166] 3 pedicle screw

[0167] 31 shaft

[0168] 32 shaft head

[0169] 33 Mounting sleeve

[0170] 331 Engagement element of the receiving sleeve 33

[0171] 332 U-shaped slot of the receiving sleeve 33

[0172] 34 Locking element

[0173] 35 stamps

[0174] 4 Pressure component

[0175] 41 Screw area of ​​the pressure component 4

[0176] 42 Fork-shaped recess of the pressure component 4 43 Recess of the pressure component 4

[0177] 44 dovetail-shaped guides

[0178] 4.VP Locking position of the pressure component 4 4. SP Placement position of the pressure component 4

[0179] 4. NP Acceptance position of the printed component 4

[0180] 5 train component

[0181] 51 Holding arm of the train component 5

[0182] 52 Locking or hooking devices

[0183] 521 Retaining lug of the locking or hooking device 52 522 Support surface of the locking or hooking device 52 53 Engagement tongue

[0184] 54 slots

[0185] 55 Slotted hole

[0186] 56 ramp-shaped ledge

[0187] 6 rod pushers

[0188] 61 Rod pusher outer sleeve

[0189] 611 Recess of the rod pusher outer sleeve 61 612 Window

[0190] 62 Rod pusher inner sleeve 621 Screw area of ​​the rod pusher inner sleeve 62 7 Screwdriver

[0191] 8 Transmission component

[0192] 81 Screw area of ​​the transmission component 8 82 Nose of the transmission component 8

[0193] 9 Mark

[0194] 10 Through opening

[0195] L Longitudinal axis

[0196] DE distal end

[0197] PE proximal end

[0198] a Angle of the support surface 33

Claims

33 / 37 Claims 1. Auxiliary system (1) for mounting a longitudinal beam (2) on a pedicle screw (3) and / or for fixing the polyaxiality of the pedicle screw (3) comprising a screwed shaft (31) with a shaft head (32) surrounded by a receiving sleeve (33), in particular a tulip-shaped sleeve, in which a plunger (35) is mounted that can be preloaded against the shaft head (32) by a locking element (34), in particular by a setscrew, and the auxiliary system (1) comprising a pressure element (4) for the compressive engagement with the plunger (35) and a tension element (5) which is movable relative to, preferably in the opposite direction to, the pressure element (4) in its axial direction and on each of two retaining arms (51) of the tension element (5) is arranged a detent or hooking means (52) which engages with the receiving sleeve (33), preferably on engagement elements (331) of the receiving sleeve (33) a pulling procedure is possibleand in the connected state of the tension component (5) with the receiving sleeve (33) between the retaining arms (51) of the longitudinal beams (2) towards the receiving sleeve (33), characterized in that the pressure component (4) is axially displaceable relative to the tension component (5) by rotary movement of a screw area (41) of the pressure component (4) and in a locking position (4.VP) of the pressure component (4) the detent or hooking means (52), in particular in their connected state with the receiving sleeve (33), can be locked and simultaneously a force, in particular on the plunger (35), can be generated by means of the pressure component (4) in a distal direction for the provisional fixing of the polyaxiality of the pedicle screw (3).

2. Auxiliary system (1) according to claim 1, characterized in that a bendable, preferably flexible, engagement tongue (53) is formed on each of the retaining arms (51), and a locking or hooking means (52) is arranged at the distal end region of the engagement tongue (53), and the engagement tongues (53) can be bent elastically in opposite directions and relative to the respective remainder of the retaining arm (51) by increasing the distance between the locking or hooking means (52), in particular to create or release the connection of the pulling component (5) with the receiving sleeve (33).34 / 37 3. Auxiliary system (1) according to claim 2, characterized in that the engagement tongue (53) is formed by a slot (54) in the respective holding arm (51) with two substantially parallel slot regions and with an arc-shaped slot region connecting these two parallel slot regions at the distal end (DE) of the engagement tongue (53).

4. Auxiliary system (1) according to one of claims 1 to 3, characterized in that the auxiliary system (1) has a rod pusher (6) for positioning the longitudinal beam (2) in a u-shaped slot (332) of the receiving sleeve (33) and the rod pusher (6) is movable in the longitudinal direction relative to the pressure component (4) and to the tension component (5) by rotation using a screwdriver (7).

5. Auxiliary system (1) according to claim 4, characterized in that the rod pusher (6) is designed as a rod pusher inner sleeve (62) arranged within the pressure component (4) with a screw area (621) rotatably held in the pressure component (4).

6. Auxiliary system (1) according to one of the preceding claims, characterized in that the pressure component (4) can be positioned in an insertion position (SP) in addition to the locking position (4.VP), in which the connection of the tension component (5) with the receiving sleeve (33) can be generated, and in a removal position (NP) in which the connection between the tension component (5) and the receiving sleeve (33) can be released again.

7. Auxiliary system (1) according to claim 6, characterized in that the pressure component (4) projects from the proximal end of the tension component (5) and at least one marking (9) is arranged on the outer circumference of the pressure component (4) by means of which the positioning of the pressure component (4) in its locking position (4.VP), insertion position (4.SP) or removal position (4.NP) is visually identifiable.

8. Auxiliary system (1) according to any one of the preceding claims, characterized in that at least one fork-shaped recess (42) is formed at the distal end of the pressure component (4) in which a retaining lug (521) of the locking or hooking means (52) engages to lock the pressure component (4) in its locking position (4.VP).

9. Auxiliary system (1) according to one of the preceding claims, characterized in that a ramp-shaped projection (56) is provided on the inside of each engagement tongue (53), which is formed in particular by means of a mushroom-head pin which projects into a recess (43) of the pressure component (4) arranged in its locking or insertion position (4.VP, 4.SP), and can be bent open by moving the pressure component (4) into its removal position (4.NP) of the engagement tongue (53) by sliding the projection (56) along the pressure component (4), the projection (56) being movable out of the recess (43) and thus in particular the locking or hooking means (52) being movable out of engagement with the engagement element (331).

10. Auxiliary system (1) according to one of the preceding claims, characterized in that the locking or hooking means (52) has a support surface (522) facing the proximal end of the auxiliary system (1) for contact with the receiving sleeve (33), in particular in the area of ​​its engagement element (331), and the support surface (522) has an angle (a) of 1° to 3°, in particular of 2°, to a plane perpendicular to the longitudinal axis (L) of the tensioning component (5) in the unconnected state and the radially inner end of the support surface (522) protrudes in the proximal direction relative to the radially outer end of the support surface (522).

11. Auxiliary system (1) according to one of the preceding claims, characterized in that a through-opening (10) is formed along the longitudinal axis (L) of the auxiliary system (1), into which a screwdriver can be inserted from the proximal end and is rotatable for mounting the locking element (34), in particular the setscrew, in the receiving sleeve (33).

12. Auxiliary system (1) according to one of the preceding claims, characterized in that the pressure component (4) is guided longitudinally in the tension component (5) by at least one dovetail-shaped guide (44).

13. Auxiliary system (1) according to one of the preceding claims, characterized in that the rod pusher (6) is guided on the pressure component (4) in the longitudinal direction with at least one retaining surface lying parallel to the longitudinal axis (L), in particular a screw profile-like outer surface, and is thus secured against rotation to the pressure component (4).

Images