Patent Publication Number: US-9421020-B2

Title: Drill guide with rotating handle

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     The present application is a continuation of U.S. patent application Ser. No. 11/693145, filed Mar 29, 2007. The present application claims priority under 35, U.S.C. §119(e) to the U.S. Provisional Patent Application No. 60/787,461, filed Mar. 30, 2006. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The invention relates generally to systems and methods for performing spinal fixation. Specifically, the invention relates to drill guides, particularly those used for orthopedic procedures. 
     2. Description of the Related Art 
     Advancing age, as well as injury, can lead to degenerative changes in the bones, discs, joints, and ligaments of the spine, producing pain and instability. Under certain circumstances, alleviation of the problems can be provided by performing spinal fusion. Spinal fusion is a surgical technique in which two or more vertebrae of the spinal column are fused together to eliminate the motion between the fused vertebrae. Spinal fusion is used to treat conditions where the spine exhibits instability. Spine instability may result from causes such as fracture, scoliosis, and spondylolisthesis, where one or more vertebrae move in a forward direction relative to the other vertebrae. Spinal fusion with discectomy is also performed for herniations of the discs. This surgery involves removal of the affected disc and fusion of the adjacent vertebrae. Traditionally, bone grafts have been used to fuse the vertebrae, but various types of vertebral implants have also been used. 
     The use of bone fixation systems for treating bone conditions is well established. For example, a bone plate may be positioned over and surrounding the bone injury area and secured to the bone. The bone plate can be secured to the bone by bone screws or other similar fasteners inserted through holes in the bone plate and into the bone itself, sometimes positioned with a drill guide. The screws are tightened so that the bone plate holds the bone to be treated in place in order to insure proper healing. Early fixation devices tended to be applicable only to long-bone injuries, with only limited uses for lower lumbar spinal injuries and disorders. The use of plate/screw fixation systems later expanded, however, to include uses for spinal injuries, including fusion of vertebrae and fixation devices for treating cervical vertebrae injuries. 
     SUMMARY OF THE INVENTION 
     In one embodiment, the present invention provides a drill guide comprising at least one drill guide lumen and a handle coupled to the at least one drill guide lumen. The drill guide lumen includes a proximal opening, a distal opening, and a longitudinal opening therebetween. The handle is movable between a first position relative to the drill guide lumen and a second position relative to the drill guide lumen. 
     The drill guide may further comprise an elongate member including a first end, a second end, and a longitudinal axis therebetween, wherein the at least one drill guide lumen is mechanically coupled proximate to the first end of the elongate member and wherein the handle is mechanically coupled proximate to the second end of the elongate member. The drill guide may further comprise a plurality of drill guide lumens coupled to the handle. The handle may be configured to rotate between the first position and the second position. 
     The first position may comprise a first angular position of the handle relative to the at least one drill guide lumen and the second position may comprise a second angular position of the handle relative to the at least one drill guide lumen. The handle may be configured with a fixed angular position transverse to the longitudinal opening of the at least one drill guide lumen. 
     The first position may comprise a first angular position of the handle transverse to the longitudinal opening of the at last one drill guide lumen and the second position may comprise a second angular position of the handle transverse to the longitudinal opening of the at least one drill guide lumen. The handle may be configured with a fixed angular position relative to the at least one drill guide lumen. 
     The handle may be movably coupled to the at least one drill guide lumen with a locking mechanism. The handle may be movable between the first position and the second position in an unlocked state an immovable between the first position and the second position in a locked state. The locking mechanism may comprise a bushing including a plurality of recesses and a collar disposed around the bushing. The collar may include a flange configured to at least partially fill at least one of the plurality of recesses when the handle is in the locked state. The bushing may be mechanically coupled to the drill guide lumen with a fastener. The plurality of recesses may be configured to permit rotation of the handle in a first direction and may be configured to limit rotation of the handle in a second direction substantially opposite the first direction. The handle may be configured to transition between the locked state when the flange at least partially fills at least one of the plurality of recesses and the unlocked state when the flange does not at least partially fill at least one of the plurality of recesses. The locking mechanism may comprise a threaded lock including a knob and a threaded portion. The threaded portion may be configured to engage a threaded portion of the handle. The threaded portion may be configured to engage a threaded portion of a drill guide lumen extending through the handle. The threaded portion may be configured to engage a threaded portion of the elongate member extending through the handle. The handle may be configured to transition between the locked state and the unlocked state by manipulating a button. The handle may be configured to transition between the locked state and the unlocked state by manipulating a lever, switch or knob. 
     The first position may comprise a first translational position of the handle relative to the at least one drill guide lumen and the second position may comprise a second translational position of the handle relative to the at least one drill guide lumen. The handle may be configured to slide between the first translational position and the second translational position. 
     In another embodiment, the present invention provides a method of positioning a drill guide lumen having a longitudinal axis. The method comprises providing a drill guide lumen mechanically coupled to a movable handle, positioning the drill guide lumen with the handle in a first position, and moving the handle from the first position to a second position while the drill guide lumen remains substantially stationary. 
     Moving the handle may comprise rotating the handle from the first position to the second position, rotating the handle about a pivot point on the drill guide lumen, translationally sliding the handle, and/or manipulating a locking mechanism. The method may further comprise using a drill to insert a bone screw through the drill guide lumen. 
     For purposes of summarizing the invention and the advantages achieved over the prior art, certain objects and advantages of the invention have been described herein above. Of course, it is to be understood that not necessarily all such objects or advantages may be achieved in accordance with any particular embodiment of the invention. Thus, for example, those skilled in the art will recognize that the invention may be embodied or carried out in a manner that achieves or optimizes one advantage or group of advantages as taught or suggested herein without necessarily achieving other objects or advantages as may be taught or suggested herein. 
     All of these embodiments are intended to be within the scope of the invention herein disclosed. These and other embodiments will become readily apparent to those skilled in the art from the following detailed description of the preferred embodiments having reference to the attached figures, the invention not being limited to any particular preferred embodiment(s) disclosed. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       These and other features, aspects, and advantages of the invention disclosed herein are described below with reference to the drawings of preferred embodiments, which are intended to illustrate and not to limit the invention. 
         FIGS. 1A through 1C  depict a perspective view of one embodiment of a drill guide with a handle in different positions. 
         FIG. 2  is an expanded perspective view of one embodiment of a movable coupling. 
         FIG. 3  is a disassembled view of the movable coupling of  FIG. 2 . 
         FIG. 4A  is an expanded disassembled view of the movable coupling of  FIG. 2 . 
         FIG. 4B  is an expanded disassembled view of another embodiment of a movable coupling. 
         FIG. 4C  is a cross-sectional view of the components of the movable coupling of  FIG. 4B  taken along lines  4 C- 4 C. 
         FIGS. 5A and 5B  depict a cross-sectional view of one embodiment of a locking mechanism in the locked and unlocked states, respectively. 
         FIGS. 6A and 6B  depict a perspective view of another embodiment of a drill guide with a handle in different positions. 
         FIG. 7  is a cross-sectional view of the components of yet another embodiment of movable coupling. 
         FIG. 8  is a cross-sectional view of the components of still another embodiment of movable coupling. 
         FIG. 9  is a cross-sectional view of yet still another embodiment of a movable coupling. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Although certain preferred embodiments and examples are disclosed below, it will be understood by those in the art that the invention extends beyond the specifically disclosed embodiments and/or uses of the invention and obvious modifications and equivalents thereof. Thus, it is intended that the scope of the invention herein disclosed should not be limited by the particular disclosed embodiments described below. 
     As described above, devices such as bone plates or other orthopedic devices can be secured to a bone by bone screws inserted through the device. The insertion of the bone screws may be directed by a drill guide for more precise placement. The drill guide typically comprises a drill guide lumen mechanically coupled to an elongate member, which is mechanically coupled to a handle. The handle provides added maneuverability such that the user may position the drill guide lumen more accurately. 
     Fixation procedures are often performed by two or more people. In certain embodiments, one user positions the drill guide lumen and the other user operates a drill to insert the bone screws into the bone plate and the bone, guided by the drill guide lumen. However, a handle in a fixed position may impede the ability of the user operating the drill in accessing the drill guide lumen. For example, the handle or the appendages of the user positioning the drill guide may impede access to or visibility of the drill guide lumen, for example by blocking an opening in the drill guide lumen. At least one embodiment of the present invention is the realization that providing a handle movably coupled to the drill guide lumen allows suitable positioning and holding of the drill guide lumen while permitting unimpeded use of the drill. 
       FIG. 1A  depicts a perspective view of one embodiment of a drill guide  10  with a handle  24  movably coupled to a drill guide lumen  18 . The drill guide  10  comprises an elongate member  12  including a first end  14 , a second end  16 , and a longitudinal axis therebetween. At least one drill guide lumen  18  is coupled proximate to the first end  14  of the elongate member  12 . The drill guide lumen  18  includes a proximal opening  22 , a distal opening  20 , and a longitudinal opening therebetween. It will be appreciated that the drill guide lumen  18  may comprise any shape suitable for accurately guiding a drill kit, including embodiments without an elongate member  12 . 
     Although the embodiment of the drill guide  10  illustrated in  FIG. 1A  comprises two drill guide lumens  18 , the drill guide  10  may comprise any number of drill guide lumens  18  appropriate for the performed procedure. For example, if a procedure requires four bone screws to be inserted into a bone plate, the drill guide  10  may comprise four drill guide lumens  18  such that the bone screws may be inserted into the bone plate and the bone after a single positioning the drill guide, thereby providing greater procedural accuracy for placement of the bone screws. In some embodiments, a drill guide with fewer lumens than the implantable device may be moved about the device after drilling each lumen or sets of lumens. 
     In some embodiments, the first end  14  of the elongate member  12  is configured to receive any of a plurality of drill guide lumen assemblies. For example, a single drill guide may be able to receive both a drill guide lumen assembly with one drill guide lumen and a drill guide lumen assembly with two drill guide lumens. For another example, a single drill guide would be able to receive both a drill guide lumen assembly with two drill guide lumens arranged in one configuration and a drill guide lumen assembly with two drill guide lumens arranged in another configuration. Suitable assemblies, such as threading and snap-on fittings, are well-known in the mechanical arts. 
     The drill guide  10  further comprises a handle  24  mechanically coupled proximate to the second end  16  of the elongate member  12  by movable coupling  30 . In alternative embodiments, the elongate member  12  is mechanically coupled to the at least one drill guide lumen  18  with a movable coupling, thereby providing a handle  24  movably coupled to the drill guide lumen  18 . In certain embodiments, both the mechanical coupling between the drill guide lumen  18  and the elongate member  12  and the mechanical coupling between the elongate member  12  and the handle  24  comprise movable couplings, as described in more detail below. The handle  24  may comprise areas for enhanced gripping, for example a grip area  28  and/or a contour area  26 . In some embodiments, the handle  24  is cylindrical. In alternative embodiments, the handle  24  is shaped contoured to a human hand, for example by providing finger and thumb recesses. 
       FIG. 1B  depicts a perspective view of the drill guide  10  of  FIG. 1A  with the handle  24  in a different position. The movement of the handle  24  from the position of  FIG. 1A  to the position of  FIG. 1B  is described in more detail with respect to the movable coupling  30  below. In some embodiments, the handle  24  is configured to move between the first position of  FIG. 1A  and second position of  FIG. 1B  by rotation. The positions of the handle  24  in  FIGS. 1A and 1B  are provided for illustrative purposes only. For example,  FIG. 1C  depicts a perspective view of the drill guide  10  of  FIG. 1A  with the handle  24  in a position different than the positions of  FIGS. 1A and 1B . It will be appreciated that the first position may be any position suitable for properly positioning the drill guide lumen  18 , and that the second position may be any position suitable for providing secure positioning of the drill guide lumen  18  while also permitting unimpeded access to the drill guide lumen  18 . In certain embodiments, the first position of the handle  24  comprises a first angular position relative to the drill guide lumen  18  and the second position of the handle  24  comprises a second angular position relative to the drill guide lumen  18 . For example, in the embodiments illustrated in  FIGS. 1A and 1B , the first position Y of  FIG. 1A  is about 90° from the second position Y′ of  FIG. 1B . For another example, in the embodiments illustrated in  FIGS. 1A and 1C , the first position of  FIG. 1A  is about 90° from the second position of  FIG. 1C . For yet another example, in the embodiments illustrated in  FIGS. 1B and 1C , the first position of  FIG. 1B  is about 180° from the second position of  FIG. 1C . In some embodiments, the handle  24  is configured to rotate continuously 360° about the movable coupling  30 . In other embodiments, rotation may be restricted to a particular movement range. 
     In certain embodiments, the handle  24  is configured with a fixed angular position transverse to the longitudinal axis of the elongate member  12  or to the drill guide lumen  18 . For example, in the embodiment illustrated in  FIG. 1A , Angle X between the handle  24  and the elongate member  12  may be approximately a 135° angle. In other positions, the handle  24  would continue to be at approximately a 135° angle transverse to the longitudinal axis of the elongate member  12  or the drill guide lumen  18 . The angular position Y relative to the drill guide lumen  18  would change, for example from 0° as depicted in  FIG. 1  to 90°, 180°, 270°, or any suitable angle. It will be appreciated that the fixed angular position between the handle  24  and the elongate member  12  or the drill guide lumen  18  may be any angle suitable for positioning the drill guide lumen  18 , and that the movable coupling  30  can be adapted to maintain the fixed angular position between the handle  24  and the elongate member  12  or the drill guide lumen  18 . In embodiments comprising an elongate member  12  in which the handle  24  is secured at a fixed angular position to the elongate member  12  or to the drill guide lumen  18 , the mechanical coupling of the drill guide lumen  18  to the elongate member  12  may be at an angle that compensates for the fixed angular position of the handle  24  transverse to the elongate member  12 . 
     In other embodiments, the handle  24  is movable from a first angular position relative to a pivot point on the longitudinal axis of the elongate member  12  or the drill guide lumen  18  to a second angular position relative to the pivot point on the longitudinal axis of the elongate member  12  or the drill guide lumen  18 . For example, a handle  24  may be movable about a pivot point proximate to the second end  16  of the elongate member  12  such that the angular position relative to the longitudinal axis of the elongate member  12  can change from about 135° to 90°, 180°, etc., such that the handle  24  may provide stable positioning of the drill guide lumen  18  while not impeding access to the drill guide lumen  18 . 
     In certain embodiments, the handle  24  is configured with a fixed angular position relative to the drill guide lumen  18 . For example, in the embodiment illustrated in  FIG. 1A , the handle  24  is secured at approximately a 0° angle from the drill guide lumen  18 . In other positions, the handle  24  would continue to be at approximately a 0° angle. The angular position transverse to the longitudinal axis of the elongate member  12  or to the drill guide lumen  18  would change, for example from 135° as depicted in  FIG. 1  to 0°, 180°, 360°, or any angle therebetween. It will be appreciated that the fixed angular position between the handle  24  and the drill guide lumen  18  may be any angle suitable for positioning the drill guide lumen  18 . In embodiments comprising an elongate member  12  in which the handle  24  is secured at a fixed angular position to the elongate member  12  or to the drill guide lumen  18 , the mechanical coupling of the drill guide lumen  18  may be at an angle to compensate for the angle of the fixed angular position of the handle  24  to the elongate member  12  or the drill guide lumen  18 . 
       FIG. 2  depicts an expanded perspective view of one embodiment of a movable coupling  30  in which the handle  24  is movably coupled proximate to the second end  16  of the elongate member  12  or the drill guide lumen  18  with a locking mechanism. The locking mechanism permits the handle  24  to move between a first position and a second position relative to the elongate member  12  or the drill guide lumen  18  in an unlocked state and does not permit movement of the handle  24  relative to the elongate member  12  between the first position and the second position in a locked state (e.g., as depicted in  FIG. 2 ). In the illustrated embodiment, the movable coupling  30  comprises a bushing  40  mechanically coupled proximate to the second end  16  of the elongate member  12  and a collar  32  disposed at least partially around the bushing  40 . The movable coupling  30  is secured to the handle  24  by a retaining member  44  connected toward an end of the bushing  40  that provides a stop to prevent the bushing  40  from sliding out from the handle  24  while maintaining rotational movement of the bushing  40 . 
       FIGS. 3 and 4A  are disassembled views of the movable coupling  30  of  FIG. 2 . The bushing  40  comprises a plurality of recesses  42 . In some embodiments, the bushing  40  comprises an aperture  39  through which a rivet  38  or any suitable fastening device may mechanically couple the bushing  40  proximate to the second end  16  of the elongate member  12 . The collar  32  comprises a flange  34  configured to engage at least one of the plurality of recesses  42  of the bushing  40  when the handle  24  is in a locked state. For example, the illustrated flange  34  of the collar  32  is configured to fit at least partially within at least one of the plurality of recesses  42  of the bushing  40 , thereby locking the handle  24  in place. In some embodiments, the plurality of recesses  42  are configured to permit rotation in a first angular direction of the handle  24  and are configured to limit rotation in a second angular direction substantially opposite the first angular direction, such as in a socket wrench system (e.g., as depicted in  FIGS. 4B and 4C ). In alternative embodiments, the bushing  40  comprises a plurality of flanges and the collar  32  comprises a recess configured to be at least partially filled by at least one of the plurality of flanges. In other alternative embodiments, the bushing  40  and the collar  32  comprise a set of interlocking teeth. 
     As described above, the handle  24  is configured to be movable between the locked state and the unlocked state when the collar  32  is positioned such that the flange  34  engages and disengages, respectively, at least one of the plurality of recesses  42  of the bushing  40 . In one embodiment, the movable coupling  30  further comprises a spring  36  bearing against the collar  32  and a button  46 .  FIG. 5A  illustrates a movable coupling  30  in a locked state wherein the flange  34  at least partially fills at least one of the plurality of recesses  42 . In this state, the handle  24  resists movement between a first position and a second position relative to the elongate member  12 .  FIG. 5B  illustrates the movable coupling  30  in an unlocked state with the button  46  engaged (as depicted by arrows  48 ). When engaged, the button  46  is manipulated to compress the spring  36 , causing the collar  32  to move away from the bushing  40 , thereby disengaging the flange  34  from the at least one of the plurality of recesses  42  in the bushing  40 . In alternative embodiments, the position and spring constant of the spring  36  are reversed such that engaging the button  46  extends the spring  36 , causing the collar  32  to move away from the bushing  40 , thereby disengaging the flange  34  from the at least one of the plurality of recesses  42  in the bushing  40 . 
     Although the button  46  depicted in  FIG. 2  is located at one end of the handle  24 , it will be appreciated that the button  46  may be positioned at any suitable location on the handle  24  such that manipulation of it causes the collar  32  to engage and/or disengage with the bushing  40 . For example, the button  46  may comprise a wedge positioned on the handle  24  substantially opposite the elongate member  12  that, when vertically manipulated, causes translational movement of the collar  32 . It will be appreciated that similar locking and unlocking operation may be achieved by providing a lever or switch rather than a button  46  to engage and disengage the collar  32  from the bushing  40 . 
     As described above, the movable coupling  30  may be provided at the mechanical coupling of the elongate member  12  and the drill guide lumen  18  with similar operation. Rather than the handle  24  moving while the elongate member  12  and the drill guide lumen  18  remain substantially stationary, in such embodiments the handle  24  and the elongate member  12  move while the drill guide lumen  18  remains substantially stationary. Embodiments are also possible in which each of the mechanical couplings comprise a movable coupling such that the handle  24  and the elongate member  12  can move independently while the drill guide lumen  18  remains substantially stationary. In each of the described embodiments, the handle  24  is movable relative to the drill guide lumen  18 . 
       FIG. 6A  depicts an embodiment of a drill guide  50 . The drill guide  50  comprises a handle  24  configured to slide between a first translational position relative to the drill guide lumen  18  (e.g., as depicted in  FIG. 6A ) and a second translational position relative to the drill guide lumen  18  (e.g., as depicted in  FIG. 6B ). The arrows  56 ,  58  illustrate the direction of movement of the handle  24  between the positions depicted in  FIGS. 6A and 6B , respectively. In some embodiments, the handle  24  comprises slide-stops  52 ,  54  to prevent the handle  24  from fully sliding through the movable coupling  30 . In other embodiments, the handle  24  is tapered outwards at the ends to prevent the handle  24  from fully sliding through the movable coupling  30 . 
       FIG. 7  is a cross-sectional view of the components of yet another embodiment of a movable coupling  30 . The movable coupling  30  comprises the second end  16  of the elongate member  12 , the handle  24 , and a threaded lock  60 . The second end  16  of the elongate member  12  is shaped such that a hollow area  25  of the handle  24  may fit around the elongate member  12  without sliding down, for example with stepped-in area  17 . At least a portion  27  of the hollow area  25  of the handle  24  distal to the elongate member  12  is threaded to engage the threaded lock  60 . The threaded lock  60  comprises a knob  62  and a threaded area  64 . The threaded area  64  of the threaded lock  60  is adapted to engage the threads of the portion  27  of the hollow area  25  of the handle  24 , for example when the knob  62  is turned. When the threaded lock  60  is not engaged, the handle  24  may freely rotate about the elongate member  12 . When the threaded lock  60  is engaged (e.g., by being substantially screwed into the hollow area  25  of the handle  24 ), an edge  65  of the threaded lock  60  bears against the top  13  of the elongate member  12 , thereby limiting the rotation of the handle  24 . In some embodiments, the edge  65  of the threaded lock  60  and/or the top  13  of the elongate member  12  include teeth, grit, or similar members to enhance effects of the rotation limitation. In some embodiments, a material or layer that enhances the effects of rotation limitation is inserted between the top  13  of the elongate member  12  and the edge  65  of the threaded lock  60 . It will be appreciated that the end of the drill guide lumen  18  assembly may be similarly shaped such that rotation of the handle  24  may be limited by a threaded lock  60  without an elongate member  12 . 
       FIG. 8  is a cross-sectional view of the components of still another embodiment of a movable coupling  30 . The movable coupling  30  comprises the second end  16  of the elongate member  12 , the handle  24 , and a threaded lock  60 . The second end  16  of the elongate member  12  is shaped such that a hollow area  25  of the handle  24  may fit around the elongate member  12  without sliding down, for example with stepped-in area  17 . At least a portion  21  of the second end  16  of the elongate member  12  is threaded to engage the threaded lock  60 . The threaded lock  60  comprises a knob  62  and a threaded area  66 . The threaded area  66  of the threaded lock  60  is adapted to engage the threads of the portion  21  of the second end  16  of the elongate member  12 , for example when the knob  62  is turned. When the threaded lock  60  is not engaged, the handle  24  may freely rotate about the elongate member  12 . When the threaded lock  60  is engaged (e.g., by being substantially screwed onto the second end  16  of the elongate member  12 ), edges  68  of the threaded lock  60  bears against the top  29  of the handle  24 , thereby limiting the rotation of the handle  24 . In some embodiments, the edges  68  of the threaded lock  60  and/or the top  29  of the handle  24  include teeth, grit, or similar members to enhance effects of the rotation limitation. In some embodiments, a material or layer that enhances the effects of rotation limitation is inserted between the edges  68  of the threaded lock  60  and the top  29  of the handle  24 . It will be appreciated that the end of the drill guide lumen  18  assembly may be similarly shaped such that rotation of the handle  24  may be limited by a threaded lock  60  without an elongate member  12 . 
       FIG. 9  is a cross-sectional view of yet still another embodiment of a movable coupling  30 . The movable coupling  30  comprises a bushing  40 , a collar  32 , the handle  24 , and a threaded lock  60 . At least a portion  29  of the handle  24  is threaded to engage the threaded lock  60 . The threaded lock  60  comprises a knob  62  and a threaded area  69 . The threaded area  69  of the threaded lock  60  is adapted to engage the threads of the portion  29  of the handle  24 , for example when the knob  62  is turned. When the threaded lock  60  is not engaged, the handle  24  may freely rotate about the bushing  40 . When the threaded lock  60  is engaged (e.g., by being substantially screwed into the handle  24 ), the edge  70  of the threaded lock  60  bears against the edge  72  of the collar  32 , which causes the edge  74  of the collar  32  to bear against the bushing  40 , thereby limiting the rotation of the handle  24 . In some embodiments, the edge  70  of the threaded lock  60 , the edges  70 ,  72  of the collar  32 , and/or the bushing  40  include teeth, grit, or similar members to enhance effects of the rotation limitation. In some embodiments, a material or layer that enhances the effects of rotation limitation is inserted between the edge  70  of the threaded lock  60  and the edge  72  of the collar  32  and/or between the edge  74  of the collar  32  and the bushing  40 . 
     A method of positioning a drill guide lumen  18  of the embodiments described above comprises positioning the drill guide lumen  18  with the handle  24  in a first position and moving the handle  24  from the first position to a second position while the drill guide lumen  18  remains substantially stationary. In certain embodiments, after positioning the drill guide lumen  18  with the handle  24  in a first position, a button  46  is depressed, thereby disengaging a flange  34  of a collar  32  from a bushing  40  within a movable coupling  30 , before the handle  24  is moved to the second position. Once the handle  24  is in the second position, the button  46  is released, thereby allowing the flange  34  of the collar  32  to engage the at least one of the plurality of recesses  42  of the bushing  40 . With the handle  24  positioned to not impede the use of a drill, a drill can secure a bone screw through the drill guide lumen  18 . 
     Although this invention has been disclosed in the context of certain preferred embodiments and examples, it will be understood by those skilled in the art that the present invention extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the invention and obvious modifications and equivalents thereof. In addition, while several variations of the invention have been shown and described in detail, other modifications, which are within the scope of this invention, will be readily apparent to those of skill in the art based upon this disclosure. It is also contemplated that various combinations or sub-combinations of the specific features and aspects of the embodiments may be made and still fall within the scope of the invention. It should be understood that various features and aspects of the disclosed embodiments can be combined with, or substituted for, one another in order to form varying modes of the disclosed invention. For all the embodiments described above, the steps of the methods need not be performed sequentially. Thus, it is intended that the scope of the present invention herein disclosed should not be limited by the particular disclosed embodiments described above, but should be determined only by a fair reading of the claims that follow.