Multiplanar bone anchor system

The present teachings provide one or more surgical implements for repairing damaged tissue, such as in the case of a spinal fixation procedure. A bone anchor is provided. The anchor can include a bone fastener. The bone fastener can include a head and a second end adapted to engage an anatomy. The bone fastener can extend along a longitudinal axis. The anchor can also include a coupling arrangement coupled to the head of the bone fastener so that the bone fastener is rotatable about the longitudinal axis to define a first plane of motion. The anchor can further include a saddle, which can be coupled to the coupling arrangement. The saddle can be movable relative to at least one of the bone fastener and the coupling arrangement to define a second plane of motion.

INTRODUCTION

In general, the human musculoskeletal system is composed of a variety of tissues including bone, ligaments, cartilage, muscle, and tendons. Tissue damage or deformity stemming from trauma, pathological degeneration, or congenital conditions often necessitates surgical intervention to restore function. Surgical intervention can include any surgical procedure that can restore function to the damaged tissue, which can require the use of one or more orthopedic prosthesis, such as orthopedic nails, screws, implants, etc., to restore function to the damaged tissue.

Generally, in order to stabilize various boney tissue relative to one another, such as vertebrae of the spine, one or more implants can be coupled to each of the vertebrae and interconnected via a suitable device. In one example, implants or anchors can be coupled to each of the vertebrae, and a connecting device, such as a rod, can be coupled to each of the anchors to stabilize or fix the vertebrae relative to each other. In certain instances, it may be desirable to provide an anchor that can move relative to the connecting device. The present teachings can provide an anchor for use in repairing damaged tissue, such as a bone anchor that can be movable in multiple planes for use in a fixation procedure.

SUMMARY

Provided is a multiplanar bone anchor system for a fixation procedure. The system can include a bone fastener. The bone fastener can include a head and a second end adapted to engage an anatomy. The bone fastener can extend along a longitudinal axis. The system can also include a coupling arrangement coupled to the head of the bone fastener so that the bone fastener is rotatable about the longitudinal axis to define a first plane of motion. The system can further include a saddle, which can be coupled to the coupling arrangement. The saddle can be movable relative to at least one of the bone fastener and the coupling arrangement to define a second plane of motion.

Further provided is a multiplanar bone anchor system for a fixation procedure. The system can include a bone fastener. The bone fastener can include a head and a second end adapted to engage an anatomy. The bone fastener can extend along a longitudinal axis. The system can also include a coupling arrangement, which can be coupled to the head of the bone fastener. The system can include a saddle. The saddle can include a first portion and a second portion. The first portion can be movable relative to the second portion along a first axis. The first axis can be transverse to the longitudinal axis of the bone fastener. The second portion can be coupled to the coupling arrangement such that the bone fastener can pivot relative to the saddle about the head of the bone fastener.

Also provided is a multiplanar bone anchor system for a fixation procedure. The system can include a bone fastener. The bone fastener can include a head and a second end adapted to engage an anatomy. The bone fastener can define a longitudinal axis. The system can also include a ring coupled about the head of the bone fastener. The ring can include at least one wing. The system can include a lock ring, which can have a distal end coupled to the head of the bone fastener. The system can further include a saddle. The saddle can include a first portion and a second portion. The first portion of the saddle can be coupled to the second portion of the saddle so as to be movable relative to the second portion. The second portion of the saddle can be coupled about the head of the bone fastener, the ring and at least a portion of the lock ring. The at least one wing of the ring can cooperate with the lock ring and the second portion of the saddle to enable the bone fastener to pivot about the head of the bone fastener. The at least one wing can also cooperate with the second portion to enable the bone fastener to rotate about the longitudinal axis.

According to various aspects, also provided is a bone anchor. The anchor can include a bone fastener having a head including a first bearing surface. The bone fastener can extend along a longitudinal axis. The anchor can include a connecting arm defining a first bore having a second bearing surface that cooperates with the first bearing surface of the bone fastener to enable the bone fastener to move relative to the connecting arm. The connecting arm can include a first preferred angle slot that defines a preferred angle for the bone fastener to articulate relative to the longitudinal axis. The anchor can include a saddle having a first member and a second member that cooperate to define a second bore that extends along the longitudinal axis. The connecting arm can be received within the second bore such that the first member is movable relative to the second member and the connecting arm in a direction transverse to the longitudinal axis.

Further provided is a bone anchor. The anchor can include a bone fastener having a head including a first bearing surface. The anchor can also include a connecting arm having a first portion, a second portion and a first bore having a second bearing surface. The first portion can include at least one friction surface and the second portion can define a first preferred angle slot in communication with the first bore. The head of the bone fastener can be received within the first bore such that the first bearing surface of the head of the bone fastener cooperates with the second bearing surface of the first bore to enable the bone fastener to move relative to the connecting arm. The anchor can include a saddle having a first member and a second member that cooperate to define a second bore that extends along a longitudinal axis. The connecting arm can be received within the second bore such that the first member is movable relative to the second member over the at least one friction surface.

Additionally, provided is a bone anchor. The anchor can include a bone fastener having a head including a hemispherical bearing surface. The anchor can also include a connecting arm including a first portion, a second portion and defining a first bore having a bearing surface that cooperates with the hemispherical bearing surface of the bone fastener to enable the bone fastener to move relative to the connecting arm. The first portion can have opposed curved features that each including a straight portion. The second portion can include a first preferred angle slot. The anchor can include a saddle having a first member and a second member that cooperate to define a second bore that extends along the longitudinal axis. The first member can be coupled to the first portion of the connecting arm such that the first member moves relative to the connecting arm along the straight portions. The second member can be coupled to the second portion of the connecting arm and can define a second preferred angle slot that cooperates with the first preferred angle slot to define a preferred angle for the bone fastener to articulate relative to the longitudinal axis.

DESCRIPTION OF VARIOUS ASPECTS

The following description is merely exemplary in nature and is not intended to limit the present teachings, application, or uses. It should be understood that throughout the drawings, corresponding reference numerals indicate like or corresponding parts and features. Although the following description is related generally to a system for use in an anatomy to repair damaged tissue, such as in the case of spinal fusion, static spinal stabilization or dynamic spinal stabilization, it will be understood that the system as described and claimed herein can be used in any appropriate surgical procedure, such as in a minimally invasive orthopedic alignment or fixation procedure. Therefore, it will be understood that the following discussions are not intended to limit the scope of the present teachings and claims herein.

As will be discussed in greater detail herein, the multiplanar coupling system16can enable the saddle18to move relative to the bone fastener12in multiple planes. Generally, the saddle18can be configured to receive a connecting device or rod20, which can be used to interconnect multiple bone anchor systems10in an exemplary spinal fixation procedure (FIG. 1). By using the multiplanar coupling system16, the saddle18can be moved relative to the bone fastener12in one or more planes to facilitate the connection of the connecting rod20to multiple bone anchor systems10. In this regard, the vertebral bodies V of the patient may be orientated in such a manner that each bone fastener12, when coupled to a respective vertebral body V, may be slightly offset from one another. By allowing the saddle18to move in multiple planes relative to the bone fastener12, the surgeon can move the saddles18into alignment without regard to the placement of the bone fasteners12. It should be noted, however, that although the multiplanar bone anchor system10is generally illustrated and described herein a single assembly for use with a single connecting rod20, any combination of bone anchor systems10and connecting rods20can be employed during a surgical procedure.

For example, in a single level spinal fixation procedure, two bone anchor systems10can receive a single connecting rod20. A multiple level spinal fixation procedure, however, will generally require additional bone anchor systems10. In addition, the multiplanar bone anchor systems10need not be coupled to adjacent vertebral bodies V, but rather, the multiplanar bone anchor systems10can be positioned so as to skip adjacent vertebral bodies V, if desired.

With reference toFIGS. 2-4, the bone fastener12can be configured to engage the anatomy to couple the multiplanar bone anchor system10to the anatomy. The bone fastener12can be composed of any suitable biocompatible material, such as titanium, stainless steel, biocompatible polymers, etc. The bone fastener12can include a proximal end or head30(FIGS. 3 and 4) and a distal end or shank32(FIG. 2). With reference toFIGS. 3 and 4, the head30can be generally arcuate, and can include a driver connection feature34and a channel36. The driver connection feature34can comprise any mating connection interface for a driver, such as a pentalobe, hexalobe, hexagon, torx, Philips, cruciate, straight, etc. Thus, the driver connection feature34can enable the application of a torque to drive the bone fastener12into the anatomy.

Briefly, it should be noted that particular tools for use with the multiplanar bone anchor system10are beyond the scope of the present teachings and need not be described herein. In a conventional manner insofar as the present teachings are concerned, various tools can be used to connect the multiplanar bone anchor system10to a respective vertebral body V. Exemplary tools can include those employed in the Polaris™ 5.5 Spinal System, commercially available from Biomet, Inc. of Warsaw, Ind., or the tools disclosed in commonly owned U.S. Patent Publication No. 2008/0077138, filed on Apr. 20, 2007 and incorporated by reference herein.

With continued reference toFIGS. 3 and 4, the channel36can be defined about a circumference of the head30. The channel36can receive a portion of the multiplanar coupling system16to enable the saddle18to rotate about the longitudinal axis L of the bone fastener12. Thus, the channel36can define a first bearing surface36a. It should be noted that although the bone fastener12is illustrated and described herein as including the channel36, the channel36need not be necessary to enable the saddle18to rotate about the longitudinal axis L of the bone fastener12.

With reference toFIG. 2, the shank32of the bone fastener12can include a plurality of threads32aand at least one cutting flute32b. The at least one cutting flute32bcan cooperate with the threads32ato cut into the anatomy, and thus, the bone fastener12does not require a pre-tapped hole. It should be noted that although the bone fastener12is illustrated and described herein as including at least one cutting flute32b, the bone fastener12need not include any cutting flutes (requiring a pre-tapped hole), or could include multiple cutting flutes, if desired.

With reference toFIGS. 3 and 4, the lock ring14can be positioned about the head30of the bone fastener12. As will be discussed herein, the lock ring14can lock at least one of the bone fastener12and the multiplanar coupling system16relative to the saddle18via a force applied by the connecting rod20. The lock ring14can be generally cylindrical, and can have a height H. The height H can be sized to extend above a receiver surface88of the saddle18so that coupling the connecting rod20to the saddle18can compress the lock ring14onto the head30of the bone fastener12. With reference toFIG. 4, the lock ring14can include a proximal end40, a distal end42, a bearing surface44, a slot46and a bore48.

The proximal end40can include an annular projection40a. With reference toFIG. 3, the projection40acan have a diameter Dp, which is larger than a diameter DI of the lock ring14. The larger diameter Dp of the projection40acan be sized to enable the lock ring14to move or rotate about the head30of the bone fastener12. With reference toFIGS. 3-5, the distal end42can include a ring or flange42aand at least one cutout43. The flange42acan be formed about an exterior surface of the lock ring14, and can retain the lock ring14within the saddle18, as will be discussed in detail herein. The at least one cutout43can be formed along a portion of a circumference of the lock ring14, and can be sized to cooperate with the multiplanar coupling system16.

In one example, the lock ring14can include two cutouts43, which can be positioned on opposite sides of the lock ring14(FIG. 4). In this example, as best illustrated inFIG. 5, the cutouts43can include a first curved recess43a, a second curved recess43band a third curved recess43cwhich can be congruent. The cutouts43can be generally symmetrical about a longitudinal axis of the lock ring14. The first curved recess43aand the third curved recess43ccan be formed from the distal end42to the flange42a. The second curved recess43bcan be formed from the distal end42to a location adjacent to the flange42a. In addition, the second curved recess43bcan have a radius which can be greater than a radius associated with each of the first curved recess43aand the third curved recess43c.

With reference toFIGS. 3 and 4, the bearing surface44can be formed on an interior surface of the lock ring14. In one example, the bearing surface44can be formed along an interior surface of the projection40aat the distal end42of the lock ring14. The bearing surface44can comprise a generally concave region, which can extend from the circumference of the projection40a. The bearing surface44can contact a portion of the head30to enable the lock ring14to move or articulate relative to the bone fastener12. The bearing surface44can also enable the lock ring14to move or articulate relative to the multiplanar coupling system16, as will be discussed herein.

With reference toFIG. 4, the lock ring14can also include a slot46. The slot46can extend through the projection40a, the proximal side40and the distal end42. The slot46can enable the lock ring14to be coupled about the head30of the bone fastener12. Note, that the slot46is optional, and the lock ring14could be continuous about the circumference of the lock ring14.

With reference toFIG. 3, the bore48can be disposed about a central axis of the lock ring14. The bore48can extend through the projection40a, the proximal end40and the distal end42. A first diameter D1of the bore48at the projection40acan be substantially smaller than a second diameter D2of the bore48at the distal end42of the lock ring14. The bearing surface44can be formed about the bore48, and can transition the bore48from the first diameter D1to the second diameter D2. The bore48can enable a driver to interface with the driver connection feature34formed on the head30of the bone fastener12.

In one example, the multiplanar coupling system16can include a ring50. The ring50can be disposed about a head30of the bone fastener12to enable the bone fastener12to move or articulate relative to the saddle18, as shown inFIG. 3. The ring50can be annular, and can be sized to fit within the saddle18to enable the bone fastener12to articulate relative to the saddle18, as shown inFIGS. 6 and 7. With reference toFIG. 4, the ring50can include a bore52and at least one wing54. The bore52can be sized to enable the ring50to be coupled to the channel36of the bone fastener12, but can also be sized so as to prevent the ring50from migrating above the head30of the bone fastener12, as best shown inFIG. 3.

With reference toFIGS. 4 and 5, at least one wing54can extend outwardly from a circumference of the ring50. In this example, the ring50can include two wings54. The wings54can extend outwardly from opposite sides of the ring50. The wings54can cooperate with the saddle18to enable the bone fastener12to move or articulate relative to the saddle18(FIG. 7). The wings54can include a first arcuate surface54a, a second arcuate surface54b, a third arcuate surface54c, a fourth arcuate surface54d, a fifth arcuate surface54eand a sixth arcuate surface54f. It should be noted that the shape of the wings54described and illustrated herein is merely exemplary, as the wings54could have any shape that enables the bone fastener12to rotate relative to the saddle18, such as elliptical, circular, rounded square, rounded rectangular, etc.

The first arcuate surface54acan be opposite the fourth arcuate surface54d, the second arcuate surface54bcan be opposite the fifth arcuate surface54eand the third arcuate surface54ccan be opposite the sixth arcuate surface54f. Generally, the second arcuate surface54band the fifth arcuate surface54ecan be positioned between the first arcuate surface54a, fourth arcuate surface54d, third arcuate surface54cand sixth arcuate surface54f. The first arcuate surface54a, second arcuate surface54band the third arcuate surface54ccan each contact one of the first curved recess43a, the second curved recess43b, third curved recess43c, respectively, which can enable the lock ring14to move or articulate relative to the ring50, as best shown inFIG. 5. The fourth arcuate surface54d, fifth arcuate surface54eand sixth arcuate surface54fcan cooperate with the saddle18to enable the bone fastener12to move or articulate relative to the saddle18, as shown inFIGS. 6 and 7.

With reference to FIGS.4and6-8, the saddle18can include a first portion or bottom portion60and a second portion or top portion62. The top portion62can move or translate relative to the bottom portion60(FIG. 8). With reference to FIGS.4and6-8, the bottom portion60can include a first or proximal end64, a second or distal end66, a bore68and a bearing surface70. The proximal end64can be generally rectangular, and can include rounded corners. The proximal end64can be coupled to the top portion62(FIG. 8). The proximal end64can define at least one rail64a. Generally, the top portion62can move or translate along the at least one rail64a(FIG. 8). In one example, the proximal end64can define two rails64a, which can be positioned on opposite sides of the bottom portion60. As will be discussed, the diameter Dp of the lock ring14can define or limit the translation of the top portion62relative to the bottom portion60. The proximal end64can taper to the distal end66.

The distal end66can be adjacent to the shank32of the bone fastener12, when the saddle18is coupled to the bone fastener12. As best shown inFIG. 3, the distal end66can define a lip or stop66aon an interior surface. In this example, the stop66acan extend into the bore68of the bottom portion60. The stop66acan extend about a circumference of the bore68, and can limit the motion or articulation of the bone fastener12relative to the saddle18.

The bore68can be defined through the bottom portion60. The bore68can be sized to receive the ring50, the lock ring14and the bone fastener12therein. With reference toFIG. 3, the bore68can include bearing surface68aand a sidewall68b. The bearing surface68acan be configured to receive the flange42aof the lock ring14, to couple the lock ring14to the saddle18. In other words, the flange42aof the lock ring14can cooperate with the bearing surface68aof the bottom portion60to prevent the lock ring14from migrating out of the saddle18. The sidewall68bof the bore68can comprise a portion of the bearing surface70.

The bearing surface70can be defined about a circumference of the bore68. In one example, the bearing surface70can be formed on a portion70aof the stop66a, and a portion70bof the sidewall68bof the bore68. The bearing surface70can generally be shaped so as to cooperate with the ring50to enable the ring50to move or articulate within the bottom portion60of the saddle18, as best shown inFIG. 7. The relative movement between the ring50and the bottom portion60can allow the bone fastener12to pivot or angulate about a central axis or longitudinal axis of the bone fastener12.

With reference toFIGS. 3,4and8, the top portion62of the saddle18can be coupled to the rails64aof the proximal end64of the bottom portion60so that the top portion62can move relative to the bottom portion60. The top portion62can be substantially U-shaped and symmetrical with respect to a longitudinal axis L2defined by the multiplanar bone anchor system10(FIG. 8). The top portion62can include a first or proximal end76and a second or distal end78. In one example, the proximal end76can include a first arm80and a second arm82. The first arm80and second arm82can extend upwardly from the distal end78to define the U-shape. Each of the first arm80and the second arm82can include a mating portion84and a cavity86.

The mating portion84can be configured to receive a fastening mechanism to couple the connecting rod20to the saddle18. For example, the mating portion84can comprise a plurality of threads, which can be formed on an interior surface80b,82bof each of the first arm80and second arm82. In this example, the mating portion84can engage threads formed on a set screw22to couple the connecting rod20to the saddle18(FIG. 3). It should be noted, however, that the proximal end76can have any suitable configuration to couple the connecting rod20to the saddle18, such as keyed portions, teeth, etc.

The cavity86can be defined in each interior surface80b,82bof the first arm80and second arm82. The cavity86can provide clearance for the movement or articulation of the top portion62relative to the bottom portion60of the saddle18. In this regard, the cavity86can be defined so as to allow the top portion62to move over a portion of the lock ring14, which can provide a range of motion for the top portion62relative to the bottom portion60. Thus, contact between the lock ring14and the cavity86can act as a stop to limit the movement or translation of the top portion62relative to the bottom portion60, however, other techniques could be used to stop or limit the movement or translation of the top portion62relative to the bottom portion60.

With reference toFIG. 4, the distal end78of the top portion62can be generally rectangular, and can include a first or a receiver surface88, a second or bottom surface90and a central bore92. The receiver surface88can receive a portion of the connecting rod20. In one example, the receiver surface88can comprise a generally arcuate, concave surface that forms the U-shape of the saddle18, however, the receiver surface88can comprise any desired shape, such as square, etc.

The bottom surface90can include at least one or more guides90a. In this example, the bottom surface90can include two guides90a. The guides90acan slidably couple the top portion62to the bottom portion60. In this regard, each guide90acan cooperate with a respective one of the rails64ato enable the top portion62of the saddle18to move or translate relative to the bottom portion60of the saddle18(FIG. 8). Generally, each guide90acan comprise a C-shape, and each rail64acan be received within the guide90a. It should be understood, however, that any suitable shape could be used to enable the top portion62to move or translate relative to the bottom portion60.

The central bore92can be defined through the distal end78from the receiver surface88to the bottom surface90. Generally, the central bore92can be sized to receive the bone fastener12, and can cooperate with the multiplanar coupling system16to allow the bone fastener12to move in the desired planes.

With reference toFIGS. 2 and 3, the connecting rod20can be received within the receiver surface88of the saddle18. The connecting rod20can be coupled to the saddle18via a suitable mechanical fastener, such as the set screw22. An exemplary connecting rod20and set screw22can be substantially similar to the connecting rod and set screw employed in the Polaris™ 5.5 Spinal System, commercially available from Biomet, Inc. of Warsaw, Ind., or the connecting element disclosed in commonly owned U.S. Patent Publication No. 2008/0077138, filed on Apr. 20, 2007 and previously incorporated by reference herein. As the connecting rod20and the set screw22can be generally known, the connecting rod20and set screw22will not be discussed in great detail herein.

Briefly, however, the connecting rod20can comprise an elongated solid cylinder. The connecting rod20can also include a slight curvature, which can correspond to the natural curvature of the spine. Typically, the connecting rod20can be composed of a suitable biocompatible material having sufficient rigidity to fix the vertebral bodies V relative to each other. The set screw22can include threads, which can matingly engage the threads formed on the mating portion84of the proximal end76of the saddle18.

With reference toFIGS. 4-8, in order to assemble the multiplanar bone anchor system10, the ring50can be positioned about the channel36of the bone fastener12(FIG. 5). Then, the bottom portion60of the saddle18can be positioned about the ring50(FIGS. 6 and 7). The lock ring14can be coupled to the top portion62. Next, the top portion62of the saddle18can be coupled to the bottom portion60of the saddle18(FIG. 8) Then, the lock ring14can be coupled to the head30of the bone fastener12.

Once assembled, the ring50can cooperate with the bottom portion60to enable movement or rotation of the bone fastener12about the central or longitudinal axis of the bone fastener12(FIGS. 6 and 7). The lock ring14can cooperate with the head30of the bone fastener12to enable the bone fastener12to move or articulate relative to the saddle18, about the head30of the bone fastener12(FIG. 5). The top portion62of the saddle18can cooperate with the bottom portion60to enable the top portion62of the saddle18to move or translate relative to the bottom portion60of the saddle18(FIG. 8). Thus, when assembled, the multiplanar bone anchor system10can have at least three degrees of movement or can be movable in at least three planes. By allowing the multiplanar bone anchor system10to move in at least three planes, the surgeon can manipulate the multiplanar bone anchor system10as necessary to conform to the anatomy of the patient.

With the bone fastener12coupled to the saddle18via the multiplanar coupling system16, surgical access can be made through the skin S adjacent to the vertebral bodies V of interest (FIG. 1). The specific surgical access approaches are beyond the scope of the present application, but for example, surgical access can be obtained via a minimally invasive surgical procedure such as that used with the Polaris™ 5.5 Spinal System, commercially available from Biomet, Inc. of Warsaw, Ind., or the minimally invasive surgical procedure disclosed in commonly owned U.S. Patent Publication No. 2008/0077138, filed on Apr. 20, 2007 and previously incorporated by reference herein.

Next, one or more multiplanar bone anchor systems10can be coupled to a respective vertebral body V via the bone fastener12(FIG. 1). Various techniques can be used to couple the multiplanar bone anchor systems10to the anatomy, such as those described in commonly owned U.S. Patent Publication No. 2008/0077138, filed on Apr. 20, 2007, previously incorporated by reference herein. In one example, if each bone fastener12includes the driver connection feature34defined in the head30, a suitable tool can be coupled to the driver connection feature34to drive the bone fastener12into the anatomy in a conventional manner. Once the multiplanar bone anchor systems10are coupled to the anatomy, the connecting rod20can be inserted into the saddle18of each of the multiplanar bone anchor systems10. Generally, the connecting rod20can be inserted such that the connecting rod20rests on the receiver surface88of the distal end78of the saddle18(FIG. 2).

With the connecting rod20positioned in the saddles18of the multiplanar bone anchor systems10, the set screw22can be coupled to each mating portion84of each saddle18(FIG. 3). The coupling of the set screw22can apply a force to the lock ring14to fixedly couple or lock the position of the bone fastener12relative to the saddle18. In this regard, the lock ring14can apply a force to the head30of the bone fastener12, which in turn, can provide a force on the ring50. Additionally, the lock ring14can apply a force directly to the ring50. The force on the ring50, can in turn be applied to the bottom portion60of the saddle18to thereby fix the position of the bone fastener12relative to the saddle18.

With reference now toFIGS. 9-11, in one example, a multiplanar bone anchor system100can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system100can be similar to the multiplanar bone anchor system10described with reference toFIGS. 1-8, only the differences between the multiplanar bone anchor system10and the multiplanar bone anchor system100will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system100can include a bone fastener102, a multiplanar coupling arrangement or system104and a saddle106. It should be noted, that although the multiplanar bone anchor system100is described and illustrated herein as not including a lock ring14, a suitable lock ring14could be employed with the multiplanar bone anchor system100, if desired.

With continued reference toFIGS. 9-11, the bone fastener102can be configured to engage the anatomy to couple the multiplanar bone anchor system100to the anatomy. The bone fastener102can be composed of any suitable biocompatible material, such as titanium, stainless steel, biocompatible polymers, etc. The bone fastener102can include a head108and the shank32. The head108can be generally arcuate, and can include the driver connection feature34and a channel108a.

The channel108acan be defined about a circumference of the head108, generally between the head108and the shank32. The channel108acan receive a portion of the multiplanar coupling system104to enable the saddle106to rotate about the longitudinal axis L of the bone fastener102(FIG. 10). Thus, the channel108acan define a first bearing surface. It should be noted that although the bone fastener102is illustrated and described herein as including the channel108a, the channel108aneed not be necessary to enable the saddle106to rotate about the longitudinal axis L of the bone fastener102.

In one example, with continued reference toFIGS. 9-11, the multiplanar coupling system104can include a connecting arm110and a bearing member or ring112. The connecting arm110and the ring112can cooperate with the bone fastener102to enable the bone fastener102to move relative to the saddle106. The connecting arm110can be disposed about a head108of the bone fastener102to enable the bone fastener102to move or articulate relative to the saddle106as shown inFIG. 11. In this example, the connecting arm110can be annular, and can be coupled to the saddle106. The connecting arm110can include a bore114. The bore114can be formed about a central axis C of the connecting arm110. As best shown inFIG. 11, the bore114can include a mating portion114a, a recess114b, a coupling portion114cand a tapered portion114d.

The mating portion114acan couple the connecting arm110to the saddle106. It should be noted that the mating portion114acan be configured so that the saddle106can move or translate relative to the connecting arm110. For example, the mating portion114acan comprise opposing guides or slots formed through a portion of the connecting arm110that can slidably receive a portion of the saddle106. It should be noted, however, any suitable method or configuration can be used to slidably couple the saddle106to the connecting arm110, such as a dovetail, rails, etc.

The recess114bcan be defined between the mating portion114aand the at least one coupling portion114c. Generally, the recess114bcan be arcuate, and in one example, can be hemispherical. The recess114bcan provide at least clearance for the rotation of the head108of the bone fastener102within and relative to the connecting arm110. In this regard, the recess114bcan be sized to enable at least rotation about the longitudinal axis L of the bone fastener102, and can also be sized to enable rotation of the connecting arm110relative to the head108of the bone fastener102, if desired.

The coupling portion114ccan be defined between the recess114band the tapered portion114d. In one example, the coupling portion114ccan comprise a channel defined about the circumference of the connecting arm110. Generally, the coupling portion114ccan be configured to receive the ring112, which can movably or rotatably couple the bone fastener102to the connecting arm110, as will be discussed herein.

The tapered portion114dcan be defined at a distal most end of the bore114. The tapered portion114dcan provide clearance for the angular movement of the bone fastener102relative to the saddle106. In this regard, the tapered portion114dcan be formed about a circumference of the bore114, and the shank32of the bone fastener102can contact the tapered portion114dto limit the angular motion of the bone fastener relative to the connecting arm110. Thus, the tapered portion114dcan provide a stop or limit for the angular movement of the bone fastener102relative to the saddle106.

With reference toFIGS. 10 and 11, the ring112can be coupled to the channel108aof the head108of the bone fastener102, and can cooperate with the bore114to enable the bone fastener102to move or rotate relative to the connecting arm110. In one example, the ring112can comprise a generally C-shape body, and can have a slot112a. The ring112can be at least partially received within the channel108aof the head108. Generally, the ring112can be snap-fit into the channel108aof the bone fastener102. In one example, the ring112can have an inner diameter which can be greater than an outer diameter of the channel108aof the head108to prevent separation of the ring112from about the head108of the bone fastener102. It should be noted, however, that the ring112could have a continuous annular body, such as an O-shape, and in this case, the ring112could be threaded over the shank32into the channel36.

With reference toFIG. 10, the ring112can include at least one wing116. The at least one wing116can extend outward from the body of the ring112to engage the coupling portion114cof the bore114. In this example, the ring112can include two wings116, which can each be received within and slidably coupled to the coupling portion114cof the bore114of the connecting arm110. The wings116can comprise bearing surfaces, which can cooperate with the coupling portion114cto enable the rotation of the bone fastener102about the connecting arm110. Thus, the wings116can have any shape, which can enable the wings116to move or slide within the coupling portion114cof the bore114, such as elliptical, spherical, rounded, annular, rounded square, rounded rectangular, etc. The wings116can also include at least one tapered surface116a, which can enable the connecting arm110to move or pivot relative to the bone fastener102. In this example, the wings116can include two opposed tapered surfaces116a, which can cooperate with the coupling portion114cto enable the connecting arm110to move or pivot about the head108of the bone fastener102.

With reference toFIGS. 9-11, the saddle106can be coupled to the multiplanar coupling system104via the connecting arm110. Generally, the saddle106can be coupled to the connecting arm110so that the saddle106can move or translate relative to the multiplanar coupling system104and the bone fastener102. The saddle106can be substantially U-shaped and symmetrical with respect to a longitudinal axis L defined by the multiplanar bone anchor system100. In one example, the saddle106can include a first or proximal end120and a second or distal end122. In one example, the proximal end120can include a first arm124and a second arm126. The first arm124and second arm126can extend upwardly from the distal end122to define the U-shape. Each of the first arm124and the second arm126can include the mating portion84.

With reference toFIGS. 10 and 11, the distal end122can be generally rectangular, and can include the receiver surface88(FIG. 10), at least one rail122a(FIG. 11) and the central bore92(FIG. 11). In one example, the distal end122can include two rails122a. Generally, the rails122acan be formed on opposite sides of the bore92, and can extend outwardly from the bore92. The rails122acan slidably couple the saddle106to the connecting arm110. In this regard, each rail122acan cooperate with a respective one of the guides or slots of the mating portion114ato enable the saddle106to move or translate relative to the connecting arm110and bone fastener102. It should be understood, however, that any suitable mechanism could be used to enable the saddle106to move or translate relative to the connecting arm110, such as a dovetail assembly, etc. Further, the distal end122could include only one rail122a, if desired. It should also be understood that the saddle106could include the mating portion114aand the rails122acould be formed on the connecting arm110to enable the relative motion between the saddle106and the connecting arm110, if desired.

With reference toFIGS. 10 and 11, in order to assemble the multiplanar bone anchor system100, the ring112can be coupled to the channel108aof the bone fastener102. Then, the connecting arm110can be coupled to the ring112such that the wings116of the ring112are received within the coupling portion114cof the connecting arm110. The saddle106can be positioned so that the rails122aare slidably coupled to the mating portion114aof the connecting arm110.

Once assembled, the connecting arm110can cooperate with the ring112to enable movement or rotation of the bone fastener102about the central or longitudinal axis of the bone fastener102, which provides a first plane of motion. In addition, the tapered surfaces116aof the wings116can cooperate with the coupling portion114cof the connecting arm110to enable the connecting arm110to move or pivot relative to the bone fastener102, about the head108of the bone fastener102, thereby providing a second plane of motion. The saddle106can also cooperate with the connecting arm110to enable the saddle106to move or translate relative to the connecting arm110, which can provide a third plane of motion. Thus, when assembled, the multiplanar bone anchor system100can have at least three planes or degrees of motion. By allowing the multiplanar bone anchor system100to move in at least three planes, the surgeon can manipulate the multiplanar bone anchor system100as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system100in a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system10in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system100will not be discussed in great detail herein. Briefly, however, once the multiplanar bone anchor system100is secured to the anatomy, the multiplanar coupling system104and the saddle106can be moved, pivoted or rotated relative to the bone fastener102into the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be coupled to a desired number of multiplanar bone anchor systems100.

With reference now toFIGS. 12-14, in one example, a multiplanar bone anchor system200can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system200can be similar to the multiplanar bone anchor system100described with reference toFIGS. 9-11, only the differences between the multiplanar bone anchor system100and the multiplanar bone anchor system200will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system200can include the bone fastener102, a multiplanar coupling arrangement or system204and a saddle206.

With reference toFIGS. 12-14, the multiplanar coupling system204can include a connecting arm210, at least one plug215and a retaining ring216. The connecting arm210can cooperate with the bone fastener102to enable the bone fastener102to move relative to the saddle206. The connecting arm210can be disposed about a head108of the bone fastener102to enable the bone fastener102to move or articulate relative to the saddle206. In this example, the connecting arm210can be annular, and can be coupled to the saddle206. The connecting arm210can include at least one coupling feature213and a bore214. The at least one coupling feature213can comprise two coupling features213. In this example, the coupling features213can comprise bores, which can be defined through opposite sides of the connecting arm210to the bore214. The bore214can be formed about a central axis C of the connecting arm210. As best shown inFIG. 14, the bore214can include a mating portion214a, the coupling portion114cand the tapered portion114d.

The mating portion214acan cooperate with the retaining ring216to couple the connecting arm210to the saddle206. Generally, the mating portion214acan be configured so that the saddle206can move relative to the connecting arm about via the retaining ring216. In this example, the mating portion214acan comprise opposing guides or slots formed through a portion of the connecting arm210, which can slidably receive a portion of the retaining ring216. It should be noted, however, any suitable method or configuration can be used to movably couple the saddle206to the connecting arm210, such as a dovetail, rails, etc.

With reference toFIG. 13, in one example, the at least one plug215acan comprise two plugs215a. The plugs215acan engage the coupling portion114cof the bore214. In this example, each of the plugs215acan be received within and slidably coupled to the coupling portion114cof the bore214of the connecting arm210. The plugs215acan comprise bearing surfaces, which can cooperate with the coupling portion114cto enable the rotation of the bone fastener102about the connecting arm210. Thus, the plugs215acan have any shape, which can enable the plugs215ato move or slide within the coupling portion114cof the bore114, such as elliptical, spherical, rounded, annular, rounded square, rounded rectangular, etc. In one example, the plugs215acan each include a cut out (or similar features)215b, which can enable the plugs215ato be snap-fit or press-fit into the connecting arm210. It should be understood, however, that the plugs215acould be integrally formed with the connecting arm210, if desired. The plugs215acan cooperate with the coupling portion114cto enable the connecting arm210to move or pivot about the head108of the bone fastener102.

As best shown inFIG. 14, the retaining ring216can couple the saddle206to the connecting arm210. In this regard, the retaining ring216can include a first or proximal end218and a second or distal end220. The proximal end218can be coupled to a portion of the saddle206, as will be discussed, and the distal end220can be coupled to the mating portion214aof the connecting arm210. The retaining ring216can comprise any suitable structure, such as an annular ring, which may or may not include a continuous, uninterrupted circumference. In this example, the retaining ring216can comprise a C-shaped ring, however, it should be understood that the retaining ring216could also comprise a non-annular structure, such as a rectangular structure, square structure, etc.

The proximal end218of the retaining ring216can include a projection218a, which can couple the proximal end218to the saddle206. The distal end220can also include a projection220a, which can couple the distal end220to the mating portion214a. The projection220aof the distal end220can also include a recess220b, as best shown inFIG. 14. The recess220bcan allow the head108of the bone fastener102to rotate about the connecting arm210without contacting the retaining ring216.

The saddle206can be coupled to the connecting arm210via the retaining ring216. Generally, the saddle206can be coupled to the connecting arm210so that the saddle206can move or rotate relative to the multiplanar coupling system204and the bone fastener102. The saddle206can be substantially U-shaped and symmetrical with respect to a longitudinal axis L defined by the multiplanar bone anchor system200(FIG. 14). In one example, the saddle206can include the first or proximal end120and a second or distal end224.

With reference toFIG. 14, the distal end224can be generally annular, and can include the receiver surface88, at least one channel224aand the central bore92. In this example, the distal end224can include two channels224a. Generally, the channels224acan be formed on opposite sides of the bore92. The channels224acan couple the saddle206to the connecting arm210. In this regard, the channels224acan receive the projection220aof the distal end220of the retaining ring216to couple the saddle206to the connecting arm210and bone fastener102.

With reference toFIGS. 13 and 14, in order to assemble the multiplanar bone anchor system200, the retaining ring216can be coupled to the channels224aof the saddle206. With the retaining ring216coupled to the saddle206, the distal end220of the retaining ring216can be pushed into the connecting arm210, such that the projection220aof the retaining ring216fits within the mating portion214aof the connecting arm210. Then, the connecting arm210can be positioned over the bone fastener102, and the plugs215acan be coupled to the connecting arm210so that the plugs215aare received through the coupling features213of the connecting arm210.

Once assembled, the connecting arm210can cooperate with the plugs215ato enable movement or rotation of the bone fastener102about the central or longitudinal axis of the bone fastener102, which provides a first plane of motion. In addition, the plugs215acan cooperate with the coupling portion114cof the connecting arm210to enable the connecting arm210to move or pivot relative to the bone fastener102, about the head108of the bone fastener102, thereby providing a second plane of motion. The saddle206can also cooperate with the connecting arm210via the retaining ring216to enable the saddle206to move or rotate relative to the connecting arm210, which can provide a third plane of motion. Thus, when assembled, the multiplanar bone anchor system200can have at least three planes or degrees of motion. By allowing the multiplanar bone anchor system200to move in at least three planes, the surgeon can manipulate the multiplanar bone anchor system200as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system200in a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system100in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system200will not be discussed in great detail herein. Briefly, however, once the multiplanar bone anchor system200is secured to the anatomy, the multiplanar coupling system204and the saddle206can be moved, pivoted or rotated relative to the bone fastener102into the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be coupled to a desired number of multiplanar bone anchor systems200.

With reference now toFIGS. 15-17, in one example, a multiplanar bone anchor system300can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system300can be similar to the multiplanar bone anchor system10described with reference toFIGS. 1-9, only the differences between the multiplanar bone anchor system300and the multiplanar bone anchor system10will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system300can include a bone fastener302, a lock ring304, a multiplanar coupling arrangement or system306and a saddle307.

With reference toFIGS. 15 and 16, the bone fastener302can be configured to engage the anatomy to couple the multiplanar bone anchor system300to the anatomy. The bone fastener302can be composed of any suitable biocompatible material, such as titanium, stainless steel, biocompatible polymers, etc. The bone fastener302can include a proximal end or head308and the distal end or shank32. The head308can include a generally arcuate or hemispherical portion308acoupled to the shank32via a shaft308b. The hemispherical portion308acan include the driver connection feature34. The hemispherical portion308acan be coupled to the lock ring304when the multiplanar bone anchor system300is assembled. The shaft308bcan be generally cylindrical, and can extend distally from the hemispherical portion308a. The shaft308bcan receive a portion of the multiplanar coupling system306to couple the multiplanar coupling system306to the bone fastener302.

The lock ring304can be positioned about the head308of the bone fastener302, as best shown inFIG. 17. The lock ring304can couple or lock the bone fastener302relative to the multiplanar coupling system306via a force applied by the connecting rod20, as will be discussed herein. The lock ring304can be generally cylindrical, and can have a height H3. The height H3can be sized to extend above or about equal to a receiver surface88of the saddle307so that coupling the connecting rod20to the saddle307can compress the lock ring304onto the head308of the bone fastener302. In this example, as shown inFIG. 16, the lock ring304can include a cut out304a, which can facilitate positioning the lock ring304about the head308of the bone fastener302. It should be understood, however, that the cut out304acan be optional, as the lock ring304can have a continuous, uninterrupted cylindrical body. In addition, the lock ring304can include a proximal end310, a distal end312, a flange314and a bore316.

The proximal end310can extend above the receiver surface88of the saddle307when the multiplanar bone anchor system300is assembled. The proximal end310can contact at least a portion of the connecting rod20when the connecting rod20is coupled to the multiplanar bone anchor system300. The distal end312can be coupled to the hemispherical portion308aof the head308of the bone fastener302when the lock ring304is coupled to bone fastener302. The distal end312can include at least one cut-out or recess312a. In one example, the distal end312can include two recesses312a,312b. The recesses312aand312bcan provide clearance for a portion of the multiplanar coupling system306. Optionally, the recesses312aand312bcan enable the bone fastener302to move or pivot about the head308of the bone fastener302, as discussed with regard toFIGS. 1-9.

The flange314can be formed between the proximal end310and the distal end312, and can extend outwardly about an exterior circumference of the lock ring304. The flange314can cooperate with a portion of the multiplanar coupling system306to couple or retain the lock ring304within the multiplanar coupling system306.

The bore316can be disposed about a central axis of the lock ring304. The bore316can extend from the proximal end310to the distal end312. The bore316can include a first countersink316aformed near or at the proximal end310and a second countersink316bformed near or at the distal end312. The first countersink316acan be configured to at least partially receive a portion of the connecting rod20when the connecting rod20is coupled to the multiplanar bone anchor system300. The second countersink316bcan comprise a bearing surface, which can be slidably coupled to the head308of the bone fastener302. Generally, the second countersink316bcan enable the head308to move, rotate and/or pivot relative to the lock ring304.

The multiplanar coupling system306can include a connecting arm320and a ring322. The connecting arm320can cooperate with the bone fastener302to enable the bone fastener302to move relative to the saddle307. It should be noted that although the multiplanar coupling system306is described and illustrated herein as including the connecting arm320and the ring322, the multiplanar coupling system306could include only a ring or only a connecting arm, if desired. In this example, the connecting arm320can have a first shell half324and a second shell half326, which can cooperate to form a substantially continuous annular or cylindrical body having a bore320awhen assembled together (FIG. 17). Each of the first shell half324and the second shell half326can include a flange328, a channel330, at least one mating feature332, a stop334, a ring retaining portion336and a lock ring retaining portion338. Generally, each of the flange328and the channel330can be formed on an exterior surface of each of the first shell half324and the second shell half326, while the stop334, the ring coupling portion336and the lock ring retaining portion338can be formed on an interior surface of the first shell half324and the second shell half326.

With reference toFIG. 16, the flange328can be defined at a proximal end324a,326aof the first shell half324and the second shell half326. The flange328can have a smaller diameter than the body of the first shell half324and the second shell half326. The flange328can cooperate with the channel330to couple a portion of the saddle307to the connecting arm320. The channel330can be defined adjacent to the flange328. The channel330can have a diameter that can be smaller than the flange328. As will be discussed, the flange328and the channel330can cooperate to rotatably couple a portion of the saddle307to the connecting arm320.

With continued reference toFIG. 16, the at least one mating feature332can couple the first shell half324and the second shell half326together. In one example, the at least one mating feature332can comprise two mating features332, however, it should be understood that any number of mating features could be employed to couple the first shell half324to the second shell half326. For example, a mating portion332aof the first shell half324can comprise a plug, and a mating portion332bof the second shell half326can comprise a receiver. It should be noted that the use of a plug and a receiver is merely exemplary as any suitable technique could be used to couple the first shell half324to the second shell half326, such as adhesives, mechanical fasteners, welding, etc. When the first shell half324and the second shell half326are coupled together via the mating portions332, the first shell half324and the second shell half326can define the bore320a. The stop334, the ring coupling portion336and the lock ring coupling portion338can generally be defined within the bore320a.

The stop334can comprise a tapered portion, which can be formed near or at a distal end324b,326bof the first shell half324and the second shell half326. The stop334can serve to limit the range of motion of the bone fastener302relative to the connecting arm320. The ring coupling portion336can be defined between the proximal end324a,326aand the distal end324b,326b. In one example, the ring coupling portion336can comprise a bore336a. The bore336aof the ring coupling portion336can receive a portion of the ring322to couple the ring322to the connecting arm320, as will be discussed in detail further herein.

The lock ring retaining portion338can be defined between the proximal end324a,326aand the ring coupling portion336of the first shell half324and the second shell half326. The lock ring retaining portion338can include a bearing surface338a. The bearing surface338acan be defined radially about the interior of the first shell half324and the second shell half326, such that when the first shell half324is coupled to the second shell half326, the bearing surface338acan extend circumferentially about the bore320a. The bearing surface338acan be configured to receive at least a portion of the flange314of the lock ring304to couple the lock ring304to the connecting arm320.

The ring322can be coupled to the connecting arm320via the ring coupling portion336. The ring322can be disposed about the head308of the bone fastener302to enable the bone fastener302to move or rotate relative to the saddle307. The ring322can be annular, and can be sized to fit within the connecting arm320to enable the connecting arm320to move or rotate with the bone fastener302relative to the saddle307. The ring322can include a bore340and at least one wing342. The bore340can be sized to enable the ring322to be coupled about the shaft308bof the bone fastener302, but can also be sized so as to prevent the ring322from migrating onto the hemispherical portion308aof the head308of the bone fastener302.

The at least one wing342can extend outwardly from a circumference of the ring322. In this example, the at least one wing342can comprise two wings342. The wings342can extend outwardly from generally opposite sides of the ring322. The wings342can be generally cylindrical in shape, and can be sized to be coupled to or received within the bore336aof the ring coupling portion336. It should be noted that the shape of the wings342described and illustrated herein is merely exemplary, as the wings342could have any shape that enables the bone fastener302to be coupled to the connecting arm320, such as elliptical, circular, rounded square, rounded rectangular, etc. The wings342can couple the ring322to the connecting arm320so that the connecting arm320can rotate with the bone fastener302relative to the saddle307.

With reference toFIGS. 16 and 17, the saddle307can be coupled to the multiplanar coupling system306via the connecting arm320. Generally, the saddle307can be coupled to the connecting arm320so that the connecting arm320can move or rotate relative to the saddle307, and so that the saddle307can move or translate relative to the multiplanar coupling system306and the bone fastener302.

The saddle307can be substantially U-shaped and symmetrical with respect to a longitudinal axis L defined by the multiplanar bone anchor system300(FIG. 17). The saddle307can include a first portion or bottom portion350, and a second portion or top portion352. The top portion352can move or translate relative to the bottom portion350.

In this regard, with reference toFIGS. 16 and 17, the bottom portion350of the saddle307can be generally annular or cylindrical in shape, and can comprise a proximal end354, a distal end356and a bore358. The bottom portion350can also include a cut out350a, if desired, which can facilitate coupling the bottom portion350to the connecting arm320. It should be noted, that the cut out350ais optional, as the bottom portion350could be coupled to the connecting arm320via other techniques, such as a snap-fit, press-fit, etc. The proximal end354can be coupled to the top portion352of the saddle307, while the distal end356can be coupled to the connecting arm320. The bore358can be sized to allow at least a portion of the proximal end310of the lock ring304to pass there through. As will be discussed, the bore358can also be configured to receive a portion of the connecting arm320therein, when the connecting arm320is coupled to the bottom portion350.

In one example, the proximal end354of the bottom portion350can define at least one rail360, which can cooperate with the top portion352of the saddle307to enable the saddle307to move or translate relative to the connecting arm320. In this example, the proximal end354can define two rails360a,360b, which can be disposed on generally opposite sides of the bore358. In on example, the rails360a,360bcan extend along a plane generally perpendicular to the longitudinal axis L of the multiplanar bone anchor system300, however, it should be understood that the rails360a,360bcan extend in any desired plane or in multiple planes. The rails360a,360bcan enable the saddle307to move, translate or slide along the proximal end354of the bottom portion350.

The distal end356of the bottom portion350can define a lip356a. The lip356acan extend about the circumference of the bottom portion350. The lip356acan project into the bore358, and can couple the distal end356of the bottom portion350to the connecting arm320. In this regard, the lip356acan be configured to be coupled to the flange328of the connecting arm320. The engagement of the lip356awith the flange328can allow the connecting arm320to move or rotate with the bone fastener302, relative to at least the top portion352of the saddle307, as will be discussed further herein.

The top portion352of the saddle307can be coupled to the rails360a,360bof the proximal end354of the bottom portion350so that the top portion352can move relative to the bottom portion350. The top portion352can be substantially U-shaped and symmetrical with respect to a longitudinal axis L defined by the multiplanar bone anchor system300. The top portion352can include the first or proximal end76and a second or distal end370.

With reference toFIG. 17, the distal end370of the top portion352can be generally rectangular, and can include the first or receiver surface88, a second or bottom surface372and a central bore374. The bottom surface372can include at least one or more guides372a. In this example, the bottom surface90can include two guides372a,372b. The guides372a,372bcan slidably couple the top portion352to the bottom portion350. In this regard, each guide372a,372bcan cooperate with a respective one of the rails360a,360bto enable the top portion352of the saddle307to move or translate relative to the bottom portion350of the saddle307. Generally, each guide372a,372bcan comprise a dovetail shape.

It should be understood, however, that although the top portion352and the bottom portion350are illustrated and described herein as including rails and guides to enable the relative motion, any suitable device or mechanism could be used to enable the relative motion between the top portion352and the bottom portion350, such as a monorail assembly, bearing, cam surface, etc. It should also be understood that the rails360a,360bof the bottom portion350could be interchanged with the guides372a,372bof the top portion352, if desired.

With reference toFIGS. 15-17, in order to assemble the multiplanar bone anchor system300, the ring322can be coupled to the shaft308bof the bone fastener302. Then, the lock ring304can be positioned on the head308of the bone fastener302. Next, the first shell half324and the second shell half326of the connecting arm320can be coupled to the ring322and the lock ring304. The bottom portion350of the saddle307can then be coupled to the connecting arm320, such that the connecting arm320can move or rotate relative to the bottom portion350of the saddle307. Next, the top portion352of the saddle307can be coupled to the bottom portion350so that the guides372a,372bare movably or slidably coupled to the guides372a,372bof the connecting arm320. Note that the movement of the top portion352relative to the bottom portion350can be limited by contact between the recess374aof the central bore374and the lock ring304.

Once assembled, the connecting arm320can cooperate with the bone fastener302to enable movement or rotation of the bone fastener302about the central or longitudinal axis of the bone fastener302, which provides a first plane of motion. The bottom portion350of the saddle307can also rotate relative to the bone fastener302, and thus, the top portion352of the saddle307can rotate relative to the bone fastener302to thereby define a second plane of motion. In addition, the top portion352can also move or translate relative to the bottom portion350, which can thereby define a third plane of motion. Therefore, when assembled, the multiplanar bone anchor system300can have at least three degrees or planes of motion. By allowing the multiplanar bone anchor system300to move in at least three planes, the surgeon can manipulate the multiplanar bone anchor system300as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system300in a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system10in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system300will not be discussed in great detail herein. Briefly, however, once the multiplanar bone anchor system300is secured to the anatomy, the multiplanar coupling system306and the saddle307can be moved, rotated or translated relative to the bone fastener302into the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be coupled to a desired number of multiplanar bone anchor systems300.

With reference now toFIGS. 18-20, in one example, a multiplanar bone anchor system400can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system400can be similar to the multiplanar bone anchor system100,300described with reference toFIGS. 9-11and15-17, only the differences between the multiplanar bone anchor system100,300and the multiplanar bone anchor system400will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system400can include the bone fastener102, a lock ring402, a multiplanar coupling arrangement or system404and a saddle406.

The lock ring402can be positioned about the head108of the bone fastener102. The lock ring402can couple or lock the bone fastener102relative to the multiplanar coupling system404via a force applied by the connecting rod20, as will be discussed herein. As best shown inFIG. 20, the lock ring402can be generally cylindrical, and can have a height H4. The height H4be sized to extend above or about equal to the receiver surface88of the saddle406so that coupling the connecting rod20to the saddle406can compress the lock ring402onto the head108of the bone fastener102. In this example, with reference toFIG. 19, the lock ring402can include a cut out402a, which can facilitate positioning the lock ring402about the head108of the bone fastener102. It should be understood, however, that the cut out402acan be optional, as the lock ring402can have a continuous, uninterrupted cylindrical body. In addition, the lock ring402can include a proximal end408, a distal end410, a flange412and a bore414.

The proximal end408can extend above or at the receiver surface88of the saddle406when the multiplanar bone anchor system400is assembled. The proximal end408can contact at least a portion of the connecting rod20when the connecting rod20is coupled to the multiplanar bone anchor system400. The distal end410can be coupled to the head108of the bone fastener102when the lock ring402is coupled to bone fastener102. The flange412can be formed near or at the distal end410, and can extend outwardly about an exterior circumference of the lock ring402. The flange412can cooperate with a portion of the multiplanar coupling system404to couple or retain the lock ring402within the multiplanar coupling system404.

The bore414can be disposed about a central axis of the lock ring402. The bore414can extend from the proximal end408to the distal end410. The bore414can include a first countersink414aformed near or at the proximal end408and a second countersink414bformed near or at the distal end410. The first countersink414acan be configured to at least partially receive a portion of the connecting rod20when the connecting rod20is coupled to the multiplanar bone anchor system400. The second countersink414bcan comprise a bearing surface, which can be slidably coupled to the head108of the bone fastener102. Generally, the second countersink414bcan enable the head108to move, rotate and/or pivot relative to the lock ring402.

The multiplanar coupling system404can include a connecting arm420. The connecting arm420can cooperate with the bone fastener102to enable the bone fastener102to move relative to the saddle406. It should be noted that although the multiplanar coupling system404is described and illustrated herein as including only a connecting arm420, the multiplanar coupling system404could include a ring, if desired. In this example, the connecting arm420can have a cylindrical body, which can include a cut out420a. The cut out420acan facilitate the coupling of the connecting arm420to the head108of the bone fastener302. For example, the cut out420acan enable the connecting arm420to be snap-fit around the head108of the bone fastener102. It should be noted, however, that the cut out410acan be optional, as the connecting arm420could have a continuous, uninterrupted cylindrical body. In the case of a continuous, uninterrupted cylindrical body, the connecting arm420could be threaded over the shank32of the bone fastener102into engagement with the head108of the bone fastener102.

In this example, the connecting arm420can further comprise a first or proximal end422, a second or distal end424, a channel426, a bore428and a coupling feature430. The proximal end422can have a generally smooth surface, which can be positioned adjacent to a portion of the saddle406when the multiplanar bone anchor system400is assembled. The distal end424can be positioned opposite the proximal end422, and generally, the distal end424can comprise a taper424a. The taper424acan provide the connecting arm420with atraumatic edges.

The channel426can be defined between the proximal end422and the distal end424. The channel426can extend about an exterior circumference of the cylindrical body of the connecting arm420. The channel426can receive a portion of the saddle406to couple the connecting arm420to the saddle406, as will be discussed in detail further herein.

The bore428can be defined about a central axis of the connecting arm420. The bore428can receive at least a portion of the lock ring402and at least a portion of the bone fastener102therein to couple each of the lock ring402and the bone fastener102to the connecting arm420. In this regard, with reference toFIG. 20, the bore428can include a lock ring coupling portion428aand a bone fastener coupling portion428b. In one example, the lock ring coupling portion428acan comprise a recess, which can be configured to engage the flange412of the lock ring402. The engagement of the flange412of the lock ring402with the lock ring coupling portion428acan couple or retain the lock ring402within the connecting arm420. The bone fastener coupling portion428bcan comprise an annular or circumferential projection, which can extend about a circumference of the bore428. Generally, the bone fastener coupling portion428bcan be sized so as to engage the channel108aformed in the head108of the bone fastener102so that the bone fastener102can move or rotate relative to the connecting arm420. Thus, the bone fastener coupling portion428bcan comprise a bearing surface, which can enable the bone fastener102to move or rotate relative to the connecting arm420.

The coupling feature430can be formed adjacent to the cut out420a, and generally, can be formed to engage the channel108aof the bone fastener102. The engagement of the coupling feature430with the channel108acan enable the multiplanar coupling system404to move (rotate and pivot) relative to the bone fastener102. It should be noted, however, that the coupling feature430can be optional, as any suitable device or technique could be used to allow the multiplanar coupling system404to move (rotate and pivot) relative to the bone fastener102, such as a ring with wings, as discussed previously herein.

The saddle406can be coupled to the multiplanar coupling system404via the connecting arm420. Generally, the saddle406can be coupled to the connecting arm420so that the connecting arm420can move or rotate relative to the saddle406, and so that the saddle406can move or translate relative to the multiplanar coupling system404and the bone fastener102.

The saddle406can be substantially U-shaped and symmetrical with respect to a longitudinal axis L defined by the multiplanar bone anchor system400(FIG. 20). The saddle406can include a first portion or bottom portion460, the second portion or top portion352and a third portion or middle portion462. The top portion352can move or translate relative to the middle portion462.

With reference toFIG. 19, the bottom portion460of the saddle406can be substantially similar to the bottom portion350of the saddle307described with reference toFIGS. 15-17, and thus, only the differences between the bottom portion460of the saddle406and the bottom portion350of the saddle307will be discussed in great detail herein. In this regard, the bottom portion460of the saddle406can have a substantially different geometric shape than the bottom portion350of the saddle307. For example, the bottom portion460can be generally octagonal, such that the rails360a,360bassociated with the first or proximal end354of the bottom portion460can be generally rectangular or dovetail in shape. By having a generally rectangular or dovetail shape, the rails360a,360bof the bottom portion460can have a substantially larger length than the rails360a,360bof the bottom portion350. This can enable the saddle406to move or translate for a greater distance than the saddle307. It should be understood, however, that the bottom portion460can have the same shape as the bottom portion350, if desired. The bottom portion460of the saddle406can be coupled to the connecting arm420so that the connecting arm420can move or rotate relative to the saddle406.

In this regard, the channel426of the connecting arm420can be coupled to the annular lip356aof the bottom portion460such that the annular lip356arests in the channel426to retain the connecting arm420to the bottom portion460of the saddle406. The engagement between the channel426and the annular lip346acan allow the connecting arm420to move or rotate with the bone fastener102, relative to at least the top portion352of the saddle406, as will be discussed further herein.

With reference toFIG. 20, the bottom portion460can also include a bore358, which can be sized to enable at least a portion of the lock ring402to pass through the bore348. In addition, as discussed, the bore348can be configured to receive a portion of the connecting arm420therein, when the connecting arm420is coupled to the bottom portion460.

With continued reference toFIG. 20, the top portion352of the saddle307can be coupled to the middle portion462so that the top portion352can move relative to at least one of the bottom portion460and the middle portion462, as will be discussed in greater detail herein. The middle portion462can be coupled between the top portion352and the bottom portion460. Generally, the middle portion462can be movable or translatable relative to each of the top portion352and the bottom portion460. The middle portion462can be generally octagonal in shape. It should be noted that the shape of the middle portion462is merely exemplary, as any suitable shape could be used, such as cylindrical, rectangular, etc. The middle portion462can include a first or rail surface464opposite a second or guide surface466and a bore468. The bore468can be defined about a central axis of the middle portion462, and can coaxially aligned with the bore358of the bottom portion460and the central bore374of the top portion352. The bore468can be sized to enable a portion of the lock ring402to extend through the middle portion462.

The rail surface464can include at least one rail464a. Generally, the rail surface464can include two rails464a,464b, which can be configured to movably or slidably engage the guides372a,372bof the top portion352. The engagement between the rails464a,464band the guides372a,372bcan enable the top portion352of the saddle406to move or translate relative to the middle portion462of the saddle406.

The guide surface466can include at least one guide466a. Generally, the guide surface466can include two guides466a,466b, which can be configured to movably or slidably engage the rails360a,360bof the bottom portion460of the saddle406. The engagement between the guides466a,466band the rails360a,360bcan enable the bottom portion460of the saddle406to move or translate relative to the middle portion462of the saddle406.

It should be understood, however, that although the top portion352, the middle portion462and the bottom portion460are illustrated and described herein as including rails and guides to enable the relative motion, any suitable device or mechanism could be used to enable the relative motion between the top portion352, the middle portion462and the bottom portion460, such as a monorail assembly, etc. It should also be understood that the guides372a,372b,466a,466bof the top portion352and the middle portion462could be interchanged with the rails360a,360b,464a,464bof the bottom portion350and the middle portion462, if desired.

With reference toFIGS. 19 and 20, in order to assemble the multiplanar bone anchor system400, the connecting arm420can be coupled to the channel108aof the bone fastener102. Then, the lock ring402can be coupled to the connecting arm420. Next, the bottom portion460of the saddle406can be coupled to the connecting arm420, such that the connecting arm420can move or rotate relative to the bottom portion460of the saddle406. The middle portion462can be coupled to the rails360a,360bof the bottom portion460of the saddle406to enable the middle portion462to move or translate relative to the bottom portion460. Note that the movement of the middle portion462relative to the bottom portion460can be limited by contact between a sidewall468aof the bore468of the middle portion462and the lock ring402(FIG. 20). Then, the top portion352of the saddle406can be coupled to the middle portion462so that the guides372a,372bare slidably coupled to the rails464a,464bof the connecting arm420. Note that the movement of the top portion352relative to the middle portion462can be limited by contact between a sidewall374bof the bore374of the top portion352and the lock ring402(FIG. 20).

Once assembled, the connecting arm420can cooperate with the bone fastener102to enable movement or rotation of the bone fastener102about the central or longitudinal axis of the bone fastener102, which provides a first plane of motion. The bottom portion460of the saddle406can also rotate relative to the bone fastener102, and thus, the top portion352of the saddle406can rotate relative to the bone fastener102to thereby define a second plane of motion. In addition, the middle portion462can move or translate relative to the connecting arm420, thereby defining a third plane of motion. As the top portion352can also move or translate relative to the middle portion462, the multiplanar bone anchor system400can define a fourth plane of motion. Therefore, when assembled, the multiplanar bone anchor system400can have at least four degrees or planes of motion. By allowing the multiplanar bone anchor system400to move in at least four planes, the surgeon can manipulate the multiplanar bone anchor system400as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system400in a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system300in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system400will not be discussed in great detail herein. Briefly, however, once the multiplanar bone anchor system400is secured to the anatomy, the multiplanar coupling system404and the saddle406can be moved, rotated or translated relative to the bone fastener102into the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be coupled to a desired number of multiplanar bone anchor systems400.

With reference now toFIGS. 21-23, in one example, a multiplanar bone anchor system500can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system500can be similar to the multiplanar bone anchor system100,200described with reference toFIGS. 9-15, only the differences between the multiplanar bone anchor system100,200and the multiplanar bone anchor system500will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system500can include the bone fastener102, a lock ring502, a multiplanar coupling arrangement or system504and a saddle506. It should be noted that although the multiplanar bone anchor system500is described and illustrated herein as including the lock ring502, it should be understood that the multiplanar bone anchor system500need not include the lock ring502. Furthermore, the multiplanar bone anchor system500could employ the lock ring14instead of the lock ring502, if desired.

The lock ring502can be received within the saddle506, and can cooperate the multiplanar coupling system504and the saddle506to fixedly couple or lock the bone fastener102into a desired angular position (FIG. 23). In one example, with reference toFIG. 22, the lock ring502can include a continuous cylindrical body, which can be formed out of any suitable biocompatible material, such as a biocompatible metal, ceramic, metal alloy, polymer or combinations thereof. The lock ring502can include a first or proximal end507, a second or distal end508and a flange509. In addition, the lock ring502can include a bore502a, which can enable a tool to engage the driver interface feature34of the bone fastener102.

The proximal end507of the lock ring502can define a first concave surface507a, which can have a curvature configured to mate with the connecting rod20. In this regard, the lock ring502can support a portion of the connecting rod20when the connecting rod20is coupled to the multiplanar bone anchor system500. In this example, the force applied by the set screw22to couple the connecting rod20to the multiplanar bone anchor system500can apply a force to the lock ring502to fixedly couple or lock the bone fastener102in the desired angular position.

The distal end508of the lock ring502can apply a force to the head108of the bone fastener102to fixedly couple or lock the bone fastener102in the desired angular position. With reference toFIG. 23, the distal end508can define a second concave surface508a. The concave surface508acan be configured to mate with the head108of the bone fastener102to fixedly couple or lock the bone fastener102in the desired angular position when the force is applied to the lock ring502.

The flange509can extend about a circumference of the lock ring502, and can be positioned between the proximal end507and the distal end508of the lock ring502. The flange509can be integrally formed with the lock ring502, or could be coupled to the circumference of the lock ring502through any suitable manufacturing technique, such as overmolding, adhesives, etc. The flange509can be configured to engage a portion of the multiplanar coupling system504to couple the lock ring502to the multiplanar coupling system504, as will be discussed in greater detail herein.

With reference toFIGS. 21-23, the multiplanar coupling system504can include a connecting arm510, at least one plug538and a retaining clip514. In one example, the multiplanar coupling system504can include two plugs538. The connecting arm510and the plugs538can cooperate with the bone fastener102to enable the bone fastener102to move relative to the saddle506. The connecting arm510can be disposed about a head30of the bone fastener102to enable the bone fastener102to move or articulate relative to the saddle506. In this example, the connecting arm510can be cylindrical, and can be coupled to the saddle506via the retaining clip514, as will be discussed (FIG. 23). The connecting arm510can include a first or proximal end520, a channel522, a second or distal end524and a bore526.

The proximal end520can be received within the saddle506, when the saddle506is coupled to the connecting arm510(FIG. 23). The channel522can be disposed between the proximal end520and the distal end524. The channel522can be received within the saddle506and can cooperate with the saddle506and the retaining clip514to couple the connecting arm510to the saddle506, as will be discussed. A majority of the distal end524can be disposed outside of the saddle506when the connecting arm510is coupled to the saddle506(FIG. 23). The distal end524can include at least one flange528.

In one example, with continued reference toFIG. 23, the distal end524can include two flanges528a,528b. Generally, the flanges528can be positioned opposite each other, and can each extend for a length beyond the distal end524of the connecting arm510, as shown inFIG. 22. With reference back toFIG. 23, each of the flanges528can include a bore530. Each of the bores530can receive a portion of one of the plugs538to couple the bone fastener102to the connecting arm510, as will be discussed in greater detail herein. In one example, the bores530can be defined through the circumference of the flanges528such that the bores530are in communication with the bore526.

The bore526can be defined from the proximal end520to the distal end524. The bore526can be formed about a central axis of the connecting arm510. The bore526can receive at least a portion of the lock ring502when the multiplanar bone anchor system500is assembled. In this regard, with reference toFIG. 23, the bore526can include a lock ring coupling portion526a, a bearing portion526band a limiting portion526c.

The lock ring coupling portion526acan be formed near or at the proximal end520. The lock ring coupling portion526acan be configured to engage the flange509of the lock ring502to couple the lock ring502to the connecting arm510. In one example, the lock ring coupling portion526acan comprise a portion of the bore526that has a contour that mates with an exterior contour of the lock ring502, however, it should be understood that the lock ring coupling portion526acan have any desired configuration operable to retain the lock ring502within the connecting arm510. In this example, the lock ring coupling portion526acan be formed such that the proximal end507of the lock ring502extends beyond the proximal end520of the connecting arm510so that the connecting rod20can be received within the concave surface507aof the lock ring502.

The bearing portion526bcan be formed adjacent to the proximal end520of the connecting arm510. The bearing portion526bcan be generally concave, and can be configured to mate with at least a portion of the hemispherical head30of the bone fastener102. The bearing portion526bcan enable the bone fastener102to move, rotate or articulate relative to the connecting arm510. The limiting portion526ccan be defined adjacent to the distal end524of the connecting arm510. Although not illustrated herein, the limiting portion526ccan include a taper, if desired. Generally, the limiting portion526ccan limit the range of motion or articulation of the bone fastener102.

With reference toFIG. 22, the plugs538can cooperate with the connecting arm510to enable the bone fastener102to move or rotate about the longitudinal axis L2of the bone fastener102. The plugs538can couple the bone fastener102to the connecting arm510. Each of the plugs538can include a coupling end540. The coupling end540can couple the plug538to the connecting arm510. The coupling end540can include a fastening feature540a, which can be accessible when the plugs538are coupled to the connecting arm510. The fastening feature540acan comprise any suitable feature, such as a slot, cut-out or other feature engagable by a tool. Generally, the fastening feature540acan enable a tool, such as a driver, to couple the plug538to the connecting arm510and the head30of the bone fastener12. In addition, if desired, the plugs538could be integrally formed with the connecting arm510. It should be noted that the shape of the plugs538is merely exemplary, as the plugs538could have any desired shape, such as elliptical, spherical, rounded, annular, cylindrical, rounded square, rounded rectangular, etc. In addition, although not illustrated herein, the plugs538can include one or more tapered surfaces, which can enable the bone fastener102to move or pivot relative to the connecting arm510, if desired.

With reference toFIGS. 22 and 23, the retaining clip514can couple the saddle506to the connecting arm510. The retaining clip514can comprise a substantially U-shaped clip, such as Dutchman clip, for example. As a Dutchman clip can be generally known, the retaining clip514will not be discussed in great detail herein. Briefly, however, the retaining clip514can define a first arm514aand a second arm514b, which can be coupled together via a connector514c. Each of the first arm514aand the second arm514bcan include a locking tang T. Generally, the first arm514aand the second arm514bcan be flexible, so that the retaining clip514can be biased into engagement with the saddle506and the connecting arm510. As will be discussed, the retaining clip514can be received through a portion of the saddle506and through the channel522of the connecting arm510to movably or rotatably couple the saddle506to the connecting arm510.

The saddle506can include the first or proximal end76and a second or distal end550. The distal end550can be generally cylindrical, and can include the first or a receiver surface88, a second or bottom surface552, a central bore554and at least one slot556.

As best shown inFIG. 23, the bottom surface552can include a taper552a. The taper552acan provide the bottom surface552with atraumatic edges. The central bore554can be defined from the receiver surface88through to the bottom surface552of the saddle506. The central bore554can be configured to receive at least a portion of the connecting arm510rotatably therein. Thus, the central bore554can have a diameter, which can be slightly greater than a diameter of the connecting arm510, so that the connecting arm510can rotate relative to the saddle506.

The at least one slot556can be defined through a portion of the distal end550of the saddle506. In one example, the at least one slot556can comprised two slots556. The two slots556can be formed opposite each other, and can generally be formed a distance apart, with the distance between the two slots556about equal to a length of the connector514cof the retaining clip514.

The slots556can be defined from a first side550ato a second side550bof the distal end550of the saddle506. The slots556can have a length from the first side550ato the second side550b, which can be about equal to a length of the first arm514aand the second arm514b. Given the length of the slots556, the connector514cof the retaining clip514can generally be disposed adjacent to an exterior surface of the distal end550of the saddle506(FIG. 23). It should be noted, however, that the saddle506could be configured so that the connector514cis received within the saddle506when the retaining clip514is coupled to the saddle506and connecting arm510.

The slots556can each include a tab556a, which can be formed near the second side550bof the distal end550. The tab556acan cooperate with the tang T of the first arm514aand the second arm514bto couple the retaining clip514to the saddle506. By coupling the retaining clip514to the saddle506, the connecting arm510can also be coupled to the saddle506.

In this regard, with reference toFIGS. 22 and 23, in order to assemble the multiplanar bone anchor system500, the lock ring502can be positioned within the bore526and coupled to the lock ring coupling portion526avia the flange509of the lock ring502. With the lock ring502coupled to the connecting arm510, the distal end550of the saddle506can be positioned onto the proximal end520of the connecting arm510. Next, the bone fastener102can be coupled to the connecting arm510by snap-fitting, press-fitting or threading the plugs538into engagement with the bores530of the connecting arm510so that the bone fastener102can move (rotate and pivot) relative to the connecting arm510.

With the distal end550of the saddle506positioned about at least the proximal end520of the connecting arm510, the retaining clip514can be inserted into the slots556so that the tangs T of the first arm514aand the second arm514bcan engage the tabs556aof the slots556. The first arm514aand the second arm514bcan be inserted such that the first arm514aand the second arm514bcan be at least partially retained within the channel522of the connecting arm510. Thus, the retaining clip514can be employed to couple the connecting arm510and bone fastener102to the saddle506.

Once assembled, the plugs538can cooperate with the channel108aof the bone fastener102to enable movement or rotation of the bone fastener102about the central or longitudinal axis of the bone fastener102, thereby providing a first plane of motion. In addition, the retaining clip514can enable the connecting arm510to move or rotate relative to the saddle506, thereby defining a second plane of motion. Thus, when assembled, the multiplanar bone anchor system500can have at least two planes or degrees of motion. By allowing the multiplanar bone anchor system500to move in at least two planes, the surgeon can manipulate the multiplanar bone anchor system500as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system500in a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system100,200in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system500will not be discussed in great detail herein. Briefly, however, once the multiplanar bone anchor system500is secured to the anatomy, the bone fastener102, the multiplanar coupling system504and/or the saddle506can be moved or rotated relative to one another until the multiplanar bone anchor system500is in the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be coupled to a desired number of multiplanar bone anchor systems500.

With reference now toFIGS. 24-26, in one example, a multiplanar bone anchor system600can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system600can be similar to the multiplanar bone anchor system400described with reference toFIGS. 18-20, only the differences between the multiplanar bone anchor system400and the multiplanar bone anchor system600will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system600can include the bone fastener102, a lock ring602, a multiplanar coupling arrangement or system604and a saddle606.

The lock ring602can be positioned about the head108of the bone fastener102. The lock ring602can couple or lock the bone fastener102relative to the multiplanar coupling system604via a force applied by the connecting rod20, as will be discussed herein. With reference toFIG. 26, the lock ring602can be generally cylindrical, and can have a height H6. The height H6be sized to extend above or about equal to a receiver surface88of the saddle606so that coupling the connecting rod20to the saddle606can compress the lock ring602onto the head108of the bone fastener102. In this example, the lock ring602can include a cut out602a, which can facilitate positioning the lock ring602about the head108of the bone fastener102. It should be understood, however, that the cut out602acan be optional, as the lock ring602can have a continuous, uninterrupted cylindrical body. In addition, the lock ring602can include the proximal end408, a distal end610, the flange412and the bore414. With reference toFIGS. 25 and 26, the distal end610can be coupled to the head108of the bone fastener102when the lock ring602is coupled to bone fastener102.

The multiplanar coupling system604can include a connecting arm620. The connecting arm620can cooperate with the bone fastener102to enable the bone fastener102to move relative to the saddle606. It should be noted that although the multiplanar coupling system604is described and illustrated herein as including only a connecting arm620, the multiplanar coupling system604could include a ring, such as the ring322illustrated inFIG. 16, if desired. In this example, the connecting arm620can have a cylindrical body, which can include a cut out620a. The cut out620acan facilitate the coupling of the connecting arm620to the head108of the bone fastener102. For example, the cut out620acan enable the connecting arm620to be snap-fit around the head108of the bone fastener102. It should be noted, however, that the cut out620acan be optional, as the connecting arm620could have a continuous, uninterrupted cylindrical body. In the case of a continuous, uninterrupted cylindrical body, the connecting arm620could be threaded over the shank32of the bone fastener102into engagement with the head108of the bone fastener102.

In this example, the connecting arm620can further comprise a first or proximal end622, the second or distal end424, the channel426, the bore428and the coupling feature430. The proximal end622can include a plurality of arcuate members622a, which can each be separated by one or more spaces622b. The plurality of arcuate members622acan generally be formed about a circumference of the proximal end622. The plurality of arcuate members622acan cooperate with the channel426to couple the connecting arm620to the saddle606. The one or more spaces622bcan enable the plurality of arcuate members622ato be flexible, such that the plurality of arcuate members622acan be snap-fit into engagement with the saddle606.

Generally, with reference toFIGS. 25 and 26, the saddle606can be coupled to the connecting arm620so that the connecting arm620can move or rotate relative to the saddle606. The saddle606can be substantially U-shaped and symmetrical with respect to a longitudinal axis L2defined by the multiplanar bone anchor system600. The saddle606can include the first or proximal end76and a second or distal end640.

With reference toFIG. 25, the distal end640of the saddle606can be generally rectangular, and can include the first or a receiver surface88, a second or bottom surface644and a bore646. With reference toFIG. 26, the bottom surface644can include a lip644a. The lip644acan extend downwardly from the bottom surface644about the perimeter of the bottom surface644. The lip644acan be configured to be received in the channel426so that a portion of the bore646can surround the plurality of arcuate members622ato couple the saddle606to the connecting arm620. This can also enable the saddle606to move or rotate relative to the connecting arm620.

With reference toFIGS. 25 and 26, in order to assemble the multiplanar bone anchor system600, the connecting arm620can be coupled to the channel108aof the bone fastener102. Then, the lock ring602can be coupled to the connecting arm620. Next, the distal end640of the saddle606can be coupled to the connecting arm620, such that the connecting arm620can move or rotate relative to the saddle606.

Once assembled, the connecting arm620can cooperate with the bone fastener102to enable movement or rotation of the bone fastener102about the central or longitudinal axis of the bone fastener102, which can provide a first plane of motion. The saddle606can also rotate relative to the connecting arm620, which can thereby define a second plane of motion. In addition, the saddle606can rotate relative to the bone fastener102to thereby define a third plane of motion. Therefore, when assembled, the multiplanar bone anchor system600can have at least three degrees or planes of motion. By allowing the multiplanar bone anchor system600to move in at least three planes, the surgeon can manipulate the multiplanar bone anchor system600as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system600in a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system400in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system600will not be discussed in great detail herein. Briefly, however, once the multiplanar bone anchor system600is secured to the anatomy, the multiplanar coupling system604and the saddle606can be moved or rotated relative to the bone fastener102into the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be coupled to a desired number of multiplanar bone anchor systems600.

With reference toFIG. 27, while the multiplanar bone anchor system300has been described herein with reference toFIGS. 15-17as including the bone fastener302, the lock ring304, the connecting arm320, the ring322and the bottom portion350, those of skill in the art will appreciate that the present disclosure, in its broadest aspects, may be constructed somewhat differently. In this regard, a multiplanar bone anchor system300′ could include the bone fastener102, the lock ring402, the connecting arm420and the bottom portion460associated with the multiplanar bone anchor system400. In this example, the multiplanar bone anchor system300′ can provide multiple planes of motion while requiring fewer components, which may be desirable for manufacturing purposes.

As a further example, with reference toFIGS. 28-30, while the multiplanar bone anchor system10,100,200,500has been described herein as having a ring50,112,322, those of skill in the art will appreciate that the present disclosure, in its broadest aspects, may be constructed somewhat differently. In this regard, a connecting arm700could be employed in place of the ring50,112,322. The connecting arm700can cooperate with the bone fastener102, and can include at least one bore702and at least one plug704. The connecting arm700can also define a throughbore706, which can receive the head108of the bone fastener102therein. The at least one plug704can be coupled to the at least one bore702of the connecting arm700to enable the bone fastener102to rotate relative to the connecting arm700. In this example, the at least one plug704can include two plugs704, which can be received within two opposite bores702. Each of the plugs704can be press fit into the bores702so that a bearing surface704aformed on the plugs704can rotate about the channel108aof the bone fastener102.

With reference now toFIGS. 31-36, in one example, a multiplanar bone anchor system800can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system800can be similar to the multiplanar bone anchor system10described with reference toFIGS. 1-8, only the differences between the multiplanar bone anchor system10and the multiplanar bone anchor system800will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system800can include a bone fastener802, a multiplanar coupling arrangement or system804(FIG. 33) and a saddle806(FIG. 31). The multiplanar bone anchor system800can define a longitudinal axis L, and the multiplanar bone anchor system800can be configured such that the bone fastener802and the saddle806can move relative to the longitudinal axis L in multiple planes.

As will be discussed in greater detail herein, the multiplanar coupling system804can enable the saddle806to move relative to the bone fastener802in multiple planes. Generally, the saddle806can be configured to receive the connecting device or rod20, which can be used to interconnect multiple bone anchor systems800in an exemplary spinal fixation procedure (similar to that illustrated inFIG. 1). By using the multiplanar coupling system804, the saddle806can be moved relative to the bone fastener802in one or more planes to facilitate the connection of the connecting rod20to multiple bone anchor systems800. In this regard, the vertebral bodies V of the patient may be orientated in such a manner that each bone fastener802, when coupled to a respective vertebral body V, may be slightly offset from one another. By allowing the saddle806to move in multiple planes relative to the bone fastener802, the surgeon can move the saddles806into alignment without regard to the placement of the bone fasteners802. It should be noted, however, that although the multiplanar bone anchor system800is generally illustrated and described herein a single assembly for use with a single connecting rod20, any combination of bone anchor systems800and connecting rods20can be employed during a surgical procedure.

For example, in a single level spinal fixation procedure, two bone anchor systems800can receive a single connecting rod20. A multiple level spinal fixation procedure, however, will generally require additional bone anchor systems800. In addition, the multiplanar bone anchor systems800need not be coupled to adjacent vertebral bodies V, but rather, the multiplanar bone anchor systems800can be positioned so as to skip adjacent vertebral bodies V, if desired.

With reference toFIG. 33, the bone fastener802can be configured to engage the anatomy to couple the multiplanar bone anchor system800to the anatomy. The bone fastener802can be composed of any suitable biocompatible material, such as titanium, stainless steel, biocompatible metals, metal alloys, polymers, etc. The bone fastener802can include a proximal end or head810and the distal end or shank32. The head810can include a first or upper portion812and a second or lower portion814.

The upper portion812can include a contact surface815and the driver connection feature34. The contact surface815can be adjacent to the connecting rod20when the connecting rod20is received within the saddle806. As will be discussed greater herein, in one example, when the set screw22is coupled to the saddle806to lock the connecting rod20to the multiplanar bone anchor system800, the connecting rod20can be pushed or forced into engagement with the contact surface815. The contact between the contact surface815and the connecting rod20can frictionally lock the bone fastener802relative to the saddle806, thereby preventing further movement of the bone fastener802. It should be noted, however, that depending upon the angulation of the bone fastener802, the lower portion814could also be in contact with the connecting rod20.

In one example, the contact surface815can be formed on the driver connection feature34, and can comprise, for example, a roughened or knurled surface formed along a proximalmost surface812aof the driver connection feature34. It should be noted that the contact surface815is merely exemplary, and the upper portion812could comprise a smooth surface, if desired.

Briefly, it should be noted that particular tools for use with the multiplanar bone anchor system10are beyond the scope of the present teachings and need not be described herein. In a conventional manner insofar as the present teachings are concerned, various tools can be used to connect the multiplanar bone anchor system10to a respective vertebral body V. Exemplary tools can include those employed in the Polaris™ 5.5 Spinal System, commercially available from Biomet, Inc. of Warsaw, Ind., or the tools disclosed in commonly owned U.S. Patent Publication No. 2008/0077138, filed on Apr. 20, 2007 and incorporated by reference herein.

The lower portion814of the head810can be generally hemispherical or conical. The lower portion814can provide a bearing surface814a, which can cooperate with the multiplanar coupling system804to enable the movement (rotation, articulation) of the bone fastener802within the saddle806, as will be discussed in greater detail herein. Generally, the bone fastener802can rotate about the longitudinal axis L and can also pivot in a single plane or multiple planes relative to the longitudinal axis L, as will be discussed herein. In addition, a proximalmost surface of the lower portion814can cooperate with a portion of the multiplanar coupling system804to provide a frictional fit between the bone fastener802and the multiplanar coupling system804.

In one example, the multiplanar coupling system804can include a connecting arm816. The connecting arm816can be composed of any suitable biocompatible material, such as a biocompatible metal, metal alloy, ceramic or polymer. The connecting arm816can be disposed about the head810of the bone fastener802to allow relative movement between the bone fastener802and the saddle806, as shown inFIG. 32. The connecting arm816can be sized to fit within the saddle806, and can also allow a portion of the saddle806to move or translate relative to another portion of the saddle806, as will be discussed in greater detail herein. With reference toFIGS. 33-35, the connecting arm816can include a first or upper portion820, a second or lower portion822and a bore824.

The upper portion820can be shaped to be received within a portion of the saddle806, and can be generally rectangular with rounded corners. In one example, the upper portion820can have opposite curved features821. The opposite curved features821can include a generally straight portion821a. As will be discussed in greater detail herein, the straight portion821acan cooperate with the saddle806to enable the saddle806to move or translate relative to the upper portion820of the connecting arm816. The opposite curved features821can project outwardly from or extend outwardly away from the lower portion822of the connecting arm816and can aid in retaining a portion of the saddle806on the connecting arm816, as will be discussed in greater detail herein. With reference toFIG. 34, the upper portion820can include at least one friction surface826, a retention surface828and a rail829.

The at least one friction surface826can be formed on opposite sides of the bore824along an exterior surface of the connecting arm816. In one example, the at least one friction surface826can comprise a first leaf spring826aand a second leaf spring826b. It should be noted that although the at least one friction surface826is described and illustrated herein as comprising two leaf springs, the at least one friction surface826could comprise a single leaf spring, a frictional coating or other interference, which can control the movement of a portion of the saddle806relative to the connecting arm816and another portion of the saddle806, as will be discussed in greater detail herein.

The retention surface828can be formed on the upper portion820near an end820aof the upper portion820. The retention surface828can extend slightly into the bore824so as to form a lip to retain the bone fastener802within the connecting arm816. Generally, the retention surface828can extend about a majority of a circumference of the bore824, but the retention surface828could be formed about the entire circumference of the bore824if desired. Further, it should be noted that the use of a retention surface828is merely exemplary, as any suitable feature could be used to retain the bone fastener802within the connecting arm816such as one or more protrusions extending into the bore824.

The rail829can be formed below each of the opposite curved features821, and can provide a contact surface for a portion of the saddle806to move or translate relative to the connecting arm816(FIG. 36). The rail829can be positioned adjacent to the lower portion822.

With reference toFIGS. 34 and 35, the lower portion822can include a connection surface830and a preferred angle slot832. The connection surface830can comprise at least one flat surface834and at least one rib836. The at least one flat surface834and at least one rib836can cooperate with a portion of the saddle806to couple that portion of the saddle806immovably to the connecting arm816. In one example, the connecting surface830can comprise three flat surfaces834a-834cand four ribs836a-836d. The flat surfaces834a-834ccan generally alternate with the ribs836a-836dabout an exterior surface of the lower portion822. The flat surfaces834a-834dcan prevent the connecting arm816from rotating relative to the portion of the saddle806. The ribs836a-836dcan be formed along arcuate surfaces of the lower portion822and can be positioned a distance D from a bottommost surface822aof the lower portion822(FIG. 35). The ribs836a-836dcan create an overlap interference or snap fit between the portion of the saddle806and the lower portion822, as will be discussed in greater detail herein. It should be noted, however that the use the ribs836a-836dis merely exemplary, as any suitable mechanism could be employed to couple the portion of the saddle806to the lower portion822, such as pins, threads, etc.

The preferred angle slot832can enable the bone fastener802to articulate to a greater angle A relative to a longitudinal axis L of the multiplanar bone anchor system800. In this regard, with reference toFIG. 36, the bone fastener802can generally articulate to an angle A1relative to the longitudinal axis L along the portion of the connecting arm816that does not include the preferred angle slot832. At the location of the preferred angle slot832, the bone fastener802can generally articulate to the greater angle A relative to the longitudinal axis L. In one example, the angle A1can be generally about less than the greater angle A, and the greater angle A can be between about 15 degrees and about 90 degrees. The preferred angle slot832can comprise an arcuate cut-out defined through the lower portion822of the connecting arm816, which can be in communication with the bore824. The arcuate cut-out of the preferred angle slot832can enable the bone fastener802to move or articulate to the greater angle A relative to the longitudinal axis L.

It should be noted that although only one preferred angle slot832is illustrated in the drawings, the connecting arm816can include any number of preferred angle slots832at any location along the connecting arm816to enable the bone fastener802to articulate in any selected direction. It should also be noted that the shape of the cut-out that forms the preferred angle slot832can be modified to reduce or increase the greater angle A of the articulation of the bone fastener802relative to the longitudinal axis L. Alternatively, the connecting arm816could be devoid of a preferred angle slot, if desired.

With reference toFIGS. 33-36, in one example, the bore824of the connecting arm816can be formed along the longitudinal axis L and can extend through an interior surface of the connecting arm816from the upper portion820to the lower portion822. The bore824can be sized to receive the bone fastener802, and can include a bearing surface838. The bearing surface838can allow the bone fastener802to articulate within the connecting arm816. The bearing surface838can be disposed about a portion of the bore824of the connecting arm816, and can have a curve configured to mate with the bearing surface814aof the bone fastener802.

With reference toFIGS. 31-33, the saddle806can be coupled to the connecting arm816and can move or translate relative to the connecting arm816. In this regard, the saddle806can include a first portion or bottom portion840and a second portion or top portion842. The bottom portion840can be immovably coupled to the connecting arm816, and the top portion842can move or translate relative to the bottom portion840and the connecting arm816(FIG. 32). It should be noted that the bottom portion840can be optional, if desired.

In one example, with reference toFIG. 33, the bottom portion840can include opposed generally arcuate surfaces840a, which can be interconnected by generally straight or flat surfaces840b. The shape of the bottom portion840can cooperate with the shape of the connecting arm816so that the bottom portion840can be coupled to the connecting arm816. The bottom portion840can include a first or proximal end844, a second or distal end846and a bore848.

The proximal end844can be positioned adjacent to the top portion842when the saddle806is coupled to the connecting arm816. The distal end846can include a preferred angle slot850. The preferred angle slot850can be defined through the distal end846so as to be in communication with the bore848. The preferred angle slot850of the bottom portion840can be positioned in substantially the same location relative to the connecting arm816such that when the bottom portion840is coupled to the connecting arm816, the preferred angle slot850of the bottom portion840is aligned with the preferred angle slot832of the connecting arm816. The alignment between the preferred angle slot832and the preferred angle slot850can enable the bone fastener802to move or articulate to the greater angle A (FIG. 36).

With reference toFIG. 36, in one example, the bore848can be formed along the longitudinal axis L from the proximal end844to the distal end846. With reference toFIG. 33, the bore848can be sized and configured to be immovably coupled about the connecting arm816. The bore848can include a rounded or chamfered edge852, at least one groove854and at least one flat surface856. The chamfered edge852can be formed at the proximal end844. The chamfered edge852can provide a lead-in for coupling the bottom portion840to the connecting arm816. It should be noted that the chamfered edge852can be optional.

The at least one groove854and the at least one flat surface856of the bottom portion840can cooperate with the at least one flat surface834and the at least one rib836of the connecting arm816to couple the bottom portion840to the connecting arm816. In one example, the bore848can include four grooves854a-854dand three flat surfaces856a-856c. A respective one of each of the grooves854a-854dcan engage a respective one of each of the ribs836a-836d. The grooves854a-854dcan be positioned about the bore848so that the grooves854a-854dalternate with the flat surfaces856a-856c. The flat surfaces856a-856ccan cooperate with the flat surfaces834a-834cof the connecting arm816to resist relative rotation between the connecting arm816and the bottom portion840.

With reference toFIG. 36, the top portion842of the saddle806can be disposed about the curved features821of the connecting arm816. The top portion842can move or translate relative the connecting arm816, and thus, move or translate relative to the bottom portion840. The top portion842can be substantially U-shaped and symmetrical with respect to a longitudinal axis L defined by the multiplanar bone anchor system800. The top portion842can include a first or proximal end860and a second or distal end862. In one example, with reference toFIG. 33, the proximal end860can include a first arm864and a second arm866. The first arm864and second arm866can extend upwardly from the distal end862to define the U-shape. Each of the first arm864and the second arm866can include the mating portion84, a cavity868and a connector feature870.

With reference toFIGS. 33 and 36, the cavity868can be defined in each interior surface864a,866aof the first arm864and the second arm866. The cavity868can provide clearance for the movement or articulation of the top portion842relative to the bottom portion840of the saddle806. In this regard, the cavity868can be defined so as to allow the top portion842to move over the head810of the bone fastener802, which can provide a range of motion for the top portion842relative to the bottom portion840. If desired, the cavity868could be configured such that contact between the head810of the bone fastener802and the cavity868can act as a stop to limit the movement or translation of the top portion842relative to the bottom portion840. Further, other techniques could be used to stop or limit the movement or translation of the top portion842relative to the bottom portion840, such as features formed on the connecting arm816.

With reference toFIG. 33, the connector feature870can be defined in an exterior surface864b,866bof the first arm864and the second arm866. The connector feature870can enable the multiplanar bone anchor system800to be coupled to instrumentation, such as rod reduction instruments or to a suitable cross-connector device in a spinal fixation procedure. The connector feature870is illustrated herein as comprising a triangular recess with rounded corners formed in each of the first arm864and the second arm866, however, it should be noted that the connector feature870can have any selected shape and dimension to cooperate with a selected cross-connector device or instrument.

With reference toFIG. 33, the distal end862of the top portion842can be generally rectangular, and can include rounded corners to correspond with the shape of the bottom portion840. It should be noted that the shape of the bottom portion840does not have to be generally rectangular, but could be generally square, cylindrical, oval, etc. The distal end862can include the first or receiver surface88, a second or bottom surface872, at least one bore874and a central bore876.

With reference toFIG. 36, the bottom surface872of the distal end862can include at least one guide878. In one example, the bottom surface872of the distal end862can include two guides878a,878b, which can be positioned opposite each other and adjacent to a respective receiver surface88. The guides878a,878b, can have a curved surface880and a lip884. The curved surface880can be shaped to cooperate with the curved features821of the connecting arm816. The cooperation between the curved surface880and the curved features821can allow the top portion842to move or translate relative to the connecting arm816. The lip884can retain the top portion842on the connecting arm816. The lip884can also contact the rail829on the connecting arm816to aid in guiding the movement of the top portion842relative to the connecting arm816.

With reference toFIG. 36, the at least one bore874can receive at least one pin886to enable frictional movement between the top portion842and the connecting arm816. In one example, the distal end862can include two bores874a,874band two pins886a,886b. The bores874a,874bcan be defined on the distal end862can define passageways for receipt of the pins886a,886b. Generally, the bores874a,874bcan be formed so that the passageways extend transverse to the longitudinal axis L. In one example, the passageways can be defined by the bores874a,874b, so as to extend adjacent to the receiver surface88from a first side864aof the distal end862to a second side864bof the distal end862.

A respective one of the pins886a,886bcan be received in a respective one of the bores874a,874b. The pins886a,886bcan be fixed relative to the top portion842. When the top portion842moves relative to the connecting arm816, the biasing force from the friction element826can resist the movement of the top portion842, which can allow for controlled movement of the top portion842relative to the connecting arm816. This can enable the surgeon to place the top portion842in a selected position and the friction between the pins886a,886band the connecting arm816can allow the top portion842to remain in that selected position.

The pins886a,886b, can be elongated and can include a first end890and a second end892. In one example, the pins886a,886bcan have a uniform cross-section, however, the pins886a,886bcould have varying cross-sections to increase the friction between the top portion842and the connecting arm816. The cross-section of the pins886a,886bis illustrated herein as being circular, but the pins886a,886bcould have any desired cross-section, such as oval, rectangular, square, triangular, trapezoidal, etc. The first end890and the second end892of the pins886a,886bcan include a taper which can allow the first end890and second end892of the pins886a,886bto be contained generally wholly within the top portion842.

The central bore876can be defined through the distal end862from the receiver surface88to the bottom surface872. Generally, the central bore876can be sized to receive the connecting arm816and the bone fastener802(FIG. 36).

With reference toFIG. 34, in order to assemble the multiplanar bone anchor system800according to one exemplary method, the bone fastener802can be inserted through the bore824of the connecting arm816and passed through the retention surface828so that the bone fastener802is retained within and can articulate within the connecting arm816. Then, the connecting arm816can be inserted into the top portion842of the saddle806. Generally, the connecting arm816can be rotated about 90° around a main axis M of the connecting arm816in order to insert the connecting arm816through the top portion842(FIG. 35). The connecting arm816can be rotated back about 90° around the axis M until the curved features821and straight portions821aof the connecting arm816are engaged with the curved surface884and flat surface886of the top portion842. Alternatively, the bone fastener802can be inserted into the bore824of the connecting arm816after the connecting arm816is coupled to the saddle806.

Next, with reference toFIG. 33, the pins886a,886b, can be pressed into the bores874a,874bof the top portion842. The bottom portion840can then be snap fit about the connecting arm816such that the grooves854a-854dof the bottom portion840engage the ribs836a-836dof the connecting arm816. It should be noted that the use of the bottom portion840is merely exemplary, as the pins886a,886bcan solely retain the connecting arm816within the top portion842.

Once assembled, the connecting arm816can enable the bone fastener802to move or rotate within the bore824of the connecting arm816. With reference toFIG. 36, the connecting arm816can also allow the bone fastener802to move or angulate relative to the longitudinal axis L of the multiplanar bone anchor system800. The preferred angle slot832of the connecting arm816can cooperate with the preferred angle slot850of the bottom portion840to enable the bone fastener802to move or articulate to the greater angle A. The top portion842of the saddle806can move or translate relative to the bottom portion840and connecting arm816to a selected position. The friction between the pins886a,886band the friction surface826of the connecting arm816can allow the top portion842to stay in the selected position once moved to the selected position. Thus, when assembled, the multiplanar bone anchor system800can have at least three degrees of movement or can be movable in at least three planes. For example, the bone fastener802can rotate about the longitudinal axis L. The bone fastener802can also pivot relative to the longitudinal axis L in at least a first direction and a second direction. The saddle806can translate relative to the longitudinal axis L. By allowing the multiplanar bone anchor system800to move in at least three planes, the surgeon can manipulate the multiplanar bone anchor system800as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system800in a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system10in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system800will not be discussed in great detail herein. Briefly, however, once the multiplanar bone anchor system800is secured to the anatomy, the multiplanar coupling system804and the saddle806can be moved, pivoted or rotated relative to the bone fastener802into the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be inserted into a desired number of multiplanar bone anchor systems800.

With the connecting rod20positioned in the saddles806of the multiplanar bone anchor systems800, the set screw22can be coupled to each mating portion84of each saddle806. The coupling of the set screw22can apply a force to the head810of the bone fastener802to fixedly couple or lock the position of the bone fastener802relative to the saddle806.

With reference now toFIGS. 37-39, in one example, a multiplanar bone anchor system900can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system900can be similar to the multiplanar bone anchor system800described with reference toFIGS. 31-36, only the differences between the multiplanar bone anchor system800and the multiplanar bone anchor system900will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system900can include the bone fastener802, a multiplanar coupling arrangement or system904and a saddle906. The multiplanar bone anchor system900can define a longitudinal axis L2, and the multiplanar bone anchor system900can be configured such that the bone fastener902and the saddle906can move relative to the longitudinal axis L2in multiple planes (FIG. 39).

The multiplanar coupling system904can include a connecting arm916. The connecting arm916can be composed of any suitable biocompatible material, such as a biocompatible metal, metal alloy, ceramic or polymer. The connecting arm916can be disposed about the head810of the bone fastener802to allow relative movement between the bone fastener802and the saddle906. The connecting arm916can be sized to fit within the saddle906, and can also allow a portion of the saddle906to move or translate relative to another portion of the saddle906, as will be discussed in greater detail herein. The connecting arm916can include a first or upper portion920, the second or lower portion822and the bore824.

The upper portion920can be shaped to be received within a portion of the saddle906, and can be generally rectangular with rounded corners. In one example, the upper portion820can have opposite curved features821. The opposite curved features821can include the generally straight portion821a. As will be discussed in greater detail herein, the straight portion821acan cooperate with the saddle906to enable the saddle906to move or translate relative to the upper portion820of the connecting arm916. The upper portion920can include at least one friction surface926, the retention surface828and the rail829.

With reference toFIG. 37, the at least one friction surface926can be formed on opposite sides of the bore824. In one example, the at least one friction surface926can comprise a first vertical spring926aand a second vertical spring926b. It should be noted that although the at least one friction surface926is described and illustrated herein as comprising two vertical springs, the at least one friction surface926could comprise a single vertical spring, a frictional coating or other interference, which can control the movement of a portion of the saddle906relative to the connecting arm916and another portion of the saddle906, as will be discussed in greater detail herein. The first vertical spring926aand the second vertical spring926bcan be biased against the saddle906to enable the saddle906to be moved in a controlled fashion.

With reference toFIGS. 37-39, the saddle906can be coupled to the connecting arm916and can move or translate relative to the connecting arm916. In this regard, the saddle906can include the first portion or bottom portion840and a second portion or top portion942. The bottom portion840can be immovably coupled to the connecting arm916, and the top portion942can move or translate relative to the bottom portion840and the connecting arm916. When the top portion942moves relative to the connecting arm916, the biasing force from the friction element926can resist the movement of the top portion942, which can allow for controlled movement of the top portion942relative to the connecting arm916. This can enable the surgeon to place the top portion942in a selected position and the friction from the connecting arm916can allow the top portion942to remain in that selected position. The top portion942can be substantially U-shaped and symmetrical with respect to a longitudinal axis L2defined by the multiplanar bone anchor system900. The top portion942can include the first or proximal end860and a second or distal end944. The distal end944of the top portion942can be generally rectangular, and can include rounded corners to correspond with the shape of the bottom portion940. The distal end944can include the first or receiver surface88, the second or bottom surface872and the central bore876.

With reference toFIG. 34, in order to assemble the multiplanar bone anchor system900according to one exemplary method, the bone fastener802can be inserted through the bore824of the connecting arm916and passed through the retention surface828so that the bone fastener802is retained within and can articulate within the connecting arm916. Then, the connecting arm916can be inserted into the top portion842of the saddle906. Generally, the connecting arm916can be rotated about 90° around a main axis of the connecting arm916in order to insert the connecting arm916through the top portion942. The connecting arm916can be rotated back about 90° around the main axis until the curved features821and straight portions821aof the connecting arm916are engaged with the curved surface884and flat surface886of the top portion942. Alternatively, the bone fastener802can be inserted into the bore824of the connecting arm916after the connecting arm916is coupled to the saddle806.

Next, the bottom portion840can then be snap fit about the connecting arm916such that the grooves854a-854dof the bottom portion840engage the ribs836a-836dof the connecting arm916.

Once assembled, the connecting arm916can enable the bone fastener802to move or rotate within the bore824of the connecting arm916. With reference toFIG. 39, the connecting arm916can also allow the bone fastener802to move or angulate relative to the longitudinal axis L2of the multiplanar bone anchor system900. The preferred angle slot832of the connecting arm916can cooperate with the preferred angle slot850of the bottom portion840to enable the bone fastener802to move or articulate to the greater angle A. The top portion942of the saddle906can move or translate relative to the bottom portion840and connecting arm916to a selected position. The friction from the friction surface926of the connecting arm916can allow the top portion942to stay in the selected position once moved to the selected position. Thus, when assembled, the multiplanar bone anchor system900can have at least three degrees of movement or can be movable in at least three planes. For example, the bone fastener802can rotate about the longitudinal axis L2. The bone fastener802can also pivot relative to the longitudinal axis L2in at least a first direction and a second direction. The saddle806can translate relative to the longitudinal axis L2. By allowing the multiplanar bone anchor system900to move in at least three planes, the surgeon can manipulate the multiplanar bone anchor system900as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system900in a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system10in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system900will not be discussed in great detail herein. Briefly, however, once the multiplanar bone anchor system900is secured to the anatomy, the multiplanar coupling system904and the saddle906can be moved, pivoted or rotated relative to the bone fastener802into the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be inserted into a desired number of multiplanar bone anchor systems900.

With the connecting rod20positioned in the saddles906of the multiplanar bone anchor systems900, the set screw22can be coupled to each mating portion84of each saddle906. The coupling of the set screw22to the saddle906can apply a force to the head810of the bone fastener802to fixedly couple or lock the position of the bone fastener802relative to the saddle906.

With reference now toFIGS. 40 and 41, in one example, a multiplanar bone anchor system950can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system950can be similar to the multiplanar bone anchor system800described with reference toFIGS. 31-36, only the differences between the multiplanar bone anchor system800and the multiplanar bone anchor system950will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system950can include a bone fastener952, a multiplanar coupling arrangement or system954and a saddle956. The multiplanar bone anchor system950can define a longitudinal axis L3, and the multiplanar bone anchor system950can be configured such that the bone fastener952and the saddle956can move relative to the longitudinal axis L3in multiple planes. It should be noted that although the multiplanar bone anchor system950is described and illustrated herein as not including a lock ring, a lock ring could be employed with the multiplanar bone anchor system950, if desired.

The bone fastener952can be configured to engage the anatomy to couple the multiplanar bone anchor system900to the anatomy. The bone fastener952can be composed of any suitable biocompatible material, such as titanium, stainless steel, biocompatible metals, metal alloys, polymers, etc. The bone fastener952can include a proximal end or head960(FIG. 41) and the distal end or shank32. The head960can be substantially spherical, and can define a bearing surface962and the driver connection feature34.

The bearing surface962can be formed adjacent to the shank32of the bone fastener952. The bearing surface962can contact the multiplanar coupling system954to enable the bone fastener952to move or angulate relative to the longitudinal axis L3. The bearing surface962can also cooperate with the multiplanar coupling system954to enable the bone fastener952to move or rotate relative to the saddle956and can also allow the saddle956to move relative to the bone fastener952, as will be discussed in greater detail herein.

In one example, the multiplanar coupling system954can include a first pin966and a second pin968. The first pin966can be positioned substantially opposite the second pin968within the saddle956. The first pin966and the second pin968can define rails or guides for the saddle956to move relative to the bone fastener952, while also allowing the bone fastener952to freely rotate and articulate relative to the saddle956. The first pin966and the second pin968can also serve to couple the bone fastener952to the saddle956and retain the bone fastener952within the saddle956. The first pin966and the second pin968can be composed of any suitable biocompatible material, such as a biocompatible metal. Generally, the first pin966and the second pin968can be press-fit into the saddle956, and thus, the first pin966and the second pin968can have a diameter that is substantially equal or slightly larger than a diameter of a first pin bore970and a second pin bore972defined in the saddle956. Alternatively, the first pin966and the second pin968can be coupled to the saddle956through any suitable technique, such as welding, swaging, etc. In addition, it should be noted that although the multiplanar coupling system954is described and illustrated herein as including the first pin966and the second pin968, only one pin could be employed, if desired.

The saddle956can move or translate relative the bone fastener952along the first pin966and the second pin968. The saddle956can be substantially U-shaped and symmetrical with respect to the longitudinal axis L3defined by the multiplanar bone anchor system950(FIG. 40). The saddle956can include a first or proximal end974and a second or distal end976. In one example, the proximal end974can include a first arm978and a second arm980. The first arm978and second arm980can extend upwardly from the distal end976to define the U-shape. Each of the first arm978and the second arm980can include the mating portion84, a cavity982and the connector feature870.

The cavity982can be defined in each interior surface978a,980aof the first arm978and the second arm980. The cavity982can provide clearance for the movement or articulation of the saddle956relative to the bone fastener952. In this regard, the cavity982can be configured so as to allow the saddle956to move over the head960of the bone fastener952, which can provide a range of motion for the saddle956relative to the bone fastener952. Thus, contact between the head960of the bone fastener952and the cavity982can act as a stop to limit the movement or translation of the saddle956relative to the bone fastener952, however, other techniques could be used to stop or limit the movement or translation of the saddle956relative to the bone fastener952, such as features formed on the first pin966and/or the second pin968.

With reference toFIG. 40, the distal end976of the saddle956can be generally rectangular, and can include rounded corners. It should be noted that the shape of the distal end976of the saddle956does not have to be generally rectangular, but could be generally square, cylindrical, oval, etc. The distal end976can include the first or receiver surface88, a second or bottom surface984and a central bore986. The bottom surface984can include the first pin bore970and the second pin bore972. The first pin bore970and the second pin bore972can be defined on substantially opposite sides of the saddle956and can extend along an axis substantially transverse to the longitudinal axis L3. In one example, the first pin bore970and the second pin bore972can be defined to extend from a first side956aof the saddle956to a second side956bof the saddle956. The first pin bore970and the second pin bore972can have a diameter that can be substantially equal or less than the diameter of the first pin966and the second pin968to enable the first pin966and the second pin968to be press-fit into the saddle956, but allow the saddle956to move or translate relative to the bone fastener952on the first pin966and the second pin968. In one example, the first pin bore970and the second pin bore972can have an open periphery over a length of the first pin bore970. The open periphery of the first pin bore970and the second pin bore972can enable the bone fastener952to contact the first pin966and the second pin968to move about the first pin966and the second pin968, while allowing the first pin966and the second pin968to retain the bone fastener952within the saddle956.

The central bore986can be defined through the distal end976from the receiver surface88to the bottom surface984. Generally, the central bore986can be sized to receive the bone fastener952and to allow the bone fastener952to move, rotate or articulate about the central bore986.

With continued reference toFIGS. 40 and 41, in order to assemble the multiplanar bone anchor system950according to one exemplary method, the bone fastener952can be inserted through the central bore986of the saddle956. Then, the first pin966and the second pin968can be pressed into the first pin bore970and the second pin bore972to retain the bone fastener952within the saddle956. The first pin966and the second pin968can allow the bone fastener952to move, rotate and articulate about the longitudinal axis L3, and can allow the saddle956to move or translate relative to the bone fastener952. Thus, when assembled, the multiplanar bone anchor system950can have at least three degrees of movement or can be movable in at least three planes. For example, the bone fastener952can rotate about the longitudinal axis L3. The bone fastener952can also pivot relative to the longitudinal axis L3in at least a first direction and a second direction. The saddle956can translate relative to the longitudinal axis L3. By allowing the multiplanar bone anchor system950to move in at least three planes, the surgeon can manipulate the multiplanar bone anchor system950as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system950in a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system10in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system950will not be discussed in great detail herein. Briefly, however, once the bone fastener952is secured to the anatomy, the saddle956can be moved, pivoted or rotated relative to the bone fastener952into the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be inserted into a desired number of multiplanar bone anchor systems950.

With the connecting rod20positioned in the saddles956of the multiplanar bone anchor systems950, the set screw22can be coupled to each mating portion84of each saddle956. The coupling of the set screw22to the saddle956can apply a force to the head960of the bone fastener952to fixedly couple or lock the position of the bone fastener952relative to the saddle956.

With reference now toFIGS. 42-45, in one example, a multiplanar bone anchor system1000can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system1000can be similar to the multiplanar bone anchor system10described with reference toFIGS. 1-8, only the differences between the multiplanar bone anchor system10and the multiplanar bone anchor system1000will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system1000can include a bone fastener1002, a lock ring1004and a saddle1006. The multiplanar bone anchor system1000can define a longitudinal axis L4, and the multiplanar bone anchor system1000can be configured such that the bone fastener1002and the saddle1006can move relative to the longitudinal axis L4in multiple planes.

With continued reference toFIGS. 42-45, the bone fastener1002can be configured to engage the anatomy to couple the multiplanar bone anchor system1000to the anatomy. The bone fastener1002can be composed of any suitable biocompatible material, such as titanium, stainless steel, biocompatible polymers, etc. The bone fastener1002can include a proximal end or head1008(FIGS. 44 and 45) and the distal end or shank32(FIG. 45). With reference toFIGS. 43-45, the head1008can be generally spherical, and can include the driver connection feature34.

With reference toFIGS. 43-45, the lock ring1004can be positioned about the head1008of the bone fastener1002and coupled to the saddle1006. The lock ring1004can lock the bone fastener1002relative to the saddle1006via a force applied by the connecting rod20. With reference toFIG. 43, the lock ring1004can be generally cylindrical, and can have a height H1. The height H1can be sized to extend above the receiver surface88of the saddle1006, as illustrated inFIG. 42, so that coupling the connecting rod20to the saddle1006can compress the lock ring1004onto the head1008of the bone fastener1002. With reference toFIGS. 43-45, the lock ring1004can include a proximal end1010, a distal end1012, a bearing surface1014and a bore1016.

With reference toFIG. 43, the proximal end1010can include one or more projections or teeth1018. The teeth1018can be formed along a proximalmost surface1010aof the proximal end1010. The teeth1018can engage the connecting rod20to assist in coupling the connecting rod20to the saddle1006. The distal end1012can include at least one tab1020. In one example, with reference toFIG. 45, the at least one tab1020can comprise two tabs1020a,1020b. The tabs1020a,1020bcan extend from the distal end1012and can be spaced about 180° apart from each other about a circumference of the lock ring1004. The tabs1020a,1020bcan include a locking tab1021, which can engage a portion of the saddle1006to couple the lock ring1004to the saddle1006. The tabs1020a,1020bcan also couple a portion of the saddle1006to another portion of the saddle1006.

The bearing surface1014can be formed adjacent to the distal end1012of the lock ring1004along a portion of the bore1016. In one example, the bearing surface1014can comprise an arcuate ring defined about the bore1016, which is configured to enable the head1008of the bone fastener1002to move, rotate and articulate relative to the lock ring1004.

With reference toFIGS. 43-45, the bore1016can be disposed about a central axis of the lock ring1004. The bore1016can extend from the proximal end1010to the distal end1012. The bearing surface1014can be formed about the bore1016. The bore1016can enable a driver to interface with the driver connection feature34formed on the head1008of the bone fastener1002.

With reference toFIGS. 42-45, the saddle1006can include a first portion or bottom portion1022and a second portion or top portion1024. The top portion1024can move or translate relative to the bottom portion1022. With reference toFIG. 43, the bottom portion1022can include a first or proximal end1026, a second or distal end1028and a bore1030.

The proximal end1026can be generally rectangular, and can include rounded corners. The proximal end1026can be coupled to the top portion1024(FIG. 42). The proximal end1026can define at least one rail1032. Generally, the top portion1024can move or translate along the at least one rail1032. In one example, the proximal end1026can define two rails1032a,1032b, which can be positioned on opposite sides of the bore1030. As will be discussed, the lock ring1004can define or limit the translation of the top portion1024relative to the bottom portion1022.

With reference toFIGS. 44 and 45, the distal end1028can include a preferred angle slot1034. The preferred angle slot1034can be formed through at least one side of the distal end1028and can be in communication with the bore1030. The preferred angle slot1034can be defined through the bottom portion1022at any desired location. With reference toFIG. 44, the preferred angle slot1034can enable the bone fastener1002to articulate to a greater angle A2relative to the longitudinal axis L4. In this regard, the bone fastener1002can articulate to an angle A3relative to the longitudinal axis L4in an area of the bottom portion1022that does not include the preferred angle slot1034. The angle A3can be less than the greater angle A2. Alternatively, the distal end1028could be devoid of the preferred angle slot, if desired.

With reference toFIG. 45, the bore1030can be defined through the bottom portion1022from the proximal end1026to the distal end1028. The bore1030can be sized to receive the lock ring1004and the bone fastener1002therein. The bore1030can include a bearing surface1036and at least one groove1038. The bearing surface1036can be configured to contact the head1008of the bone fastener1002to enable the bone fastener1002to move, rotate or articulate relative to the bottom portion1022. Thus, the bearing surface1036can be generally arcuate. The at least one groove1038can be formed in a sidewall of the bore1030, and can mate with the at least one tab1020. In one example, the at least one groove1038can comprise two grooves1038a,1038b. The grooves1038a,1038bcan be spaced about 180° apart from each other about a circumference of the bore1030. A respective one of the tabs1020a,1020bcan engage a respective one of the grooves1038a,1038bto secure the lock ring1004to the saddle1006, and to secure the bottom portion1022to the top portion1024.

With reference toFIG. 42, the top portion1024of the saddle1006can be coupled to the at least one rail1032of the proximal end1026of the bottom portion1022so that the top portion1024can move relative to the bottom portion1022. The top portion1024can be substantially U-shaped and symmetrical with respect to a longitudinal axis L4defined by the multiplanar bone anchor system1000. With reference toFIG. 43, the top portion1024can include a first or proximal end1040and a second or distal end1042. In one example, the proximal end1040can include a first arm1044and a second arm1046. The first arm1044and second arm1046can extend upwardly from the distal end1042to define the U-shape. Each of the first arm1044and the second arm1046can include the mating portion84.

With reference toFIG. 43, the distal end1042of the top portion1024can be generally rectangular, and can include the receiver surface88, at least one guide1050, an assembly slot1052, an assembly aperture1054and a central bore1056. It should be noted that the shape of the distal end1042does not have to be generally rectangular, but could be generally square, cylindrical, oval, etc. The at least one guide1050can cooperate with the at least one rail1032to enable the top portion1024to move relative to the bottom portion1022. In one example, the at least one guide1050can comprise two guides1050a,1050b. The guides1050a,1050bcan allow the top portion1024to move along the rails1032a,1032bto enable the top portion1024to move or translate relative to the bottom portion1022. It should be noted that while the guides1050a,1050band the rails1032a,1032bare illustrated herein as comprising a dovetail arrangement (FIG. 42), any type of arrangement can be used to enable the top portion1024to move relative to the bottom portion1022.

With reference toFIG. 44, the assembly slot1052can be defined from the assembly aperture1054to an opposite side1024aof the top portion1024. The assembly slot1052can be sized to enable the top portion1024to pass over the bottom portion1022to couple the top portion1024to the bottom portion1022, as will be discussed herein. It should be noted that although one assembly slot1052is described and illustrated herein, more than one assembly slot1052could be defined in the distal end1042.

The assembly aperture1054can be defined through a sidewall1024bof the top portion1024. The assembly aperture1054can have a width, which can be less than a width of the assembly slot1052. Generally, the width of the assembly aperture1054can be sized to enable the top portion1024to pass over the head1008of the bone fastener1002, but can contact the lock ring1004when the lock ring1004is assembled within the saddle1006to prevent the disassembly of the top portion1024and the bottom portion1022. As will be discussed, the assembly aperture1054can cooperate with the assembly slot1052to enable the top portion1024to be coupled to the bottom portion1022.

The central bore1056can be defined through the distal end1042from the receiver surface88to the guides1050a,1050b. Generally, the central bore1056can be sized to receive the bone fastener1002and the tabs1020a,1020bof the lock ring1004.

With reference toFIGS. 42-45, in order to assemble the multiplanar bone anchor system1000according to one exemplary method, the bone fastener1002can be inserted through the bore1030of the bottom portion1022of the saddle1006. Initially, the bone fastener1002can rest within a pocket defined by the bearing surface1036of the bore1030(FIG. 44). Then, the lock ring1004can be inserted into the central bore1056of the top portion1024of the saddle1006and can be pushed into the central bore1056from the distal end1042. With the lock ring1004positioned within the top portion1024, the top portion1024can be slid onto the bottom portion1022with the rails1032a,1032bengaging the grooves1050a,1050b. In one example, the top portion1024can be slid onto the bottom portion1022in the direction of the assembly slot1052such that the assembly slot1052contacts the bottom portion1022first. The assembly slot1052can be sized to enable the top portion1024to pass over the head1008of the bone fastener1002. Once the top portion1024is assembled onto the bottom portion1022, the lock ring1004can be pushed down until the tabs1020a,1020bof the lock ring1004engage the grooves1050a,1050bof the bottom portion1022(FIG. 45).

When assembled, the multiplanar bone anchor system1000can have at least three degrees of movement or can be movable in at least three planes. In this regard, the bone fastener1002can move or rotate about the longitudinal axis L4and can also move or articulate relative to the longitudinal axis L4. The top portion1024can move or translate relative to the bottom portion1022in a direction transverse to the longitudinal axis L4. By allowing the multiplanar bone anchor system1000to move in at least three planes, the surgeon can manipulate the multiplanar bone anchor system1000as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system1000in a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system10in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system1000will not be discussed in great detail herein. Briefly, however, once the bone fastener1002is secured to the anatomy, the saddle1006can be moved, pivoted or rotated relative to the bone fastener1002into the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be inserted into a desired number of multiplanar bone anchor systems1000.

With the connecting rod20positioned in the saddles1006of the multiplanar bone anchor systems1000, the set screw22can be coupled to each mating portion84of each saddle1006. The coupling of the set screw22to the saddle1006can apply a force to the head1008of the bone fastener1002to fixedly couple or lock the position of the bone fastener1002relative to the saddle1006.

With reference now toFIGS. 46-49, in one example, a multiplanar bone anchor system1100can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system1100can be similar to the multiplanar bone anchor system10described with reference toFIGS. 1-8, only the differences between the multiplanar bone anchor system10and the multiplanar bone anchor system1100will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system1100can include a bone fastener1102, a lock ring1104, a multiplanar coupling arrangement or system1106and a saddle1108. The multiplanar bone anchor system1100can define a longitudinal axis L5, and the multiplanar bone anchor system1100can be configured such that the bone fastener1102and the saddle1108can move relative to the longitudinal axis L5in multiple planes.

With reference toFIGS. 46 and 47, the bone fastener1102can be configured to engage the anatomy to couple the multiplanar bone anchor system1100to the anatomy. The bone fastener1102can be composed of any suitable biocompatible material, such as titanium, stainless steel, biocompatible polymers, etc. The bone fastener1102can include a proximal end or head1110(FIG. 47) and the distal end or shank32(FIG. 46). With reference toFIG. 47, the head1110can be generally spherical, and can include the driver connection feature34.

With reference toFIGS. 47-49, the lock ring1104can be positioned about the head1110of the bone fastener1102. As will be discussed herein, the lock ring1104can lock at least one of the bone fastener1102and the multiplanar coupling system1106relative to the saddle1108via a force applied by the connecting rod20. The lock ring1104can be generally cylindrical, and can have a height H4. The height H4can be sized to extend above the receiver surface88of the saddle1108so that coupling the connecting rod20to the saddle1108can compress the lock ring1104onto the head1110of the bone fastener1102(FIG. 46). With reference toFIG. 47, the lock ring1104can include a proximal end1112, a distal end1114and a bore1116.

The proximal end1112can bear against the connecting rod20when the connecting rod20is coupled to the saddle1108. The proximal end1112can include a slot1118and a plurality of teeth1119. The slot1118can enable a tool to engage the lock ring1104to move the lock ring1104within the saddle1108. As will be discussed, the movement of the lock ring1104within the saddle1108can enable the user to select a position for the bone fastener1102to articulate to a greater angle. The teeth1119can engage or bite into the connecting rod20to assist in coupling the connecting rod20to the saddle1108.

The distal end1114can include a collar1120and a preferred tab1122. The collar1120can extend about a circumference of the lock ring1104and can contact a portion of the saddle1108to assist in coupling the portion of the saddle1108to the connecting arm1130. As illustrated inFIG. 49, the preferred tab1122can be keyed to mate with a preferred slot1124defined in a connecting arm1130. The engagement of the preferred tab1122with the preferred slot1124can enable the lock ring1104to move in concert with the connecting arm1130. The coordinated movement of the lock ring1104and the connecting arm1130can allow the user to move the lock ring1104to adjust a position of a preferred angle slot1126defined in the connecting arm1130, as will be discussed herein.

With reference toFIG. 49, the bore1116can be defined from the proximal end1112to the distal end1114. The bore1116can enable an instrument to engage the driver connection feature34when the multiplanar bone anchor system1100is assembled. It should be noted that the use of the driver connection feature34is merely exemplary, as a tool could engage the lock ring1104couple the bone fastener1102to the anatomy. The bore1116can include a bearing surface1128. The bearing surface1128can generally be formed adjacent to the distal end1114. The bearing surface1128can be arcuate and generally concave to slidably engage the spherical head1110of the bone fastener1102. The bearing surface1128can also enable the lock ring1104to move or articulate relative to the multiplanar coupling system1106, as will be discussed herein.

In one example, with reference toFIG. 47, the multiplanar coupling system1106can include a connecting arm1130. The connecting arm1130can be disposed about a head1110of the bone fastener1102to enable the bone fastener1102to move or articulate relative to the saddle1108, as shown inFIG. 48. The connecting arm1130can be annular, and can be sized to receive a portion of the saddle1108and the lock ring1104. With reference toFIGS. 47 and 49, the connecting arm1130can include the preferred slot1124(FIG. 49), the preferred angle slot1126and a bore1132.

With reference toFIG. 49, the preferred slot1124can be defined near the preferred angle slot1126. The preferred slot1124can be configured to receive the preferred tab1122to enable the operator to control the location of the preferred angle slot1126. The preferred angle slot1126can enable the bone fastener1102to articulate to a greater angle A4relative to the longitudinal axis L5. In one example, the preferred angle slot1126can comprise a cut-out in a portion of the connecting arm1130, which can be in communication with the bore1132to enable the bone fastener1102to articulate to the greater angle A4. In this regard, the bone fastener1102can articulate to an angle A5relative to the longitudinal axis L5in an area of the connecting arm1130that does not include the preferred angle slot1126. The angle A5can be less than the greater angle A4.

With reference toFIG. 48, the bore1132can have a first portion1134and a second portion1136. The first portion1134can include a lip1138and a recess1140for coupling a portion of the saddle1108to the connecting arm1130. The lip1138can be formed adjacent to a proximalmost end1130aof the connecting arm1130. The lip1138can cooperate with a portion of the saddle1108to couple the saddle1108to the connecting arm1130. The recess1140can be sized to receive a portion of the saddle1108, a portion of the lock ring1104and the head1110of the bone fastener1102.

The second portion1136of the bore1132can be sized to receive the head1110of the bone fastener1102. The second portion1136can include a bearing surface1136a. The bearing surface1136acan contact the head1110of the bone fastener1102to enable the bone fastener1102to move, rotate or articulate relative to the connecting arm1130.

With reference toFIG. 47, the saddle1108can include a first portion or bottom portion1142and a second portion or top portion1144. The top portion1144can move or translate relative to the bottom portion1142. The bottom portion1142can include a first or proximal end1146, a second or distal end1148and a bore1150. The bore1150can be defined through the bottom portion1142. The bore1150can be sized to receive the lock ring1104therein (FIG. 48).

The proximal end1146can define at least one rail1152. In one example, the proximal end1146can include two rails1152a,1152b, which can be positioned on substantially opposite sides of the bottom portion1142. Generally, the top portion1144can move or translate along the rails1152a,1152b.

The distal end1148can include at least one locking tab1154. In one example, the distal end1148can include four locking tabs1154a-1154d, which can be spaced about a circumference of the bottom portion1142. The locking tabs1154a-1154dcan include an edge1156, which can engage the lip1138of the connecting arm1130to couple the bottom portion1142to the connecting arm1130(FIGS. 48 and 49).

With reference toFIGS. 47 and 48, the top portion1144of the saddle1108can be coupled to the rails1152a,1152bof the proximal end1146of the bottom portion1142so that the top portion1144can move relative to the bottom portion1142. The top portion1144can be substantially U-shaped and symmetrical with respect to a longitudinal axis L5defined by the multiplanar bone anchor system1100(FIG. 46). The top portion1144can include the first or proximal end76and a second or distal end1160.

With reference toFIG. 47, the distal end1160of the top portion1144can be generally rectangular, and can include the first or a receiver surface88, a second or bottom surface1162and a central bore1164. It should be noted that the shape of the distal end1160does not have to be generally rectangular, but could be generally square, cylindrical, oval, etc. The central bore1164can be defined through the distal end1160from the receiver surface88to the bottom surface1162. Generally, the central bore1164can be sized to receive the lock ring1104(FIG. 48).

With reference toFIGS. 47 and 48, the bottom surface1162can include at least one or more guides1166. In this example, the bottom surface1162can include two guides1166a,1166b. The guides1166a,1166bcan slidably couple the top portion1144to the bottom portion1142. In this regard, each guides1166a,1166bcan cooperate with a respective one of the rails1152a,1152bto enable the top portion1144of the saddle1108to move or translate relative to the bottom portion1142of the saddle1108. Generally, the guides1166a,1166bcan cooperate with the rails1152a,1152bto create a dovetail relationship. It should be understood, however, that any suitable relationship or technique could be used to enable the top portion1144to move or translate relative to the bottom portion1142.

In addition, it should be noted that the lock ring1104can define or limit the translation of the top portion1144relative to the bottom portion1142. In this regard, with reference toFIG. 49, the cavity86can be defined in each interior surface80b,82bof the first arm80and second arm82of the top portion1144of the saddle1108. The cavity86can provide clearance for the movement or articulation of the top portion1144relative to the bottom portion1142of the saddle1108. Generally, the cavity86can be defined so as to allow the top portion1144to move over a portion of the lock ring1104, which can provide a range of motion for the top portion1144relative to the bottom portion1142. Thus, contact between the lock ring1104and the cavity86can act as a stop to limit the movement or translation of the top portion1144relative to the bottom portion1142, however, other techniques could be used to stop or limit the movement or translation of the top portion1144relative to the bottom portion1142.

With reference toFIG. 47, in order to assemble the multiplanar bone anchor system1100according to one exemplary method, the bone fastener1102can be inserted through the bore1132of the connecting arm1130. Then, the bottom portion1142of the saddle1108can be snap-fit into the connecting arm1130with the lock ring1104inserted into the bottom portion1142and positioned such that the preferred tab1122engages the preferred slot1124of the connecting arm1130so that the edge1156of the locking tabs1154a-1154dengage the lip1138of the connecting arm1130(FIG. 48). The guides1162a,1162bof the top portion1144can be slid onto the rails1152a,1152bof the bottom portion1142to couple the top portion1144to the bottom portion1142.

When assembled, the multiplanar bone anchor system1100can have at least three degrees of movement or can be movable in at least three planes. In this regard, the bone fastener1102can move or rotate about the longitudinal axis L5and can also move or articulate relative to the longitudinal axis L5. The top portion1144can move or translate relative to the bottom portion1142in a direction transverse to the longitudinal axis L5. By allowing the multiplanar bone anchor system1100to move in at least three planes, the surgeon can manipulate the multiplanar bone anchor system1100as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system1100in a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system10in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system1100will not be discussed in great detail herein. Briefly, however, once the bone fastener1102is secured to the anatomy, the saddle1108can be moved, pivoted or rotated relative to the bone fastener1102into the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be inserted into a desired number of multiplanar bone anchor systems1100.

With the connecting rod20positioned in the saddles1108of the multiplanar bone anchor systems1100, the set screw22can be coupled to each mating portion84of each saddle1108. The coupling of the set screw22to the saddle1108can apply a force to the lock ring1104to fixedly couple or lock the position of the bone fastener1102relative to the saddle1108.

With reference now toFIGS. 50-53, in one example, a multiplanar bone anchor system1200can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system1200can be similar to the multiplanar bone anchor system1100described with reference toFIGS. 46-49, only the differences between the multiplanar bone anchor system1100and the multiplanar bone anchor system1200will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system1200can include the bone fastener1102, a lock ring1204, a multiplanar coupling arrangement or system1206and a saddle1208. The multiplanar bone anchor system1200can define a longitudinal axis L6, and the multiplanar bone anchor system1200can be configured such that the bone fastener1102and the saddle1208can move relative to the longitudinal axis L6in multiple planes.

With reference toFIGS. 51-53, the lock ring1204can be positioned about the head1110of the bone fastener1102. As will be discussed herein, the lock ring1204can lock at least one of the bone fastener1102and the multiplanar coupling system1206relative to the saddle1208via a force applied by the connecting rod20. The lock ring1204can be generally cylindrical, and can have a height H6. The height H6can be sized to extend above the receiver surface88of the saddle1208so that coupling the connecting rod20to the saddle1208can compress the lock ring1204onto the head1110of the bone fastener1102. With reference toFIG. 51, the lock ring1204can include a proximal end1205, the distal end1114and the bore1116. The proximal end1205can bear against the connecting rod20when the connecting rod20is coupled to the saddle1208. The proximal end1205can include the slot1118. Although not illustrated herein, the lock ring1204can include teeth formed along the proximal end1205, if desired.

In one example, the multiplanar coupling system1206can include a connecting arm1210. The connecting arm1210can be disposed about the head1110of the bone fastener1102to enable the bone fastener1102to move or articulate relative to the saddle1208. The connecting arm1210can be annular, and can be sized to receive a portion of the saddle1208and the lock ring1104(FIG. 52). With reference toFIG. 51, the connecting arm1210can include the preferred slot1124, the preferred angle slot1126and a bore1212.

With reference toFIG. 52, the bore1212can have a first portion1214and the second portion1136. The first portion1214can include a plurality of threads1216and a recess1217for coupling a portion of the saddle1208to the connecting arm1210. The threads1216can be formed adjacent to a proximalmost end1210aof the connecting arm1210and can extend about a circumference of the connecting arm1210. The threads1216can cooperate with a portion of the saddle1208to couple the saddle1208to the connecting arm1210.

With reference toFIGS. 51-53, the saddle1208can include a first portion or bottom portion1218and the second portion or top portion1144. The top portion1144can move or translate relative to the bottom portion1218. With reference toFIG. 51, the bottom portion1218can include the first or proximal end1146, a second or distal end1220and the bore1150.

The distal end1220can include a plurality of threads1222formed about an exterior of the bottom portion1218. The plurality of threads1222can extend from the proximal end1146to the distal end1220and can engage the threads1216of the connecting arm1210to couple the bottom portion1218to the connecting arm1210, as illustrated inFIGS. 52 and 53.

With reference toFIG. 51, in order to assemble the multiplanar bone anchor system1200according to one exemplary method, the bone fastener1102can be inserted through the bore1132of the connecting arm1210. Then, the threads1222of the bottom portion1218of the saddle1208can be threaded into the threads1216of the connecting arm1210to couple the bottom portion1218to the connecting arm1210with the lock ring1204assembled to the bottom portion1218and the preferred tab1122aligned with the preferred slot1124of the connecting arm1210(FIG. 52). The guides1162a,1162bof the top portion1144can be slid onto the rails1152a,1152bof the bottom portion1218to couple the top portion1144to the bottom portion1218(FIG. 53).

When assembled, the multiplanar bone anchor system1200can have at least three degrees of movement or can be movable in at least three planes. In this regard, the bone fastener1102can move or rotate about the longitudinal axis L6and can also move or articulate relative to the longitudinal axis L6. The top portion1144can move or translate relative to the bottom portion1218in a direction transverse to the longitudinal axis L6. By allowing the multiplanar bone anchor system1200to move in at least three planes, the surgeon can manipulate the multiplanar bone anchor system1200as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system1200in a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system1100in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system1200will not be discussed in great detail herein. Briefly, however, once the bone fastener1102is secured to the anatomy, the saddle1208can be moved, pivoted or rotated relative to the bone fastener1102into the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be inserted into a desired number of multiplanar bone anchor systems1200.

With the connecting rod20positioned in the saddles1208of the multiplanar bone anchor systems1200, the set screw22can be coupled to each mating portion84of each saddle1208. The coupling of the set screw22to the saddle1208can apply a force to the lock ring1104to fixedly couple or lock the position of the bone fastener1102relative to the saddle1208.

With reference now toFIGS. 54-57, in one example, a multiplanar bone anchor system1300can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system1300can be similar to the multiplanar bone anchor system1100described with reference toFIGS. 46-49, only the differences between the multiplanar bone anchor system1100and the multiplanar bone anchor system1300will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system1300can include the bone fastener1102, a lock ring1304, a multiplanar coupling arrangement or system1306, a saddle1308and a coupling device1310. The multiplanar bone anchor system1300can define a longitudinal axis L7, and the multiplanar bone anchor system1300can be configured such that the bone fastener1102and the saddle1308can move relative to the longitudinal axis L7in multiple planes.

With reference toFIGS. 55-57, the lock ring1304can be positioned about the head1110of the bone fastener1102. As will be discussed herein, the lock ring1304can lock at least one of the bone fastener1302and the multiplanar coupling system1306relative to the saddle1308via a force applied by the connecting rod20. The lock ring1304can be generally cylindrical, and can have a height H6. The height H6can be sized to extend above the receiver surface88of the saddle1308so that coupling the connecting rod20to the saddle1308can compress the lock ring1304onto the head1110of the bone fastener1102(FIG. 54). With reference toFIG. 55, the lock ring1304can include a proximal end1311, a distal end1312and the bore1116.

The proximal end1311can bear against the connecting rod20when the connecting rod20is coupled to the saddle1308. The proximal end1311can include a plurality of teeth1311a. The teeth1311acan engage or bite into the connecting rod20to assist in coupling the connecting rod20to the saddle1308. It should be noted, that the teeth1311aare optional.

The distal end1312can include a collar1314. The collar1314can extend about a circumference of the lock ring1304and can be positioned a distance above a distalmost surface1304aof the lock ring1304. The collar1314can be in contact with the connecting arm1316and a portion of the saddle1308. The collar1314can include at least one flat surface1315.

The at least one flat surface1315can contact the connecting arm1316to assist in coupling the lock ring1304to the connecting arm1316. In one example the at least one flat surface1315can comprise three flat surfaces1315a-1315c, which can be spaced about a perimeter of the collar1314of the lock ring1304. The flat surfaces1315a-1315ccan cooperate with the connecting arm1316to enable the user to manipulate the lock ring1304and the connecting arm1316to select a preferred angle, as will be described further herein. It should be noted that although not illustrated herein, the lock ring1304could include the preferred angle tab to mate with a preferred angle slot as described with regard to the multiplanar bone anchor system1100.

With reference toFIGS. 55-57, the multiplanar coupling system1306can include a connecting arm1316. The connecting arm1316can be disposed about the head1110of the bone fastener1102to enable the bone fastener1102to move or articulate relative to the saddle1308. The connecting arm1316can be annular, and can be sized to receive a portion of the saddle1308and the lock ring1304. With reference toFIG. 55, the connecting arm1316can include a bore1318and an annular recess1320. The annular recess1320can receive a portion of the saddle1308and the coupling device1310to couple the portion of the saddle1308to the connecting arm1316.

The bore1318can have a counterbored portion1322and a bearing surface1324. The counterbored portion1322can be formed near a proximalmost end1316aof the connecting arm1316. The counterbored portion1322can receive the collar1314of the lock ring1304. The counterbored portion1322can include at least one flat surface1323. In one example, the counterbored portion1322can include three flat surfaces1323a-1323c, which can cooperate with the flat surfaces1315a-1315cof the lock ring1304to couple the lock ring1304to the connecting arm1316. The bearing surface1324can contact the head1110of the bone fastener1102to enable the bone fastener1102to move, rotate or articulate relative to the connecting arm1316.

With reference toFIGS. 54-57, the saddle1308can include a first portion or bottom portion1326and a second portion or top portion1144. The top portion1144can move or translate relative to the bottom portion1326. With reference toFIG. 55, the bottom portion1326can include the first or proximal end1146, a second or distal end1328and a bore1330.

The distal end1328can include at least one coupling bore1332and a coupling recess1334. In one example, the at least one coupling bore1332can comprise two coupling bores1332a,1332b, as best illustrated inFIG. 57. The coupling bores1332a,1332bcan receive the coupling device1310to couple the connecting arm1316to the bottom portion1326. The coupling bores1332a,1332bcan be positioned substantially opposite each other, and can generally extend in a direction transverse to the longitudinal axis L7. A portion of each of the coupling bores1332a,1332bcan be defined by the annular recess1320of the connecting arm1316. With reference toFIGS. 55 and 56, the coupling recess1334can be formed through a portion of the distal end1328and can be generally elongate. The coupling recess1334can be positioned between the coupling bores1332a,1332b. The coupling recess1334can receive a portion of the coupling device1310to enable the coupling device1310to be substantially flush with a surface of the bottom portion1326(FIG. 54).

The bore1330can be defined through the bottom portion1326. The bore1330can be sized to receive a portion of the lock ring1304and the connecting arm1316therein (FIG. 56). The bore1330can have a first diameter at the proximal end1146and second diameter at a distal end1328. The diameter can be sized to receive the lock ring1304therethrough, while the diameter can be sized to receive the bone fastener1102, the lock ring1304and the connecting arm1316.

With reference toFIG. 55, the coupling device1310can be received through the coupling bores1332a,1332band the coupling recess1334. In one example, the coupling device1310can comprise a clip, such as a Dutchman clip, however, any suitable device or technique could be used to couple the connecting arm1316to the bottom portion1326, such as pins, adhesives, mechanical fasteners, etc. The coupling device1310can be substantially U-shaped, with a first arm1336and an opposed second arm1338. The first arm1336can be coupled to the second arm1338via a body1340. The first arm1336and the second arm1338can include a flange at a distalmost end, if desired, which can engage a portion of the bottom portion1326to further secure the coupling device1310within the bottom portion1326of the saddle1308. The first arm1336and the second arm1338can each be received through a respective one of the coupling bores1332a,1332buntil the body1340is received within and in contact with the coupling recess1334(FIG. 54).

With reference toFIG. 55, in order to assemble the multiplanar bone anchor system1300according to one exemplary method, the bone fastener1102can be inserted through the bore1318of the connecting arm1316. Then, the bottom portion1326of the saddle1308can be positioned over the connecting arm1316with the lock ring1304positioned over the head1110of the bone fastener1102such that the connecting arm1316is received within the bore1330of the bottom portion1326. The guides1162a,1162bof the top portion1144can be slid onto the rails1152a,1152bof the bottom portion1326to couple the top portion1144to the bottom portion1326. Next, the coupling device1310can be inserted through the coupling bores1332a,1332buntil the body1340of the coupling device1310is received within the coupling recess1334(FIG. 54).

When assembled, the multiplanar bone anchor system1300can have at least three degrees of movement or can be movable in at least three planes. In this regard, the bone fastener1102can move or rotate about the longitudinal axis L7and can also move or articulate relative to the longitudinal axis L7. The top portion1144can move or translate relative to the bottom portion1326in a direction transverse to the longitudinal axis L7. By allowing the multiplanar bone anchor system1300to move in at least three planes, the surgeon can manipulate the multiplanar bone anchor system1300as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system1300in a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system10in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system1300will not be discussed in great detail herein. Briefly, however, once the bone fastener1102is secured to the anatomy, the saddle1308can be moved, pivoted or rotated relative to the bone fastener1102into the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be inserted into a desired number of multiplanar bone anchor systems1300.

With the connecting rod20positioned in the saddles1308of the multiplanar bone anchor systems1300, the set screw22can be coupled to each mating portion84of each saddle1308. The coupling of the set screw22to the saddle1308can apply a force to the lock ring1304to fixedly couple or lock the position of the bone fastener1102relative to the saddle1308.

With reference now toFIGS. 58-63, in one example, a multiplanar bone anchor system1400can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system1400can be similar to the multiplanar bone anchor system1100described with reference toFIGS. 46-49, only the differences between the multiplanar bone anchor system1100and the multiplanar bone anchor system1400will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system1400can include the bone fastener1102, a lock ring1404, a multiplanar coupling arrangement or system1406and a saddle1408. The multiplanar bone anchor system1400can define a longitudinal axis L8, and the multiplanar bone anchor system1400can be configured such that the bone fastener1102and the saddle1408can move relative to the longitudinal axis L8in multiple planes (FIG. 58).

With reference toFIGS. 59-61, the lock ring1404can be positioned about the head1110of the bone fastener1102. As will be discussed herein, the lock ring1404can lock at least one of the bone fastener1102and the multiplanar coupling system1406relative to the saddle1408via a force applied by the connecting rod20. The lock ring1404can be generally cylindrical, and can have a height H8. The height H8can be sized to extend above the receiver surface88of the saddle1408so that coupling the connecting rod20to the saddle1408can compress the lock ring1404onto the head1110of the bone fastener1102(FIG. 58). The lock ring1404can contact a portion of the saddle1408to limit the motion of the saddle1408, as will be discussed in greater detail herein. With reference toFIG. 59, the lock ring1404can include a proximal end1412, a distal end1414, a slot1416, at least one wing1418and a bore1420.

The proximal end1412can bear against the connecting rod20when the connecting rod20is coupled to the saddle1408. The distal end1414can be adjacent to and in contact with the head1110of the bone fastener1102. The slot1416can extend from the proximal end1412to the distal end1414. The slot1416can enable the lock ring1404to flex. The at least one wing1418can engage a portion of the saddle1408. In one example, the at least one wing1418can comprise two wings1418a,1418b. The wings1418a,1418bcan be positioned about 180° apart about the circumference of the lock ring1404. Each of the wings1418a,1418bcan include a base1422and an arm1424. The base1422can couple the arm1424to the lock ring1404. The base1422can be coupled between the proximal end1412and the distal end1414, and the arm1424can extend from the base1422so as to be at or below a plane defined by the distal end1414. The arm1424can have a flat portion1424aopposite a curved portion1424b.

The flat portion1424acan aid in keeping the wings1418a,1418bin contact with the connecting arm1430and within a portion of the saddle1408, as illustrated inFIG. 61. With reference toFIG. 62, the curved portion1424bcan enable the lock ring1404to move or articulate relative the connecting arm1430and the saddle1408, which can thereby allow the bone fastener1102to move or articulate relative the connecting arm1430and the saddle1408, as will be discussed further herein.

With reference toFIG. 59, the bore1420can be defined from the proximal end1412to the distal end1414. The bore1420can enable an instrument to engage the driver connection feature34when the multiplanar bone anchor system1400is assembled. The bore1420can include a bearing surface1426. The bearing surface1426can generally be formed adjacent to the distal end1414. The bearing surface1426can be arcuate and generally concave to slidably engage the spherical head1110of the bone fastener1102(FIG. 61).

In one example, with reference toFIG. 59, the multiplanar coupling system1406can include a connecting arm1430. The connecting arm1430can be disposed about the head1110of the bone fastener1102to enable the bone fastener1102to move or articulate relative to the saddle1408, as shown inFIG. 63. The connecting arm1430can be annular, and can be sized to be received within a portion of the saddle1408. With reference toFIG. 59, the connecting arm1430can include at least one pocket1432and a bore1434.

The at least one pocket1432can be defined in a proximalmost end1430aof the connecting arm1430. In one example, the at least one pocket1432can comprise two pockets1432a,1432b. The pockets1432a,1432bcan be positioned about 180° apart about the circumference of the connecting arm1430. The pockets1432a,1432bcan be sized to receive a respective one of the wings1418a,1418b. The pockets1432a,1432bcan each define cut-outs, which extend for about 5° to about 25° around the circumference of the connecting arm1430. The pockets1432a,1432bcan have a depth sized to receive the arm1425of the wings1418a,1418b. The depth can also be sized to enable the lock ring1404to move, pivot or rotate relative to the connecting arm1430, as will be discussed herein.

The bore1434can be defined through the connecting arm1430, and can have a chamfered surface1436and a bearing surface1438. The chamfered surface1436can provide clearance for the movement of the lock ring1404. The bearing surface1438can be defined adjacent to the chamfered surface1436. The bearing surface1438can be generally concave. The bearing surface1438can contact the head1110of the bone fastener1102to enable the bone fastener1102to move, rotate or articulate relative to the connecting arm1430.

With reference toFIGS. 58-61, the saddle1408can include a first portion or bottom portion1440and a second portion or top portion1442. The top portion1442can move or translate relative to the bottom portion1440. With reference toFIG. 59, the bottom portion1440can include a first or proximal end1444, a second or distal end1446and a bore1448. The proximal end1444can be generally rectangular, and can include rounded corners. It should be noted that the shape of the proximal end1444is merely exemplary, and the proximal end1444could have any selected shape, such as generally square, cylindrical, oval, etc. The proximal end1444can be coupled to the top portion1442(FIG. 60). The proximal end1444can define at least one rail1452. Generally, the top portion1442can move or translate along the at least one rail1452. In one example, the proximal end1444can define two rails1452a,1452b, which can be positioned on opposite sides of the bottom portion1440. As will be discussed, the height H8and/or diameter of the lock ring1404can define or limit the translation of the top portion1442relative to the bottom portion1440. The distal end1446can be adjacent to the shank32of the bone fastener1102, when the saddle1408is coupled to the bone fastener1102. The bore1448can be defined from the proximal end1444to the distal end1446.

The bore1448can be sized to receive the connecting arm1430and the bone fastener1102therein. With reference toFIGS. 59 and 61, the bore1448can include at least one groove1454, a bearing surface1456and a tapered surface1458. The at least one groove1454can be defined under a proximalmost surface1444aof the bottom portion1440. In one example, the at least one groove1454can comprise two grooves1454a,1454b. The two grooves1454a,1454bcan each extend for about 90° about a circumference of the bore1448, and can be positioned generally 180° apart from each other about the bore1448. The grooves1454a,1454bcan receive the wings1418a,1418bof the lock ring1404to enable the lock ring1404to move, rotate or pivot relative to the connecting arm1430and bottom portion1440.

The bearing surface1456can be configured to receive the connecting arm1430and can enable the connecting arm1430to move, rotate or pivot relative to the bottom portion1440. As best illustrated inFIG. 61, the tapered surface1458can provide clearance for the movement or articulation of the bone fastener1102relative to the connecting arm1430and the saddle1408.

With reference toFIGS. 59 and 60, the top portion1442of the saddle1408can be coupled to the rails1452a,1452bof the proximal end1444of the bottom portion1440so that the top portion1442can move relative to the bottom portion1440. The top portion1442can be substantially U-shaped and symmetrical with respect to the longitudinal axis L8defined by the multiplanar bone anchor system1400(FIG. 58). The top portion1442can include a first or proximal end1460and a second or distal end1462. In one example, the proximal end1460can include a first arm1464and a second arm1466. The first arm1464and second arm1466can extend upwardly from the distal end1462to define the U-shape. Each of the first arm1464and the second arm1466can include the mating portion84, the cavity86and a connector feature1468.

The connector feature1468can be defined in an exterior surface1464a,1466aof the first arm1464and the second arm1466. The connector feature1468can enable the multiplanar bone anchor system1400to be coupled to instrumentation, such as rod reduction instruments or to a suitable cross-connector device in a spinal fixation procedure. The connector feature1468is illustrated herein as comprising a triangular recess formed in each of the first arm1464and the second arm1466, however, it should be noted that the connector feature1468can have any selected shape and dimension to cooperate with a selected cross-connector device or instrument.

It should be noted that the lock ring1404can define or limit the translation of the top portion1442relative to the bottom portion1440. In this regard, the cavity86can be defined in each interior surface1464b,1466bof the first arm1464and second arm1466of the top portion1442of the saddle1408. The cavity86can provide clearance for the movement or articulation of the top portion1442relative to the bottom portion1440of the saddle1408. Generally, the cavity86can be defined so as to allow the top portion1442to move over a portion of the lock ring1404, which can provide a range of motion for the top portion1442relative to the bottom portion1440. Thus, contact between the lock ring1404and the cavity86can act as a stop to limit the movement or translation of the top portion1442relative to the bottom portion1440, however, other techniques could be used to stop or limit the movement or translation of the top portion1442relative to the bottom portion1440.

With reference toFIG. 59, the distal end1462of the top portion1442can be generally rectangular, and can include the first or a receiver surface88, a second or bottom surface1470and a central bore1472. It should be noted that the shape of the distal end1442does not have to be generally rectangular, but could be generally square, cylindrical, oval, etc. The central bore1472can be defined through the distal end1462from the receiver surface88to the bottom surface1470.

The bottom surface1470can include at least one or more guides1474. In this example, the bottom surface1470can include two guides1474a,1474b. The guides1474a,1474bcan slidably couple the top portion1442to the bottom portion1440. In this regard, each guide1474a,1474bcan cooperate with a respective one of the rails1452a,1452bto enable the top portion1442of the saddle1408to move or translate relative to the bottom portion1440of the saddle1408(FIG. 60). Generally, each guide1474a,1474bcan comprise a C-shape, and each rail1452a,1452bcan be received within a center of a respective guide1474a,1474b. It should be understood, however, that any suitable shape could be used to enable the top portion1442to move or translate relative to the bottom portion1440.

With reference toFIG. 59, in order to assemble the multiplanar bone anchor system1400according to one exemplary method, the bone fastener1102can be inserted through the bore1434of the connecting arm1430until the bone fastener1102is seated within the connecting arm1430. Then, bone fastener1102and the connecting arm1430can be inserted into the bottom portion1440of the saddle1408. The lock ring1404can be inserted into the central bore1472of the top portion1442. The rails1452a,1452bof the top portion1442can be slid onto the guides1452a,1452bof the bottom portion1440(FIG. 60). Then, the lock ring1404can be pushed downward and compressed until the wings1418a,1418bare received within the grooves1454a,1454bof the bottom portion1440and the pockets1432a,1432bof the connecting arm1430(FIG. 61).

When assembled, the multiplanar bone anchor system1400can have at least three degrees of movement or can be movable in at least three planes. The bone fastener1102can move or rotate about the longitudinal axis L8and can also move or articulate relative to the longitudinal axis L8. In this regard, with reference toFIGS. 62 and 63, the multiplanar bone anchor system1400can enable the bone fastener1102to articulate to a first preferred angle A6(FIG. 61) and a second preferred angle A7(FIGS. 62 and 63) relative to the longitudinal axis L8. The second preferred angle A7can be greater than the second preferred angle A6. The first preferred angle A6can be defined by the articulation of the bone fastener1102relative to the connecting arm1430(FIG. 61). The second preferred angle A7can be defined by the articulation of the connecting arm1430within the bottom portion1440(FIGS. 62 and 63). It should be noted that the multiplanar bone anchor system1400need not include one or more preferred angles, if desired.

In this regard, the wings1418a,1418bof the lock ring1404can prevent the articulation of the connecting arm1430within the bottom portion1440. In a plane perpendicular to the wings1418a,1418b, however, the connecting arm1430can be free to articulate relative to the bottom portion1440. This articulation of the connecting arm1430within the bottom portion1440in the plane can define the second preferred angle A7. In addition, as the lock ring1404can move within the saddle1408, the operator can move the lock ring1404to a desired location to enable the selection of the location for the second preferred angle A5.

The top portion1442can also move or translate relative to the bottom portion1440in a direction transverse to the longitudinal axis L8. By allowing the multiplanar bone anchor system1400to move in at least three planes, the surgeon can manipulate the multiplanar bone anchor system1400as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system1400in a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system10in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system1400will not be discussed in great detail herein. Briefly, however, once the bone fastener1102is secured to the anatomy, the saddle1408can be moved, pivoted or rotated relative to the bone fastener1102into the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be inserted into a desired number of multiplanar bone anchor systems1400.

With the connecting rod20positioned in the saddles1408of the multiplanar bone anchor systems1400, the set screw22can be coupled to each mating portion84of each saddle1408. The coupling of the set screw22to the saddle1408can apply a force to the lock ring1404to fixedly couple or lock the position of the bone fastener1102relative to the saddle1408.

With reference now toFIGS. 64-71, in one example, multiplanar bone anchor systems1500a,1500bcan be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor systems1500a,1500bcan be similar to the multiplanar bone anchor system800described with reference toFIGS. 31-36, only the differences between the multiplanar bone anchor system800and the multiplanar bone anchor systems1500a,1500bwill be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor systems1500a,1500bcan include the bone fastener802, a multiplanar coupling arrangement or system1504a,1504band a saddle1506. The multiplanar bone anchor system1500can define a longitudinal axis L9, and the multiplanar bone anchor system1500can be configured such that the bone fastener802and the saddle1506can move relative to the longitudinal axis L9in multiple planes.

In one example, with reference toFIGS. 65 and 69, the multiplanar coupling system1504a,1504bcan include a connecting arm1516a,1516b. The connecting arm1516a,1516bcan be composed of any suitable biocompatible material, such as a biocompatible metal, metal alloy, ceramic or polymer. The connecting arm1516a,1516bcan be disposed about the head810of the bone fastener802to allow relative movement between the bone fastener802and the saddle806. The connecting arm1516a,1516bcan be sized to fit within the saddle1506, and can also allow a portion of the saddle1506to move or translate relative to another portion of the saddle1506, as will be discussed in greater detail herein. The connecting arm1516a,1516bcan include a first or upper portion1520, a second or lower portion1522a,1522band the bore824.

The upper portion1520can be shaped to be received within a portion of the saddle1506, and can be generally rectangular with rounded corners. In one example, the upper portion1520can have opposite curved features821. The opposite curved features821can include generally straight portions821a. The straight portion821acan cooperate with the saddle1506to enable the saddle806to move or translate relative to the upper portion1520of the connecting arm1516a,1516b. The upper portion1520can include the rail829as illustrated inFIGS. 67 and 71.

With reference toFIGS. 65 and 69, the lower portion1522a,1522bcan include the connection surface830and a preferred angle slot1532aor preferred angle slot1532b, respectively. Each of the preferred angle slots1532a,1532bcan enable the bone fastener802to articulate to a greater angle A8relative to a longitudinal axis L9of the multiplanar bone anchor system800. In this regard, with reference toFIGS. 67 and 70, the bone fastener802can generally articulate to an angle A9relative to the longitudinal axis L9along the portion of the connecting arm1516a,1516bthat does not include the preferred angle slot1532a,1532b. At the location of the preferred angle slot1532a,1532b, the bone fastener802can generally articulate to the greater angle A8relative to the longitudinal axis L9. In one example, the angle A9can be about less than the greater angle A8, and the greater angle A8can be between about 15 degrees and about 90 degrees. The preferred angle slot1532a,1532bcan comprise an arcuate cut-out defined through the lower portion1522of the connecting arm1516a,1516b, which can be in communication with the bore824. The arcuate cut-out of the preferred angle slot1532a,1532bcan enable the bone fastener802to move or articulate to the greater angle A8relative to the longitudinal axis L9.

In one example, as illustrated inFIGS. 64-67, the preferred angle slot1532acan be defined to enable the bone fastener802to articulate to the greater angle A8in a cephalad-caudal direction. In another example, as illustrated inFIGS. 68-71, the preferred angle slot1532bcan be defined to enable the bone fastener802to articulate to the greater angle A8in a medial-lateral direction.

Further, it should be noted that although only one preferred angle slot1532a,1532bis illustrated in the drawings for the multiplanar bone anchor systems1500a,1500b, the connecting arm1516a,1516bcan include any number of preferred angle slots1532at any location along the connecting arm1516a,1516bto enable the bone fastener802to articulate in any selected direction. It should also be noted that the shape of the cut-out that forms the preferred angle slot1532can be modified to reduce or increase the greater angle A8of the articulation of the bone fastener802relative to the longitudinal axis L9. In addition, it should be noted that the multiplanar bone anchor systems1500a,1500bneed not include one or more preferred angle slots, if desired.

With reference toFIGS. 65 and 69, the saddle1506can be coupled to the connecting arm1516a,1516band can move or translate relative to the connecting arm1516a,1516b. In this regard, the saddle1506can include a first portion or bottom portion1538and a second portion or top portion1542. The bottom portion1538can be immovably coupled to the connecting arm1516a,1516band the top portion1542can move or translate relative to the bottom portion1538and the connecting arm1516a,1516b. In one example, the bottom portion1538can include the opposed generally arcuate surfaces840a, which can be interconnected by generally straight or flat surfaces840b. It should be noted that any suitable geometry could be employed to enable the top portion1542to move or translate relative to the bottom portion1538. The shape of the bottom portion1538can correlate with the shape of the connecting arm1516a,1516b. The bottom portion1538can include the first or proximal end844, a second or distal end1540and the bore848.

The distal end1540can include a preferred angle slot1541a,1541b. The preferred angle slot1541a,1541bcan be defined through the distal end1540so as to be in communication with the bore848. In one example, as illustrated inFIGS. 64-67, the preferred angle slot1541acan be defined to enable the bone fastener802to articulate to the greater angle A8in the cephalad-caudal direction. In another example, as illustrated inFIGS. 68-71, the preferred angle slot1541bcan be defined to enable the bone fastener802to articulate to the greater angle A8in the medial-lateral direction. The preferred angle slot1541a,1541bof the bottom portion1538can be positioned in substantially the same location relative to the connecting arm1516a,1516bsuch that when the bottom portion1538is coupled to the connecting arm1516a,1516b, a respective one of the preferred angle slot1541a,1541bof the bottom portion1538is aligned with a respective one of the preferred angle slot1532a,1532bof the connecting arm1516a,1516b. The alignment between the preferred angle slot1532a,1532band the preferred angle slot1541a,1541bcan enable the bone fastener802to move or articulate to the greater angle A8.

With reference toFIGS. 67 and 71, the top portion1542of the saddle1506can be disposed about the curved features821of the connecting arm1516a,1516b. The top portion1542can move or translate relative the connecting arm1516a,1516b, and thus, move or translate relative to the bottom portion1538. The top portion1542can be substantially U-shaped and symmetrical with respect to a longitudinal axis L9defined by the multiplanar bone anchor system1500a,1500b(FIGS. 64 and 68). With reference toFIGS. 65 and 69, the top portion1542can include a first or proximal end1544and a second or distal end1546. In one example, the proximal end1544can include a first arm1548and a second arm1550. The first arm1548and second arm1550can extend upwardly from the distal end1546to define the U-shape. Each of the first arm1548and the second arm1550can include the mating portion84, the cavity868(FIGS. 67 and 71) and a connector feature1552.

With reference toFIGS. 65 and 69, the connector feature1552can be defined in an exterior surface1548a,1550aof the first arm1548and the second arm1550. The connector feature1552can enable the multiplanar bone anchor system1500a,1500bto be coupled to instrumentation, such as rod reduction instruments or to a suitable cross-connector device in a spinal fixation procedure. The connector feature1552is illustrated herein as comprising a recess formed in each of the first arm1548and the second arm1550, it should be noted that the connector feature1552can have any selected shape and dimension to cooperate with a selected cross-connector device or instrument.

With reference toFIGS. 65 and 69, the distal end1546of the top portion1542can be generally rectangular, and can include rounded corners to correspond with the shape of the bottom portion1538. It should be noted that the shape of the distal end1546does not have to be generally rectangular, but rather could be generally square, cylindrical, oval, etc. The distal end1546can include the first or receiver surface88, the second or bottom surface872and the central bore876.

With reference toFIGS. 65 and 69, in order to assemble the multiplanar bone anchor system1500a,1500baccording to one exemplary method, the bone fastener802can be inserted into the bore824of the connecting arm1516a,1516bso that the bone fastener802is retained within and can articulate within the connecting arm1516a,1516b. Then, the connecting arm1516a,1516bcan be inserted into the top portion1542of the saddle1506. Generally, the connecting arm1516a,1516bcan be rotated about 90° around the main axis M1of the connecting arm1516a,1516bin order to insert the connecting arm1516a,1516bthrough the top portion1542. The connecting arm1516a,1516bcan be rotated back about 90° around the axis M1until the curved features821and straight portions821aof the connecting arm1516a,1516bare engaged with the curved features880and straight features882of the top portion1542. Then, the bottom portion1538can be coupled to the connecting arm1516a,1516b.

It should be noted that this assembly technique is merely exemplary, as the multiplanar bone anchor systems1500a,1500bcould be assembled according to various methods. For example, the connecting arm1516a,1516bcould be inserted into the saddle1506, and then the bone fastener802could be inserted into connecting arm1516a,1516b. Then, the bottom portion1538can be coupled to the connecting arm1516a,1516b.

Once assembled, the connecting arm1516a,1516bcan enable the bone fastener802to move or rotate within the bore824of the connecting arm1516a,1516b. The connecting arm1516a,1516bcan also allow the bone fastener802to move or angulate relative to the longitudinal axis L9of the multiplanar bone anchor system1500a,1500b.

In one example, the preferred angle slot1532aof the connecting arm1516acan cooperate with the preferred angle slot1540aof the bottom portion1538to enable the bone fastener802to move or articulate to the greater angle A8in the calphalad-caudal direction. In another example, the preferred angle slot1532bof the connecting arm1516bcan cooperate with the preferred angle slot1540bof the bottom portion1538to enable the bone fastener802to move or articulate to the greater angle A8in the medial-lateral direction. In either example, the top portion1542of the saddle1506can move or translate relative to the bottom portion1538and connecting arm1516a,1516bto a selected position.

Thus, when assembled, the multiplanar bone anchor system1500a,1500bcan have at least three degrees of movement or can be movable in at least three planes. For example, the bone fastener802can rotate about the longitudinal axis L9. The bone fastener802can also pivot relative to the longitudinal axis L9in at least a first direction and a second direction. The saddle1506can translate relative to the longitudinal axis L9. By allowing the multiplanar bone anchor system1500a,1500bto move in at least three planes, the surgeon can manipulate the multiplanar bone anchor system1500a,1500bas necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system1500a,1500bin a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system10in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system1500a,1500bwill not be discussed in great detail herein. Briefly, however, once the multiplanar bone anchor system1500a,1500bis secured to the anatomy, the multiplanar coupling system1504and the saddle1506can be moved, pivoted or rotated relative to the bone fastener802into the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be inserted into a desired number of multiplanar bone anchor systems1500.

With the connecting rod20positioned in the saddles1506of the multiplanar bone anchor systems1500a,1500b, the set screw22can be coupled to each mating portion84of each saddle1506. The coupling of the set screw22to the saddle1506can apply a force to the head810of the bone fastener802to fixedly couple or lock the position of the bone fastener802relative to the saddle1506.

With reference now toFIGS. 72-75, in one example, a multiplanar bone anchor system1554can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system1554can be similar to the multiplanar bone anchor system800described with reference toFIGS. 31-36, only the differences between the multiplanar bone anchor system800and the multiplanar bone anchor system1554will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system1554can include a bone fastener1555, a multiplanar coupling arrangement or system1556and a saddle1557. The multiplanar bone anchor system1554can define a longitudinal axis L12, and the multiplanar bone anchor system1554can be configured such that the bone fastener1555and the saddle1557can move relative to the longitudinal axis L12in multiple planes.

With reference toFIGS. 72 and 73, the bone fastener1555can be configured to engage the anatomy to couple the multiplanar bone anchor system1554to the anatomy. The bone fastener1555can be composed of any suitable biocompatible material, such as titanium, stainless steel, biocompatible metals, metal alloys, polymers, etc. The bone fastener1555can include a proximal end or head1558(FIG. 73) and the distal end or shank32. In one example, the head1558can be larger than the head810of the multiplanar bone anchor system800, and the larger head1558can be coupled to and received within the saddle1557. It should also be noted that the shank32illustrated herein is merely exemplary, as the shank32could have any desired length or thread. With reference toFIG. 73, the head1558can include a first or upper portion1559and the second or lower portion814.

The upper portion1559can include the contact surface815and a driver connection feature1559a. The driver connection feature1559acan comprise any mating connection interface for a driver, such as a pentalobe, hexalobe, hexagon, torx, Philips, cruciate, straight, etc. In one example, the driver connection feature1559acan comprise a pentalobe, and the contact surface815can be formed on the driver connection feature1559a.

With continued reference toFIG. 73, in one example, the multiplanar coupling system1556can include a connecting arm1560. The connecting arm1560can be composed of any suitable biocompatible material, such as a biocompatible metal, metal alloy or polymer. The connecting arm1560can be disposed about the head1558of the bone fastener1555to allow relative movement between the bone fastener1555and the saddle1557. The connecting arm1560can be sized to fit within the saddle1557, and can also allow a portion of the saddle1557to move or translate relative to another portion of the saddle1557, as will be discussed in greater detail herein. The connecting arm1560can include a first or upper portion1561, a second or lower portion1562, the bore824and at least one slot1563.

The upper portion1561can be shaped to be received within a portion of the saddle1557, and can be generally rectangular with rounded corners. In one example, the upper portion1561can have the opposite curved features821. The opposite curved features821can include generally straight portions821a. The straight portion821acan cooperate with the saddle1557to enable the saddle1557to move or translate relative to the upper portion1561of the connecting arm1560. The upper portion1561can include the rail829as illustrated inFIG. 75.

With reference toFIG. 73, the lower portion1562can include a connection surface1564. The connection surface1564can comprise at least one flat surface1565and at least one rib1566. The at least one flat surface1565and at least one rib1566can cooperate with a portion of the saddle1557to couple that portion of the saddle1557immovably to the connecting arm1560. In one example, the connection surface1564can comprise two flat surfaces1565a,1565band two ribs1566a,1566b. The flat surfaces1565a,1565bcan be substantially opposite each other about a perimeter of the connecting arm1560. The flat surfaces1565a,1565bcan prevent the connecting arm1560from rotating relative to the portion of the saddle1557. The ribs1566a,1566bcan be formed along arcuate surfaces of the lower portion1562and can generally be positioned a distance from a bottommost surface1562aof the lower portion1562(FIG. 74). The ribs1566a,1566bcan create an overlap, interference or snap fit between the portion of the saddle1557and the lower portion1562, as will be discussed in greater detail herein.

With reference toFIG. 73, the at least one slot1563can be defined through the upper portion1561and the lower portion1562. The at least one slot1563can enable the connecting arm1560to expand to accept the bone fastener1555. In this regard, the at least one slot1563can enable the connecting arm1560to expand to except a larger sized head of a bone fastener, such as the head1558of the bone fastener1555, without requiring the use of a larger sized connecting arm1560and saddle1557. In addition, the at least one slot1563can enable the connecting arm1560to expand to accept the bone fastener1555after the connecting arm1560is retained within the saddle1557from a bottom loading position, as will be discussed in greater detail herein. It should be noted that any suitable technique can be used to couple the bone fastener1555to the saddle1557from a bottom loading position, such as freezing the head1558of the bone fastener1555so that it contracts and heating the connecting arm1560so that it expands to accept the head1558.

With reference toFIGS. 73 and 74, the saddle1557can be coupled to the connecting arm1560and can move or translate relative to the connecting arm1560. In this regard, the saddle1557can include a first portion or bottom portion1567and a second portion or top portion1568. The bottom portion1567can be immovably coupled to the connecting arm1560, and the top portion1568can move or translate relative to the bottom portion1567and the connecting arm1560.

In one example, with reference toFIG. 73, the bottom portion1567can include the opposed generally arcuate surfaces840a, which can be interconnected by the generally straight or flat surfaces840b. The shape of the bottom portion1567can cooperate with the shape of the connecting arm1560so that the bottom portion1567can be coupled to the connecting arm1560. The bottom portion1567can include the first or proximal end844, the second or distal end846and a bore1567a.

With reference toFIG. 74, the bore1567acan be formed along the longitudinal axis L12from the proximal end844to the distal end846. The bore1567acan be sized and configured to be immovably coupled about the connecting arm1560. With reference toFIG. 73, the bore1567acan include the chamfered edge852and at least one groove1569.

The at least one groove1569can cooperate with the at least one rib1565of the connecting arm1560to couple the bottom portion1567to the connecting arm1560(FIG. 74). In one example, the bore1567acan include two grooves1569a,1569b. A respective one of each of the grooves1569a,1569bcan engage a respective one of each of the ribs1566a,1566b. Generally, the grooves1569a,1569bcan be configured to enable the ribs1566a,1566bto snap-fit into the grooves1569a,1569bto couple the bottom portion1567with the connecting arm1560.

With reference toFIG. 75, the top portion1568of the saddle1557can be disposed about the curved features821of the connecting arm1560. The top portion1568can move or translate relative the connecting arm1560, and thus, move or translate relative to the bottom portion1567. With reference toFIG. 72, the top portion1568can be substantially U-shaped and symmetrical with respect to a longitudinal axis L12defined by the multiplanar bone anchor system1554. The top portion1568can include a first or proximal end1570and a second or distal end1571. In one example, with reference toFIG. 73, the proximal end1570can include a first arm1572and a second arm1573. The first arm1572and second arm1573can extend upwardly from the distal end1571to define the U-shape. Each of the first arm1572and the second arm1573can include the mating portion84, a cavity1574and a connector feature1575.

With reference toFIGS. 73 and 74, the cavity1574can be defined in each interior surface1572a,1573aof the first arm1572and the second arm1573. The cavity1574can provide clearance for the movement or articulation of the top portion1568relative to the bottom portion1567of the saddle1557. In this regard, the cavity1574can be defined so as to allow the top portion1568to move over the head1558of the bone fastener1555, which can provide a range of motion for the top portion1568relative to the bottom portion1567. Thus, contact between the head1558of the bone fastener1555and/or the connecting arm1560and the cavity1574can act as a stop to limit the movement or translation of the top portion1568relative to the bottom portion1567, however, other techniques could be used to stop or limit the movement or translation of the top portion1568relative to the bottom portion1567, such as features formed on the connecting arm1560. In addition, the cavity1574can be sized to enable the connecting arm1560to expand to accept a larger diameter head1558of the bone fastener1555.

With reference toFIG. 73, the connector feature1575can be defined in an exterior surface1572b,1573bof the first arm1572and the second arm1573. The connector feature1575can enable the multiplanar bone anchor system1554to be coupled to instrumentation, such as a rod reduction instrument, or a suitable cross-connector device in a spinal fixation procedure. The connector feature1575is illustrated herein as comprising an oblong recess with rounded corners formed in each of the first arm1572and the second arm1573, however, it should be noted that the connector feature1575can have any selected shape and dimension to cooperate with a selected cross-connector device or instrument.

With continuing reference toFIG. 73, the distal end1571of the top portion1568can be generally rectangular, and can include rounded corners to correspond with the shape of the bottom portion1567. The distal end1571can include the first or receiver surface88, a second or bottom surface1574and the central bore876.

With reference toFIG. 75, the bottom surface1574can include at least one guide1577. In one example, the bottom surface1574can include two guides1577a,1577b, which can be positioned opposite each other. The guides1577a,1577bcan allow the top portion1568to move or translate relative to the connecting arm1560. The guides1577a,1577bcan retain the top portion1568on the connecting arm1560and can be configured to mate with the curved features821of the connecting arm1560. An end of each of the guides1577a,1577bcan contact the rail829to guide the movement of the top portion1568relative to the connecting arm1560.

With reference toFIG. 73, in order to assemble the multiplanar bone anchor system1554according to one exemplary method, the connecting arm1560can be inserted into the central bore876of the saddle1557. Generally, the connecting arm1560can be rotated about 90° around a main axis of the connecting arm1560in order to insert the connecting arm1560through the top portion1568. The connecting arm1560can be rotated back about 90° around the main axis until the curved features821are engaged with the guides1577a,1577bof the top portion1568. Then, the bone fastener1555can be inserted through the bore824of the connecting arm1560. The at least one slot1563in the connecting arm1560and the size of the cavity1574can enable the connecting arm1560to expand to accept the head1558of the bone fastener1555. Then, the bottom portion1567can be coupled to the connecting arm1560.

Once assembled, with reference toFIGS. 72-74, the connecting arm1560can enable the bone fastener1555to move or rotate within the bore824of the connecting arm1560. The connecting arm1560can also allow the bone fastener1555to move or angulate relative to the longitudinal axis L12of the multiplanar bone anchor system1554. The top portion1568of the saddle1557can move or translate relative to the bottom portion1567and connecting arm1569to a selected position. Thus, when assembled, the multiplanar bone anchor system1554can have at least three degrees of movement or can be movable in at least three planes. For example, the bone fastener1555can rotate about the longitudinal axis L12. The bone fastener1555can also pivot relative to the longitudinal axis L12in at least a first direction and a second direction. The saddle1557can translate relative to the longitudinal axis L12. By allowing the multiplanar bone anchor system1554to move in at least three planes, the surgeon can manipulate the multiplanar bone anchor system1554as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system1554in a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system10in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system1554will not be discussed in great detail herein. Briefly, however, once the multiplanar bone anchor system1554is secured to the anatomy, the multiplanar coupling system1556and the saddle1557can be moved, pivoted or rotated relative to the bone fastener1555into the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be inserted into a desired number of multiplanar bone anchor systems1554.

With the connecting rod20positioned in the saddles1557of the multiplanar bone anchor systems1554, the set screw22can be coupled to each mating portion84of each saddle1557. The coupling of the set screw22can apply a force to the head1558of the bone fastener1555to fixedly couple or lock the position of the bone fastener1555relative to the saddle1557.

With reference now toFIGS. 76-80, in one example, a multiplanar bone anchor system1580can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system1580can be similar to the multiplanar bone anchor system1554described with reference toFIGS. 72-75, only the differences between the multiplanar bone anchor system1554and the multiplanar bone anchor system1580will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system1580can include the bone fastener1555, a multiplanar coupling arrangement or system1581and the saddle1557. The multiplanar bone anchor system1580can define a longitudinal axis L13, and the multiplanar bone anchor system1580can be configured such that the bone fastener1555and the saddle1557can move relative to the longitudinal axis L13in multiple planes.

With reference toFIG. 77, in one example, the multiplanar coupling system1581can include a connecting arm1583. The connecting arm1583can be composed of any suitable biocompatible material, such as a biocompatible metal, metal alloy or polymer. The connecting arm1583can be disposed about the head1558of the bone fastener1555to allow relative movement between the bone fastener1555and the saddle1557. The connecting arm1583can be sized to fit within the saddle1557, and can also allow a portion of the saddle1557to move or translate relative to another portion of the saddle1557, as will be discussed in greater detail herein. The connecting arm1583can include the first or upper portion1561, a second or lower portion1584, the bore824and the at least one slot1563.

With reference toFIGS. 77 and 78, the lower portion1584can include the connection surface1564and at least one preferred angle slot1585. In one example, the preferred angle slot1585can comprise a two preferred angle slots1585a,1585b. The preferred angle slots1585a,1585bcan enable the bone fastener1555to articulate to a greater angle A13relative to a longitudinal axis L13of the multiplanar bone anchor system1580. In this regard, with reference toFIG. 79, the bone fastener1555can generally articulate to an angle A14relative to the longitudinal axis L13along the portion of the connecting arm1583that does not include the preferred angle slots1585a,1585b. With reference toFIG. 80, at the location of the preferred angle slots1585a,1585b, the bone fastener1555can generally articulate to the greater angle A13relative to the longitudinal axis L13. In one example, the angle A14can be less than the greater angle A13, and the greater angle A13can be between about 15 degrees and 90 degrees. The preferred angle slots1585a,1585bcan comprise an arcuate cut-out defined through the lower portion1584of the connecting arm1583, which can be in communication with the bore824. The arcuate cut-out of the preferred angle slots1585a,1585bcan enable the bone fastener1555to move or articulate to the greater angle A13relative to the longitudinal axis L13.

It should be noted that although two preferred angle slots1585a,1585bis illustrated in the drawings, the connecting arm1583can include any number of preferred angle slots1585at any location along the connecting arm1583to enable the bone fastener1555to articulate in any selected direction. It should also be noted that the shape of the cut-out that forms the preferred angle slots1585a,1585bcan be modified to reduce or increase the greater angle A13of the articulation of the bone fastener1555relative to the longitudinal axis L13.

With reference toFIG. 77, in order to assemble the multiplanar bone anchor system1580according to one exemplary method, the connecting arm1583can be inserted into the central bore876of the saddle1557. Generally, the connecting arm1583can be rotated about 90° around a main axis of the connecting arm1583in order to insert the connecting arm1583through the top portion1568. The connecting arm1583can be rotated back about 90° around the main axis until the curved features821are engaged with the guides1577a,1577bof the top portion1568. Then, the bone fastener1555can be inserted through the bore824of the connecting arm1583. The at least one slot1563in the connecting arm1583and the size of the cavity1574can enable the connecting arm1583to expand to accept the head1558of the bone fastener1555. Then, the bottom portion1567can be coupled to the connecting arm1560.

Once assembled, with reference toFIGS. 77,79and80, the connecting arm1583can enable the bone fastener1555to move or rotate within the bore824of the connecting arm1583. The connecting arm1583can also allow the bone fastener1555to move or angulate relative to the longitudinal axis L13of the multiplanar bone anchor system1580. The preferred angle slot1585of the connecting arm1583can enable the bone fastener1555to move or articulate to the greater angle A13. The top portion1568of the saddle1557can move or translate relative to the bottom portion1567and connecting arm1583to a selected position. Thus, when assembled, the multiplanar bone anchor system1580can have at least three degrees of movement or can be movable in at least three planes. For example, the bone fastener1555can rotate about the longitudinal axis L13. The bone fastener1555can also pivot relative to the longitudinal axis L13in at least a first direction and a second direction. The saddle1557can translate relative to the longitudinal axis L13. By allowing the multiplanar bone anchor system1580to move in at least three planes, the surgeon can manipulate the multiplanar bone anchor system1580as necessary to conform to the anatomy of the patient.

As the surgical insertion and use of the multiplanar bone anchor system1580in a fixation procedure can be similar to the surgical insertion and insertion of the multiplanar bone anchor system10in a fixation procedure, the surgical insertion and use of the multiplanar bone anchor system1580will not be discussed in great detail herein. Briefly, however, once the multiplanar bone anchor system1580is secured to the anatomy, the multiplanar coupling system1581and the saddle1557can be moved, pivoted or rotated relative to the bone fastener1555into the desired alignment for the fixation procedure. Once the aligned, the connecting rod20can be inserted into a desired number of multiplanar bone anchor systems1580.

With the connecting rod20positioned in the saddles1557of the multiplanar bone anchor systems1580, the set screw22can be coupled to each mating portion84of each saddle1557. The coupling of the set screw22can apply a force to the head1558of the bone fastener1555to fixedly couple or lock the position of the bone fastener1555relative to the saddle1557.

With reference now toFIGS. 81-84, in one example, a lateral connector1600can be employed with any one of the multiplanar bone anchor systems10,100,200,300,400,500,600,700,800,900,1000,1100,1200,1300,1400,1500a,1500b,1554,1580and can be coupled to the connecting rod20to repair a damaged portion of an anatomy. In an exemplary procedure, the lateral connector1600can be used to connect one of the multiplanar bone anchor systems10,100,200,300,400,500,600,700,800,900,1000,1100,1200,1300,1400,1500a,1500b,1554,1580to a laterally spaced connecting rod20. Generally, the lateral connector1600can be coupled to each of the connecting rods20in a direction transverse to a longitudinal axis of the connecting rods20. The lateral connector1600can include a body1602and an arm1604. The lateral connector1600can be composed of a suitable biocompatible material, such as a biocompatible metal or polymer.

With reference toFIGS. 82-84, the body1602can include a main portion1605and at least one translation assembly1608. The main portion1605can be substantially linear and cylindrical. The at least one translation assembly1608can be coupled to the main portion1605.

The translation assembly1608can include a cylindrical housing1610and a locking device1612. The cylindrical housing1610can be integrally formed with the main portion1605if desired, or could be coupled to the main portion1605in a suitable post processing step, such as welding. With reference toFIG. 84, the cylindrical housing1610can define a cross bore1614and a locking bore1616. The cross bore1614can be sized to receive a portion of the arm1604. The locking bore1616can be configured to receive the locking device1612, and can extend along an axis transverse to an axis of the cross bore1614. In one example, the locking bore1616can include a plurality of threads1616a, which can engage a plurality of threads1612aassociated with the locking device1612.

The locking device1612can include the plurality of threads1612a, which can mate with the plurality of threads1616aof the locking bore1616. In one example, the locking device1612can comprise a set screw, which can lock the arm1604to the body1602.

The arm1604can include a rod1618and a hook1620. It should be noted that although the arm1604is described and illustrated herein as including a rod1618having an annular cross-section, the rod1618could have any shape, such as square. In this example, the rod1618can be configured to be slidably received in the cross bore1614, and can be cylindrical. As will be discussed, the rod1618can be movable relative to the body1602to enable the lateral connector1600to adapt to a variety of patient anatomies. The rods1618can be coupled to the body1602via pressure applied by the locking device1612.

The hook1620can be coupled to the rod1618, and in one example, the hook1620can be integrally formed with the rod1618. Alternatively, the hook1620could be coupled to the rod1618in a suitable post processing step. The hook1620can include a C-shaped cavity1622and a coupling device1624. The C-shaped cavity1622can be configured to receive a connecting rod20. The coupling device1624can couple the connecting rod20to the C-shaped cavity1622. In one example, with reference toFIG. 84, the coupling device1624can comprise a set screw1624a, which can be threadably engaged with a threaded bore1624b. The advancement of the set screw1624awithin the threaded bore1624bcan couple the lateral connector1600to the connecting rod20.

With reference toFIGS. 81 and 84, the lateral connector1600can be assembled by inserting the arm1604into the cross bore1614. Then, the locking device1612can be tightened to secure the arm1604to the body1602. The lateral connector1600can then be positioned so as to span between an exemplary multiplanar bone anchor system800and a connecting rod20. The hook1620of the arm1604can be coupled to the connecting rod20by tightening the set screw1624aand the arm1604can be coupled to the exemplary multiplanar bone anchor system800by tightening a set screw22.

If, due to the patient's anatomy, the lateral connector1600is too short or too long, the arm1604can be moved or translated within the cross bore1614to enable the lateral connector1600to be coupled to the connecting rod20. For example, the locking device1612of the translation assembly1608can be loosened to enable the arm1604to move to a desired position within the cross bore1614to extend a length of the lateral connector1600or to reduce the length of the lateral connector1600. This can allow the lateral connector1600to be used with a variety of differently sized patients.

With reference now toFIGS. 85 and 86, in one example, a domino connector1650can be employed with any one of the multiplanar bone anchor systems10,100,200,300,400,500,600,700,800,900,1000,1100,1200,1300,1400,1500a,1500b,1554,1580and can be coupled to one or more connecting rods20to repair a damaged portion of an anatomy. In an exemplary procedure, the domino connector1650can be used to impart rigidity to two vertically extending multiplanar bone anchor systems10,100,200,300,400,500,600,700,800,900,1000,1100,1200,1300,1400,1500a,1500b,1554,1580having connecting rods20. Generally, the domino connector1650can be coupled to each of the connecting rods20in a direction transverse to a longitudinal axis of the connecting rods20.

The domino connector1650can include a movable body1652and at least one connector1654. The domino connector1650can be composed of a suitable biocompatible material, such as a biocompatible metal or polymer. In one example, the domino connector1650can include two connectors1654a,1654bpositioned on either end1652a,1652bof the movable body1652.

The movable body1652can include a first portion1656and a second portion1658. The first portion1656can define a cross bore1660(FIG. 86). The cross bore1660can receive the second portion1658so that the second portion1658can move or translate relative to the first portion1656. It should be noted that the second portion1658can include a stop, which can enable the second portion1658to move or translate relative to the first portion1656without disconnecting, if desired. Alternatively, a mechanical fastener or other technique could be used to movably secure the first portion1656to the second portion1658. The movement of the second portion1658relative to the first portion1656can enable a length of the domino to increase or decrease in a medial-lateral direction depending upon the particular anatomy of the patient. It should be noted that the domino connector1650could also be configured to enable translation in a cephalad-caudal direction, if desired.

With continued reference toFIGS. 85 and 86, the connectors1654a,1654bcan be coupled to a respective one of the connecting rods20. The connectors1654a,1654bcan each include a throughbore1662and a locking bore1664. The throughbore1662can be sized to receive the connecting rod20, and can extend in a direction transverse to the locking bore1664. The locking bore1664can include threads1664a, which can be configured to receive a suitable locking device, such as a set screw, to couple the domino connector1650to the connecting rod20.

The domino connector1650can be assembled by inserting a connecting rod20through the throughbore1662of the connector1654a, and then inserting a connecting rod20through the throughbore1662of the connector1654b. Then, the second portion1658can be slid into the first portion1656. As the second portion1658is movable or slidable relative to the first portion1656, the length of the domino connector1650can be sized during the procedure to correspond to the particular patient's anatomy.

With reference now toFIGS. 87 and 88, in one example, a multiplanar bone anchor system1700can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar bone anchor system1700can be similar to the multiplanar bone anchor system800described with reference toFIGS. 31-36, only the differences between the multiplanar bone anchor system800and the multiplanar bone anchor system1700will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar bone anchor system1700can include a bone fastener1702and a saddle1704.

In one example, the bone fastener1702can comprise a bone hook having a C-shaped hook portion1706and a base1708. The C-shaped hook portion1706can be impacted into the anatomy to secure the C-shaped hook portion1706to the anatomy. In order to facilitate engagement of the C-shaped hook portion1706with the anatomy, the C-shaped hook portion1706can include a tapered tip1706a. The C-shaped hook portion1706can be positioned below the base1708.

The base1708can couple the C-shaped hook portion1706to the saddle1704. The base1708can have a first end1710and a second end1712. The first end1710can be coupled to the C-shaped hook portion1706. The second end1712can be coupled to the base1708. The first end1710can be angled relative to the second end1712, however, the first end1710need not be angled relative to the second end1712. The second end1712can include at least one rail1714. The at least one rail1714can cooperate with the saddle1704to enable the saddle1704to move or translate relative to the bone fastener1702.

The saddle1704can be substantially U-shaped and symmetrical with respect to a longitudinal axis L10defined by the saddle1704(FIG. 88). The saddle1704can include a first or proximal end1716and a second or distal end1718. In one example, the proximal end1716can include a first arm1720and a second arm1722. The first arm1720and second arm1722can extend upwardly from the distal end1718to define the U-shape. Each of the first arm1720and the second arm1722can include the mating portion84and the connector feature870.

With reference toFIGS. 87 and 88, the distal end1718of the saddle1704can be generally rectangular. It should be noted that the distal end1718can have any desired shape, such as generally square, cylindrical, oval, etc. The distal end1718can include the first or receiver surface88and a second or bottom surface1724. The bottom surface1724can include at least one guide1726. The at least one guide1726can be coupled to the at least one rail1714to enable the saddle1704to move or translate relative to the bone fastener1702. It should be noted that the movement or translation of the saddle1704relative to the bone fastener1702need not be limited to a single direction, but rather, multiple rails and guides could be employed to enable movement or translation along multiple planes.

In order to assemble the multiplanar bone anchor system1700, the saddle1704can be slid onto the base1708so that the at least one guide1726engages the at least one rail1714. Then, in order to couple the multiplanar bone anchor system1700to the anatomy, with access provided to the anatomy, the C-shaped hook portion1706can be impacted into the anatomy to secure the multiplanar bone anchor system1700to the anatomy. Then, the saddle1704can be moved or translated relative to the C-shaped hook portion1706into a selected position for receipt of the connecting rod20. Once the connecting rod20is received within the saddle1704, the set screw22can be inserted into the mating portion84of the first arm1720and second arm1722to couple the connecting rod20to the multiplanar bone anchor system1700.

With reference now toFIGS. 89-92, in one example, a multiplanar occipital plate seat1750can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the multiplanar occipital plate seat1750can be similar to the multiplanar bone anchor system800described with reference toFIGS. 31-36, only the differences between the multiplanar bone anchor system800and the multiplanar occipital plate seat1750will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The multiplanar occipital plate seat1750can include a saddle1754.

The saddle1754can include a first portion or bottom portion1756and a second portion or top portion1758. The top portion1758can move or translate relative to the bottom portion1756, as will be discussed in greater detail herein. In one example, the bottom portion1756can include a first or proximal end1760, a second or distal end1762and a pin1764. The proximal end1760can be coupled to the top portion1758. The proximal end1760can include at least one rail1766. In one example, the proximal end1760can include two rails1766a,1766b. The rails1766a,1766bcan be positioned on opposed sides of bottom portion1756such that the rails1766a,1766bare about 180° apart. The rails1766a,1766bcan be T-shaped, however, any shape could be employed. The distal end1762can be generally rectangular with rounded corners, and can be substantially planar.

The pin1764can extend from the bottom portion1756to couple the saddle1754to an exemplary bone plate P. The pin1764can be generally square, but the pin1764could have any selected shape to couple the saddle1754to the bone plate P.

The top portion1758of the saddle1754can be substantially U-shaped and symmetrical with respect to a longitudinal axis L11defined by the multiplanar occipital plate seat1750(FIG. 89). The top portion1758can include a first or proximal end1767and a second or distal end1768. In one example, the proximal end1767can include a first arm1770and a second arm1772. The first arm1770and second arm1772can extend upwardly from the distal end1768to define the U-shape. Each of the first arm1770and the second arm1772can include the mating portion84.

The distal end1768of the top portion1758can be generally rectangular, and can include rounded corners to correspond with the shape of the bottom portion1756. The distal end1768can include the first or receiver surface88and a guide1774.

The guide1774can be configured to mate with the rails1766a,1766bof the bottom portion1756. In one example, the guide1774can comprise a T-shape, however, any suitable shape could be employed to meet with the rails1766a,1766b. The engagement of the guide1774with the rails1766a,1766bcan enable the top portion1758to move or translate relative to the bottom portion1756.

In order to assemble the multiplanar occipital plate seat1750, the top portion1758can be slid onto the bottom portion1756so that the guide1774engages the rails1766a,1766b. Then, the pin1764of the bottom portion1756can be coupled to the bone plate P to couple the saddle1704to the bone plate P. Once the bone plate P is positioned within the anatomy, the top portion1758can be moved relative to the bottom portion1756into a selected position for receipt of the connecting rod20. With the connecting rod20inserted between the first arm1770and the second arm1772, the set screw22can be inserted to couple the connecting rod20to the multiplanar occipital plate seat1750.

Accordingly, the multiplanar bone anchor system10,100,200,300,400,500,600,700,800,900,1000,1100,1200,1300,1400,1500a,1500b,1554,1580can be used to repair damaged tissue in the anatomy, such as in the case of a spinal fixation or fusion procedure. By allowing the bone fastener12,102,302,802,952,1002,1102,1555and/or the saddle18,106,206,308,406,506,606,806,906,956,1006,1106,1108,1308,1408,1506,1557to move in multiple planes, but in a controlled fashion. In addition, the ability to manipulate the position of the bone fastener12,102,302,802,952,1002,1102,1555and/or the saddle18,106,206,308,406,506,606,806,906,956,1006,1106,1108,1308,1408,1506,1557can enable the multiplanar bone anchor system10,100,200,300,400,500,600,700,800,900,1000,1100,1200,1300,1400,1500a,1500b,1554,1580to be used with a variety of different anatomical structures.

While specific examples have been described in the specification and illustrated in the drawings, it will be understood by those of ordinary skill in the art that various changes can be made and equivalents can be substituted for elements thereof without departing from the scope of the present teachings. Furthermore, the mixing and matching of features, elements and/or functions between various examples is expressly contemplated herein so that one of ordinary skill in the art would appreciate from the present teachings that features, elements and/or functions of one example can be incorporated into another example as appropriate, unless described otherwise, above. Moreover, many modifications can be made to adapt a particular situation or material to the present teachings without departing from the essential scope thereof. Therefore, it is intended that the present teachings not be limited to the particular examples illustrated by the drawings and described in the specification, but that the scope of the present teachings will include any embodiments falling within the foregoing description.

For example, while the multiplanar bone anchor system1000has been described herein with reference toFIGS. 42-45as including the saddle1006having a bottom portion1022with rails1032a,1032band a top portion1024with guides1050a,1050b, those of skill in the art will appreciate that the present disclosure, in its broadest aspects, may be constructed somewhat differently. In this regard, with reference toFIGS. 93 and 94, a saddle1800can include a first or top portion1802, a second or middle portion1804and a third or bottom portion1806. The top portion1802can include rails1808a,1808b. The rails1808a,1808bcan slidably engage guides1810a,1810bdefined on a top surface1804aof the middle portion1804. A bottom surface1804bof the middle portion1804can include rails1812a,1812b, which can engage guides1814a,1814bformed on a top surface1806aof the bottom portion1806. Thus, the saddle1800can have two dovetail connections, which can allow for translation along a line or in a two-dimensional plane. It should be noted that the rails1808a,1808b,1812a,1812bcan be orientated at any angle relative to a longitudinal axis defined by the saddle1800to allow translation in any plane.

In this regard, translation along a single dovetail (ex. movement along rails1808a,1808band guides1810a,1810bor rails1812a,1812band guides1814a,1814b) allows for movement along a line of translation. Translation along both dovetails (e.g. movement along rails1808a,1808band guides1810a,1810b, and rails1812a,1812band guides1814a,1814b) allows for movement along a two-dimensional plane of translation. It should be noted that the use of dovetail connections is merely exemplary, as any suitable connection mechanism could be used to enable translation along a plane.

In another example, while the multiplanar bone anchor system1000has been described herein with reference toFIGS. 42-45as including the saddle1006having a bottom portion1022with rails1032a,1032band a top portion1024with guides1050a,1050b, those of skill in the art will appreciate that the present disclosure, in its broadest aspects, may be constructed somewhat differently. In this regard, with reference toFIGS. 95-97, a saddle1850can include a first or top portion1852, a second or middle portion1854and a third or bottom portion1856. The top portion1852can include rails1858a,1858b, which can be formed along a first arc. The rails1858a,1858bcan slidably engage guides1860a,1860bdefined on a top surface1854aof the middle portion1854. The guides1860a,1860bcan also be formed along the first arc.

A bottom surface1854bof the middle portion1854can also include rails1862a,1862b, which can be formed along a second arc. The rails1862a,1862bcan engage guides1864a,1864bformed on a top surface1856aof the bottom portion1856. The guides1864a,1864bcan also be formed along the second arc (FIG. 99).

The first arc and the second arc can be orientated relative to each other at any selected non-zero angle to enable three-dimensional movement of the saddle1850. In addition, it should be noted that if the first arc and the second arc are sufficiently large, the movement could approximate planar motion. Further, it should be noted, that the use of dovetail connections is merely exemplary, as any suitable connection mechanism could be used to enable translation along a plane. In addition, it should be noted that the use of two arcs is merely exemplary, as only one arc could be used, or an arc and a linear dovetail connection could be used.

In another of various examples, while the multiplanar bone anchor system1000has been described herein with reference toFIGS. 42-45as including a U-shaped top portion1024for receipt of a connecting rod20that is translatable relative to a bone fastener1002, those of skill in the art will appreciate that the present disclosure, in its broadest aspects, may be constructed somewhat differently. In this regard, with reference toFIGS. 98 and 99, a saddle1900can include a first or top portion1902movable relative to a bottom portion1904. The top portion1902can include a first half1906, a second half1908and a locking device1910. The first half1906can include a first end1914, a second end1916and an opening1918. The first end1914can be coupled to the locking device1910. The second end1916can include at least one guide1920, which can enable the top portion1902to move relative to the bottom portion1904. The opening1918can be semi-circular and configured to receive a portion of the connecting rod20(FIG. 99). The opening1918can be positioned between the first end1914and the second end1916.

The second half1908can include a first end1922, a second end1924and an opening1926. The first end1922can be coupled to the locking device1910. The second end1924can include at least one guide1928, which can enable the top portion1902to move relative to the bottom portion1904. The opening1926can be semi-circular and configured to receive a portion of the connecting rod20(FIG. 99). The opening1926can be positioned between the first end1922and the second end1924.

The locking device1910can be U-shaped, and can be positionable over the first end1914of the first half1906and the first end1922of the second half1908. The locking device1910can be positioned over the first half1906and the second half1908to retain the connecting rod20within the openings1918,1926(FIG. 99).

The bottom portion1904can include at least one rail1930, which can enable both the first half1906and the second half1908to move or translate relative to the bottom portion1904. The bottom portion1904can also receive a bone fastener1932therethrough, which can move, rotate and/or articulate relative to the saddle1900, if desired.

In use, the bottom portion1904can be coupled to the anatomy via the bone fastener1932. Then, the first half1906and the second half1908can be slidably engaged with the bottom portion1904. The first half1906and the second half1908can be slid about the connecting rod20. Once the connecting rod20is received within the openings1918,1926, the locking device1910can be positioned over the first half1906and the second half1908to secure the connecting rod20to the saddle1900.

In another example, with reference toFIGS. 100 and 101, a saddle1950can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the saddle1950can be similar to the saddle1900described with reference toFIGS. 98 and 99, only the differences between the saddle1900and the saddle1950will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The saddle1950can include a first or top portion1952movable relative to a bottom portion1954. The top portion1952can include the second half1908and the locking device1910.

The bottom portion1954can include an arm1956and at least one rail1957(FIG. 100). The arm1956can include an opening1958and a ledge1960. The opening1958can be semi-circular and configured to receive a portion of the connecting rod20. The ledge1960can support a portion of the locking device1910to couple the connecting rod20to the saddle1950. The bottom portion1904can also receive a bone fastener1962therethrough, which can move, rotate and/or articulate relative to the saddle1950, if desired.

In use, the bottom portion1954can be secured to the anatomy via the bone fastener1962. Then, the second half1908can be slidably engaged with the bottom portion1954. The second half1908can be slid about the connecting rod20. Once the connecting rod20is received within the openings1926,1958the locking device1910can be positioned over the arm1956and the second half1908to secure the connecting rod20to the saddle1950(FIG. 101).

In another of various examples, with reference toFIGS. 102 and 103, a saddle2000can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the saddle2000can be similar to the saddle1900described with reference toFIGS. 98 and 99, only the differences between the saddle1900and the saddle2000will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The saddle2000can include a first or top portion2002movable relative to the bottom portion1904.

The top portion2002can include a first half2006, a second half2008and the locking device1910. The first half2006can include the first end1914, the second end1916and an opening2010. The opening2010can be semi-circular and elongated to receive a portion of the connecting rod20(FIG. 103). The elongated opening2010can enable the connecting rod20to move in the approximate medial-lateral direction. The opening2010can be positioned between the first end1914and the second end1916.

The second half2008can include the first end1922, the second end1924and an opening2012. The opening2012can be semi-circular and elongated to receive a portion of the connecting rod20(FIG. 103). The elongated opening2012can enable the connecting rod20to move in the medial-lateral direction. The opening2012can be positioned between the first end1922and the second end1924.

In use, the bottom portion1904can be secured to the anatomy via the bone fastener1932. Then, the first half1906and the second half1908can be slidably engaged with the bottom portion1904. The first half1906and the second half1908can be slid about the connecting rod20. Once the connecting rod20is received within the openings2010,2012, the locking device1910can be positioned over the first half1906and the second half1908to secure the connecting rod20to the saddle2000, while permitting the connecting rod20to move in a medial-lateral direction (FIG. 103).

In another example, with reference toFIGS. 104 and 105, a saddle2020can be employed with the connecting rod20to repair a damaged portion of an anatomy. As the saddle2020can be similar to the saddle1900described with reference toFIGS. 98 and 99, only the differences between the saddle1900and the saddle2020will be discussed in great detail herein, and the same reference numerals will be used to denote the same or similar components. The saddle2020can include a first or top portion2022movable relative to the bottom portion1904.

With reference toFIG. 104, the top portion2022can include a first half2026, a second half2028and the locking device1910. The first half2026can include the first end1914, the second end1916and an opening2030. The opening2030can be wedge-shaped to receive a portion of the connecting rod20. The wedge-shaped opening2030can enable the opening2030to accept connecting rods20of varying diameters (FIG. 105). The opening2030can be positioned between the first end1914and the second end1916.

With reference toFIG. 104, the second half2028can include the first end1922, the second end1924and an opening2032. The opening2032can be wedge-shaped to receive a portion of the connecting rod20. The wedge-shaped opening2032can enable the opening2032to accept connecting rods20of varying diameters (FIG. 105). The opening2032can be positioned between the first end1914and the second end1916.

In use, the bottom portion1904can be secured to the anatomy via the bone fastener1932. Then, the first half1906and the second half1908can be slidably engaged with the bottom portion1904. The first half1906and the second half1908can be slid about the connecting rod20. Once the connecting rod20is received within the openings2030,2032, the locking device1910can be positioned over the first half1906and the second half1908to secure the connecting rod20to the saddle2020(FIG. 105).

In addition, while the multiplanar bone anchor system1000has been described herein with reference toFIGS. 42-45as including the saddle1006having a bottom portion1022with rails1032a,1032band a top portion1024with guides1050a,1050b, those of skill in the art will appreciate that the present disclosure, in its broadest aspects, may be constructed somewhat differently. In this regard, with reference toFIGS. 106 and 107, a saddle2050can include a first or top portion2052and a second or bottom portion2054. The top portion2052can include guides2052a,2052b. The guides2052a,2052bcan slidably engage rails2054a,2054bdefined on a top surface2054cof the bottom portion2054.

The bottom portion2054can include the rails2054a,2054band at least one marking2056(FIG. 107). As discussed, the rails2054a,2054bcan cooperate with the guides2052a,2052bto enable the top portion2052to move or translate relative to the bottom portion2054. With reference toFIG. 107, the at least one marking2056can provide the operator with a visual indicator of the presence or amount of translation of the top portion2052relative to the bottom portion2054.

Thus, in use, with the bottom portion2054coupled to the anatomy via a suitable bone fastener, the operator can move or translate the top portion2052a selected amount based on a reading of the at least one marking2056(FIG. 107).

In another of various examples, a translating fastener3000can be used with a plate, such as a bone plate B, to repair a damaged portion of an anatomy. In one example, with reference toFIGS. 108 and 109, a translating fastener3000can include a head3002and a shank3004. With reference toFIG. 109, the head3002can include at least one T-shaped rail3006. The T-shaped rail3006can be received within a pocket3008defined in the shank3004. One or more pins3010can be inserted between the T-shaped rail3006and the pocket3008. The one or more pins3010can prevent the head3002from disassembling from the shank3004, while enabling the head3002to move relative to the shank3004. The use of the T-shaped rail3006and the pocket3008is merely exemplary as any geometry could be employed to enable the head3002to move relative to the shank3004. Further, the geometry employed could enable the head3002to move relative to the shank3004in a line, plane, arc, two-dimensional path, three-dimensional path, etc. The movement between the head3002and the shank3004can enable the translating fastener3000to provide compression when used in a fixation procedure, such as when used with a cervical plate (FIG. 108).

It should be noted that the translation techniques described herein are merely exemplary, as translation could be achieved through any suitable technique, such as the use of flexible materials, shape memory materials, springs, etc. Further, the various systems incorporating the translation techniques described and illustrated herein are merely exemplary, as the translation techniques described herein could be applied to top-loading bone screws, posted bone screws, closed bone screws, polyaxial bone screws, uniplanar bone screws, fixed screws, etc.