WO2001054599A1 - Locking device and method for using this device - Google Patents

Locking device and method for using this device Download PDF

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Publication number
WO2001054599A1
WO2001054599A1 PCT/SE2001/000194 SE0100194W WO0154599A1 WO 2001054599 A1 WO2001054599 A1 WO 2001054599A1 SE 0100194 W SE0100194 W SE 0100194W WO 0154599 A1 WO0154599 A1 WO 0154599A1
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WO
WIPO (PCT)
Prior art keywords
expandable body
bar
shaped
ring
shaped element
Prior art date
Application number
PCT/SE2001/000194
Other languages
French (fr)
Inventor
Sven Olerud
Original Assignee
Sven Olerud
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Sven Olerud filed Critical Sven Olerud
Priority to AU2001230696A priority Critical patent/AU2001230696A1/en
Publication of WO2001054599A1 publication Critical patent/WO2001054599A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7053—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant with parts attached to bones or to each other by flexible wires, straps, sutures or cables
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8861—Apparatus for manipulating flexible wires or straps

Definitions

  • the present invention relates to a device for the locking of wires, cables, preferably made of metal, monofilament wires and braided wires, cables, against a bar-shaped element, preferably made of metal, the device to be used for spinal surgical measures, in which mutual stabilization and positional adjustment of vertebrae is indispensable, as well as a method of locking said wires, cables against a bar-shaped element.
  • metal wires, cables are conventionally used in order to tie up vertebrae and fix them against bar-shaped elements and in this way try to obtain stabilization between the vertebrae and to try to retain them in an appropriate position during the time, when deposited bone material is incorporated between the vertebrae for the purpose of attaining bone healing.
  • metal wires, cables which are fastened to a vertebra and in most cases in the rear part of the vertebra, are fastened against a metal bar, the ends of the wires, cables, being twisted around each other and around the bar and enveloping it.
  • the object of the present invention is to eliminate the above-mentioned drawbacks and to develop a device, which brings about a substantially improved locking between the wires, cables and the bar, preferably during spinal surgery measures.
  • the above mentioned problems are solved by positioning the bar-shaped element in a ring-shaped fastener as well as by mounting an expandable body in a space between the bar-shaped element and the ring-shaped fastener, which expandable body jointly with a conical screw, which is active in the center of the body, also allows space for holes in its circumferential part, preferably two, arranged in this circumferential part, and through which holes the wire, e.g. subsequent to an anchoring in the rear part of a vertebra, are guided, said expandable body, when the conical screw is driven into it, at the same time stably fixing the ring-shaped fastener as well as the wire, cable against the bar-shaped element.
  • a device which prevents the sliding of the wire, cable along the bar as well as the twisting of it around the bar, brings about a reliable anchoring of the rear part of the vertebra and consequently also the vertebra per se against the bar-shaped element, fixes several vertebrae against the same bar and gives the vertebrae a mutual stability, which is indispensable as far as the growing together of the vertebrae is concerned, and is simple to handle, is eonomic to manufacture and is flexible
  • Fig. 1 show the parts of the device according to the invention, i.e. the bar-shaped element and a double ring-shaped fastener, seen at an angle in a lateral perspective view, the bar being positioned in the double ring-shaped fastener with the expandable body and the conical screw being positioned above the fastener.
  • Fig. 2 shows the expandable body, which is a part of the device, in a perspective view from below.
  • Fig. 3 shows the expandable body in Fig. 2 : a)showing the expandable body from above; b)showing a central longitudinal cross-section of the expandable body with its lower threaded part; c)showing the expandable body from below ; d)showing a central cross-section of the expandable body ; and e)showing the expandable body in cross-section with a conical screw partially screwed into the locking device.
  • Fig. 4 shows : a)a cross-sectional view of the locking device according to the invention ; and b)the same cross-sectional view as in a), but the locking device according to the invention is now shown with its conical screw fully screwed into the expandable body.
  • the device according to the invention comprises a bar-shaped element 23, a wire, cable 18, a double ring-shaped fastener 17 and an expandable body 1, which comprises a partially cylindrical part having a plane head.
  • Bar-shaped element 23 preferably is a metal bar 23, which is positioned in double ring-shaped fastener 17 and against its bottom.
  • the expandable body is provided with slits in an axial direction, gaps from its top down to about 2/3 of its length, which gaps run at right angles to each other through center 4 and outwards to outer sides la, lb of expandable body 1, which slits have variable widths, one wider 2 and one more narrow 3.
  • This central hole has an opening facing upper part 4-0 of the expandable body.
  • In this part there is a space having a cylindrical shape 5 for a screw head 22.
  • a hole 6 is made, provided with a thread for screw 22, which is to be driven into center 4 of expandable body 1.
  • the space has a conical shape 7.
  • a screw 22 having a key socket is a part of the device according to the invention.
  • Screw 22, the head of which is cone-shaped, is provided with a machine thread 13.
  • Fig. 4a and b shows expandable body 1, arranged in double ring-shaped fastener 17, which is fastened to an imaginary bar-shaped element 23, against which wire, cable 18 will be indirectly fixed.
  • Wire, cable 18 runs downwards into the slit, gap 2, within the upper part of the locking body at opposite sides of cone-shaped screw 22, and then passes holes 9 in the sides of the expandable body.
  • conical screw 22 is threaded into cylinder hole 6, the cone will press sides 20 of expandable body 1 apart.
  • the cone of • screw 22 exerts a pressure on wire, cable 18, which is positioned in the slit, gap 2, within the upper part of exandable body 1. The continued driving of screw 22 downwards compresses wire, cable 18.
  • the wire, cable which preferably is made of a metal (a monofilament or braided) is guided around the rear part of a vertebra.
  • Ring-shaped fastener 17 double ring
  • the two wire, cable ends are guided through space 24, which is obtained, when ring-shaped fastener 17 abuts bar-shaped element 23.
  • the two free ends of wire, cable 18 are then guided through holes 9 in the lower part of expandable body 1 and past the loosely inserted conical screw.
  • While holding the two wire, cable ends body 1 is inserted into the ring-shaped fastener.
  • a screw driver is inserted into the key hole of the screw.
  • the wires, cable are stably fastened against a contraction device having a gear.
  • Wires, cables 18 are drawn and stretched by means of the gear, until a stable connection between the rear part of the vertebra and bar-shaped element 23 is obtained.
  • the screw driver is rotated several turns, until conical screw 22 will be stably fastened in expandable body 1.
  • wires, cables 18 are also fixed in expandable body 1.
  • Wires, cables 18 are cut off at the same level as conical screw 22.
  • a stable locking can be obtained in the following manner.
  • the wire, cable ends are guided through partially cylindrical expandable body 1, which in its center 4 is provided with a conical screw 22.
  • Upper part 4-0 of the cylindrical expandable body is divided into sectors 20 having slits, gaps 2,3 , between them, in the shape of a cross.
  • the two wires, cables 18 are positioned opposite each other in the slits, gaps 2,3, which dimensionally fit the diameter of wires, cables 18.
  • a condition of the functioning of the invention is, that expandable body 1 is surrounded by a ring-shaped surrounding element, in this case designed as a ring 17, jointly with a bar-shaped element 23, but a simpler embodiment, which only includes expandable body 1 and ring-shaped fastener 17 is of course possible.
  • Expandable body 1 with the two wires, cables 18 is inserted into space 24, which is obtained between bar-shaped element 23 and double ring-shaped fastener 17, which abuts element 23 (see Fig. 1).
  • screw 22 of the device is driven into the expandable body, an expansion of upper part 4-0 of expansion body 1 takes place, expansion body 1 being locked against bar-shaped element 23.
  • a locking of metal wires, cables 18, which are placed in expandable body 1, takes place.

Abstract

The present invention, which belongs to the orthopedic field, relates to a device for locking of wires, cables, against a bar-shaped element (23) by means of an expandable body (1), the device to be used for spinal operations, as well as to a method of locking the device. The expandable body (1) has a mainly cylindrical shape, about 2/3 of its circumference being cylindrical, four sectors (20) being defined by wide and narrow grooves (2, 3). Through the lower part (9, 10, 11) of the body the wires (18), which e.g. have been attached to the rear part of a vertebra, are guided through holes (9) and subsequently guided outwards into the two side slits, gaps (2) (Fig. 5) past a conical screw (22), centrally positioned in said cylinder, which screw, when it has been completely driven into the expandable body, at the same time locks the metal wires, cables, and cause an expansion of the sides (flanges) (20) of the cylindrical body, which results in, that the expandable body (1) will be surrounded by and fixed in the ring-shaped fastener (Fig. 1), which has been positioned against the bar-shaped element (23), which is designed to become a link to an adjacent vertebra.

Description

LOCKING DEVICE AND METHOD FOR USING THIS DEVICE
TECHNICAL FIELD
The present invention relates to a device for the locking of wires, cables, preferably made of metal, monofilament wires and braided wires, cables, against a bar-shaped element, preferably made of metal, the device to be used for spinal surgical measures, in which mutual stabilization and positional adjustment of vertebrae is indispensable, as well as a method of locking said wires, cables against a bar-shaped element.
BACKGROUND ART
Within the above-mentioned technical field metal wires, cables, are conventionally used in order to tie up vertebrae and fix them against bar-shaped elements and in this way try to obtain stabilization between the vertebrae and to try to retain them in an appropriate position during the time, when deposited bone material is incorporated between the vertebrae for the purpose of attaining bone healing. Thus, it is known, that metal wires, cables, which are fastened to a vertebra and in most cases in the rear part of the vertebra, are fastened against a metal bar, the ends of the wires, cables, being twisted around each other and around the bar and enveloping it. However, with this method it has not been possible to obtain a satisfactory stabilization, which in its turn has resulted in, that it has not been possible to bring about an optimal bone healing. As far as we know up till now, no satisfactory technical solution has been developed to solve this problem and obtaining a completely stable and reliable connection between the wires, cables and the bar.
BRIEF DISCLOSURE OF THE INVENTION
The object of the present invention is to eliminate the above-mentioned drawbacks and to develop a device, which brings about a substantially improved locking between the wires, cables and the bar, preferably during spinal surgery measures.
According to the inventive idea the above mentioned problems are solved by positioning the bar-shaped element in a ring-shaped fastener as well as by mounting an expandable body in a space between the bar-shaped element and the ring-shaped fastener, which expandable body jointly with a conical screw, which is active in the center of the body, also allows space for holes in its circumferential part, preferably two, arranged in this circumferential part, and through which holes the wire, e.g. subsequent to an anchoring in the rear part of a vertebra, are guided, said expandable body, when the conical screw is driven into it, at the same time stably fixing the ring-shaped fastener as well as the wire, cable against the bar-shaped element.
According to the invention a device is obtained, which prevents the sliding of the wire, cable along the bar as well as the twisting of it around the bar, brings about a reliable anchoring of the rear part of the vertebra and consequently also the vertebra per se against the bar-shaped element, fixes several vertebrae against the same bar and gives the vertebrae a mutual stability, which is indispensable as far as the growing together of the vertebrae is concerned, and is simple to handle, is eonomic to manufacture and is flexible
BRIEF DESCRIPTION OF THE DRAWINGS
Fig. 1 show the parts of the device according to the invention, i.e. the bar-shaped element and a double ring-shaped fastener, seen at an angle in a lateral perspective view, the bar being positioned in the double ring-shaped fastener with the expandable body and the conical screw being positioned above the fastener.
Fig. 2 shows the expandable body, which is a part of the device, in a perspective view from below.
Fig. 3 shows the expandable body in Fig. 2 : a)showing the expandable body from above; b)showing a central longitudinal cross-section of the expandable body with its lower threaded part; c)showing the expandable body from below ; d)showing a central cross-section of the expandable body ; and e)showing the expandable body in cross-section with a conical screw partially screwed into the locking device.
Fig. 4 shows : a)a cross-sectional view of the locking device according to the invention ; and b)the same cross-sectional view as in a), but the locking device according to the invention is now shown with its conical screw fully screwed into the expandable body.
It is shown in the drawings, that the device according to the invention comprises a bar-shaped element 23, a wire, cable 18, a double ring-shaped fastener 17 and an expandable body 1, which comprises a partially cylindrical part having a plane head. Bar-shaped element 23 preferably is a metal bar 23, which is positioned in double ring-shaped fastener 17 and against its bottom. Bar-shaped element 23 and ring-shaped fastener 17, which is connected to this element, form an opening 24 between ring-shaped fastener 17 and bar-shaped element 23. The expandable body is provided with slits in an axial direction, gaps from its top down to about 2/3 of its length, which gaps run at right angles to each other through center 4 and outwards to outer sides la, lb of expandable body 1, which slits have variable widths, one wider 2 and one more narrow 3. This central hole has an opening facing upper part 4-0 of the expandable body. In this part there is a space having a cylindrical shape 5 for a screw head 22. In the center of the lower part of expandable body 1 a hole 6 is made, provided with a thread for screw 22, which is to be driven into center 4 of expandable body 1. Between upper cylindrical hole 5 and hole 6 of the threaded part in the central hole the space has a conical shape 7. Below the area, where the wide slit, gap 2, is terminated on both sides, there is a hole 9 inside the body wall, which leads to lower end 10 of exandable body 1. Lower part of hole 9 faces an additional slit, gap 11. Upper part of expandable body 1 is provided with a collar 12, which is partially bevelled at 14 towards the projecting part of plane side la of expandable body 1 and towards the diametrically opposite side of collar 12 above cylinder-shaped part lb. Below this part of collar 12 a shoulder 15 is arranged on outer side lb of the cylinder. Similar shoulders 16 are arranged adjacent wide slit 2, a gap, at the same distance from the collar 12 as the above-mentioned shoulder 15.
A screw 22 having a key socket is a part of the device according to the invention. Screw 22, the head of which is cone-shaped, is provided with a machine thread 13.
Fig. 4a and b shows expandable body 1, arranged in double ring-shaped fastener 17, which is fastened to an imaginary bar-shaped element 23, against which wire, cable 18 will be indirectly fixed. Wire, cable 18 runs downwards into the slit, gap 2, within the upper part of the locking body at opposite sides of cone-shaped screw 22, and then passes holes 9 in the sides of the expandable body. When conical screw 22 is threaded into cylinder hole 6, the cone will press sides 20 of expandable body 1 apart. At the same time the cone of • screw 22 exerts a pressure on wire, cable 18, which is positioned in the slit, gap 2, within the upper part of exandable body 1. The continued driving of screw 22 downwards compresses wire, cable 18. It will then be deformed against edge 21, which the upper part of the double ring-shaped fastener forms against screw 22. Wire, cable 18 is efficiently locked in this way. The final phase of the driving of conical screw 22 causes also an expansion of the upper part of the expandable body. Expandable body 1 is then pressed between bar-shaped element 23 and double ring-shaped fastener 17. Plane part la of expandable body 1 is pressed against bar-shaped element 23 and round part lb of the expandable body against the inner round shape of double ring-shaped fastener 17. Expandable body 1 will in this way be efficiently locked against bar-shaped element 23. When body 1 expands, shoulders 15,16 will be pressed inwards below the lower edge of upper ring fastener 17. They will prevent expandable body 1 from being pressed out from the ring of ring-shaped fastener 17, when the conical screw is driven into expandable body 1. Shoulders 15,16 on the outer side of the cylinder prevent the locking body from being pressed out of ring fastener 17 during the final phase of the driving of screw 22 into expandable body 1.
The wire, cable which preferably is made of a metal (a monofilament or braided) is guided around the rear part of a vertebra. Ring-shaped fastener 17 (double ring) is pressed against bar-shaped element 23. The two wire, cable ends are guided through space 24, which is obtained, when ring-shaped fastener 17 abuts bar-shaped element 23. The two free ends of wire, cable 18 are then guided through holes 9 in the lower part of expandable body 1 and past the loosely inserted conical screw. While holding the two wire, cable ends body 1 is inserted into the ring-shaped fastener. A screw driver is inserted into the key hole of the screw. The wires, cable are stably fastened against a contraction device having a gear. Wires, cables 18 are drawn and stretched by means of the gear, until a stable connection between the rear part of the vertebra and bar-shaped element 23 is obtained. When wires, cables 18 have obtained a sufficiently drawn position, the screw driver is rotated several turns, until conical screw 22 will be stably fastened in expandable body 1. When this has been done, wires, cables 18 are also fixed in expandable body 1. Wires, cables 18 are cut off at the same level as conical screw 22.
According to the inventive idea a stable locking can be obtained in the following manner. When wires, cables 18 have formed a loop, the wire, cable ends are guided through partially cylindrical expandable body 1, which in its center 4 is provided with a conical screw 22. Upper part 4-0 of the cylindrical expandable body is divided into sectors 20 having slits, gaps 2,3 , between them, in the shape of a cross. The two wires, cables 18 are positioned opposite each other in the slits, gaps 2,3, which dimensionally fit the diameter of wires, cables 18. A condition of the functioning of the invention is, that expandable body 1 is surrounded by a ring-shaped surrounding element, in this case designed as a ring 17, jointly with a bar-shaped element 23, but a simpler embodiment, which only includes expandable body 1 and ring-shaped fastener 17 is of course possible. Expandable body 1 with the two wires, cables 18 is inserted into space 24, which is obtained between bar-shaped element 23 and double ring-shaped fastener 17, which abuts element 23 (see Fig. 1). When screw 22 of the device is driven into the expandable body, an expansion of upper part 4-0 of expansion body 1 takes place, expansion body 1 being locked against bar-shaped element 23. At the same time a locking of metal wires, cables 18, which are placed in expandable body 1, takes place.
By means of the present invention a complete stability between wire, cables 18 and supporting bar- shaped element 23 is obtained. Thus, this new device cannot slide along the bar of rotate around it. The rear part of the vertebra and consequently also the vertebra per se will in this way be firmly conncected to the bar-shaped element. Several vertebrae can be fixed against the same bar-shaped element and in this way a stability between the vertebrae is obtained, which stability is a condition of the ability of the vertebrae to grow together.
It must be pointed out, that the present invention can be modified in a plurality of ways within the scope of protection set forth in the attached claims.

Claims

CLAIMS :
l.A device for locking a monofilament wire or braided wire, cables (18), preferably a metal wire, cable, against a bar-shaped element (23), particularly during a mutual positional adjustment and stabilization of vertebrae during spinal surgery operations, c h a r a c t e r i z e d in that said bar-shaped element (23) is positioned in a ring- shaped fastener (17) as well as in that an expandable body (1) is arranged in a space (24) between said bar-shaped element (23) and said ring-shaped fastener (17), which expandable body (1) in addition to a conical screw (22), which is active in the center (4) of the expandable body, also allows space for holes (9), preferably two, arranged in its circumferential part, through which holes the wire, cable (18), subsequent to e.g. an anchoring of it in the rear part of a vertebra, has been guided, said expandable body (1), when the conical screw (22) is being driven into it, at the same time stably fixing the ring- shaped fastener (17) as well as the wire, cable (18) against the bar-shaped element (23).
2.A locking device according to claim 1, ch a r a c t e r i z e d in that the expandable body (1) has a cylindrical part (20), which is provided with longitudinal slits (2,3), which divide the upper half of the cylinder into four flange parts (20), which renders possible an expansion of the upper part (5) of the body, when the conical screw (22), positioned in the center (4) of the cylindrical part (20), is driven into it.
3.A locking device according to claim 1, c ha r a c t e r i z e d in that the expandable body (1) is provided with shoulders (15,16) immediately below a collar (12), which shoulders (15,16) are designed to prevent the expandable body (1) from being displaced out of the ring-shaped fastener (17), when the conical screw is driven completely into the expandable body.
4.A method of fixing metal wires against bar-shaped elements by means of a locking device, according to claim 1, c h a r a c t e r i z e d in that said metal wires, cables (18), which have been guided through said cylinder, are fixed against edges (21) in the ring-shaped fastener (17), and at the same time the expandable body (1) will, through its expansion, be fixed against the bar-shaped element (23) and the ring-shaped fastener (17), which surrounds the bar-shaped element (23) as well the expandable body ( 1 ), through a tightening of the conical screw (22), which is positioned in the center (4) of the expandable body (1).
PCT/SE2001/000194 2000-01-31 2001-01-31 Locking device and method for using this device WO2001054599A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU2001230696A AU2001230696A1 (en) 2000-01-31 2001-01-31 Locking device and method for using this device

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
SE0000327A SE0000327D0 (en) 2000-01-31 2000-01-31 Device for locking metal wire against metal bar and method for locking the same to be used in spinal surgery
SE0000327-7 2000-01-31

Publications (1)

Publication Number Publication Date
WO2001054599A1 true WO2001054599A1 (en) 2001-08-02

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SE (1) SE0000327D0 (en)
WO (1) WO2001054599A1 (en)

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US8721645B2 (en) 2007-10-11 2014-05-13 Zimmer Spine Bone fixing system and method of use
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US8926668B2 (en) 2010-08-25 2015-01-06 Zimmer Spine Anchor for attachment to a bony structure
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US8801759B2 (en) 2002-07-23 2014-08-12 Zimmer Spine S.A.S. Vertebral fixing system
US9848921B2 (en) 2002-07-23 2017-12-26 Zimmer Spine S.A.S. Vertebral fixing system
US8323319B2 (en) 2002-07-23 2012-12-04 Zimmer Spine S.A.S. Vertebral fixing system
US9717536B2 (en) 2005-09-20 2017-08-01 Zimmer Spine S.A.S. Vertebral fixing system
US8430918B2 (en) 2005-09-20 2013-04-30 Zimmer Spine S.A.S. Vertebral fixing system
US9113966B2 (en) 2005-09-20 2015-08-25 Zimmer Spine S.A.S. Vertebral fixing system
US20150045833A1 (en) * 2005-09-20 2015-02-12 Zimmer Spine S.A.S. Vertebral fixing system
US8870870B2 (en) 2005-09-20 2014-10-28 Zimmer Spine S.A.S. Vertebral fixing system
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US10426537B2 (en) 2005-09-21 2019-10-01 Zimmer Spine, S.A.S. Method and instrument for tensioning a flexible tie
US8323318B2 (en) 2005-09-21 2012-12-04 Zimmer Spine S.A.S. Flexible tie fastening system
US8814910B2 (en) 2005-09-21 2014-08-26 Zimmer Spine S.A.S. Method and instrument for tensioning a flexible tie
US8747405B2 (en) 2007-10-11 2014-06-10 Zimmer Spine Bone fixing system and method of use
US8721645B2 (en) 2007-10-11 2014-05-13 Zimmer Spine Bone fixing system and method of use
US9101406B2 (en) 2007-10-11 2015-08-11 Zimmer Spine Bone fixing system and method of use
US9204902B2 (en) 2007-10-23 2015-12-08 Zimmer Spine S.A.S Bone fixation tensioning tool and method
US8870869B2 (en) 2007-10-23 2014-10-28 Zimmer Spine Fixing devices and stabilization systems using said fixing devices
US20150073481A1 (en) * 2007-10-23 2015-03-12 Zimmer Spine Fixing devices and stabilization systems using said fixing devices
US9204903B2 (en) 2007-10-23 2015-12-08 Zimmer Spine S.A.S. Bone fixation tensioning tool and method
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