Abstract:
Described herein is a pedicle screw for use in the thoracolumbar spine where the height can be adjusted intra-operatively before or after installation member of the longitudinal member. The pedicle screws with adjustable height may be made with a monoaxial or polyaxial configuration. The height of the pedicle screw can be lengthened or shortened.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This is application claims the priority to U.S. Provisional Application No. 62/127,030 filed Mar. 2, 2015, the entire disclosure of which is expressly incorporated herein by reference. 
     
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
       [0002]    This invention was not made with any government support. 
       BACKGROUND 
       [0003]    Spinal fusion surgery usually involves placement of pedicle screws in lumbar and thoracic spine. Pedicle screws are typically available in different length and diameter and are used for a wide variety of indications such as open conventional surgery and minimally invasive spinal surgery. Typically, a longitudinal member is fastened to two or more vertebral anchors with the help of set screws or others similar fasteners on either side of the spine. Occasionally, the height of the screws inserted in to the vertebrae does not match up, particularly if more than two screws are inserted on each side. Uneven height of the head of the pedicle screw makes it harder for installation of the longitudinal member. If such a situation is encountered, the surgeon typically addresses it by utilization of reduction tools or a washer to raise the height of the pedicle screw. Occasionally, a previously inserted pedicle screw may need to be backed out a few turns such that the longitudinal member may be well seated inside the tulip of the pedicle screw. These manures can be tedious and time consuming Loss of fixation is also a concern if a screw has to be backed out for alignment purposes. In minimally invasive cases, height alignment of the screws is even more critical because of limited access to the hardware. 
         [0004]    It will be advantageous to have adjustable height pedicle screws, which allow elongation or shortening such that some of the aforementioned difficulties encountered during spinal instrumentation can be mitigated. 
         [0005]    Most current designs of pedicle screws have a fixed height of the head of the screw in relation to the screw shaft. Intraoperative height adjustment is sometimes necessary for anchoring the longitudinal members, particularly in patients requiring multi-segmental fixation. Most surgeons tend to either utilize washers or back out the pedicle screws when there is a height mismatch. Backing out the screws may compromise the quality of fixation. Additionally, it is difficult to adjust the height of the pedicle screw during minimally invasive spinal surgery with currently available devices. Finally, it may be also be advantageous to further adjust the height of the pedicle screws after placement of the longitudinal member but before final tightening of the construct. 
       SUMMARY 
       [0006]    Described herein is a variable height pedicle screw that may be utilized during spinal surgery. The overall length of the pedicle screw can be lengthened or shortened. 
         [0007]    Also, several methods of accomplishing elongation or shortening of the rod are described. The lower threaded stationary portion of the screw mounted on the vertebra is coupled with a variable height upper portion of the pedicle screw. Incremental elongation is achieved by means of a helical ramp. A combination of features such as a variable height ramp, pressure distribution ramp and a positive ratchet locator may be utilized, as disclosed in greater detail below. 
         [0008]    Alternatively, a height adjusting sleeve is utilized in another embodiment, which engages with left hand and right hand external mounting threads of the stationary lower and variable upper components. By rotating the height adjusting sleeve, incremental elongation of the pedicle screw is accomplished. 
         [0009]    In yet another embodiment, the variable height upper portion may telescope into the stationary threaded lower portion to accomplish overall shortening of the pedicle screw. The pedicle screw head design may be fixed or polyaxial. One or more lugs may be utilized to facilitate forced rotation and height adjustment of the pedicle screw. 
         [0010]    Further, in several situations where the longitudinal member is well seated within the head, it may be advantageous to alter the height of the vertebral anchors after rod installation. One example of such a situation would be further reduction of residual deformity in patients with spondylolisthesis after hardware installation, whereby the height of the distal vertebral pedicle screw can be elongated, forcing further improvement in vertebral alignment. 
         [0011]    In another instance during scoliosis surgery, residual rotational deformity is frequently left after installation of hardware. By elongating the height of the pedicle screw on the convex side of the deformity after hardware installation, the surgeon would be able to achieve further derotation. In a similar manner, a vertebral height could be shortened on the concave side of the deformity. In this setting, the pedicle screws are pulled towards the longitudinal member by collapsing the screw height, thus enabling further rotatory correction. 
         [0012]    In particular embodiments, the pedicle screw includes: a longitudinal screw portion; and, an adjustable height component that is capable of being co-axially and adjustable affixed to the longitudinal screw portion, and that is capable of being axially adjusted intraoperatively with respect to the longitudinal screw portion. 
         [0013]    In certain embodiments, the height of the adjustable height component is capable of being adjusted intraoperatively before or after installation of the longitudinal screw portion. 
         [0014]    In certain embodiments, the adjustable height screw component includes an internally threaded portion capable of accepting a polyaxial screw or a monoaxial screw. 
         [0015]    In certain embodiments, the polyaxial screw or monoaxial is configured for accepting a rod compression screw. 
         [0016]    In certain embodiments, the height adjustable component has at least one positive ratchet locator for incremental height adjustment. 
         [0017]    In certain embodiments, the pedicle screw further includes a variable height engagement ramp. 
         [0018]    In certain embodiments, the variable height component ramp is positioned at an end of the longitudinal screw portion that is adjacent to the adjustable height component. 
         [0019]    In certain embodiments, the variable height component ramp is at an end of the adjustable height component that is adjacent to the longitudinal screw portion. In a particular embodiment, the adjustable height component includes a positive stop is configured to engage a portion of variable height component ramp. 
         [0020]    In certain embodiments, the variable height component ramp is capable of being coaxially positioned at an end of the longitudinal screw portion that is adjacent to the adjustable height component. 
         [0021]    In certain embodiments, wherein the variable height component ramp further includes a pressure distribution ramp. 
         [0022]    In certain embodiments, the polyaxial screw has an external polyaxial pivot head, and wherein the adjustable height component includes an internal polyaxial locator capable of accepting the external polyaxial pivot head on the polyaxial screw. 
         [0023]    In certain embodiments, the longitudinal screw portion has a smooth or threaded shank for allowing the adjustable height component to be moved co-axially with respect to the longitudinal screw portion. 
         [0024]    In certain embodiments, pedicle screw further includes a lug capable of being adjusted for forced rotation and height adjustment of the adjustable height component. 
     
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         [0025]      FIG. 1 . Exploded, perspective assembly view of a first embodiment of an adjustable height pedicle screw having a positive ratchet locator. 
           [0026]      FIG. 2 . Exploded perspective assembly view of another embodiment of an adjustable height pedicle screw having a variable height ramp. 
           [0027]      FIG. 3 . Rotated view of a mounting attachment stationary screw with lower variable height for the embodiment shown in  FIG. 2 . 
           [0028]      FIG. 4 . Assembly view of the variable ramp height non-rotating version in the retracted position for the embodiment shown in  FIG. 2 . 
           [0029]      FIG. 5 . Assembly view of the variable ramp height non-rotating version in the extended position for the embodiment shown in  FIG. 2 . 
           [0030]      FIG. 6 . Exploded, perspective assembly view of another embodiment of an adjustable height pedicle screw having a variable height ramp and the pressure distribution ramp. 
           [0031]      FIG. 7 . Assembly view of the variable ramp height non-rotating version with the pressure distribution ramp in the retracted position for the embodiment shown in  FIG. 6 . 
           [0032]      FIG. 8 . Assembly view of the variable ramp height non-rotating version with the pressure distribution ramp in the extended position for the embodiment shown in  FIG. 6 . 
           [0033]      FIG. 9 . Exploded, perspective assembly view of another embodiment of an adjustable height pedicle screw having a variable height ramp with a lower swivel ramp. 
           [0034]      FIG. 10 . Rotated view of the lower swivel ramp for the embodiment shown in  FIG. 9 . 
           [0035]      FIG. 11 . Assembly view of the variable ramp height rotating version with the swivel in the retracted position for the embodiment shown in  FIG. 9 . 
           [0036]      FIG. 12 . Assembly view of the variable ramp height rotating version with the swivel in the extended position for the embodiment shown in  FIG. 9 . 
           [0037]      FIG. 13 . Exploded, perspective assembly view of a telescoping variable height non-rotating embodiment of an adjustable height pedicle screw. 
           [0038]      FIG. 14 . Assembly view of the telescoping variable height non-rotating version in the retracted position for the embodiment shown in  FIG. 13 . 
           [0039]      FIG. 15 . Assembly view of the telescoping variable height non-rotating version in the extended position for the embodiment shown in  FIG. 13 . 
           [0040]      FIG. 16 . Exploded, perspective assembly view of a telescoping variable height polyaxial rotating embodiment of an adjustable height pedicle screw. 
           [0041]      FIG. 17 . Assembly view of the telescoping variable height polyaxial rotating version in the retracted position for the embodiment shown in  FIG. 1 . 
           [0042]      FIG. 18 . Assembly view of the telescoping variable height polyaxial rotating version in the extended position for the embodiment shown in  FIG. 16 . 
           [0043]      FIG. 19 . Exploded, perspective assembly view of a telescoping variable height compression polyaxial rotating embodiment of an adjustable height pedicle screw the screw is omitted for clarity. 
           [0044]      FIG. 20 . Assembly view of the telescoping variable height compression polyaxial rotating version for the embodiment shown in  FIG. 20  the screw is omitted for clarity. 
       
    
    
       [0045]    Component call out—it is to be understood that components having the same element may have the same number for ease of explanation herein: 
         [0046]    Item # 1  One piece mounting attachment stationary screw with mounting thread 
         [0047]    Item # 2  Fine pitch left hand external mounting thread 
         [0048]    Item # 3  Height adjusting sleeve-type component 
         [0049]    Item # 4  Fine pitch right hand internal thread 
         [0050]    Item # 5  Fine pitch left hand internal thread 
         [0051]    Item # 6  Spanner adjusting lug 
         [0052]    Item # 7  Fine pitch right hand external thread 
         [0053]    Item # 8  Upper rod holder with external thread 
         [0054]    Item # 9  Internal mounting threads 
         [0055]    Item # 10  Final internal rod locating locator 
         [0056]    Item # 11  Rod compression screw 
         [0057]    Item # 12  Polyaxial compression threads 
         [0058]    Item # 13  Polyaxial compression screw 
         [0059]    Item # 14  Polyaxial tightening face 
         [0060]    Item # 15  External polyaxial pivot head 
         [0061]    Item # 16  Mounting attachment stationary screw with polyaxial head 
         [0062]    Item # 17  Fine pitch left hand external thread component 
         [0063]    Item # 18  Internal polyaxial locator 
         [0064]    Item # 19  Lower polyaxial cradle 
         [0065]    Item # 20  Polyaxial compression tightener 
         [0066]    Item # 21  Compression tightener compressor 
         [0067]    Item # 22  Internal compression thread 
         [0068]    Item # 23  Adjusting lug 
         [0069]    Item # 24  External compression thread 
         [0070]    Item # 25  Mounting attachment stationary screw with rotary head 
         [0071]    Item # 26  Upper smooth portion of attachment screw 
         [0072]    Item # 27  Upper threaded portion of attachment screw optional 
         [0073]    Item # 28  Engagement head of attachment screw 
         [0074]    Item # 29  Lower variable height swivel component 
         [0075]    Item # 30  Variable height engagement ramp 
         [0076]    Item # 31  Internal thread for polyaxial screw 
         [0077]    Item # 32  External thread for polyaxial screw 
         [0078]    Item # 33  Polyaxial screw 
         [0079]    Item # 34  Positive stop 
         [0080]    Item # 35  Upper variable height component 
         [0081]    Item # 36  Counterbored retainer 
         [0082]    Item # 37  Mounting attachment stationary screw with lower variable height 
         [0083]    Item # 38  Indexing ratchet 
         [0084]    Item # 39  Pressure distribution ramp 
       DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0085]      FIG. 1  shows an exploded assembly view of the variable height with positive ratchet locator. The variable height adjustment screw assembly allows the height of the final installed alignment rod (not shown) to be incrementally adjusted due to required height variations. With this design the mounting attachment stationary screw with lower variable height  37  is rotated to achieve the required height. The mounting attachment stationary screw with lower variable height  37  is mounted inside the bone. There is an optional upper threaded portion of attachment screw  27  that can provide additional mounting strength if required. The mounting attachment stationary screw with lower variable height  37  has a variable height engagement ramp  30  with optional indexing ratchets  38  that allow for incremental height adjustments when the upper variable height component  35  is engaged with its respective variable height engagement ramp  30  with optional indexing ratchets  38 . There is a positive stop  34  that will maintain a minimum retracted height engagement with the stationary screw with lower variable height  37  and the upper variable height component  35 . There is an internal polyaxial locator pocket  18  in the upper variable height component  35  that will accept the external polyaxial pivot head  15  on the polyaxial screw  33 . The polyaxial screw  33  has polyaxial screw external threads  32  that will engage in internal threads located in the mounting attachment stationary screw with lower variable height  37  near the area of the attachment screw  27 . When the desired position with the mounting attachment stationary screw with lower variable height  37  and the upper variable height component  35  is achieved the polyaxial screw  33  is tightened. At this time the alignment rod not shown can be placed into the final internal rod locating locator  10  that is in the upper variable height component  35 . The rod compression screw  11  can be tightened in the internal mounting threads  9  that are located in the upper variable height component  35 . The alignment rod not shown will be tightened between the rod compression screw  11  and the final internal rod locating locator  10 . 
         [0086]    Referring now to  FIG. 2 , it shows an exploded assembly view of the variable height with variable height ramp. The variable height adjustment screw assembly allows the height of the final installed alignment rod (not shown) to be infinitely adjusted due to required height variations. With this design the mounting attachment stationary screw with lower variable height  37  is rotated to achieve the required height. The mounting attachment stationary screw with lower variable height  37  is mounted inside the bone. There is an optional upper smooth portion of attachment screw  26  that can allow less upper gripping if required. The mounting attachment stationary screw with lower variable height  37  has a variable height engagement ramp  30  that allows for infinitely variable height adjustments when the upper variable height component  35  is engaged with its respective variable height engagement ramp  30 . There is a positive stop  34  that will maintain a minimum retracted height engagement with the stationary screw with lower variable height  37  and the upper variable height component  35 . There is an internal polyaxial locator pocket  18  in the upper variable height component  35  that will accept the external polyaxial pivot head  15  on the polyaxial screw  33 . The polyaxial screw  33  has polyaxial screw external threads  32  that will engage in internal threads located in the mounting attachment stationary screw with lower variable height  37  near the area of the attachment screw  26 . When the desired position with the mounting attachment stationary screw with lower variable height  37  and the upper variable height component  35  is achieved the polyaxial screw  33  is tightened. At this time, the alignment rod (not shown) can be placed into the final internal rod locating locator  10  that is in the upper variable height component  35 . The rod compression screw  11  can be tightened in the internal mounting threads  9  that are located in the upper variable height component  35 . The alignment rod (not shown) will be tightened between the rod compression screw  11  and the final internal rod locating locator  10 . 
         [0087]    Referring now to  FIG. 3 , a rotated view of the mounting attachment stationary screw with lower variable height is shown for clarity purposes. With this design the mounting attachment stationary screw with lower variable height  37  is rotated to achieve the required height. The mounting attachment stationary screw with lower variable height  37  is mounted inside the bone. There is an optional upper smooth portion of attachment screw  26  that can allow less upper gripping if required. The mounting attachment stationary screw with lower variable height  37  has a variable height engagement ramp  30  that allows for infinitely variable height adjustments when the upper variable height component  35  (not shown for clarity purposes) is engaged with its respective variable height engagement ramp  30 . There is a positive stop  34  that will maintain a minimum retracted height engagement with the stationary screw with lower variable height  37  and the upper variable height component  35  not shown for clarity purposes. There is an internal thread for polyaxial screw  31  located in the mounting attachment stationary screw with lower variable height  37  near the area of the attachment screw  26 . 
         [0088]      FIG. 4  shows an assembly view of the variable ramp height non-rotating version in the retracted position. The screw is omitted for clarity. The variable height adjustment screw assembly allows the height of the final installed alignment rod (not shown) to be infinitely adjusted due to required height variations. With this design the mounting attachment stationary screw with lower variable height  37  is rotated to achieve the required height. The mounting attachment stationary screw with lower variable height  37  is engaged with the upper variable height component  35 . The components are aligned as required and joined together with the polyaxial screw  33 . 
         [0089]      FIG. 5  shows an assembly view of the variable ramp height non-rotating version in the extended position. The screw is omitted for clarity. The variable height adjustment screw assembly allows the height of the final installed alignment rod (not shown) to be infinitely adjusted due to required height variations. With this design the mounting attachment stationary screw with lower variable height  37  is rotated to achieve the required height. The mounting attachment stationary screw with lower variable height  37  is engaged with the upper variable height component  35 . The components are aligned as required and joined together with the polyaxial screw  33 . 
         [0090]      FIG. 6  demonstrates an exploded assembly view of the variable height with variable height ramp and the pressure distribution ramp. The variable height adjustment screw assembly allows the height of the final installed alignment rod (not shown) to be infinitely adjusted due to required height variations. With this design the mounting attachment stationary screw with lower variable height  37  is rotated to achieve the required height. The mounting attachment stationary screw with lower variable height  37  is mounted inside the bone. There is an optional upper smooth portion of attachment screw  26  that can allow less upper gripping if required. The mounting attachment stationary screw with lower variable height  37  has a variable height engagement ramp  30  that allows for infinitely variable height adjustments when the upper variable height component  35  is engaged with its respective variable height engagement ramp  30 . There is a positive stop  34  that will maintain a minimum retracted height engagement with the stationary screw with lower variable height  37  and the upper variable height component  35 . There is an internal polyaxial locator pocket  18  in the upper variable height component  35  that will accept the external polyaxial pivot head  15  on the polyaxial screw  33 . The polyaxial screw  33  has polyaxial screw external threads  32  that will engage in internal thread for polyaxial screw  31  located in the mounting attachment stationary screw with lower variable height  37  near the area of the attachment screw  26 . When the desired position with the mounting attachment stationary screw with lower variable height  37  and the upper variable height component  35  is achieved the polyaxial screw  33  is tightened. There is an optional pressure distribution ramp  39  that runs parallel with the engagement ramp  30 . Any adjusted height variation is done in coordination with the optional pressure distribution ramp  39 . The optional pressure distribution ramp  39  is part of the mounting attachment stationary screw with lower variable height  37 . At this time the alignment rod (not shown) can be placed into the final internal rod locating locator  10  that is in the upper variable height component  35 . The rod will also have even distribution on the optional pressure distribution ramp  39  and the final internal rod locating locator  10 . This will evenly distribute the applied pressure. The rod compression screw  11  can be tightened in the internal mounting threads  9  that are located in the upper variable height component  35 . The alignment rod (not shown) will be tightened between the rod compression screw  11  and the final internal rod locating locator  10  and the optional pressure distribution ramp  39 . 
         [0091]      FIG. 7  shows an assembly view of the variable ramp height non-rotating version with the pressure distribution ramp in the retracted position. The screw is omitted for clarity. The variable height adjustment screw assembly allows the height of the final installed alignment rod (not shown) to be infinitely adjusted due to required height variations. With this design the mounting attachment stationary screw with lower variable height  37  is rotated to achieve the required height. The mounting attachment stationary screw with lower variable height  37  is engaged with the upper variable height component  35 . The components are aligned as required and joined together with the polyaxial screw  33 . There is an optional pressure distribution ramp  39  that distributes the applied pressure from the alignment rod (not shown). 
         [0092]    Referring now to  FIG. 8 , an assembly view of the variable ramp height non-rotating version with the pressure distribution ramp in the extended position is shown. The screw is omitted for clarity. The variable height adjustment screw assembly allows the height of the final installed alignment rod (not shown) to be infinitely adjusted due to required height variations. With this design the mounting attachment stationary screw with lower variable height  37  is rotated to achieve the required height. The mounting attachment stationary screw with lower variable height  37  is engaged with the upper variable height component  35 . The components are aligned as required and joined together with the polyaxial screw  33 . There is an optional pressure distribution ramp  39  that distributes the applied pressure from the alignment rod (not shown). 
         [0093]      FIG. 9  shows an exploded assembly view of the variable height with variable height ramp with lower swivel ramp. The variable height adjustment screw assembly allows the height of the final installed alignment rod (not shown) to be infinitely adjusted due to required height variations. With this design the lower variable height swivel component  29  is rotated to achieve the required height. There are optional singular or multiple spanner adjusting lug  6  can be used for rotating the lower variable height swivel component  29 . The optional singular or multiple spanner adjusting lug  6  can be applied to any varied design. The lug will allow for easier forced rotation. The mounting attachment stationary screw with rotary head  25  is placed inside the lower variable height swivel component  29 . The mounting attachment stationary screw with rotary head  25  is then mounted inside the bone. There is an engagement head of attachment screw  28  on the end of the mounting attachment stationary screw with rotary head  25 . There is a counterbored retainer in the lower variable height swivel component  29  that accepts the engagement head of attachment screw  28 . When this is engaged the lower variable height swivel component  29  is able to rotate about the axis of the engagement head of attachment screw  28 . There is an optional upper smooth portion of attachment screw  26  that can allow less upper gripping if required. The lower variable height swivel component  29  has a variable height engagement ramp  30  that allows for infinitely variable height adjustments when the upper variable height component  35  is engaged with its respective variable height engagement ramp  30 . There is a positive stop  34  that will maintain a minimum retracted height engagement with the lower variable height swivel component  29  and the upper variable height component  35 . There is an internal polyaxial locator pocket  18  in the upper variable height component  35  that will accept the external polyaxial pivot head  15  on the polyaxial screw  33 . The polyaxial screw  33  has polyaxial screw external threads  32  that will engage in internal thread for polyaxial screw  31  located in the mounting attachment stationary screw with rotary head  25  near the area of the attachment screw  26 . When the desired position with the lower variable height swivel component  29  and the upper variable height component  35  is achieved the polyaxial screw  33  is tightened. At this time the alignment rod (not shown) can be placed into the final internal rod locating locator  10  that is in the upper variable height component  35 . The rod compression screw  11  can be tightened in the internal mounting threads  9  that are located in the upper variable height component  35 . The alignment rod (not shown) will be tightened between the rod compression screw  11  and the final internal rod locating locator  10 . 
         [0094]    Referring now to  FIG. 10 , a rotated view of the lower swivel ramp is shown separately for clarity. The lower variable height swivel component  29  is rotated to achieve the required height. There are optional singular or multiple spanner adjusting lug  6  can be used for rotating the lower variable height swivel component  29 . The optional singular or multiple spanner adjusting lug  6  can be applied to any varied design. The lug will allow for easier forced rotation. The mounting attachment stationary screw with rotary head  25  not shown for clarity purposes is placed inside the lower variable height swivel component  29 . On the end of the mounting attachment stationary screw with rotary head  25  not shown for clarity purposes there is a counterbored retainer  36  in the lower variable height swivel component  29  that accepts the engagement head of attachment screw  28  not shown for clarity purposes. 
         [0095]      FIG. 11  shows an assembly view of the variable ramp height rotating version with the swivel in the retracted position. The variable height adjustment screw assembly allows the height of the final installed alignment rod (not shown) to be infinitely adjusted due to required height variations. With this design the mounting attachment stationary screw with rotary head  25  has a lower variable height swivel component  29  that is rotated to achieve the required height. The mounting attachment stationary screw with rotary head  25  is engaged with the upper variable height component  35 . The components are aligned as required and joined together with the polyaxial screw  33 . The alignment rod (not shown) can be placed into the final internal rod locating locator that is in the upper variable height component  35 . The rod compression screw  11  can be tightened against the alignment rod (not shown) to complete the assembly. 
         [0096]      FIG. 12  shows an assembly view of the variable ramp height rotating version with the swivel in the extended position. The variable height adjustment screw assembly allows the height of the final installed alignment rod (not shown) to be infinitely adjusted due to required height variations. With this design the mounting attachment stationary screw with rotary head  25  has a lower variable height swivel component  29  that is rotated to achieve the required height. The mounting attachment stationary screw with rotary head  25  is engaged with the upper variable height component  35 . The components are aligned, as required, and joined together with the polyaxial screw  33 . The alignment rod (not shown) can be placed into the final internal rod locating locator that is in the upper variable height component  35 . The rod compression screw  11  can be tightened against the alignment rod (not shown) to complete the assembly. 
         [0097]    The variable height adjustment screw assembly allows the height of the final installed alignment rod (not shown) to be infinitely adjusted due to required height variations. With this design the mounting attachment stationary screw with rotary head  25  has a lower variable height swivel component  29  that is rotated to achieve the required height. The mounting attachment stationary screw with rotary head  25  is engaged with the upper variable height component  35 . The components are aligned as required and joined together with the polyaxial screw  33 . The alignment rod (not shown) can be placed into the final internal rod locating locator that is in the upper variable height component  35 . The rod compression screw  11  can be tightened against the alignment rod (not shown) to complete the assembly. 
         [0098]    Referring to  FIG. 13 , it shows an exploded assembly view of the telescoping variable height non-rotating version. The telescoping variable height adjustment screw assembly allows the height of the final installed alignment rod (not shown) to be infinitely adjusted due to required height variations. With this design the height adjusting sleeve  3  is rotated to achieve the required height. The one piece mounting attachment stationary screw with mounting thread  1  is mounted inside the bone. There is an optional upper smooth portion of attachment screw  26  that can allow less upper gripping if required. The pitch and the direction of the telescoping threads can vary however they must match up with the corresponding component as well as being reversed with the adjacent threads in order to properly function. The fine external mounting thread  2  must correspond with the internal thread  5  and be opposite direction of the external thread  7  that must correspond with the internal thread  4 . The one piece mounting attachment stationary screw with mounting thread  1  has a fine pitch left hand external mounting thread  2  that will be engaged with the fine pitch left hand internal thread  5  on the end of the height adjusting sleeve  3  while at the same time the upper rod holder with external thread  8  with the fine pitch right hand external thread  7  will be engaged with the fine pitch right hand internal thread  4  on the end of the height adjusting sleeve  3 . It is desirable to have enough thread engagement for durability. When the height adjusting sleeve  3  is rotated the components will extend or retract depending on the rotation that is applied with the height adjusting sleeve  3 . On the perimeter of the height adjusting sleeve  3  there are optional singular or multiple spanner adjusting lug  6  that can be applied to any varied design. The lug will allow for easier forced rotation about it respective axis. When the proper required height is achieved with the height adjusting sleeve  3  the alignment rod (not shown) can be placed into the final internal rod locating locator  10  that is in the upper rod holder with external thread  8 . The rod compression screw  11  can be tightened in the internal mounting threads  9  that are located in the upper rod holder with external thread  8 . The alignment rod (not shown) will be tightened between the rod compression screw  11  and the final internal rod locating locator  10 . When the alignment rod (not shown) is placed into more than one assembly with the upper rod holder with external thread  8  the height adjusting sleeve  3  can be adjusted into the final desired position. A fine thread jam screw (not shown) can be installed to lock the final location. 
         [0099]      FIG. 14  shows an assembly view of the telescoping variable height non-rotating version in the retracted position. The one piece mounting attachment stationary screw with mounting thread  1  is engaged with the height adjusting sleeve  3  while engaged at the same time with the upper rod holder with external thread  8 . When the proper required height is achieved with the height adjusting sleeve  3  the alignment rod (not shown) can be placed into the final internal rod locating locator. The rod compression screw  11  will be tightened compressing the alignment rod (not shown) between the rod compression screw  11  and the final internal rod locating locator. 
         [0100]      FIG. 15  shows an Assembly view of the telescoping variable height non-rotating version in the extended position. The one piece mounting attachment stationary screw with mounting thread  1  is engaged with the height adjusting sleeve  3  while engaged at the same time with the upper rod holder with external thread  8 . When the proper required height is achieved with the height adjusting sleeve  3  the alignment rod (not shown) can be placed into the final internal rod locating locator. The rod compression screw  11  will be tightened compressing the alignment rod (not shown) between the rod compression screw  11  and the final internal rod locating locator. 
         [0101]      FIG. 16  shows an exploded assembly view of the telescoping variable height polyaxial rotating version. The telescoping variable height adjustment screw assembly allows the height of the final installed alignment rod (not shown) to be infinitely adjusted due to required height variations as well as polyaxial. With this design the height adjusting sleeve  3  is rotated to achieve the required height. The mounting attachment stationary screw with polyaxial head  16  is placed inside of the fine pitch left hand external thread base component  17 . The mounting attachment stationary screw with polyaxial head  16  is mounted inside the bone. There is an internal polyaxial locator pocket  18  located in the fine pitch left hand external thread base component  17 . This internal polyaxial locator pocket  18  will accept and locate the external polyaxial pivot head  15 . The pitch and the direction of the telescoping threads can vary however they must match up with the corresponding component as well as being reversed with the adjacent threads in order to properly function. The fine external mounting thread  2  must correspond with the internal thread  5  and be opposite direction of the external thread  7  that must correspond with the internal thread  4 . The one piece mounting attachment stationary screw with mounting thread  1  has a fine pitch left hand external mounting thread  2  that will be engaged with the fine pitch left hand internal thread  5  on the end of the height adjusting sleeve  3  while at the same time the upper rod holder with external thread  8  with the fine pitch right hand external thread  7  will be engaged with the fine pitch right hand internal thread  4  on the end of the height adjusting sleeve  3 . It is desirable to have enough thread engagement for durability. When the height adjusting sleeve  3  is rotated the components will extend or retract depending on the rotation that is applied with the height adjusting sleeve  3 . On the perimeter of the height adjusting sleeve  3  there are optional singular or multiple spanner adjusting lug  6  that can be applied to any varied design. The lug will allow for easier forced rotation about it respective axis. When the proper required height is achieved with the height adjusting sleeve  3  the assembly must be tightened utilizing the polyaxial compression screw  13  into the polyaxial internal compression threads  12 . The applied force from the polyaxial compression screw  13  will press against the polyaxial tightening face  14 . This will maintain the infinitely variable desired polyaxial angle. The alignment rod (not shown) can then be placed into the final internal rod locating locator  10  that is in the upper rod holder with external thread  8 . The rod compression screw  11  can be tightened in the internal mounting threads  9  that are located in the upper rod holder with external thread  8 . The alignment rod (not shown) will be tightened between the rod compression screw  11  and the final internal rod locating locator  10 . When the alignment rod (not shown) is placed into more than one assembly with the upper rod holder with external thread  8  the height adjusting sleeve  3  can be adjusted into the final desired position. 
         [0102]      FIG. 17  shows an assembly view of the telescoping variable height polyaxial rotating version in the retracted position. The mounting attachment stationary screw with polyaxial head  16  is placed inside of the fine pitch left hand external thread base component  17 . The fine pitch left hand external thread base component  17  is engaged with the height adjusting sleeve  3  while engaged at the same time with the upper rod holder with external thread  8 . When the proper required height is achieved with the height adjusting sleeve  3  the polyaxial compression screw  13  is tightened maintaining the infinitely variable desired polyaxial angle. The alignment rod (not shown) can be placed into the final internal rod locating locator. The rod compression screw  11  will be tightened compressing the alignment rod (not shown) between the rod compression screw  11  and the final internal rod locating locator. 
         [0103]      FIG. 18  shows an assembly view of the telescoping variable height polyaxial rotating version in the extended position. The mounting attachment stationary screw with polyaxial head  16  is placed inside of the fine pitch left hand external thread base component  17 . The fine pitch left hand external thread base component  17  is engaged with the height adjusting sleeve  3  while engaged at the same time with the upper rod holder with external thread  8 . When the proper required height is achieved with the height adjusting sleeve  3  the polyaxial compression screw  13  is tightened maintaining the infinitely variable desired polyaxial angle. The alignment rod (not shown) can be placed into the final internal rod locating locator. The rod compression screw  11  will be tightened compressing the alignment rod (not shown) between the rod compression screw  11  and the final internal rod locating locator. 
         [0104]      FIG. 19  shows an exploded assembly view of the telescoping variable height compression polyaxial rotating version the screw is omitted for clarity. The telescoping variable height adjustment screw assembly allows the height of the final installed alignment rod (not shown) to be infinitely adjusted due to required height variations as well as polyaxial. With this design the height adjusting sleeve  3  is rotated to achieve the required height. The mounting attachment stationary screw with polyaxial head  16  is placed inside of the lower polyaxial cradle  19 . The mounting attachment stationary screw with polyaxial head  16  is mounted inside the bone. There is an internal polyaxial locator pocket  18  located in the lower polyaxial cradle  19 . The internal polyaxial locator pocket  18  will accept and locate the external polyaxial pivot head  15 . There are optional singular or multiple adjusting lug  23  located on the lower perimeter on the lower polyaxial cradle  19  that will allow for easier forced rotation about it respective axis. There is a polyaxial compression tightener  20  that compresses the polyaxial tightening face  14  on the mounting attachment stationary screw with polyaxial head  16  against the compression tightener compressor  21  on the polyaxial compression tightener  20 . This occurs when the internal compression thread  22  has full thread engagement and tightened against the external compression thread  24  on the lower polyaxial cradle  19 . There are optional singular or multiple adjusting lug  23  located on the lower perimeter of the polyaxial compression tightener  20  that will allow for easier forced rotation about it respective axis. 
         [0105]    When tightened, this will maintain the infinitely variable desired polyaxial angle. The pitch and the direction of the telescoping threads can vary however they must match up with the corresponding component as well as being reversed with the adjacent threads in order to properly function. The fine external mounting thread  2  must correspond with the internal thread  5  and be opposite direction of the external thread  7  that must correspond with the internal thread  4 . The polyaxial compression tightener  20  has a fine pitch left hand external mounting thread  2  that will be engaged with the fine pitch left hand internal thread  5  on the end of the height adjusting sleeve  3  while at the same time the upper rod holder with external thread  8  with the fine pitch right hand external thread  7  will be engaged with the fine pitch right hand internal thread  4  on the end of the height adjusting sleeve  3 . It is desirable to have enough thread engagement for durability. When the height adjusting sleeve  3  is rotated the components will extend or retract depending on the rotation that is applied with the height adjusting sleeve  3 . On the perimeter of the height adjusting sleeve  3  there are optional singular or multiple spanner adjusting lug  6  that can be applied to any varied design. The lug will allow for easier forced rotation about it respective axis. When the proper required height is achieved with the height adjusting sleeve  3 , the alignment rod (not shown) can then be placed into the final internal rod locating locator that is in the upper rod holder with external thread  8 . The rod compression screw  11  can be tightened in the internal mounting threads  9  that are located in the upper rod holder with external thread  8 . The alignment rod (not shown) will be tightened between the rod compression screw (not shown) and the final internal rod locating locator. When the alignment rod (not shown) is placed into more than one assembly with the upper rod holder with external thread  8  the height adjusting sleeve  3  can be adjusted into the final desired position. A fine thread jam screw (not shown) can be installed to lock the final location. 
         [0106]    Referring to  FIG. 20 , an assembly view of the telescoping variable height compression polyaxial rotating version the screw is omitted for clarity is shown. The mounting attachment stationary screw with polyaxial head  16  is placed inside of the lower polyaxial cradle  19 . The mounting attachment stationary screw with polyaxial head  16  is mounted inside the bone. There is a polyaxial compression tightener  20  that compresses the mounting attachment stationary screw with polyaxial head  16  against the polyaxial compression tightener  20 . When the required angle is achieved the polyaxial compression tightener  20  is tightened against the lower polyaxial cradle  19 . 
         [0107]    The fine pitch left hand external thread polyaxial compression tightener  20  is engaged with the height adjusting sleeve  3  while engaged at the same time with the upper rod holder with external thread  8 . When the proper required height is achieved the alignment rod (not shown) can be placed into the final internal rod locating locator. The rod compression screw  11  will be tightened compressing the alignment rod (not shown) between the rod compression screw  11  and the final internal rod locating locator. A fine thread jam screw (not shown) can be installed to lock the final location. 
         [0108]    The above detailed description of the present invention is given for explanatory purposes. It will be apparent to those skilled in the art that numerous changes and modifications other than those cited can be made without departing from the scope of the invention. Accordingly, the whole of the foregoing description is to be construed in an illustrative and not a limitative sense, the scope of the invention being defined solely by the appended claims.