Abstract:
A spinal clip for creating a potential space within the spinal canal and thus stabilizing the spine without the need for additional spinal components is embodied in different forms. The spinal clips are configured to provide a clamping or holding force against and/or to the spinous processes, transverse processes and/or the lamina of adjacent vertebrae. In one form, the spinous process clips utilize pivoting to effect clamping or holding. In another form, the spinous process clips utilize rotation to effect clamping or holding. Such rotation may be between clamping or holding members or via a screw system. In yet another form, the spinous process clips utilize ratcheting to effect clamping or holding. In a still further form, the spinous process clips utilize expansion to effect clamping or holding. Depending on the form of clamping or holding, the spinous process clips can provide infinite adjustment of the clamping or holding force within an adjustment range, or provide discrete steps or levels of the clamping or holding force.

Description:
RELATED APPLICATIONS 
       [0001]    This patent application claims the benefit of and/or priority under 35 U.S.C. §119(e) to U.S. Provisional Patent Application Ser. No. 61/355,204 filed Jun. 16, 2010, entitled “Spinal Clips For Interspinous Decompression” the entire contents of which is specifically incorporated herein by this reference. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    1. Field of the Invention 
         [0003]    The present invention relates to implants for the spine and, more particularly, to spinal implants pertaining to the spinous process of the spine. 
         [0004]    2. Background Information 
         [0005]    As we age various changes can occur in the body. For instance, the ligaments of the spine can thicken and calcify (i.e. harden from deposits of calcium), bone and joints may enlarge, bone spurs called osteophytes may form, spinal discs may collapse and bulge (i.e. herniate) or one vertebra may slip over another (spondylolisthesis). Any one or these conditions and/or others can cause what is known as spinal stenosis. Spinal stenosis is a narrowing of the bony spinal canal. While some people are born with this condition, most often spinal stenosis is the result of one of the above-identified degenerative conditions that develop in mainly the middle-aged and elderly population. 
         [0006]    In this regard, spinal stenosis may be considered as the gradual result of aging and “wear and tear” on the spine from everyday activities. Such degenerative or age-related changes in our bodies can lead to compression of nerves (i.e. pressure on the nerves that can cause pain and/or damage). Symptoms of spinal stenosis include leg pain (“pins and needles”) that can limit standing, walking, self-supporting daily activities, work, social and recreational pursuits. Lack of activity because of spinal stenosis may lead to obesity, depression and general physical deterioration. 
         [0007]    Once diagnosed with spinal stenosis the doctor will usually try non-surgical treatments first. Such treatments may include anti-inflammatory medications (orally or by injection) to reduce associated swelling or analgesic drugs to control pain. Physical therapy may be prescribed with goals of improving ones strength, endurance and flexibility so that you can maintain or resume a more normal lifestyle. Spinal injections such as an epidural injection of cortisone may also be used. Such non-surgical treatments do not correct the spinal canal narrowing of spinal stenosis itself but may provide long-lasting pain control and improved life function without requiring a more invasive treatment. However, as a last resort for those patients who don&#39;t respond to non-surgical treatments, surgery will be advised. 
         [0008]    Spinal stenosis is one of the most common reason for back surgery in people over the age of 50 in the United States. While there are various non-surgical treatments for spinal stenosis, a surgical procedure known as a laminectomy may be performed in order to reduce or eliminate the symptoms of spinal stenosis. A laminectomy or spinal decompression surgery has the goal of opening up the bony canal to improve available space for the spinal nerves. As indicated, however, a laminectomy is usually a last resort for treating spinal stenosis. This is because a laminectomy is an invasive surgical procedure. Other invasive spinal decompression surgical procedures include the laminotomy, the foraminotomy and the facetectonomy. 
         [0009]    Fortunately, another surgical treatment for spinal stenosis is known that is less invasive than a laminectomy. This other surgical treatment involves implanting a device between bony projections of adjacent vertebrae, particularly, but not necessarily, between spinous processes of the adjacent vertebrae. This achieves interspinous process decompression for alleviating spinal stenosis. However, even these surgical procedures are still invasive as compared to typical minimally invasive surgical procedures. 
         [0010]    In view of the foregoing, it is therefore desirable to provide a compact interspinous process spacer for interspinous process decompression. Moreover, it is desirable to provide an interspinous process spacer for use in minimally invasive surgery that can be placed in a collapsed interspinous space and then expanded. 
       SUMMARY OF THE INVENTION 
       [0011]    Spinal clips are provided for creating a potential space within the spinal canal and thus stabilizing the spine without the need for additional spinal instrumentation. The spinal clips are configured for introduction to the spine in a collapsed state then provide a clamping or holding force against and/or to the spinous processes, transverse processes and/or the lamina of adjacent vertebrae (collectively, spinous processes). The spinal clips utilize mechanical torque and/or tension to deploy and effect retention. 
         [0012]    In one form, the spinous process clips utilize pivoting to effect deployment and retention. In another form, the spinous process clips utilize rotation to effect deployment and retention. Such rotation may be between clamping or holding members or via a screw system. In yet another form, the spinous process clips utilize ratcheting to effect deployment and retention. In a still further form, the spinous process clips utilize expansion to effect deployment and retention. 
         [0013]    Depending on the form of clamping or holding, the spinous process clips can provide infinite adjustment of the clamping or holding force within an adjustment range, or provide discrete steps or levels of the clamping or holding force. 
         [0014]    The spinous process clips are made from a biocompatible material such as PEEK (PolyEtherEtherKetone), titanium, stainless steel or the like that will provide flexure given the geometry or configuration of the unitary body thereof. 
         [0015]    The present spinous process clips are an improvement over current devices in that the present spinous process clips can be inserted posteriorly, laterally or posteriorlaterally with minimum tissue resection or posterior-laterally with no ligament resection (i.e. the ligament that covers the spinous process). Other advantages are also achieved. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0016]    The above mentioned and other features, advantages and objects of this invention, and the manner of attaining them, will become apparent and the invention itself will be better understood by reference to the following description of embodiments of the invention taken in conjunction with the accompanying drawings, wherein: 
           [0017]      FIG. 1  is a perspective view of an embodiment of a spinous process clip fashioned in accordance with the principles of the present invention, the spinous process clip shown in an open (clamping/holding) position or state; 
           [0018]      FIG. 2  is a perspective view of the spinous process clip of  FIG. 1  shown in a closed (insertion) or unexpanded position or state; 
           [0019]      FIG. 3  is a perspective view of another embodiment of a spinous process clip fashioned in accordance with the principles of the present invention, the spinous process clip shown in a holding position or state; 
           [0020]      FIG. 4  is a perspective view of the spinous process clip of  FIG. 3  shown in an insertion position or state; 
           [0021]      FIG. 5  is a perspective view of another embodiment of a spinous process clip fashioned in accordance with the principles of the present invention, the spinous process clip shown in holding position or state; 
           [0022]      FIG. 6  is a perspective view of the spinous process clip of  FIG. 5  shown in a closed (insertion) position or state; 
           [0023]      FIG. 7  is a perspective view of another embodiment of a spinous process clip fashioned in accordance with the principles of the present invention, the spinous process clip shown in an expanded (holding) position or state; 
           [0024]      FIG. 8  is a perspective view of the spinous process clip of  FIG. 7  shown in an unexpanded (insertion) position or state; 
           [0025]      FIG. 9  is a perspective view of another embodiment of a spinous process clip fashioned in accordance with the principles of the present invention, the spinous process clip shown in a clamping position or state; 
           [0026]      FIG. 10  is a perspective view of the spinous process clip of  FIG. 9  shown in an open position or state; 
           [0027]      FIG. 11  is a perspective view of another embodiment of a spinous process clip fashioned in accordance with the principles of the present invention, the spinous process clip shown in a clamping position or state; and 
           [0028]      FIG. 12  is a perspective view of the spinous process clip of  FIG. 11  shown in a closed position or state. 
       
    
    
       [0029]    Like reference numerals indicate the same or similar parts throughout the several figures. 
         [0030]    A discussion of the features, functions and/or configurations of the components depicted in the various figures will now be presented. It should be appreciated that not all of the features of the components of the figures are necessarily described. Some of these non discussed features as well as discussed features are inherent from the figures. Other non discussed features may be inherent in component geometry and/or configuration. 
       DETAILED DESCRIPTION OF THE INVENTION 
       [0031]    Referring to  FIGS. 1-2 , there is shown one exemplary embodiment of a spinous process clip generally designated  10  fashioned in accordance with the present principles. The spinous process clip  10 , is used for posterior, lateral and/or posterior-lateral insertion into the interspinous process space and thus is configured to retract or be closed prior to and during insertion, then expand or deploy once inserted onto the spine space with minimum tissue resection. The spinous process clip  10  is made from a biocompatible material such as PEEK (polyetheretherketone), titanium or stainless steel. It should be appreciated that other biocompatible materials may be used. 
         [0032]    The spinous process clip  10  is characterized by a three-piece construction, namely a middle portion  12 , a first lateral portion  14 , and a second lateral portion  16 . It should be appreciated that the nomenclature first and second is arbitrary. The first lateral portion  14  and the second lateral portion  16  are pivotally connected to the middle portion  12  via a pivot/pivot pin  18 . Thus, the first and second lateral portions  14 ,  16  may be considered to pivot with respect to the middle portion  12  or the middle portion  12  may be considered to pivot with respect to the first and second lateral portions. In either and both cases, the spinous process clip  10  may be pivoted into the position illustrated in  FIG. 1  open (clamping) position, the closed (insertion) position illustrated in  FIG. 2 , and positions in between the positions illustrated in  FIGS. 1 and 2 . 
         [0033]    The middle portion  12  is formed by a unitary body  13  that defines an arm  22  which extends from one end of an elbow  24 , and an arm  26  that extends from the other end of the curved elbow  24 . The arm  22  is linear as it extends from the elbow  24 , while the arm  26  is curvilinear as it extends from the elbow  24 . The elbow  24  is likewise curvilinear as it extends from the arm  22 . It should be appreciated that the arm  22  may not necessarily be linear. Additionally, the curvatures of the elbow  24  and arm  26  may be different than that shown. 
         [0034]    The first lateral portion  14  is formed by a unitary body  15  that defines an arm  32  which extends from one end of an elbow  34 , and an arm  36  that extends from the other end of the curved elbow  34 . The arm  32  is linear as it extends from the elbow  34 , while the arm  36  is curvilinear as it extends from the elbow  24 . The elbow  34  is likewise curvilinear as it extends from the arm  32 . It should be appreciated that the arm  32  may not necessarily be linear. Additionally, the curvatures of the elbow  34  and arm  36  may be different than that shown. 
         [0035]    The second lateral portion  16  is formed by a unitary body  17  defining and arm  42  which extends from one end of an elbow  44 , and an arm  46  that extends from the other end of the curved elbow  44 . The arm  42  is linear as it extends from the elbow  44 , while the arm  46  is curvilinear as it extends from the elbow  44 . The elbow  44  is likewise curvilinear as it extends from the arm  42 . It should be appreciated that the arm  42  may not necessarily be linear. Additionally, the curvatures of the elbow  44  and arm  46  may be different than that shown. 
         [0036]    The first and second lateral portions  14 ,  16  are situated relative to the middle portion  14  such that the curvatures of the elbows  34 ,  44  and arms  35 ,  46  of the first and second lateral portions  14 ,  16  are opposite the curvature of the elbow  24  and arm  26  of the middle portion. The opposite curvatures of the elbow/arm combinations of the first and second lateral portions  14 ,  16  relative to the elbow/arm combination of the middle portion  12 , define a clamping space between the respective elbow/arm combinations of the first and second lateral portions  14 ,  16  and the middle portion  12 , and thus the ability to clamp onto the spinous processes, transverse processes or the lamina of a vertebra. 
         [0037]    The spinous process clip  10  is adjustable and/or provides clamping. Adjustment is effected by the pivoting of the middle and the first and second lateral portions. In order for the spinous process clip  10  to provide clamping and/or a clamping force and/or to maintain the clamping force, a bias is provided between the first and second lateral portions  14 ,  16  and the middle portion  12 . Such bias is provided through the pivot/pivot pin  18 . Other manners of providing a clamping force bias between the first and second lateral portions  14 ,  16  and the middle portion  12  may be used and are contemplated. 
         [0038]    Referring now to  FIGS. 3-4 , there is shown another exemplary embodiment of a spinous process clip generally designated  50  fashioned in accordance with the present principles. Like the spinous process clip  10  the spinous process clip  50  is used for spinal distraction and stabilization and thus is configured to compress and expand, and to be inserted posteriorly onto the spine with minimum tissue resection. The spinous process clip  50  is also made from a biocompatible material such as PEEK (polyetheretherketone), titanium or stainless steel. It should be appreciated that other biocompatible materials may be used. 
         [0039]    The spinous process clip  50  utilizes a combined gear rack and ratchet mechanism similar in form and function to that of a zip strip (cable tie) in order to effect adjustment thereof. The spinous process clip  50  is characterized by a two-piece construction, namely a first or upper portion  52 , and a second or lower portion  54 . It should be understood that the nomenclature upper, lower, first and second are arbitrary. The first portion  52  and the second portion  54  are adjustably connected to each other via a combined gear rack and ratchet mechanism  56 . The first and second portions  52 ,  54  thus move with respect to each other but in discrete steps according to the spacing/geometry of the combined gear rack and ratchet mechanism  56 . This is described further below. Movement of the first and second portions  52 ,  54  allows the spinous process clip  50  to assume the holding position illustrated in  FIG. 3 , the closed or insertion position illustrated in  FIG. 4 , and positions in between the positions illustrated in  FIGS. 3 and 4 . 
         [0040]    The first portion  52  is formed by a unitary body  53  that defines a base  70 , a first arm  76  which extends from one side of the base  70 , and a second arm  78  that extends from the other side of the base  70 . Again, it should be appreciated that the nomenclature first and second is arbitrary. The first arm  76  is linear but extends at an angle laterally outwardly from the base  70 . The second arm  78  is likewise linear but extends at an angle laterally outwardly from the base  70 . The angles of the first and second arms  76 ,  78  are opposite one another such that the body  53  essentially defines a “V” shape. 
         [0041]    The second portion  54  is formed by a unitary body  55  that defines a base  60 , a first arm  64  which extends from one side of the base  60 , and a second arm  66  that extends from the other side of the base  60 . Again, it should be appreciated that the nomenclature first and second is arbitrary. The first arm  64  is linear but extends at an angle laterally outwardly from the base  60 . The second arm  66  is likewise linear but extends at an angle laterally outwardly from the base  60 . The angles of the first and second arms  64 ,  66  are opposite one another such that the body  55  essentially defines a “V” shape. 
         [0042]    The first and second portions  52 ,  54  are connected together via the combined gear rack and ratchet  56  such that their respective “V” shapes are opposite or upside down relative to one another. The opposite “V” shapes of the arms of the first and second portions  52 ,  54  define a clamping or holding space between their respective arms and thus the ability to clamp or hold onto adjacent spinous processes, transverse processes or the lamina (spinal structures) of adjacent vertebrae, as well as fit between the area or space between the adjacent spinal structures. 
         [0043]    As indicated above, discrete adjustable movement between the first and second portions  52 ,  54  is accomplished by the combined gear rack and ratchet  56 . Particularly, the first portion  52  includes a gear rack  62  on a side surface of the base  60 . The gear rack  62  extends from a top to bottom end of the base  60  and includes a plurality of teeth, serrations or the like  63 . The second portion  54  includes a configured slot, channel, groove or the like  72  (“slot”) formed in the base  70 . The configured slot  72  extends from a top to bottom end of the base  70 . The base  70  further includes a flange  73  formed at the end of the configured slot  72 . The flange  73  has a pawl or similar protrusion such that the configured slot  72  and flange  73  form the ratchet. Together, the configured slot  72  and the ratchet  62  form the combined gear rack and ratchet  56 . The combined gear rack and ratchet  56  allows the first and second portions  52 ,  54  to discretely move away from each other while preventing backwards movement. For example, if the first portion  52  is moved from the position shown in  FIG. 4  to the position shown in  FIG. 3 , the first portion  52  is prevented from returning to the position shown in  FIG. 4 . It should be appreciated that while the gear rack is shown as being a part of the first portion  52  and the ratchet is shown as being part of the second portion  54 , they can be reversed such that the gear rack may be a part of the second portion and the ratchet may be a part of the first portion. 
         [0044]    Referring now to  FIGS. 5-6 , there is shown another exemplary embodiment of a spinous process clip generally designated  80  fashioned in accordance with the present principles. The spinous process clip  80  is used for distraction and stabilization and thus is configured to retract and expand and to be inserted laterally, posterior-laterally or posteriorly onto the spine with no ligament (i.e. the ligament that covers the spinous process) resection. The spinous process clip  80  is made from a biocompatible material such as PEEK (polyetheretherketone), titanium or stainless steel. It should be appreciated that other biocompatible materials may be used. 
         [0045]    The spinous process clip  80  is characterized by a two-piece construction, namely a first portion  82 , and a second portion  84 . It should be appreciated that the nomenclature first and second is arbitrary. The first portion  82  and the second portion  84  are pivotally connected to each other via a pivot/pivot pin  86 . Thus, the first and second portions  82 ,  84  pivot with respect each other. As such, the spinous process clip  80  may be pivoted into the position illustrated in  FIG. 5  (an open/holding position), the position illustrated in  FIG. 6  (a closed/insertion position), and positions in between the open and closed positions illustrated in  FIGS. 5 and 6 . 
         [0046]    The first portion  82  is formed by a unitary body  83  that defines a middle linear portion  88 , a first linear arm  90  extending from an end of the middle linear portion  88 , and a second linear arm  92  extending from the other end of the middle linear portion  88 . The first linear arm  90  extends at an angle relative to the longitudinal axis of the middle linear portion  88 . The second linear arm  92  likewise extends at an angle relative to the longitudinal axis of the middle linear portion  88 . The first and second arms  90 ,  92  extend at opposite angles relative to one another so as to form one “leg” of the “X” shape of the spinous process clip  80 . 
         [0047]    The second portion  84  is formed by a unitary body  85  that defines a middle linear portion  94 , a first linear arm  96  extending from an end of the middle linear portion  94 , and a second linear arm  98  extending from the other end of the middle linear portion  94 . The first linear arm  96  extends at an angle relative to the longitudinal axis of the middle linear portion  94 . The second linear arm  98  likewise extends at an angle relative to the longitudinal axis of the middle linear portion  94 . The first and second arms  94 ,  96  extend at opposite angles relative to one another so as to form the other “leg” of the “X” shape of the spinous process clip  80 . 
         [0048]    The first and second portions  82 ,  84  are pivotally coupled to one another such that the arms  90 ,  96  of the first and second portions  82 ,  84  extend in the same direction while the arms  92 ,  98  of the first and second portions  82 ,  84  extend in the same direction. Thus, when the first and second portions  82 ,  84  are pivoted into the position shown in  FIG. 6  (and other positions from the position shown in  FIG. 5 ) a clamping space is defined between the respective arms of the first and second portions  82 ,  84 , and thus the ability to clamp onto the spinous processes, transverse processes or the lamina of adjacent vertebrae. 
         [0049]    The spinous process clip  80  is adjustable and/or provides clamping. Adjustment is effected by the pivoting of the first and second portions. In order for the spinous process clip  80  to provide clamping and/or a clamping force and/or to maintain the clamping force, a bias is provided between the first and second lateral portions  82 ,  84 . Such bias is provided through the pivot/pivot pin  86 . Other manners of providing a clamping force bias between the first and second lateral portions  82 ,  84  may be used and are contemplated. 
         [0050]    Referring now to  FIGS. 7-8 , there is shown another exemplary embodiment of a spinous process clip generally designated  100  fashioned in accordance with the present principles. The spinous process clip  100  is used for distraction and stabilization of adjacent vertebrae and thus is configured to be inserted laterally, posterolaterally, and posteriorly onto the spine with minimum tissue resection. The spinous process clip  100  is made from a biocompatible material such as PEEK (polyetheretherketone), titanium or stainless steel. It should be appreciated that other biocompatible materials may be used. 
         [0051]    The spinous process clip  100  is characterized by a two-piece construction, namely a bolt  102  and an expander  104 . The bolt  102  is formed by a unitary body  103  that defines a generally cylindrical head  106  with an elongated cylindrical portion  108  extending from one side of the cylindrical head  106 . The bolt body  103  further defines an expansion portion  110  that extends axially from the elongated cylindrical portion  108 . The expansion portion  110  is formed by a plurality of elongated axial slats  112  that define a plurality of elongated axial openings  113  and terminates in a cylindrical end  114 . The plurality of elongated axial slats  112  thus extend from the elongated cylindrical portion  108  to the cylindrical end  114 . 
         [0052]    The expander  104  is characterized by a shaft  116  that extends through a threaded bore  107  of the cylindrical head  106  of the bolt body  103 , a bore of the bolt body  103 , the expansion portion  110 , a bore of the cylindrical end  114 , and terminates in a plate  122  at the axial end of the cylindrical end  114 . The shaft  116  has a hexagonal head  118  proximate the cylindrical head  106  that receives a tool for rotating the shaft  116 . It should be appreciated that the head  118  of the shaft  116  may take other shapes as desired. The shaft  116  further has a threaded portion  120  that operatively engages the threaded bore  120  of the cylindrical head  106 . 
         [0053]    The spinous process clip  100  is implanted in an unexpanded position such as illustrated in  FIG. 8 . Rotation of the shaft  116  pulls the plate  122  against the cylindrical end  114 . Compression of the plate  122  against the cylindrical end  114  causes the slats  112  to fold or buckle into an expanded position such as is illustrated in  FIG. 7 . The provides the ability of the spinous process clip  100  to clamp onto the spinous processes, transverse processes or the lamina of adjacent vertebrae. Particularly, the spinous process clip  100  provides clamping between the cylindrical head  106  and the expanded expansion portion  110 . 
         [0054]    Referring now to  FIGS. 9-10 , there is shown another exemplary embodiment of a spinous process clip generally designated  130  fashioned in accordance with the present principles. The spinous process clip  130  is used for vertebral expansion and thus is configured to distract and stabilize adjacent vertebrae and to be inserted posteriorly and posterior-laterally onto the spine with no ligament (i.e. the ligament that covers the spinous process) resection. The spinous process clip  130  is made from a biocompatible material such as PEEK (polyetheretherketone), titanium or stainless steel. It should be appreciated that other biocompatible materials may be used. 
         [0055]    The spinous process clip  130  is characterized by a multiple construction, namely a first portion  132 , a second portion  134 , and an adjustment portion  136 . It should be appreciated that the nomenclature first and second is arbitrary. The first portion  132  and the second portion  134  are movably connected to each other via a mutual slot and pin configuration whose movement is controlled via the adjustment portion  136 . Thus, the first and second portions  132 ,  134  slide with respect to each other under the control of the adjustment portion  136 . As such, the spinous process clip  130  may be adjusted into the position illustrated in  FIG. 9  (a clamping position), the position illustrated in  FIG. 10  (an open position), and positions in between the open and clamping positions illustrated in  FIGS. 10 and 9 . 
         [0056]    The first portion  132  is formed by a first unitary body  133  that defines a generally elongated oval wing  150  having a generally half-tubular arm  160  extending transverse from an inner surface of an upper portion of the wing  150 . The wing  150  also includes a plurality of spikes  151  that project from the inner surface of a lower portion of the wing  150 . The spikes  151  are adapted to extend into and grip the spinous processes, transverse processes or the lamina. The arm  160  has a slot  161  that extends through approximately three-quarters (¾) of the length of the arm  160  to essentially divide the arm  160  into a first quarter (¼)  162  and a second quarter (¼)  163 . The inside of the first and second quarters  162 ,  163  are configured to define an upper portion of a rectangular channel. 
         [0057]    The first portion  132  is further formed by a second unitary body  135  that defines generally elongated oval wing  152  having a generally half-tubular arm  164  extending transverse from an inner surface of a lower portion of the wing  152 . The wing  152  also includes a plurality of spikes  153  that project from the inner surface of an upper portion of the wing  152 . The spikes  153  are adapted to extend into and grip the spinous processes, transverse processes or the lamina. The arm  164  has a slot  165  that extends through approximately three-quarters (¾) of the length of the arm  164  to essentially divide the arm  164  into a first quarter (¼)  166  and a second quarter (¼)  167 . The inside of the first and second quarters  166 ,  167  are configured to define an upper portion of a rectangular channel. 
         [0058]    The first and second unitary bodies  132 ,  134  are movably coupled to one another via the mutual slot and pin configuration mentioned above. Particularly, the wing  150  has an elongated slot  155  that extends laterally through the wing  150  from one lateral side thereof to the other. Likewise, the wing  152  has an elongated slot  154  that extends laterally through the wing  152  from one lateral side thereof to the other. The wing  152  has a projection  156  that extends from a lateral side of the wing  152  and into the slot  155  of the wing  150 . Likewise, the wing  150  has a projection (not seen) that extends from a lateral side of the wing  150  and into the slot  154  of the wing  150 . In this manner, the wings  150 ,  152  are movably linked to one another. 
         [0059]    The second portion  134  is formed of a unitary body  140  that defines an essentially two-ended paddle. The unitary body  140  has a first paddle  142  and a second paddle  143  situated on opposite ends of a mid section. The first paddle  142  has a plurality of spikes  144  on an inside surface there of that are adapted to extend into and grip the spinous processes, transverse processes or the lamina. The second paddle  143  has a plurality of spikes  145  that are adapted to extend into and grip the spinous processes, transverse processes or the lamina. The mid section has a boss  141  having a bore therethrough. 
         [0060]    The adjustment portion  136  includes a central screw  170  that extends through the half tubular arms  160 ,  164 . The screw  170  also extends through a support  173 . Support  173  doubly acts as a “shim” used to expand the assembly. A threaded collar  174  is received onto the screw  170  for pushing the second portion  134  towards the first portion  132  and into a clamping or holding position. Initially, the spinous process clip  130  is in the open position as shown in  FIG. 10 . In order to effect clamping or holding, a drive nut  180  is threaded onto the screw  170 . The collar  174  is proximate the second portion  134 . The drive nut  180  has a hexagonal body  181  (other shapes may be used) that accepts a hexagonal (or other) driver (not shown). The body  181  has a threaded bore  182  that extends therethrough for receipt onto the screw  170 . The body  181  further has an end  183  that is configured to abut the collar  174 . Rotation of the drive nut  180  pushes against the collar  174  which pushes against the boss  141  of the second portion  134  to drive the second portion towards the first portion  132 . As it does, the wings  150 ,  154  slide to open the tubular arms  160 ,  164 . At the same time, the second portion  134  moves toward the wings  150 ,  154  to provide a clamping space therebetween and to provide the ability to clamp onto the spinous processes, transverse processes or the lamina. 
         [0061]    Referring now to  FIGS. 11-12 , there is shown another exemplary embodiment of a spinous process clip generally designated  200  fashioned in accordance with the present principles. The spinous process clip  200  is used for distraction and stabilization of the spine and thus is configured to contract and expand and to be inserted laterally, posterior-laterally and posteriorly onto the spine with no ligament (i.e. the ligament that covers the spinous process) resection. The spinous process clip  200  is made from a biocompatible material such as PEEK (polyetheretherketone), titanium or stainless steel. It should be appreciated that other biocompatible materials may be used. 
         [0062]    The spinous process clip  200  is characterized by a three-piece construction, namely a first portion  202 , a second portion  204 , and an adjustment portion  206 . It should be appreciated that the nomenclature first and second is arbitrary. 
         [0063]    The first portion  202  is formed by a unitary body  203  that defines a central, generally annular hub  210 , a first arm  212  extending from a side of the central, generally annular hub  210 , and a second arm  214  extending from another side of the central annular hub  210  diametrically opposite the first arm  212 . The first arm  212  has a plurality of serrations or teeth  213  on an inside surface thereof (see particularly,  FIG. 11 ) and a longitudinal groove or channel  227  on an outside surface thereof (see particularly,  FIG. 12 ). The second arm  214  has a plurality of serrations or teeth  215  on an inside surface thereof (see particularly,  FIG. 12 ) and a longitudinal groove or channel  216  on an outside surface thereof (see particularly,  FIG. 11 ). The first arm  212  forms one leg of a first clamp of the spinous process clip  200 , while the second arm  214  forms one leg of a second clamp of the spinous process clip  200 . 
         [0064]    The second portion  204  is formed by a unitary body  205  that defines a central, generally annular hub  220 , a first arm  222  extending from a side of the central, generally annular hub  220 , and a second arm  224  extending from another side of the central annular hub  220  diametrically opposite the first arm  222 . The first arm  222  has a plurality of serrations or teeth  223  on an inside surface thereof (see particularly,  FIG. 11 ) and a longitudinal groove or channel  227  on an outside surface thereof (see particularly,  FIG. 12 ). The second arm  224  has a plurality of serrations or teeth  225  on an inside surface thereof (see particularly,  FIG. 12 ) and a longitudinal groove or channel  226  on an outside surface thereof (see particularly,  FIG. 11 ). The first arm  222  forms the other leg of the first clamp of the spinous process clip  200 , while the second arm  224  forms the other leg of the second clamp of the spinous process clip  200 . 
         [0065]    The first portion  202  and the second portion  204  are pivotally or rotatably connected to each other via a pivot/pivot boss  206 . Thus, the first and second portions  202 ,  204  pivot or rotate with respect each other. This can be considered as one portion (either the first or second portion) pivoting or rotating with respect to the other portion (the opposite one of the first and second portion). This allows the spinous process clip  200  to assume the closed position such as is illustrated in  FIG. 12  and an open position such as illustrated in  FIG. 11 . It should be appreciated that the spinous process clip  200  may assume all positions between those shown in the figures. 
         [0066]    Moreover, the spinous process clip  200  assumes a plurality of discrete positions each one of which can be locked into place and against further rotation (i.e. positions of the first and second portions  202 ,  204  are discretely rotatably adjustable relative to one another). This provides clamping by the first clamp, defined by the arms  212  and  224 , and by the second clamp, defined by the arms  214  and  222 . The discrete positions are provided through meshing of teeth or serrations on the various portions as described below. Particularly, the generally annular hub  220  of the second portion  204  includes a plurality of teeth or serrations  230  situated in a generally annular pattern on an inside surface of the hub  220 . Likewise, the generally annular hub  210  of the first portion  202  includes a plurality of teeth or serrations  229  situated in a generally annular pattern on an outside surface of the hub  110 . The teeth or serrations  229  rotationally mesh with the teeth or serrations  230  to provide the discrete rotational positions of the first and second portions  202 ,  204  relative to one another. 
         [0067]    In order to lock the positions of the first and second portions  202 ,  204  relative to one another, the adjustment portion  206  is used. The adjustment portion  206  includes a generally annular knob  209 . The knob  209  has a central, threaded bore  217  that is threaded onto the threads  211  of a boss  208  that extends from the hub  220  of the second portion  204  and through the hub  210  of the first portion  202 . The knob has a plurality of teeth or serrations  218  situated in a generally annular pattern on an inside surface thereof. The hub  110  of the first portion  202  has a plurality of teeth or serrations  228  situated in a generally annular pattern on an outside surface thereof. The teeth or serrations  218  of the knob  209  rotationally mesh with the teeth or serrations  228  of the hub  110  when the knob  209  rotationally threads onto the threaded boss  208 . As the knob  209  is tightened against the hub  210 , the teeth  218  of the knob  209  mesh with the outside teeth  228  of the hub  210  which pushes the inside teeth  229  of the hub  210  against the inside teeth  230  of the hub  220  to fix the position of the first and second portions. In this manner, the first and second clamps of the spinous process clip  200  provide the necessary clamping onto the spinous processes, transverse processes or the lamina. 
         [0068]    It should be appreciated that variations of the spinous process clip  200  are contemplated but not shown. For example, and without being exhaustive, there may not be threads on elements  208  and  209 . The intent of the illustrated spinous process clip  200  is that the knob ( 209 ) be compressively held (via tension springs or something of the like) against hubs  210  and  220  to engage the teeth and lock the position. Other manners of accomplishing this may be used. 
         [0069]    While the invention has been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that only preferred embodiments have been shown and described and that all changes and/or modifications that come within the spirit of the invention are desired to be protected.