# Patent

## Title
Artificial vertebral disk replacement implant with crossbar spacer and method

## Abstract

The present invention is directed to a device that can be placed between two vertebrae. The implant is characterized by having a first plate and a second plate with a crossbar therebetween. The crossbar fits within cavities on each of the first and second plates and allows for pivotal or rotational motion and also for twisting motion.

## Background
CLAIM OF PRIORITY
This application is a divisional application of U.S. patent application Ser. No. 10/684,668 filed Oct. 14, 2003, now U.S. Pat. No. 7,273,496, and entitled “ARTIFICIAL VERTEBRAL DISK REPLACEMENT IMPLANT WITH CROSSBAR SPACER AND METHOD”, which claims priority to U.S. Provisional Application No. 60/422,021, filed on Oct. 29, 2002, entitled “ARTIFICIAL VERTEBRAL DISK REPLACEMENT IMPLANT WITH CROSSBAR SPACER AND METHOD”, both of which are incorporated herein by reference.
CROSS REFERENCE TO RELATED APPLICATIONS
This application is related to U.S. Provisional Application No. 60/422,039, filed Oct. 29, 2002, entitled “ARTIFICIAL VERTEBRAL DISK REPLACEMENT IMPLANT WITH TRANSLATING PIVOT POINT AND METHOD,” U.S. patent application Ser. No. 10/684,669, filed Oct. 14, 2003, entitled “ARTIFICIAL VERTEBRAL DISK REPLACEMENT IMPLANT WITH TRANSLATING PIVOT POINT AND METHOD” U.S. Provisional Application No. 60/422,011, filed Oct. 29, 2002, entitled “TOOLS FOR IMPLANTING AN ARTIFICIAL VERTEBRAL DISK AND METHOD” U.S. patent application Ser. No. 10/685,134, filed Oct. 14, 2003, entitled “TOOLS FOR IMPLANTING AN ARTIFICIAL VERTEBRAL DISK AND METHOD” , U.S. Provisional Application No. 60/422,022, filed Oct. 29, 2002, entitled “ARTIFICIAL VERTEBRAL DISK REPLACEMENT IMPLANT WITH A SPACER AND METHOD,” , and U.S. patent application Ser. No. 10/685,011, filed Oct. 14, 2003, entitled “ARTIFICIAL VERTEBRAL DISK REPLACEMENT IMPLANT WITH SPACER AND METHOD,” , which are incorporated herein by reference.


FIELD OF THE INVENTION
This invention relates to an artificial vertebral disk replacement and method.
BACKGROUND OF THE INVENTION
The spinal column is a biomechanical structure composed primarily of ligaments, muscles, vertebrae and intervertebral disks. The biomechanical functions of the spine include: (1) support of the body, which involves the transfer of the weight and the bending movements of the head, trunk and arms to the pelvis and legs, (2) complex physiological motion between these parts, and (3) protection of the spinal cord and nerve roots.
As the present society ages, it is anticipated that there will be an increase in adverse spinal conditions which are characteristic of older people. Pain associated with such conditions can be relieved by medication and/or surgery. Of course, it is desirable to eliminate the need for major surgery for all individuals, and, in particular, for the elderly.
More particularly, over the years, a variety of intervertebral implants have been developed in an effort to relieve the pain associated with degenerative and dysfunctional disk conditions. For example, U.S. Pat. No. 4,349,921 to Kuntz discloses an intervertebral disk prosthesis. The Kuntz prosthesis is designed to restore the space between the disks.
U.S. Pat. No. 4,714,469 to Kenna discloses a spinal implant that fuses vertebrae to the implant. The implant has a rigid body that fits between the vertebra with a protuberance extending from a vertebral contacting surface and extends into the vertebral body.
U.S. Pat. No. 5,258,031 to Salib et al. discloses another prosthetic disk with a ball that fits into a socket.
U.S. Pat. Nos. 5,425,773 and 5,562,738 are related patents to Boyd et al. that disclose a disk arthroplasty device for replacement of the spinal disk. A ball-and-socket are provided to enable rotation.
U.S. Pat. No. 5,534,029 to Shima discloses an articulated vertebral body spacer with a pair of upper and lower joint pieces inserted between the vertebra. An intermediate layer is provided to allow for movement between the upper joint piece and the lower joint piece.
U.S. Pat. No. 5,782,832 to Larsen et al. discloses a two-pieceball-and-socket spinal implant with upper and lower plates for insertion within the intervertebral space.
U.S. Pat. No. 6,156,067 to Bryan et al. discloses a prosthesis having two plates with a nucleus therebetween.
None of these solutions provide an implant that restores a wide range of natural movement.
Accordingly, there needs to be developed implants for alleviating such conditions and restoring natural movement.
SUMMARY OF THE INVENTION
Embodiments of the present invention are directed to providing an implant for alleviating discomfort associated with the spinal column. One embodiment of the implant is characterized by having a first plate and a second plate with a crossbar therebetween.
Other aspects, objects, features and elements of embodiments of the invention are described or are evident from the accompanying specification, claims and figures.



BRIEF DESCRIPTION OF THE FIGURES
FIG. 1A is a front view of an embodiment of an implant of the invention. FIG. 1B is aside view of an embodiment of an implant of the invention. FIG. 1C is a top view of an embodiment of the implant of the invention. FIG. 1D is a top view of an embodiment of the first surface of the top plate of the implant of the invention. FIG. 1E is a perspective view of an embodiment of the upper plate of the implant of the invention. FIG. 1F is a plan view of the first surface of the lower plate of an embodiment of the implant of the invention. FIG. 1G is a perspective view of the lower plate of an embodiment of the implant of the invention. FIG. 1H is a cross-sectional view of the upper and lower plates of an embodiment of the implant of the invention taken at H-H in FIG. 1A.
FIG. 2A is an upper view of a crossbar of an embodiment of the implant of the invention. FIG. 2B is a side view of a crossbar of an embodiment of the implant of the invention. FIG. 2C is a lower view of a crossbar of an embodiment of the implant of the invention. FIG. 2D is a perspective view of a crossbar of an embodiment of the implant of the invention.
FIG. 3 is a perspective view of an assembled implant of an embodiment the invention.
FIG. 4 is a side view of the implant implanted between the vertebral bodies.
FIG. 5 is a block diagram showing the method steps for implanting the implant of the invention.



DETAILED DESCRIPTION OF THE PRESENT INVENTION
The following description is presented to enable any person skilled in the art to make and use the invention. Various modifications to the embodiments described will be readily apparent to those skilled in the art, and the principles defined herein can be applied to other embodiments and applications without departing from the spirit and scope of the present invention as defined by the appended claims. Thus, the present invention is not intended to be limited to the embodiments shown, but is to be accorded the widest scope consistent with the principles and features disclosed herein. To the extent necessary to achieve a complete understanding of the invention disclosed, the specification and drawings of all patents and patent applications cited in this application are incorporated herein by reference.
FIG. 1A shows an embodiment of the implant 100 of the invention. The implant 100 has a first part or plate 110 that is configured to mate with a first vertebra and a second part or plate 120 that is configured to mate with a second vertebra. The first plate 110 is an upper plate and the second plate 120 is a lower plate. A third part 130 that sits between the first plate 110 and the second plate 120 is also provided. The third part 130 acts as a spacer between the first plate 110 and the second plate 120 and facilitates pivotal or rotational and also twisting movement of the first plate 110 and the second plate 120, relative to each other. The third part 130 is in the form of a crossbar as discussed in more detail below.
The upper plate 110 has a first surface 112 from which a keel 114 extends with teeth 115. The teeth in this embodiment point forward or anteriorly when the embodiment is meant to be put into a slot in a vertebral body from the anterior of the spine. The teeth in an alternative embodiment would point rearward or posteriorly when the embodiment is meant to be put into a slot in a vertebral body from the posterior of the spine. The first surface 112, or upper surface, abuts the vertebral body when the implant 100 is implanted. The first keel 114 extends into the vertebral body to anchor the implant into position. The second surface 116, or lower surface, engages the spacer 130 of the implant and faces the second plate 120. The second surface 116 can form a planar surface that is parallel to the first surface 112, or can form a planar surface that is not parallel to the first surface 112.
When the implant is implanted between spinous processes the planar surfaces corresponding to the first surface 112 and the second surface 116 of the first plate 110 lie within, or substantially within, the axial plane of the body, while the first keel 114 (which is at or near a 90° angle from the surfaces 112, 116) is aligned within the sagittal plane of the body.
The lower plate 120 has a first surface 122 from which a keel 124 extends with teeth 125. The first surface 122 or lower surface, abuts the vertebral body when the implant 100 is implanted. The second keel 124 extends into the vertebral body to anchor the implant into position. The second surface 126, or upper surface, engages the spacer 130 of the implant and faces the first plate 110. The second surface 126 can form a planar surface that is parallel to the first surface 122, or can form a planar surface that is not parallel to the first surface. The first surface 112 of the first plate 110 can be parallel to the first surface 122 of the second plate 120 when the implant 100 is assembled and is in a neutral position (i.e., the position where the first plate 110 has not rotated relative to the second plate 120). Alternatively, the first surface 112 of the first plate 110 can be non-parallel to the planar surface of the first surface 122 of the second plate 120 when the implant 100 is assembled and in a neutral position.
As with the first plate, when the implant is implanted between vertebral bodies the planar surfaces corresponding to the first surface 122 and the second surface 126 of the second plate 120 lie within, or substantially within, the axial plane of the body while the second keel 124 (which is at or near a 90° angle from the surfaces 122, 126) is aligned within the sagittal plane of the body.
FIG. 1B shows a side view of an embodiment of the implant 100 of the invention shown in FIG. 1A. Again, the implant 100 has a first plate 110 that is configured to mate with a first vertebra and a second plate 120 that is configured to mate with a second vertebra. The spacer 130 separates the first plate 110 from the second plate 120. FIG. 1C shows a top view of the upper plate 110 with the upper surface 112 and the upper keel 114. As evidenced from the upper view, the perimeter shape of the upper plate 110 can be configured to correspond to the perimeter shape of a vertebral disk. This is particularly advantageous where a single implant is placed between two vertebral bodies from an anterior approach. As will be appreciated by those of skill in the art, the perimeter shape of the upper plate 110 and the lower plate 120 can be the same.
FIG. 1D and FIG. 1E show an embodiment of the first or upper plate 110 of the implant 100 of the invention. The upper plate 110 has a second surface 116 having a channel 150 therein. As will be discussed below, the spacer includes a beam which can be placed into the channel 150 in order to allow the first and second plates of the assembled implant to pivot or rotate relative to each other. The curved side 152 of the first plate 110 is oriented to be anterior A after the device is implanted. The flat side 154 of the first plate 110 is oriented to be posterior P after the device is implanted. As shown in FIG. 1E, the second surface 116 can be formed so that it is received with a ridge 117 surrounding the second surface 116.
FIG. 1F and FIG. 1G show the second or lower plate 120 of the implant 100 of the invention. The lower plate 120 has a second surface 126 having a channel 160 therein. As will be discussed below, the spacer includes a beam which can be placed into the channel 160 in order to allow the first and second plates of the assembled implant to pivot or rotate relative to each other. The curved side 162 of the second plate 120 is oriented to be anterior A after the device is implanted. The flat side 164 of the second plate 120 is oriented to be posterior P after the device is implanted. As shown in FIG. 1G, the second surface 126 can be formed so that it is recessed with a ridge 127 surrounding the second surface 126.
FIG. 1H is a cross-section of the upper plate 110 and the lowerplate 120 taken along the lines H-H of FIG. 1A. As shown in FIG. 1H, the second surface 116 of the first plate 110 faces the second surface 126 of the second plate 120.
In FIG. 2, the crossbar or spacer 130 is shown. FIG. 2A is an upper view of an embodiment of a crossbar or spacer 130 of the implant of the invention. The crossbar 130 has a first beam 210 and a second beam 220. Each beam 210, 220, has a first end 212, 222, and a second end 214, 224, and a midpoint 216,226, respectively. FIG. 2B shows a side view of a crossbar 130 of the implant 100 of the invention. As is apparent from the side view, the first beam 210 can be configured to sit above the second beam 220. FIG. 2C shows the crossbar 130 of the implant of the invention from a bottom view with the first beam 210 configured to sit above the second beam 220.
The first beam 210 can be configured to be positioned transversely along the length of the second beam 220 at a point preferably corresponding about the midpoint 226 of the second beam 220. The second beam 220 can be configured to be positioned along the length of the first beam 210 at a point preferably corresponding about the midpoint 216 of the first beam 210. Where both beams are positioned at the respective midpoints 216, 226 the crossbar forms a “+”.
In the alternative embodiment, the first beam 210 can also be configured to be positioned transversely along the length of the second beam 220 at a point corresponding to a location between the midpoint 226 and an end (222, 224). The second beam 220 can be configured to be positioned transversely along the length of the first beam 210 at a point corresponding to about the midpoint 216 of the first beam 210. Where one beam 210,220 is positioned along the length between the midpoint and an end of the other beam, the crossbar forms “T”.
In constructing the crossbar 130, the first beam 210 can be formed integrally with the second beam 220 such that is unitary in construction. Alternatively, the first beam 210 can be adhered to the second beam 220 using a suitable method, such as spot welding.
FIG. 2D shows a perspective view of a crossbar or spacer 130 of the implant of the invention. As shown in FIG. 2D, the first beam 210 and the second beam 220 are configured so that the second beam 220 is positioned along the length of the first beam 210 at a point between the midpoint 226 of the second beam 220 and an end 222 of the second beam 220.
Viewing FIGS. 1A, 1B and 3, an assembled embodiment of the implant 100 of the invention is depicted. The implant 100 has a first plate 110 that is configured to mate with a first vertebra and a second plate 120 that is configured to mate with a second vertebra. A crossbar 130 that sits between the first plate 110 and the second plate 120 is also provided. As is evident from the figures, the upper beam 210 is placed in the channel 150 of the upper plate 110 such that the upper beam is about perpendicular to the keels 114 and 124. As can be seen from FIG. 1B, the upper beam is positioned toward the posterior of the implant 100. In alternative embodiments the upper beam can be positioned midway between the posterior and the anterior of the implant 100. The lower beam 220 is placed in the channel 160 of the lower plate 120 such that the lower beam is about parallel to the keels 114 and 124. The crossbar 130 acts as a spacer between the first plate 110 and the second plate 120 and facilitates pivotal or rotational movement of the first plate 110 and the second plate 120, relative to each other. With the implant 100 placed between vertebral bodies of a patient, the keels 114 and 124 are directed along a posterior to anterior line or in the sagittal plane of the patient. Accordingly as the patient bends forward or backward the upper plate 110 can pivot or rotate about the beam 210. When the patient bends laterally or side to side, the lower beam 220 can pivot or rotate in the lower channel 160, allowing the upper beam 210 to pivot or rotate about the lower beam 220 and also allowing the upper plate 110 to pivot or rotate about the lower beam 220, and, thus, relative to the lower plate 120. In an alternative embodiment, there is a loose fit between the spacer 130 and the first and second plates, and, in particular, there is a loose fit between the upper beam 210 and the upper channel 150 and also between the lower beam 220 and the lower channel 160. This loose fit allows for a twisting motion about an axis that is perpendicular to the plates as, for example, perpendicular to the surface 112 of the upperplate. Thus, this loose fit allows for twisting about the length of the spine.
As illustrated in FIGS. 1B, 1G and 3, the ridge 127 adjacent to the second surface 126 of the lower plate is not parallel to the first surface 122 of the lower plate nor to the upper plate.
The orientation of the plates 110, 120 in FIGS. 1A, 1B and 3, show the implant 100 assembled in a neutral position (i.e., the position where the first plate 110 has not rotated relative to the second plate 120). The distance between the first plate 110 and the second plate 120 enable the implant to achieve movement in forward, backward, lateral and rotational directions.
FIG. 4 shows a side view of an implant 100 of the invention implanted between two vertebrae 410, 420. Given the difference between the first plate 110 and the second plate 120 at its anterior end A and its posterior end P, i.e., the distance between the plates is greater at the anterior A end than the posterior P end, forward (bending) movement is facilitated to a greater degree than backward (bending) movement. Thus, for this embodiment, an example of a forward bending movement of up to 10° can be achieved while a backward bending movement of 5° will be achieved. By sloping the lower plate and/or the upper plate toward the posterior portion, the amount of backward bending can be increased.
In a preferred embodiment, the implant can be made of titanium or a stainless steel that is approved for implantation into a patient. Other materials that have appropriate structural strength and that are suitable for implantation into a patient can also be used.
FIG. 6 is a block diagram showing the basic steps of the method of inserting the implant 100 of this invention. First the spine is exposed 610, then the intervertebral disk is removed 620 and the implant is inserted 630. Finally, the wound is closed 640. This procedure can be followed for either an anterior approach or posterior-lateral approach. Additional steps, such as cutting channels into the vertebral bodies to accept the keels of the plates and assembling the implant by inserting the crossbar member between the upper and lower plates prior to installation can also be performed without departing from the scope of the invention.
The foregoing description of preferred embodiments of the present invention has been provided for the purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise forms disclosed. Many modifications and variations will be apparent to one of ordinary skill in the relevant arts. The embodiments were chosen and described in order to best explain the principles of the invention and its practical application, thereby enabling others skilled in the art to understand the invention for various embodiments and with various modifications that are suited to the particular use contemplated. It is intended that the scope of the invention be defined by the claims and their equivalence.
A method of implanting a device between an upper and lower vertebral body in a spine, the method comprising: a. exposing an affected region of the spine anteriorly; b. removing an affected disk; c. cutting a keel receiving channel into the upper and lower vertebral body using a keel cutting tool; d. assembling the implant by inserting a crossbar member between an upper implant and a lower implant; and e. inserting the assembled implant between the vertebral bodies.
A method of implanting a device between an upper and lower vertebral body in a spine, the method comprising: a. exposing an affected region of the spine posteriorly; b. removing an affected disk; c. cutting a keel receiving channel into the upper and lower vertebral body using a keel cutting tool; d. assembling the implant by inserting a crossbar member between an upper implant and a lower implant; and e. inserting the assembled implant between the vertebral bodies.

## Claims

1. A method of replacing a disk with an implant between an upper and lower vertebral body in a spine, the method comprising the steps of:
a. preparing the upper and lower vertebral bodies to receive an implant; and
b. inserting an implant between the upper and lower vertebral body, the implant having:
an upper implant member;
a lower implant member; and
a crossbar member therebetween shaped as two bars crossing each other, wherein at least the upper implant and the lower implant members are movable about the crossbar member to allow twisting of said members.

2. The method of claim 1 wherein the step of preparing further comprises exposing an affected region of the spine.

3. The method of claim 1 wherein the step of preparing further comprises removing an affected disk from an affected region of the spine.

4. The method of claim 1 wherein the step of preparing further comprises cutting a keel receiving channel into the upper vertebral body.

5. The method of claim 1 wherein the step of preparing further comprises cutting a keel receiving channel into the lower vertebral body.

6. The method of claim 1 wherein the step of inserting further comprises mating a keel of the upper implant member with the upper vertebral body.

7. The method of claim 1 wherein the step of inserting further comprises mating a keel of the lower implant member with the lower vertebral body.

8. The method of claim 1 wherein the assembled implant is inserted anteriorly.

9. The method of claim 1 wherein the assembled implant is inserted posteriorly.

10. The method of claim 1 further comprising the step of assembling the implant before inserting the implant between the upper and lower vertebral bodies.

11. The method of claim 10 wherein the step of assembling further comprises:
a. providing the upper implant member;
b. providing the lower implant member; and
c. inserting the crossbar between the upper and lower implant members.

12. A method of replacing a disk with an implant between an upper and lower vertebral body in a spine, the method comprising:
a. preparing the upper and lower vertebral bodies to receive an implant;
b. mating an upper implant member of the implant with the upper vertebral body; and
c. mating a lower implant member of the implant with the lower vertebral body, wherein the implant includes a crossbar member between the upper implant member and the lower implant member, the crossbar member being shaped as two bars crossing each other, wherein at least the upper implant and the lower implant members are movable about the crossbar member to allow twisting of said members.

13. The method of claim 12 wherein the step of preparing further comprises exposing an affected region of the spine.

14. The method of claim 12 wherein the step of preparing further comprises removing an affected disk from an affected region of the spine.

15. The method of claim 12 wherein the step of preparing further comprises cutting a keel receiving channel into the upper vertebral body.

16. The method of claim 12 wherein the step of mating the upper implant member further comprises mating a keel of the upper implant member with a keel receiving channel in the upper vertebral body.

17. The method of claim 12 wherein the step of preparing further comprises cutting a keel receiving channel into the lower vertebral body.

18. The method of claim 12 wherein the step of mating the lower implant member further comprises mating a keel of the lower implant member with a keel receiving channel in the lower vertebral body.

19. The method of claim 12 wherein the upper and lower implant members are inserted anteriorly.

20. The method of claim 12 wherein the upper and lower implant members are inserted posteriorly.

21. The method of claim 12 further comprising assembling the implant including the steps of:
a. providing the upper implant member;
b. providing the lower implant member; and
c. inserting the crossbar between the upper and lower implant members.

22. A method of implanting a device between an upper vertebral body and a lower vertebral body in a spine, the method comprising:
a. accessing an affected region along the sagittal plane of the spine;
b. preparing the affected region to receive a replacement device;
C. providing an implant having a crossbar member positioned between an upper implant member and a lower implant member, the crossbar member being shaped as two bars crossing each other, wherein at least the upper implant and the lower implant members are movable about the crossbar member to allow twisting of said members; and
d. inserting the implant into the affected region parallel to the sagittal plane.

23. The method of claim 22 wherein the step of preparing further comprises removing an affected disk from the affected region.

24. The method of claim 22 wherein the step of preparing further comprises cutting a keel receiving channel into the upper vertebral body.

25. The method of claim 22 wherein the step of preparing further comprises cutting a keel receiving channel into the lower vertebral body.

26. The method of claim 22 wherein the step of inserting further comprises mating a keel of the upper implant member with the upper vertebral body.

27. The method of claim 22 wherein the step of inserting further comprises mating a keel of the lower implant member with the lower vertebral body.

28. The method of claim 22 wherein the implant is inserted into the affected region anteriorly.

29. The method of claim 22 wherein the implant is inserted into the affected region posteriorly.

30. A method of implanting a device between an upper and lower vertebral body in a spine, the method comprising:
a. exposing an affected region of the spine anteriorly;
b. removing an affected disk;
c. cutting a keel receiving channel into the upper and lower vertebral body using a keel cutting tool;
d. providing an implant having a crossbar member between an upper implant member and a lower implant member, the crossbar member being shaped as two bars crossing each other, wherein at least the upper implant and the lower implant members are movable about the crossbar member to allow twisting of said members; and
e. inserting the implant between the vertebral bodies.

31. The method of claim 30 wherein inserting the implant further comprises inserting a keel protruding from the upper implant member into the keel receiving channel in the upper vertebral body.

32. The method of claim 30 wherein inserting the implant further comprises inserting a keel protruding from the lower implant member into the keel receiving channel in the lower vertebral body.

33. The method of claim 30 wherein inserting the implant further comprises inserting a keel protruding from the upper implant member into the keel receiving channel in the upper vertebral body.

34. The method of claim 30 wherein the implant is inserted anteriorly.

35. The method of claim 30 wherein the implant is inserted posteriorly.

36. A method of implanting a device between an upper and lower vertebral body in a spine, the method comprising:
a. exposing an affected region of the spine posteriorly;
b. removing an affected disk;
c. cutting a keel receiving channel into the upper and lower vertebral body using a keel cutting tool;
d. providing an implant having a crossbar member between an upper implant member and a lower implant member, the crossbar member being shaped as two bars crossing each other, wherein at least the upper implant and the lower implant members are movable about the crossbar member to allow twisting of said members; and
e. inserting the implant between the upper and lower vertebral bodies.

37. The method of claim 36 wherein the implant is inserted anteriorly.

38. The method of claim 36 wherein the implant is inserted posteriorly.

39. A method of implanting a device between an upper and lower vertebral body in a spine, the method comprising:
a. removing an affected disk;
b. forming a first receiving channel into the upper vertebral body parallel to the sagittal plane;
c. forming a second receiving channel into the lower vertebral body parallel to the sagittal plane;
d. providing an implant having a crossbar member between an upper implant member and a lower implant member, the crossbar member being shaped as two bars crossing each other, wherein at least the upper implant and the lower implant members are movable about the crossbar member to allow twisting of said members; and
e. inserting the implant between the upper and lower vertebral bodies, wherein portions of the implant are received in the first and second receiving channels.

40. The method of claim 39 wherein the implant is inserted into the first and second receiving channels posteriorly.

41. The method of claim 39 wherein the implant is inserted into the first and second receiving channels anteriorly.

42. A method of implanting a device between an upper and a lower vertebral body in a spine, the method comprising:
a. removing an affected disk between the upper and lower vertebral body;
b. cutting a keel receiving channel into the upper and lower vertebral bodies, wherein the keel receiving channels are parallel to the sagittal plane of the spine;
c. selecting an implant having a crossbar member between an upper implant member and a lower implant member, the crossbar member being shaped as two bars crossing each other, wherein at least the upper implant and the lower implant members are movable about the crossbar member to allow twisting of said members, the upper and lower implants having a keel; and
d. inserting the keels of the replacement device into the keel receiving channels.

43. The method of claim 42 wherein the keels of the implant are inserted into the keel receiving channels anteriorly.

44. The method of claim 42 wherein the keels of the implant are inserted into the keel receiving channels posteriorly.

45. The method of claim 1 wherein the implant further includes:
the upper implant member having an upper channel;
the lower implant member having a lower channel; and
the crossbar member is at least partially received in the upper channel and the lower channel, wherein at least the upper implant is capable of pivoting about the crossbar member to accommodate at least one of flexion, extension and lateral bending.

46. The method of claim 12 wherein the implant further includes:
the upper implant member having an upper channel;
the lower implant member having a lower channel; and
the crossbar member is at least partially received in the upper channel and the lower channel, wherein at least the upper implant is capable of pivoting about the crossbar member to accommodate at least one of flexion, extension and lateral bending.

47. The method of claim 22 wherein the implant further includes:
the upper implant member having an upper channel;
the lower implant member having a lower channel; and
the crossbar member is at least partially received in the upper channel and the lower channel, wherein at least the upper implant is capable of pivoting about the crossbar member to accommodate at least one of flexion, extension and lateral bending.

48. The method of claim 30 wherein the implant further includes:
the upper implant member having an upper channel;
the lower implant member having a lower channel; and
the crossbar member is at least partially received in the upper channel and the lower channel, wherein at least the upper implant is capable of pivoting about the crossbar member to accommodate at least one of flexion, extension and lateral bending.

49. The method of claim 36 wherein the implant further includes:
the upper implant member having an upper channel;
the lower implant member having a lower channel; and
the crossbar member is at least partially received in the upper channel and the lower channel, wherein at least the upper implant is capable of pivoting about the crossbar member to accommodate at least one of flexion, extension and lateral bending.

50. The method of claim 39 wherein the implant further includes:
the upper implant member having an upper channel;
the lower implant member having a lower channel; and
the crossbar member is at least partially received in the upper channel and the lower channel, wherein at least the upper implant is capable of pivoting about the crossbar member to accommodate at least one of flexion, extension and lateral bending.

51. The method of claim 42 wherein the implant further includes:
the upper implant member having an upper channel;
the lower implant member having a lower channel; and
the crossbar member is at least partially received in the upper channel and the lower channel, wherein at least the upper implant is capable of pivoting about the crossbar member to accommodate at least one of flexion, extension and lateral bending.