SOFT STABILIZATION ASSEMBLIES WITH OFF-SET CONNECTOR

Abstract

A spinal longitudinal connecting member includes a soft stabilization assembly segment having a tensioned cord and a hard rod segment. A connector in fixed engagement with the hard rod also captures the tensioned cord of the soft segment, the connector being in fixed or sliding relation with the tensioned cord. The connector places the soft assembly segment in lateral or off-set and staggered relation to the hard rod segment. The connector may be integral to a bone anchor.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS

This continuation application claims priority under 35 U.S.C. §120 from co-pending U.S. Nonprovisional Application No. 14/171,168 entitled “SOFT STABILIZATION ASSEMBLIES WITH OFF-SET CONNECTOR,” filed on Feb. 3, 2014, which claims priority under 35 U.S.C. §119 from U.S. Provisional Application No. 61/849,934 entitled “SOFT STABILIZATION ASSEMBLIES WITH OFF-SET CONNECTOR,” filed Feb. 5, 2013.

U.S. Nonprovisional Application No. 14/171,168 is also a continuation-in-part of and claims priority from U.S. Nonprovisional Application No. 12/802,849 entitled “LONGITUDINAL CONNECTING MEMBER WITH SLEEVED TENSIONED CORDS,” filed Jun. 15, 2010 which claims priority from U.S. Provisional Application No. 61/268,708 entitled “DYNAMIC STABILIZATION ASSEMBLY WITH CORD AND FLUSH SLIDING SLEEVES,” filed Jun. 15, 2009; U.S. Provisional Application No. 61/270,754 entitled “DYNAMIC STABILIZATION ASSEMBLY WITH CORD AND FLANGED SLEEVES,” filed Jul. 13, 2009; U.S. Provisional Application No. 61/336,911 entitled “POLYAXIAL BONE ANCHOR WITH NON-PIVOTABLE SNAP-ON SPRING RING AND FRICTION FIT INSERT,” filed Jan. 28, 2010; U.S. Provisional Application No. 61/395,564 entitled “POLYAXIAL BONE ANCHOR WITH FRICTION FIT CROWN INSERT, POP-ON SHANK AND FLANGE FORM CLOSURE,” filed May 14, 2010; U.S. Provisional Application No. 61/395,752 entitled “POLYAXIAL BONE ANCHOR WITH POP-ON DIRECT ENGAGEMENT SHANK,” filed May 17, 2010; and U.S. Provisional Application No. 61/396,390 entitled “POLYAXIAL BONE ANCHOR WITH POP-ON DIRECT ENGAGEMENT SHANK,” filed May 26, 2010, all of which are incorporated by reference herein for all purposes.

BACKGROUND OF THE INVENTION

The present invention is directed to soft or dynamic fixation assemblies for use in bone surgery, particularly spinal surgery, and in particular to longitudinal connecting members for such assemblies, the connecting members being attached to at least two bone fasteners.

Historically, it has been common to fuse adjacent vertebrae that are placed in fixed relation by the installation therealong of bone screws or other bone anchors and cooperating longitudinal connecting members or other elongate members. Fusion results in the permanent immobilization of one or more of the intervertebral joints. Because the anchoring of bone screws, hooks and other types of anchors directly to a vertebra can result in significant forces being placed on the vertebra, and such forces may ultimately result in the loosening of the bone screw or other anchor from the vertebra, fusion allows for the growth and development of a bone counterpart to the longitudinal connecting member that can maintain the spine in the desired position even if the implants ultimately fail or are removed. Because fusion has been a desired component of spinal stabilization procedures, longitudinal connecting members have been designed that are of a material, size and shape to largely resist flexure, extension, torsion, distraction and compression, and thus substantially immobilize the portion of the spine that is to be fused. Thus, longitudinal connecting members are typically uniform along an entire length thereof, and usually made from a single or integral piece of material having a uniform diameter or width of a size to provide substantially rigid support in all planes.

An alternative to fusion, which immobilizes at least a portion of the spine, and the use of more rigid longitudinal connecting members or other rigid structure has been a “soft” or “dynamic” stabilization approach in which a flexible loop-, S-, C- or U-shaped member or a coil-like and/or a spring-like member is utilized as an elastic longitudinal connecting member fixed between a pair of pedicle screws in an attempt to create, as much as possible, a normal loading pattern between the vertebrae in flexion, extension, distraction, compression, side bending and torsion. Another type of soft or dynamic system known in the art includes bone anchors connected by flexible cords or strands, typically made from a plastic material. Such a cord or strand may be threaded through cannulated spacers that are disposed between adjacent bone anchors when such a cord or strand is implanted, tensioned and attached to the bone anchors. The spacers typically span the distance between bone anchors, providing limits on the bending movement of the cord or strand and thus strengthening and supporting the overall system. Such cord or strand-type systems have typically required specialized bone anchors and tooling for tensioning and holding the cord or strand in the bone anchors.

The complex dynamic conditions associated with spinal movement create challenges for the design of elongate elastic longitudinal connecting members that exhibit an adequate fatigue strength to provide stabilization and protected motion of the spine, without fusion, and that allow for some natural movement of the portion of the spine being reinforced and supported by the elongate elastic or flexible connecting member. A further challenge are situations in which a portion or length of the spine requires a more rigid stabilization, possibly including fusion, while another portion or length may be better supported by a more dynamic system that allows for protective movement.

SUMMARY OF THE INVENTION

Longitudinal connecting member assemblies according to the invention for use between at least two bone anchors provide soft or dynamic, protected motion of the spine and may be extended to provide additional soft or dynamic sections or more rigid support along an adjacent length of the spine, with fusion, if desired. An illustrated longitudinal connecting member assembly according to an embodiment of the invention includes a soft portion or segment connected to a more rigid or hard portion or segment by a transversely oriented connector structure, the connector structure placing the soft portion of the assembly in parallel but lateral or off-set and staggered relationship with the hard portion of the assembly. Stated in another way, when implanted onto a patient's spine, the assembly generally runs along a portion of the spine with a connector attaching a soft elongate segment with a hard elongate segment; however, the soft and hard elongate segments of the assembly are not directly in line with one another but rather are positioned medial/lateral or lateral/medial with respect to one another. The soft portion of the assembly includes an inner segment or core, typically a tensioned cord or cords, the core being fixed at either end thereof to substantially rigid segments or structures, the rigid segments including but not limited to the off-set connector structure, bone anchors (typically bone screws, such as mono-axial or poly-axial screws), or end blocking structures or stops that are not part of a bone anchor or screw structure. The core is also usually surrounded by a spacer that may be elastomeric or hard and rigid. Furthermore elastomeric bumpers may be used at locations along the soft portion of the assembly and about the tensioned cord or core to provide a continuous axial load. The tensioned inner core or cord of the soft portion of the assembly and one or more compressed spacers and/or bumpers cooperate dynamically, such features also having some flexibility in bending, but also protecting and limiting flexing movement of the inner core. The rigid or hard portion of the assembly is typically a hard rod or bar that is attached to both the off-set connector structure and to one or more bone anchors. The off-set connector may be closed or open at a top thereof, having structure for mating cooperation with set screws or other closure tops that in turn have structure for fixing to the soft portion inner core or to the hard rod portion located within the off-set connector structure. In some embodiments, the off-set connector is integral with a bone anchor. Assemblies of embodiments of the invention may include mono-and/or poly-axial bone anchors, both open and closed. Typically open mono- or poly-axial bone anchors are fixed to the hard rod portion of the assembly, while either open or closed bone anchors may be used to capture, and if desired, fix the inner core of the assembly soft portion against the respective bone anchor. In certain embodiments it may be desirable to allow the soft core or cord to be in sliding engagement with the off-set connector and also with one or more bone anchors.

A variety of embodiments according to the invention are possible. Rods or other substantially rigid structures having different measures of rigidity may be connected according to embodiments of the invention. Either rigid lengths or flexible cords may be of greater or lesser lengths for attaching to one and up to a plurality of bone anchors.

It is an object of the invention to provide apparatus and methods that are easy to use and especially adapted for the intended use thereof and wherein the apparatus are comparatively inexpensive to make and suitable for use. Other objects and advantages of this invention will become apparent from the following description taken in conjunction with the accompanying drawings wherein are set forth, by way of illustration and example, certain embodiments of this invention.

The drawings constitute a part of this specification and include exemplary embodiments of the present invention and illustrate various objects and features thereof.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an off-set connector structure according to an embodiment of the invention.

FIG. 2 is a top plan view of the connector of FIG. 1.

FIG. 3 is a reduced perspective view of the connector of FIG. 1 shown operatively attached to a longitudinal connecting member assembly that includes a rigid rod portion fixed to three open bone anchors and a tensioned cord portion captured by two closed bone anchors, the tensioned cord portion including an end blocker or fixer, two elastic bumpers and a spacer.

FIG. 3a is also a reduced perspective view of the connector of FIG. 1 shown operatively attached to an alternative longitudinal connecting member assembly that includes a rigid rod portion fixed to three open bone anchors and a tensioned cord portion captured by one closed bone anchor, the tensioned cord portion including an end blocker or fixer, a bumper and a spacer.

FIG. 4 shown in FIG. 3 is a front elevational view of the assembly

FIG. 5 is a top plan view of the assembly shown in FIG. 3.

FIG. 6 is a partial front elevational view of the assembly of FIG. 3, similar to FIG. 4 but with portions of the rigid rod portion broken away to show the detail thereof.

FIG. 7 is partial front elevational view of the assembly of FIG. 3, similar to FIG. 4, but with portions of the tensioned cord portion broken away to show the detail thereof.

FIG. 8 is a partial perspective view of another embodiment of a connector shown with a hard rod, a tensioned cord and a portion of a spacer.

FIG. 9 is a reduced and partial perspective view of the connector of FIG. 8 shown with a hard rod, a tensioned cord, an end blocker, a bumper and a partial spacer.

FIG. 10 is a perspective view of another alternative off-set connector shown integral with a bone screw and showing a rigid rod and tensioned cord in phantom.

DETAILED DESCRIPTION OF THE INVENTION

required, detailed embodiments of the present invention are disclosed herein; however, it is to be understood that the disclosed embodiments are merely exemplary of the invention, which may be embodied in various forms. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the present invention in virtually any appropriately detailed structure. It is also noted that any reference to the words top, bottom, up and down, and the like, in this application refers to the alignment shown in the various drawings, as well as the normal connotations applied to such devices, and is not intended to restrict positioning of the connecting member assemblies of the application and cooperating bone anchors in actual use.

With reference to FIGS. 3-7, a longitudinal connecting member assembly according to an embodiment of the invention, generally 1, is shown that includes a connector structure 2 that attaches a soft segment or assembly portion, generally 3, with a hard segment or portion, generally 3′ in a staggered and offset orientation to one another. As best shown in FIG. 5, the soft non-fusion segment 3 is elongate and extends substantially along a central axis A. The hard segment portion 3′ is also elongate and extends substantially along a central axis A′ that is substantially parallel to the axis A. The elongated segments 3 and 3′ are in a lateral/medial or medial/lateral relationship to one another when the assembly 1 is connected to a spine (not shown) utilizing bone anchors, such as open and closed mono-axial and polyaxial bone screws and hooks.

The illustrated soft segment 3 of the assembly 1 includes the following components: an elongate bendable and soft, flexible core in the form of a tensioned cord 4; a cannulated spacer 6 that may be compressible; two elastic bumpers 8; and a fixing structure or blocking member in the form of a blocker 10 with cooperating set screw 11 sized and shaped for pressing against and/or into the cord 4 and fixing the cord with respect to the blocker 10. The hard portion or segment 3′ is illustrated as a cylindrical rod 14.

The assembly 1 is shown with two closed monoaxial bone screws 16 and three open monoaxial bone screws 18. The closed screws 16 each have an upper portion or head 21 integral with a lower shank 22 having at least one helical thread form for rotating and driving the screw into a vertebra. Each head 21 has a cylindrical opening 24 formed in a top thereof that is sized, shaped and threaded for mating with a set screw, such as the set screw 11′, best illustrated in FIG. 7. Each of the illustrated open bone screws 18 includes a head or upper portion 27 integral with a lower shank 28 having at least one helical thread form for rotating and driving the screw into a vertebra. The head 27 is in the form of opposed arms that form an open channel 30 sized and shaped to closely receive the rod 14 in an open or percutaneous manner and having a guide and advancement structure, illustrated as a flange form 31 for rotating into and mating engagement with a closure top such as a closure top 35 shown in FIGS. 3 and 5, for example. Details of both open and closed screws and closures, such as the screws 11 and 11′ and the closures 35 for use with longitudinal connecting member embodiments of the invention are described in greater detail in Applicant's U.S. patent application Ser. No. 13/506,657 filed May 7, 2012, published as US 2012/0221054, the entire disclosure of which is incorporated by reference herein (and hereafter identified as the '657 application). For example, certain open screws are shown in FIGS. 33-43 of the '657 application and certain closed bone screws are shown in FIGS. 69-71 of the '657 application. The '657 applications also discloses a variety of set screws and closure tops for use with the bone screws described therein. In the present application, although the assembly 1 soft segment 3 is shown with closed screws, it is noted that the soft segment 3′ may also be used with open bone screws, both monoaxial and polyaxial, as described, for example, in Applicant's '657 application. It is also noted that although the soft segment 3 is shown with the cord gripping closure top 11′ and another of the closed screws 16 is shown without a closure, in certain embodiments, the bone anchors used with the soft segment 3 may also be used with non-gripping closures that allow for the cord 4 to slip or slide with respect to the closure as described in detail in Applicant's '657 application.

The tensioned cord 4, spacer 6, bumpers 8 and blocker 10 with set screw 11 are identical or substantially similar to the longitudinal connecting member components identified by the same names and described in greater detail in Applicant's '657 application, the disclosure of which has already been incorporated by reference herein. For example, a tensioned cord 1004 is shown in FIGS. 28-32 of the '657 application and described in paragraph 146 therein that is the same or substantially similar in form and function to the tensioned cord 4. Spacers 1006 and 2006, for example, are shown in FIGS. 30-32 and 44-49, respectively, of the '657 application and described in paragraphs 147 and 168-72 therein that are the same or substantially similar in form and function to the spacer 6. Bumpers 1008 and 2008, for example, are shown in FIGS. 30-32 and 44-49, respectively, of the '657 application and described in paragraphs 148-49 and 168-72 therein that are the same or substantially similar in form and function to the elastic bumpers 8. A blocker and set screw combination 2010, 2011 is shown in FIGS. 44-49 of the '657 application and described in paragraph 170 therein that is the same or substantially similar in form and function to the end blocker 10 and set screw 11 combination. Spacers 6 and bumpers 8 of embodiments of the invention are typically cylindrical tubes prior to assembly, but may be formed in other geometric shapes. Also, it is noted that the illustrated elastic bumpers 8 shown in the drawings are shown compressed in the drawing figures and thus are not shown as cylinders, but rather in a compressed form wherein the bumper bulges outwardly at a middle portion thereof.

With particular reference to FIGS. 1 and 2, the off-set connector 2 can also be described as a double-wide blocker, with one portion of the connector sized and shaped for receiving a tensioned cord and an adjacent portion sized and shaped for receiving another connector, such as a hard rod. The illustrated connector 2 includes a first through bore defined by a substantially cylindrical surface 50 and a second, parallel through bore formed by a substantially cylindrical surface 52, both bore cylindrical surfaces 50 and 52 formed in the connector 2 between and through substantially planar front 54 and rear 56 surfaces. The front surface 54 is parallel to the rear surface 56. A top surface 58 perpendicular to both the front surface 54 and the rear surface 56 is substantially planar and terminates at the front and rear surfaces 54 and 56. In the illustrated embodiment, opposed side surfaces 60 and 62 are each curved and also terminate at the top surface 58. A bottom substantially planar surface 65 spans between the curved side surfaces 60 and 62. However, it is foreseen that in other embodiments of the invention the bottom surface 65 may include cut-outs and curves. The cylindrical surface 50 is located near the side surface 60 and the cylindrical surface 52 is located near the side surface 62, the cylindrical surfaces 50 and 52 being uniformly spaced from the respective side surfaces 60 and 62. Formed in the top surface 58 are a pair of spaced apertures defined by threaded cylindrical surfaces 70 and 72. The cylindrical surface 70 runs from the top surface 58 and terminates at the bore 50 while the cylindrical surface 72 runs from the top surface 58 and terminates at the bore 52. Thus apertures defined by the surfaces 70 and 72 communicate with and are perpendicular to the bores defined by the respective cylindrical surfaces 50 and 52. The threaded surface 70 is sized and shaped for mating engagement with a set screw 111, as shown for example in FIG. 3a, and the threaded surface 72 is sized and shaped for mating engagement with a set screw 111′, shown in both FIG. 3 and FIG. 3a. It is noted that in the embodiment illustrated in FIG. 3a, the set screws 11, 11′ and 111 are identical. However, in other embodiments of the invention, set screws or closure tops of different sizes or geometries may be utilized to press the tensioned cord 4 into frictional engagement with other connectors, end blockers or bone screws.

In the illustrated embodiment, the through bores defined by the cylindrical surfaces 50 and 52 are substantially the same size, allowing a user to laterally connect any two longitudinal connecting member assembly segments, either soft or hard without concern of how to orient the connector 2 with respect to such segments. Thus, the connector 2 may be used with or without a hard rod. For example, two soft connector segments, possibly having spacers or bumpers of different durometer or segments that differ only in length may be medially/laterally connected in a staggered manner by the connector 2. Similarly, both the threaded bores 70 and 72 are shown having the same diameter and thus only the closures or screws would need to be different in height to adequately fix against a hard rod 14 or a soft tensioned cord 4. As shown in FIGS. 6 and 7, for example, the set screws 11 and 11′ shown in FIG. 7 each include a central projection 12 and 12′ respectively, for pressing downwardly against the cord 4 while the set screw 111′ shown in FIG. 6 is of a shorter length than the screws 11 and 11 and includes an edge or shallow rim 112′ for gripping and penetrating the hard rod 14. In other embodiments, the screw 111 may include other surfaces, points or edges for gripping the rod 14 or may have a planar bottom surface.

It is foreseen that in other embodiments of the invention, the cylindrical surface 50 that slidingly receives the cord 4 may have a diameter that is smaller than a diameter of the surface 52 that slidingly receives the rod 14. Also, the set screw receiving surfaces 70 and 72 may have different diameters, thus requiring various set screws of not only different heights but also different diameters for cooperating with either side of the connector 2.

With further reference to FIGS. 3 and 4-7, the assembly 1 is shown wherein the cord 4 is fixed to the end blocker 10 at a first end thereof, the set screw 11 pressing the cord 4 into frictional engagement with the blocker 10. The cord 4 is then threaded through one of the elastic bumpers 8 and then through the head 21 of one of the bone screws 16. The cord 4 is then threaded through the inelastic spacer 6 and the connector 2, followed by another elastic bumper 8 and finally the head 21 of the bone screw 16 that also includes the set screw 11′ that fixes the cord 4 to the bone screw 16. The cord 4 is in sliding relation with both bumpers 8, the bone screw 16 that is located between one of the bumpers 8 and the spacer 6. The cord 4 is also in sliding relation with the connector 2, the threaded cylindrical surface 70 being shown without a set screw. The soft segment 3 of the assembly 1 is shown in a nominal state, as, for example, the assembly would be in after the cord 4 is tensioned (in some embodiments, after the cord 4 has had some extension after creep and wherein the cord 4 may have been re-tensioned and recaptured at either the bumper 10 or the set screw 11′. As shown, tensioning of the cord 4 results in some compression placed on the bumpers 8. As best shown in FIG. 7, the cord 4 is in tension between the blocker 10 and the end screw 16 that has the set screw 11′ pressing against the cord 4. The cord 4 is free to slide with respect to all the soft segment components located between the blocker 10 and the end screw 16, allowing the soft segment 3 to respond to compressive and extension forces on vertebrae (not shown) attached to both of the bone screws 16. As shown in FIG. 3 and FIGS. 47, the hard rod 14 is fixed to the connector 2 by the set screw 111′ and is fixed to three bone screws 18 by three closure tops 35.

With reference to FIG. 3a, the assembly 1 has been modified to create an assembly 1′ wherein a soft segment 3″ has the cord 4 fixed at one end by the blocker 10 and at an opposite end thereof by the set screw 111 rotatingly mated with the threaded cylindrical surface 70 of the connector 2. Thus, the connector 2 is also a termination of the soft segment 3″, the connector 2 functioning as an end blocker for the tensioned cord 4. The tensioned cord 4 is in sliding relation with a bumper 8, a bone screw 16 and a spacer 6. The bone screw 16 is shown with the opening 24 empty, similar to what is shown in FIG. 3. However, in some embodiments of the invention, it may be desirable to insert a set screw 11′ in the bone screw head 21 to fix the cord 4 to the bone screw 16. In such an embodiment, a bumper 8 may be placed on an opposite side 56 of the connector 2 and the cord threaded through an additional end blocker 10 located adjacent such bumper 8. Thus, a wide variety of combinations of bumpers, blockers, spacers and bone screws for a soft segment can be visualized. In the embodiment illustrated in FIG. 3a, the connector 2 is fixed to the hard rod segment 3′ identical to what is shown in FIG. 3. However, it is foreseen that hard rod segments of different lengths or other hard or soft segments may be slidingly captured by the connector 2 or fixed to the connector 2 by a set screw 111 or 111′ in lieu of the rod segment 3′ shown.

With reference to FIGS. 8 and 9 another embodiment of a connector 2′ is shown. The connector 2′ is similar to the connector 2 previously described herein with the exception that an open channel for a rod is formed in the connector 2′ in lieu of the rod receiving through bore 52 and set screw aperture 72 combination. Thus, the connector 2′ includes a cylindrical surface 50′ defining a through bore, a front surface 54′, a rear surface 56′, a top surface 58′, a curved side surface 60′, a bottom surface 65′ and a threaded aperture 70′ substantially similar in form and function to the respective cylindrical surface 50, front surface 54, rear surface 56, top surface 58, curved side surface 60, bottom surface 65 and threaded aperture 70 previously described herein with respect to the connector 2. The connector 2′ also includes a side portion 27′ defining a rod receiving channel 30′ further defined by a guide and advancement structure that is shown as a flange form structure 31′ for receiving a closure top 35′ that is substantially similar in form and function to the respective bone anchor upper portion or head 27 defining the rod receiving channel 30 further defined by the flange form guide and advancement structure 31 for receiving the closure top 35 previously described herein with respect to the open bone anchor 18. As shown in FIG. 8, the rod 14 is received in the connector 2′ channel 30′ and the closure top 35′ is rotated with respect to the flange form 31′ to capture and fix the rod 14 within the connector 2′. Similar to what has been discussed previously herein, with respect to FIG. 8, a tensioned cord 4 is shown fixed to the connector 2′ by a set screw 111 inserted within the opening 70′ at the top 58′ of the connector 2′. FIG. 8 also shows a partial spacer 6 disposed about the tensioned cord 4 and further soft connector components, including bumpers, additional bone anchors and end blockers may be connected by the tensioned cord 4 at an opposite side of the spacer 6.

With respect to FIG. 9, the alternative connector 2′ is shown with a rod 14 and closure top 35′ similar to what is shown in FIG. 8 and further shown with a tensioned cord 4 is sliding engagement with the connector 2′, the connector aperture surface 70′ not having a set screw 111 rotatingly mated therein. The cord 4 is shown in sliding engagement with a bumper 8 and being fixed to an end blocker 10 with a set screw 11. Similar to FIG. 8, FIG. 9 shows a partial spacer 6 surrounding the tensioned cord 4 at the back surface 56′ of the connector 2′. A bone screw (not shown) may be placed at an opposite end of the spacer 6 that may be in fixed or slidable engagement with the cord 4. Further bumpers 8, spacers 6, bone anchors and possibly another end blocker 10 may be located along the tensioned cord 4.

With reference to FIG. 10, another alternative connector, generally 201, is shown. The connector 201 includes a closed connector portion 202 integral with a bone screw, generally 218. Thus the connector portion 202 includes a cylindrical surface 250 defining a through bore, a front surface 254, a rear surface 256, a top surface 258, a curved side surface 260, a bottom surface 265 and a threaded aperture 270 perpendicular to the cylindrical surface 260 that is substantially similar in form and function to the respective cylindrical surface 50, front surface 54, rear surface 56, top surface 58, curved side surface 60, bottom surface 65 and threaded aperture 70 previously described herein with respect to the connector 2. The connector 202 also includes a head portion 227 that is integral to the connector portion 202 and a shank 228, the head portion 227 defining a rod receiving channel 230 further defined by a guide and advancement structure that is shown as a flange form structure 231 for receiving a closure top 235 that is substantially similar in form and function to the respective bone anchor 18 upper portion or head 27 and shank 28, the head 27 defining the rod receiving channel 30 further defined by the flange form guide and advancement structure 31 for receiving the closure top 35 previously described herein with respect to the open bone anchor 18.

It is foreseen that a connector may also include two open channels, one for receiving a rod and the other for receiving a cord 4. Furthermore, such a dual open channel embodiment could be integral with a bone screw shank.

It is to be understood that while certain forms of the present invention have been illustrated and described herein, it is not to be limited to the specific forms or arrangement of parts described and shown.

Claims

1. A longitudinal connecting member assembly having first and second bone anchors spanning between first and second vertebrae, the assembly comprising:

a) a soft portion having a cord in continuous tension, the cord being in slideable relation with the first bone anchor, wherein the anchor is positioned between an end blocker-bumper and a spacer;

b) a hard portion being in fixed relation with the second bone anchor;

c) a connecting structure in fixed relation with the hard portion and in one of a fixed and a sliding relation with the cord, the connecting structure positioning the soft portion in a lateral and staggered relation with the hard portion;

d) a hard end structure fixed to the cord; and

e) an elastic bumper and a spacer both being in slidable relation with the cord, the elastic bumper positioned between the end structure and the first bone anchor, the first bone anchor being positioned between the elastic bumper and the spacer.

2. The assembly of claim 1 further comprising a third bone anchor attached to a third vertebra, the third bone anchor fixed to the hard structure.

3. The assembly of claim 1 further comprising a third bone anchor attached to a third vertebra, the third bone anchor fixed to the cord, the cord in slidable relation with the connecting structure.

4. The assembly of claim 1 wherein the elastic bumper is a first bumper and further comprising a second elastic bumper, the first and second bumpers located on either side of the connecting structure.

5. The assembly of claim 4 further comprising a third bone anchor fixed to the cord, the first bumper located adjacent the first bone anchor and the second bumper located adjacent the third bone anchor.

6. The assembly of claim 1 wherein the connecting structure has a first through bore for receiving the cord and a second through bore for receiving the hard portion, the first and second through bores being parallel.

7. The assembly of claim 6 wherein the connecting structure has and a third bore disposed perpendicular to the first through bore and in communication therewith and a fourth bore disposed perpendicular to the second through bore and in communication therewith, the third bore having a thread for mating engagement with a set screw, the set screw sized and shaped for frictionally fixing the cord against the connecting structure.

8. The assembly of claim 7 wherein the fourth through bore has a helical guide and advancement structure formed thereon, the guide and advancement structure sized and shaped for mating engagement with a closure top, the closure top fixing the hard portion within the connecting structure.

9. The assembly of claim 1 wherein the hard portion is a cylindrical rod.

10. The assembly of claim 1 wherein the connecting structure is integral with a third bone anchor.

11. The assembly of claim 1 wherein the hard portion is a cylindrical rod and the connecting structure has an open channel sized and shaped for receiving the hard rod.

12. In a spinal longitudinal connecting member assembly having a soft segment and a hard rod segment, the soft segment having a tensioned inner core, the tensioned inner core being captured within a first bone anchor and the rod segment being attached to second and third bone anchors, the improvement comprising:

a) a connector structure oriented transverse to both the soft segment and the hard rod segment, the connector structure fixed to the hard rod and capturing the tensioned inner core, the connector structure being in one of sliding and fixed relation to the tensioned inner core, the inner core being in sliding relation with respect to the first bone anchor; and

b) a rigid end blocker fixed to the tensioned inner core and spaced from the connector structure.

13. A spinal connector structure for attaching a rod segment to a soft stabilization longitudinal connecting assembly segment, the assembly having a tensioned cord, a spacer surrounding the cord and a rigid end structure fixed to the cord, the connector structure comprising:

a) a body forming first and second parallel through bores, the first bore sized and shaped for receiving and capturing the tensioned cord in a sliding relation thereto and the second bore sized and shaped for receiving and capturing the rod, the first and second bores placing the soft stabilization segment and the rod segment in staggered lateral/medial parallel orientation to one another, the body also having an open channel communicating with and disposed perpendicular to the second through bore, the channel sized and shaped for receiving the rod, the channel being partially defined by a first helically wound flange form; and

b) a closure structure extending into the aperture having a second helically wound flange form sized and shaped for mating engagement with the first flange form, the closure structure being sized and shaped for frictional engagement with the rod located in the second bore.

14. The spinal connector structure of claim 13 wherein the connector structure is a bone anchor having a shank.

15. A longitudinal connecting member assembly having first and second bone anchors spanning between first and second vertebrae, the assembly comprising:

a) a first elongate segment having an inner cord in continuous tension and having a steady state length, the cord being surrounded by at least one of a spacer and a blocker, the cord being in slideable relation with the first bone anchor; a second elongate segment attached to the second bone anchor; and

b) a connecting structure capturing the second elongate segment, the connecting structure being in one of a fixed and a sliding relation with the tensioned cord, the connecting structure positioning the first elongate segment in an off-set and staggered relation with the second elongate segment.

16. The assembly of claim 15 wherein the second elongate segment is a hard rod fixed to the first bone anchor.