Abstract: A system for direct visualization of the spine and the epidural and/or intra-discal space to facilitate diagnosis and treatment of spinal conditions and that is adapted for percutaneous introduction into the spinal space. The system includes a disposable flexible catheter, a fiber-optic bundle disposed within the catheter which is connected to a light source and camera. The bundle is removably and adjustably connected to the proximal end of the catheter to permit rotation of the bundle relative to the catheter. A mechanism for controllably deflecting the tip of the catheter is provided to vary the viewing angle of the fiber-optic bundle within and to assist in steering the catheter through the spinal space. The mechanism includes a deflection wire extending through the catheter and affixed at the distal end thereof. The proximal end of the deflection wire is affixed to a sleeve which is slidably disposed around the catheter and within a housing.

Abstract: A double-apertured L-shaped crimp is crimped to one end of a cable. The other end of the cable is passed around the bone and an orthopedic device to be attached to the bone, and it is then passed through the other aperture in the crimp. A releasable, lever-operated cable clamp is installed on the cable, followed by a tensioning tool. The tensioning tool applies a pre-positioning tension on the cable. The cable clamp is clamped to the cable to hold the tension. The tool is removed for use on another cable. When ready for final tensioning, the tensioning tool is re-installed, adjusted to the desired final tension, the crimp swaged onto the cable to hold the final tension, the cable clamp unclamped, the tensioning tool released and removed with the cable clamp, and the cable is cut off at the crimp.

Abstract: A device for holding in compression, a bone graft placed in the space between two vertebral bodies and from which a diseased or injured vertebral body has been removed, comprises an elongate space-spanning plate of implant grade material having a concavo-convex cross section, with an integral prong at each end to be driven into the vertebral bodies. Each prong has a proximal portion and a distal portion, with each portion having an inboard surface facing an inboard surface of the other prong, the inboard surfaces converging as they extend from the distal ends of the prongs toward the concave surface of the plate to urge the vertebral bodies toward each other as the prongs are driven into them. The outboard surface at the proximal portion of the prong is parallel to the inboard surface and at the distal portion converges from the proximal portion to intersection with the inboard surface at the distal end of the prong.

Abstract: A tool and method for derotating a scoliotic spine while it is being manipulated from a scoliotic configuration to a kyphotic configuration. The tool is used to apply a derotating force to the convex side of the scoliotic spine. The method uses the tool to reduce the derotation of a scoliotic spine.

Abstract: An anterior cervical plating system is disclosed which includes an elongated plate having a pair of bone screw bores at opposite ends of the plate, and with bone screw slot configurations in the middle bridge portion of the plate. A single locking screw is provided at each end of the plate which engages the heads of the bone screws trapped within recesses of the plate. The locking screw provides a rigid fixation of the screws to the plate, while the heads of the screws are flush or recessed below the upper surface of the plate. The invention further contemplates a drill and tap guide assembly which can be mounted on the fixation plate to provide a firm foundation for accurately drilling and tapping screw holes into the vertebra to be instrumented. The drill and tap guide assembly includes an assembly support which is engaged to the plate by way of a positioning screw and cross pins mounting the positioning screw to the guide body.

Abstract: A method for internal fixation of vertebra of the spine to facilitate graft fusion includes steps for excising the nucleus of an affected disc, preparing a bone graft, instrumenting the vertebrae for fixation, and introducing the bone graft into the resected nuclear space. Disc resection is conducted through two portals through the annulus, with one portal supporting resection instruments and the other supporting a viewing device. The fixation hardware is inserted through small incisions aligned with each pedicle to be instrumented. The hardware includes bone screws, fixation plates, engagement nuts, and linking members. In an important aspect of the method, the fixation plates, engagement nuts and linking members are supported suprafascially but subcutaneously so that the fascia and muscle tissue are not damaged. The bone screw is configured to support the fixation hardware above the fascia.

Abstract: A tool assembly has a shaft with a sleeve slidable along it. A hexagonal drive post at the lower end of tile shaft is received in a hex socket at the upper end of a bone bolt secured in a patient's spine. A nut to secure a connector on the bolt, is temporarily stored on a short thread on the shaft near the lower end. The sleeve is slid down the shaft and a hex socket at tile lower end of tile sleeve is received on the nut. The sleeve is manually turned while a handle on a drive post at the top of the shaft prevents the shaft, and thereby the bolt, from turning. As the sleeve turns, the nut is turned off the short thread and down onto the bolt thread. A torque wrench coupled to a tool receiving surface at the top of the sleeve tightens the nut on the bolt to the specified torque while the handle on the top of the shaft prevents the bolt from turning.

Abstract: An internal anterior fixation system for treatment of vertebral burst fractures includes an elongated plate having longitudinal axis which includes integral superior, inferior and bridge portions. The superior and inferior portions are provided for fixation to corresponding vertebrae while the bridge portion spanning between the portions over the affected vertebra. The superior portion includes a pair of generally parallel elongated slots therethrough each having scallops on for receiving bone fixation screws or bolts. The inferior portion includes a pair of openings through which fixation screws or bolts extend. The slots in the superior portion allow for compression or distraction of the intermediate vertebral region. The openings in the inferior portion are oriented at an oblique angle relative to the axis of the plate to provide a quadrilateral fixation construct. The bridge portion has a width significantly less than the width of the superior and inferior fixation portions.

Abstract: A curved needle with a flexible leader wire and a multi-stranded cable fastened to the leader wire is passed through one half of a vertically split sternum from in front of the one half of the sternum to the back of the one half and then across behind the sternum to the back of the other half of the sternum and then forward to a location in front of the other half of the sternum. A crimp on the trailing end of the cable abuts one side of a stop bar in front of the sternum. The needle and other end of the cable are passed from the other side of the bar through an aperture in the bar. The needle is then separated from the leader. This procedure is repeated at the desired number of vertically spaced sites on the sternum. Then the sternum halves are brought together. Each of the cables is tensioned to hold the sternum together, and a crimp is swaged onto the cable at the other side of the bar whereby the crimp holds the cable in tension. Then the extra cable is cut off.

Abstract: This is an instrument for applying tension to a metal surgical cable used in certain surgical procedures. The cable tensioner has a ratchet feature which has the ability to steadily increase the tension in the cable. Also included is a scale incorporated into the cable tensioner so that the tension in the cable is directly measured and indicated at all times. Finally, the cable tensioner is ergonomically designed into an elongated cylindrical shape to easily fit in the cupped hand of a surgeon.

Abstract: A spinal fixation system is provided for engagement to the spine of a patient between several vertebral levels, which includes an elongated spinal rod configured for placement adjacent the spine. The system includes a number of vertebral fixation elements, each including a vertebra engaging portion and a rod engaging portion formed by a pair of posts extending from the vertebra engaging portion. The vertebral fixation elements are engaged to the spinal rod each by way of a top-loading clamp that permits access directly from the top of the instrumentation site for tightening the system. In particular, the clamp includes a body defining an elongated bore configured to receive the spinal rod therethrough so that the rod can at least initially slide along the length of the bore. A pair of threaded bores extend from opposite top and bottom surfaces of the body, each intersecting the elongated rod bore.

Abstract: A variable angle bone screw system for use in a spinal implant system to connect a vertebral fixation element to a spinal rod extending adjacent the vertebral column in a patient. The system includes an eyebolt having a threaded stem, a washer receivable over the stem of the eyebolt, a bone screw including a yoked head to permit top loading of the stem of the eyebolt, and a nut engaging the threaded stem of the eyebolt and cooperating with the eyebolt to clamp the bone screw and washer therebetween. The bone screw head and the washer include interdigitating locking means for restraining the pivoting of the screw about the axis of the eyebolt threaded stem but permitting interlocking in variable angular orientations.

Abstract: A new spinal hook of the present invention which comprises a hook-configured shoe with an integral portion. The top portion includes a pair of central posts which are displaced to form a slot therebetween. Each central post includes a groove colinearly formed to receive a spinal rod within. The slot between the two posts is oriented with respect to the grooves so that an eyebolt assembly may be used to engage the hook to the fixation rod. In another aspect of the invention, a slot is formed in the end faces of the hook. The slot forms one part of a tongue and slot instrumentation engagement arrangement, with the hook-holding instrument including a correspondingly configured tongue. In another aspect of the invention, each of the pair of central posts include grooves on both lateral faces of the posts so that the spinal rod can be situated on either side of the spinal hook.

Abstract: A one piece item of stainless steel or other material suitable for permanent placement in the human body, forms the eye and shaft of an eyebolt by a combination of two shell-like portions, each having threaded bosses at distal ends thereof. The distal ends are placed around a spinal rod simultaneously with insertion of one of the shell-like portions through the yoke of a spinal column connecting hook device. Then the bosses are brought toward each other and the two bosses combine to form a bolt on which a nut is received and advanced along the threads. As this is done, it forms the eye of the eyebolt and it is brought into cooperation with the hook device to clamp tightly on a spinal rod with which the eyebolt is used. The two threaded bosses have interfitting, and thus mating, rib and groove to establish and maintain alignment of the threads of the two bosses to facilitate reception of the nut on the bosses.

Abstract: A spinal fixation system includes a relatively rigid fixation plate which is engaged to a plurality of vertebrae by bone screws or bolts. The plate includes a longitudinal slot defined therethrough with an arrangement of scallops formed at the edge of the slot on the upper and lower surfaces of the plate. The scallop arrangement includes a first set of scallops formed at one spherical radius and a second set of scallops nested within the first that are formed at a smaller radius. Thus, the fixation plate can accommodate bone screws or bolts, or other bone engagement or load transmitting components having curved engagement surfaces of various diameters and providing varying degrees of rigidity. In another feature of the invention, a C-shaped ring is provided which encircles the plate to entrap the side walls of the plate, thereby restricting the plate walls from spreading as the bone screws or bolts are tightened onto the plate.

Abstract: A lateral offset connector is provided for engaging a spinal rod to a vertebral fixation element, such as a hook or a bone screw. The lateral offset connector includes a head portion from which a pair of parallel arms extend to form a slot opening between the arms. The arms are configured with grooves on their underside for receiving the spinal rod. The slot opening between the arms is configured to receive an eyebolt engagement assembly therebetween. The eyebolt is disposed between the arms of the connector and a nut is threaded onto the threaded post of the eyebolt to clamp the spinal rod between the eyebolt and the offset connector arms. The offset connector further includes a threaded post extending from the end of the connector for engagement with the spinal fixation component, such as the bone screw or hook. A nut clamps the fixation component between a rounded shoulder of the connector and the nut.

Abstract: A device for restraining a patient, i.e., the device usually would be used in pairs with one such device being used to restrain one arm of the patient while another such device would be used to restrain his other arm. Although, the device may also be used in like fashion for restraining either of the legs, if desired. The device generally comprises four main parts, namely: a cuff part for bindable placement about either arm or leg; an anchoring part for attachment to structure of the patient's bed, wheelchair, etc.; an elongated strap for extending the reach between the cuff part and the anchoring part, thus the anchoring part will be inaccessible to the patient; and quick release structure for effectively facilitating expeditious release of the patient when desired and for subseqently returning him to the original restraint condition with minimum effort. The quick release part preferably is situated adjacent the anchoring part so it too will be inaccessible to the patient.