Patent Publication Number: US-11376134-B1

Title: Dual expanding spinal implant, system, and method of use

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation in part of U.S. patent application Ser. No. 17/331,058, titled DUAL WEDGE EXPANDABLE IMPLANT, SYSTEM AND METHOD OF USE, filed May 26, 2021 which is a continuation in part of U.S. patent application Ser. No. 17/123,889, titled EXPANDABLE INTER-BODY DEVICE, SYSTEM, AND METHOD, filed Dec. 16, 2020 which claims priority to and incorporates by reference co-related international patent applications, PCT/IB2020/000942, titled Expandable Inter-Body Device, System, and Method, filed Nov. 5, 2020; and PCT/IB2020/000953, titled Expandable Inter-Body Device, System, and Method, filed Nov. 5, 2020. The contents of each are hereby incorporated in their entireties. This application also incorporates the entire contents of U.S. Pat. No. 10,238,503 filed Nov. 1, 2016 and U.S. Pat. No. 10,610,376 filed Oct. 16, 2015. 
    
    
     FIELD 
     The present disclosure generally relates to medical devices for the treatment of musculoskeletal disorders, and more particularly to a surgical device that includes an expandable spinal implant, systems for implanting and manipulating the expandable spinal implant, and a method for treating a human spine. In some embodiments, disclosed implants may be used in a transforaminal lumbar interbody fusion (TLIF) procedure and other embodiments may be used in an anterior cervical discectomy and fusion (ACDF) procedure although other uses in other areas of the spine or for other orthopedic applications are also contemplated. 
     BACKGROUND 
     Spinal disorders such as degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor, and fracture may result from factors including trauma, disease and degenerative conditions caused by injury and aging. Spinal disorders typically result in symptoms including pain, nerve damage, and partial or complete loss of mobility. 
     Non-surgical treatments, such as medication, rehabilitation and exercise can be effective; however, they may fail to relieve the symptoms associated with these disorders. Surgical treatment of these spinal disorders includes fusion, fixation, correction, discectomy, laminectomy and implantable prosthetics. As part of these surgical treatments, spinal constructs, such as, for example, bone fasteners, spinal rods and interbody devices can be used to provide stability to a treated region. For example, during surgical treatment, interbody devices may be introduced to a space between adjacent vertebral bodies (the interbody space) to properly space the vertebral bodies and provide a receptacle for bone growth promoting materials (BGM), e.g., bone graft and/or synthetic materials. 
     Mechanically operated interbody implants may be used to align and/or realign a patient&#39;s spine during a medical procedure. Conventional implants designed for the Thoracic and Lumbar region of the spine often include top and bottom endplates and a mechanical means to separate the top and bottom endplates. The mechanical mechanisms to separate the top and bottom endplates are often cumbersome and require a large footprint that is often unsuitable for TLIF type surgeries and/or ACDF type surgeries of the spine. 
     SUMMARY 
     The techniques of this disclosure generally relate, for example, to highly adjustable interbody devices that are expandable to selectively increase and decrease a spacing distance between superior and inferior endplates of the interbody device at either or both of a proximal end and/or a distal end of the implant. 
     In one aspect, an expandable implant movable between a contracted position and an expanded position, is disclosed. The implant may include, an expandable body extending from a proximal end to a distal end in a proximal-to-distal direction, extending from a first lateral side to a second lateral side in a widthwise direction, and extending from a superior end to an inferior end in a vertical direction, for example. In various embodiments, the expandable body may be defined by a superior endplate and an inferior endplate opposite the superior endplate, for example. In various embodiments, the superior endplate may include a first outside surface and a first inside surface opposite the first outside surface, the first inside surface may include first proximal ramps and first distal ramps disposed opposite the first proximal ramps, for example. In various embodiments, the inferior endplate may include a second outside surface and a second inside surface opposite the second outside surface, the second inside surface may include second proximal ramps and second distal ramps disposed opposite the second proximal ramps, for example. In various embodiments, a support frame may be coupled to the superior endplate and the inferior endplate, the support frame may have a proximal screw guide and a distal screw guide opposite the proximal screw guide, for example. In various embodiments, a proximal set screw rotatably supported by the proximal screw guide and a distal set screw rotatably supported by the distal screw guide may be provided, for example. In various embodiments, a proximal wedge may include first superior ramped surfaces and first inferior ramped surfaces, the proximal wedge may be coupled to the proximal set screw; and a distal wedge may include second superior ramped surfaces and second inferior ramped surfaces, the distal wedge may be coupled to the distal set screw, for example. In various embodiments, in a contracted position the proximal wedge and the distal wedge are disposed in a medial position of the body, for example. Additionally, in some embodiments, in a first expanded position a spacing between the superior and inferior endplates at the proximal side is greater than a spacing between the superior and inferior endplates at the proximal side in the contracted position, in the first expanded position the proximal wedge may contact the first superior ramped surfaces and the first inferior ramped surfaces and is disposed proximate the proximal side, for example. Additionally, in some embodiments, in a second expanded position a spacing between the superior and inferior endplates at the distal side is greater than a spacing between the superior and inferior endplates at the distal side in the contracted position, in the second expanded position the distal wedge may contact the first and second proximal ramps and is disposed proximate the proximal side with respect to the medial position, for example. 
     In another aspect, a spinal implant system is disclosed. The spinal implant system may include an expandable implant movable between a contracted position and an expanded position. The implant may include, an expandable body extending from a proximal end to a distal end in a proximal-to-distal direction, extending from a first lateral side to a second lateral side in a widthwise direction, and extending from a superior end to an inferior end in a vertical direction, for example. In various embodiments, the expandable body may be defined by a superior endplate and an inferior endplate opposite the superior endplate, for example. In various embodiments, the superior endplate may include a first outside surface and a first inside surface opposite the first outside surface, the first inside surface may include first proximal ramps and first distal ramps disposed opposite the first proximal ramps, for example. In various embodiments, the inferior endplate may include a second outside surface and a second inside surface opposite the second outside surface, the second inside surface may include second proximal ramps and second distal ramps disposed opposite the second proximal ramps, for example. In various embodiments, a support frame may be coupled to the superior endplate and the inferior endplate, the support frame may have a proximal screw guide and a distal screw guide opposite the proximal screw guide, for example. In various embodiments, a proximal set screw rotatably supported by the proximal screw guide and a distal set screw rotatably supported by the distal screw guide may be provided, for example. In various embodiments, a proximal wedge may include first superior ramped surfaces and first inferior ramped surfaces, the proximal wedge may be coupled to the proximal set screw; and a distal wedge may include second superior ramped surfaces and second inferior ramped surfaces, the distal wedge may be coupled to the distal set screw, for example. 
     In another aspect, and in various embodiments, in a contracted position the proximal wedge and the distal wedge are disposed in a medial position of the body, for example. Additionally, in some embodiments, in a first expanded position a spacing between the superior and inferior endplates at the proximal side is greater than a spacing between the superior and inferior endplates at the proximal side in the contracted position, in the first expanded position the proximal wedge may contact the first superior ramped surfaces and the first inferior ramped surfaces and is disposed proximate the proximal side, for example. Additionally, in some embodiments, in a second expanded position a spacing between the superior and inferior endplates at the distal side is greater than a spacing between the superior and inferior endplates at the distal side in the contracted position, in the second expanded position the distal wedge may contact the first and second proximal ramps and is disposed proximate the proximal side with respect to the medial position, for example. Additionally, in various embodiments, the support frame may further include a plurality of engagement prongs extending towards the proximal end in the proximal-to-distal direction, for example. Additionally, the system may include an insertion tool extending in a longitudinal direction from a proximal end to a distal end thereof, and the insertion tool may include a plurality of engagement arms that may have a size and shape corresponding to the plurality of engagement prongs, for example. 
     In another aspect, an expandable and contractable spinal implant is disclosed. The implant may include an expandable body extending from a proximal end to a distal end in a proximal-to-distal direction, extending from a first lateral side to a second lateral side in a widthwise direction, and extending from a superior end to an inferior end in a vertical direction, the expandable body may be defined by a superior endplate and an inferior endplate opposite the superior endplate, for example. In various embodiments, the expandable body may include a beveled hook portion at a distal end thereof. In various embodiments, the superior endplate may include a first outside surface and a first inside surface opposite the first outside surface, the first inside surface may include first proximal ramps and first distal ramps disposed opposite the first proximal ramps, for example. In various embodiments, the inferior endplate may include a second outside surface and a second inside surface opposite the second outside surface, the second inside surface may include second proximal ramps and second distal ramps disposed opposite the second proximal ramps, for example. In various embodiments, a support frame may be coupled to the superior endplate and the inferior endplate, the support frame may have a proximal screw guide and a distal screw guide opposite the proximal screw guide, for example. Additionally, the proximal screw guide may define a first rotation axis and the distal screw guide may define a second rotation axis, the first and second rotation axes may extend in the proximal-to-distal direction, for example. In various embodiments, a proximal set screw rotatably supported by the proximal screw guide and a distal set screw rotatably supported by the distal screw guide may be provided. In various embodiments, a proximal wedge may be to the proximal set screw and may include first superior ramped surfaces and first inferior ramped surfaces, and a distal wedge may be coupled to the distal set screw and may include second superior ramped surfaces and second inferior ramped surfaces, for example. In various embodiments, the proximal wedge may be coupled to the proximal set screw and movable toward and away from the proximal end in the proximal-to-distal direction by rotation of the proximal set screw along the first rotation axis, the distal wedge may be coupled to the distal set screw and movable toward and away the distal end in the proximal-to-distal direction by rotation of the distal set screw along the second rotation axis, for example. Additionally, in various embodiments, the proximal wedge and distal wedge may be configured to simultaneously distract the superior and inferior endplates in a parallel manner upon simultaneous rotation of both the proximal set screw and distal set screw in a first direction and simultaneously contract the superior and inferior endplates in a parallel manner upon simultaneous rotation of both the proximal set screw and distal set screw in a second direction opposite the first direction, for example. 
     In another aspect, and in various embodiments, the proximal set screw may be configured to urge the proximal wedge towards the proximal end in the proximal-to-distal direction upon independent rotation of the proximal set screw in the first direction, thereby distracting the superior and inferior endplates at the proximal end, for example. In various embodiments, the distal set screw may be configured to urge the distal wedge towards the distal end in the proximal-to-distal direction upon independent rotation of the distal set screw in the first direction, thereby distracting the superior and inferior endplates at the distal end. 
     The details of one or more aspects of the disclosure are set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the techniques described in this disclosure will be apparent from the description and drawings, and from the claims. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         FIG. 1  is a front perspective view of an expandable implant. 
         FIG. 2  is an alternate front perspective view of an expandable implant. 
         FIG. 3  is a top down view of an expandable implant. 
         FIG. 4  is a front perspective view of an expandable implant. 
         FIG. 5  is an alternate front perspective view of an expandable implant. 
         FIG. 6  is an exploded parts view of an expandable implant. 
         FIG. 7  is an interior view of a superior endplate. 
         FIG. 8  is an alternate view of a superior endplate. 
         FIG. 9  is an interior view of an inferior endplate. 
         FIG. 10  is an alternate view of an inferior endplate. 
         FIG. 11  is a front perspective view of an expandable implant showing various example curvature profiles. 
         FIG. 12  is a side view of an inferior portion of expandable implant. 
         FIG. 13  is a rear perspective view of an expandable implant. 
         FIG. 14  is a rear perspective view of an expandable implant in a first expanded configuration. 
         FIG. 15  is a rear perspective view of an expandable implant in the first expanded configuration. 
         FIG. 16  is an alternate rear perspective view of an expandable implant in a second expanded configuration. 
         FIG. 17  is a side view of a cross section cut of an expandable implant in a contracted configuration. 
         FIG. 18  is a perspective view of a cross section cut of an expandable implant in an expanded configuration. 
         FIG. 19  is a perspective view of a cross section cut of an expandable implant in an expanded configuration. 
         FIG. 20A  is a top down view of a disc space and an expandable spinal implant in a first position. 
         FIG. 20B  is a top down view of a disc space and an expandable spinal implant in a first position. 
         FIG. 21  is a perspective view of an inserter tool for use with disclosed expandable implants. 
         FIG. 22  is a perspective view of an inserter tool for use with disclosed expandable implants. 
         FIG. 23  is a perspective view of an inserter tool for use with disclosed expandable implants. 
         FIG. 24A  is a perspective view of an inserter tool for use with disclosed expandable implants. 
         FIG. 24B  is a perspective view of a distal region of an inserter tool for use with disclosed expandable implants. 
         FIG. 25  is a perspective view of an inserter tool coupled to an expandable implant. 
         FIG. 26  is a perspective view of an inserter tool and a driver tool for use with disclosed expandable implants. 
         FIG. 27  is a perspective view of a drive tool for use with disclosed expandable implants. 
         FIG. 28A  is an enlarged view of a proximal end of an inserter tool in an unlocked position. 
         FIG. 28B  is an enlarged view of a proximal end of an inserter tool in a locked position. 
         FIG. 29  is a cross section cut showing a drive tool operably engaged with an expandable implant. 
         FIG. 30  is a cross section cut showing a drive tool operably engaged with an expandable implant. 
         FIG. 31  is a perspective view of an alternate drive tool for use with disclosed expandable implants. 
         FIG. 32  is a cross section cut of the alternate drive tool of  FIG. 31  engaged with an expandable implant. 
         FIG. 33  is a reference drawing showing the human spine of which various disclosed implant embodiments may be installed in. 
         FIG. 34  is a reference drawing showing various planes and reference directions of which the various disclosed implant embodiments may move in or act in. 
     
    
    
     DETAILED DESCRIPTION 
     Embodiments of the present disclosure relate generally, for example, to spinal stabilization systems, and more particularly, to surgical instruments for use with spinal stabilization systems. Embodiments of the devices and methods are described below with reference to the Figures. 
     The following discussion omits or only briefly describes certain components, features and functionality related to medical implants, installation tools, and associated surgical techniques, which are apparent to those of ordinary skill in the art. It is noted that various embodiments are described in detail with reference to the drawings, in which like reference numerals represent like parts and assemblies throughout the several views, where possible. Reference to various embodiments does not limit the scope of the claims appended hereto because the embodiments are examples of the inventive concepts described herein. Additionally, any example(s) set forth in this specification are intended to be non-limiting and set forth some of the many possible embodiments applicable to the appended claims. Further, particular features described herein can be used in combination with other described features in each of the various possible combinations and permutations unless the context or other statements clearly indicate otherwise. 
     Terms such as “same,” “equal,” “planar,” “coplanar,” “parallel,” “perpendicular,” etc. as used herein are intended to encompass a meaning of exactly the same while also including variations that may occur, for example, due to manufacturing processes. The term “substantially” may be used herein to emphasize this meaning, particularly when the described embodiment has the same or nearly the same functionality or characteristic, unless the context or other statements clearly indicate otherwise. 
     Referring generally to  FIGS. 1-6  various views of an expandable implant  100  are illustrated. For example,  FIGS. 1-2 and 4-5  are various perspective views of an expandable implant  100 ,  FIG. 3  is a top down view of an expandable implant  100  showing various axes and points of reference, and  FIG. 6  is an exploded parts view of an expandable implant  100 . As illustrated, expandable implant  100  may include a proximal end  100   p , a distal end  100   d , and first and second lateral sides  100   l . The proximal end  100   p  may include an adjustment aperture  101  and an engagement cutout  103  for use with various surgical tools disclosed in  FIGS. 21-32 . In various embodiments, engagement cutout  103  may be defined by a superior engagement cutout  103   s  and an inferior engagement cutout  103   i , for example. As shown in  FIG. 3 , implant  100  may extend in a proximal-to-distal direction from the proximal end  100   p  to the distal end  100   d  though axis P-D through the center of the moving mechanism of implant  100 , for example. Implant  100  may extend in a widthwise direction from the first lateral side  100   l  to the second lateral side  100   l  through a widthwise axis W-W through the center of the moving mechanism of implant  100 , for example. Axis P-D may be perpendicular and/or substantially perpendicular to the widthwise axis B-B. 
     In various embodiments, implant  100  may include tip portion  104  including a superior endplate  10  hooked portion  11  and an inferior endplate  20  hooked portion  21 . In various embodiments, tip portion  104  may extend in a transverse and/or diagonal orientation with respect to the widthwise direction W-W and/or proximal-to-distal P-D direction, for example. As seen in  FIG. 1 , when implant  100  is in the collapsed position, the tip portion  104  is beveled. For example, hooked portion  11  and hooked portion  21  slope towards one another towards the tip portion  104 . At least one advantage of a beveled surface at the tip portion may be easier initial insertion within a disc space. Another advantage may be an increased surface area, enabling implant  100  to withstand greater loads during implant expansion, and to create lordosis, for example. As will be explained in greater detail below with reference to  FIGS. 20A and 20B , the tip portion  104  may be configured for insertion of the implant  100  into a disc space between an upper vertebral body and a lower vertebral body, to hook around the vertebral foramen VF in a multitude of viable positions, thereby avoiding interference with the neural elements, particularly the spinal cord, located in the vertebral foramen VF, for example. Additionally, in various embodiments, superior endplate  10  may include a lateral aperture  16  and inferior endplate  20  may include a lateral aperture  26  (see  FIGS. 5, 15, and 16 ) for facilitating a fusion process as will be explained in further detail below in conjunction with  FIG. 32 . 
     In various embodiments, superior endplate  10  may include a first slot  13  and a second slot  14  on opposite lateral ends thereof, for example. Similarly, inferior endplate  20  may include a third slot  23  and a fourth slot  24  on opposite lateral ends thereof, for example. Slots  13 ,  14 ,  23 ,  24  may be used to constrain a support frame  30  (see  FIG. 6 ) within the interior of the superior and inferior endplates  10 ,  20 . In some embodiments, support frame  30  may be a relatively long extended and approximately rectangular shaped frame extending in the proximal-to-distal direction P-D. In some embodiments, support frame  30  may be a relatively short and approximately square shaped frame. 
       FIG. 6  is an example exploded parts views of an expandable implant  100 . Consistent with the disclosure herein, the superior and inferior endplates  10 ,  20  may be movable with respect to one another in the vertical direction and also may be inclinable, e.g., capable of distraction and lordosis and even kyphotic adjustments. The superior endplate  10  and inferior endplate  20  may be operably engaged and/or coupled with one another by a support frame  30 , for example. Support frame  30  may include a first post  34  and a second post  33  on each lateral side surface of support frame  30 . For example, first post  34  may be an elongate cylindrical post extending in the widthwise direction W-W from support frame and second post  33  may be a relatively shorter elongate cylindrical post extending in the widthwise direction W-W, for example. Additionally, in some embodiments, post  34  and post  33  may have an inclined end cap having a planar end surface approximating the shape of an oval (at least in a head on view from the side). Similarly, the other lateral side of support frame  30  may also include a first post  34  and a second post  33 . In some embodiments, the posts  34 ,  33  on opposite lateral ends may be transposed. For example, on a first lateral end, post  34  may be above post  33  and on the other lateral end post  33  may be above post  34 . This arrangement may facilitate the symmetrical transference of forces throughout implant  100 , for example. Additionally, posts  34  may extend through slotted apertures  14 ,  24  of superior and inferior endplates  10 ,  20 , for example. Similarly, posts  33  may extend through slotted apertures  13 ,  23  of superior and inferior endplates  10 ,  20 , for example. In various embodiments, support frame  30  may include a lateral aperture  35  adjacent posts  33 ,  34  on at least one lateral side surface thereof, for example. In the example embodiment, a single lateral aperture  35  is disposed on a single lateral side surface of support frame  30  for facilitating a direction of flow of a bone growth promoting material which will be explained in further detail below. 
     Support frame  30  may include a plurality of engagement prongs  32  or post like structures extending towards proximal end  100   p . In the example illustration, four engagement prongs  32  are symmetrically distributed at respective corners of a proximal end of support frame  30 . However, other embodiments may include more or less engagement prongs  32 , for example, 1, 2, 3, 5, 6, etc. Engagement prongs  32  may be used to couple implant  100  to an inserter tool  200 , as will be explained in further detail below. For example, an inserter tool  200  may grasp the outside of the engagement prongs  32 . In various embodiments, the outside surfaces of engagement prongs  32  may form right angles at four corners such that a generally square or rectangular shape is formed. Additionally, in various embodiments, the inside surfaces of engagement prongs  32  may include a thread pattern. For example, the four engagement prongs  32  may define a thread pattern for supporting a set screw  40  and such thread pattern may be discontinuous between respective prongs  32  and pick back up at the next respective prong  32  such that set screw  40  may be rotatably supported therein by a discontinuous thread pattern. Support frame  30  may include a proximal screw guide  31   p  and a distal screw guide  31   d . The proximal and distal screw guides  31   p ,  31   d  may each be defined by a circular aperture having an internal circumferential surface including a thread pattern and define a rotation axis extending through a center of the thread pattern, respectively. In some embodiments, the thread patterns may be reversed and in other embodiments they may be the same. The proximal screw guide  31   p  may rotatably support a proximal set screw  40  and the distal screw guide  31   d  may rotatably support a distal set screw  50 , for example. The proximal set screw  40  may include a thread pattern  41  extending along a portion of the outside circumferential surface thereof and a drive engagement surface  43  extending along a portion of the inside circumferential surface thereof. A remaining portion of the outside circumferential surface thereof may be defined by a diameter that is less than a diameter of the portion of set screw  40  having thread pattern  41 , for example. For example, a smooth circumferential surface  44  that is inset towards an axial centerline of set screw  40  and with respect to thread pattern  41 . For example still, one end of set screw  40  may include a thread pattern  41  and the other end may include an inset circumferential surface  44  having at least one flange  42  on an end thereof. In some embodiments, an upper flange  42  and a lower flange  42  are provided, and in other embodiments the flange  42  extends all the way around the end of circumferential surface  44  as an annular ring, for example. Similarly, the distal set screw  50  may include a thread pattern  51  extending along a portion of the outside circumferential surface thereof and a drive engagement surface  53  extending along a portion of the inside circumferential surface thereof. A remaining portion of the outside circumferential surface thereof may be defined by a diameter that is less than a diameter of the portion of set screw  50  having thread pattern  51 , for example. For example, a smooth circumferential surface  54  that is inset towards an axial centerline of set screw  50  with respect to thread pattern  51 . For example still, one end of set screw  50  may include a thread pattern  51  and the other end may include an inset circumferential surface  54  having at least one flange  52  extending from an end thereof. In some embodiments, an upper and lower flange  52  are provided, and in other embodiments the flange  52  extends all the way around the end of circumferential surface  54  as an annular ring. In various embodiments, set screws  40  and  50  may be the same, similar, different, and/or substantially similar. 
     Implant  100  may include a proximal wedge structure  60  and a distal wedge structure  70 , for example. Proximal wedge structure  60  may be coupled to proximal set screw  40  and distal wedge structure  70  may be coupled to distal set screw  50 , for example. Proximal wedge  60  may include an aperture  61  having a size and shape corresponding to circumferential surface  44 . For example, set screw  40  may be coupled to proximal wedge  60  by disposing the circumferential surface  44  within aperture  61  such that flange(s)  42  extend through aperture  61  and securely couple the proximal wedge  60  with proximal set screw  40  such that proximal set screw  40  may rotate within aperture  61 . Additionally, flange  42  may permit axial translation of forces, for example by pushing and/or pulling. Proximal wedge  60  may further include a pair of superior ramped surfaces  63  and a pair of inferior ramped surfaces  64 . Superior ramped surfaces  63  may be disposed on opposite lateral ends of proximal wedge  60  from one another and inferior ramped surface  64  may be disposed on opposite lateral ends of proximal wedge  60  from one another, for example. Similarly, distal wedge structure  70  may include an aperture  71  having a size and shape corresponding to circumferential surface  54  of distal set screw  50 . For example, set screw  50  may be coupled to distal wedge  70  by disposing the circumferential surface  54  within aperture  71  such that flanges  52  extend through aperture  71  and securely couple the distal wedge  70  with distal set screw  50  such that distal set screw  50  may rotate within aperture  71  and permit axial translation of forces. Distal wedge  70  may further include a pair of superior ramped surfaces  73  and a pair of inferior ramped surfaces  74 . Superior ramped surfaces  73  may be disposed on opposite lateral ends of distal wedge  70  from one another and inferior ramped surfaces  74  may be disposed on opposite lateral ends of distal wedge  70  from one another. In various embodiments, proximal wedge  60  and distal wedge  70  may be the same, similar, different, and or substantially the same. Additionally, in various embodiments, the angle of inclination and length of proximal ramps  63 ,  64  may be different on each end to provide for a different magnitude of expansion and/or kyphotic expansion. Similarly, the angle of inclination and length of distal ramps  73 , 74  may be different on each end to provide for a different magnitude of expansion and/or kyphotic expansion. 
     Referring generally to  FIGS. 7-8 , there are various interior views of an interior portion of a superior endplate  10  and referring generally to  FIGS. 9-10 , there are various views of an interior portion of an inferior endplate  20 . In various embodiments, the proximal wedge  60  and distal wedge  70  may act against various surfaces of superior and inferior endplates  10 ,  20  to expand, contract, and incline implant  100  in various positions. For example, superior endplate  10  may include a pair of proximal ramps  18  that are disposed proximate the proximal end of superior endplate  10  and are inclined from a medial position of superior endplate  10  towards the proximal end  100   p  of implant  100 , for example. In the disclosed embodiment, a first proximal ramp  18  and a second proximal ramp  18  are disposed on opposite sides of superior engagement cutout  103   s . Additionally, superior endplate  10  may include a pair of distal ramps  19  that are disposed proximate the distal end of superior endplate  10  and are inclined from a medial position of superior endplate  10  towards the distal end  100   d  of implant  100 . Additionally, in at least some embodiments, a pair of lower distal catches  19   a  may be disposed adjacent to distal ramps  19 , respectively, and be positioned towards the outside lateral surface of superior endplate  10 . Additionally, the pair of lower distal catches  19   a  may extend farther in a vertical direction than the remaining portions of superior endplate  10  and be generally inclined in the same, similar, and or substantially similar direction as distal ramps  19 . In some embodiments, lower distal catches  19   a  may be referred to as guidewalls. Additionally, in some embodiments the combination of a ramp  19  and a catch  19   a  may be referred to as a channel in which a corresponding portion of a wedge is disposed within. 
     Similarly, inferior endplate  20  may include a pair of proximal ramps  28  that are disposed proximate the proximal end of inferior endplate  20  and are inclined from a medial position of inferior endplate  20  towards the proximal end  100   p  of implant  100 , for example. In the disclosed embodiment, a first proximal ramp  28  and a second proximal ramp  28  are disposed on opposite sides of inferior engagement cutout  103   i . Additionally, inferior endplate  20  may include a pair of distal ramps  29  that are disposed proximate the distal end of inferior endplate  20  and are inclined from a medial position of inferior endplate  20  towards the distal end  100   d  of implant  100 . Additionally, in at least some embodiments, a pair of upper distal catches  29   a  may be disposed adjacent to distal ramps  29 , respectively, and be positioned towards the outside lateral surface of inferior endplate  20 . Additionally, the pair of upper distal catches  29   a  may extend farther in a vertical direction than the remaining portions of inferior endplate  20  and be generally inclined in the same, similar, and or substantially similar direction as distal ramps  29 . Furthermore, in some embodiments the combination of a ramp  29  and a catch  29   a  may be referred to as a channel in which a corresponding portion of a wedge is disposed within. 
     As will be explained in more detail below, superior ramped surfaces  63  of proximal wedge  60  may directly contact and act against proximal ramps  18  of superior endplate  10  and inferior ramped surfaces  64  of proximal wedge  60  may directly contact and act against proximal ramps  28  of inferior endplate  20 . As will also be explained in more detail below, superior ramped surfaces  73  of distal wedge  70  may directly contact and act against distal ramps  19  of superior endplate  10  and inferior ramped surfaces  74  of distal wedge  70  may directly contact and act against distal ramps  29  of inferior endplate  20 . 
     Referring generally to  FIGS. 11-19 , there are various perspective views of an expandable implant  100  in a contracted position and in various expanded configurations. In various embodiments, the superior endplate  10  and inferior endplate  20  may optionally include fixation surfaces such as scallops  10   s  and/or teeth or surface roughened textures (not illustrated) for facilitating fixation of implant  100 . As shown in  FIG. 11 , superior endplate  10  is bi-concave. For example, superior endplate  10  is concave in the proximal-to-distal direction P-D along curved line  10 -P-D and superior endplate  10  is concave in the widthwise direction W-W along curved line  10 -W-W, for example. This arrangement may be advantageous for mating with the concavity of a lower surface of a superior endplate of an adjacent vertebrae (not illustrated), for example. Other embodiments may have substantially planar upper surfaces and/or be concave in only one of the proximal-to-distal direction P-D and widthwise direction W-W. For example, superior endplate  10  may be uni-convex. Additionally, inferior endplate  20  may have any of the same concavity relationships as explained above with respect to superior endplate  10 , for example. 
       FIG. 12  illustrates an embodiment where the superior endplate  10  and inferior endplate  20  are inclined in the proximal-to-distal direction P-D. For example, a height between endplates at the proximal end  100   p  may be less than a height between endplates at the distal end  100   d  such that in a collapsed position the relationship between the superior endplate  10  and inferior endplate  20  may be understood as a kyphotic relationship, for example. Additionally, tip portion  104  may be understood to have a tapered leading tip which may facilitate insertion of implant  100  between two collapsed vertebrae, for example. For example, as shown best in  FIG. 13 . 
       FIG. 13  illustrates an example configuration of implant  100  in a contracted position and  FIG. 17  illustrates a cross section of an example configuration of implant  100  in a contracted position.  FIGS. 14-15  and  FIG. 18  each illustrate an example configuration of implant  100  in an expanded configuration where the distal end  100   d  is expanded relative to the contracted position. In  FIG. 14  and  FIG. 15 , it is illustrated that the distal wedge  70  has moved towards the distal end  100   d  of implant  100  in the proximal-to-distal direction P-D, for example. Distal wedge  70  may have moved towards the distal end  100   d  from a medial position due to distal set screw  50  being rotated within distal screw guide  31   d  such that distal set screw  50  is linearly translated towards distal end  100   d  of implant  100 . In doing so, distal set screw  50  pushes distal wedge  70  towards distal end  100   d . Due to the inclination of superior ramps  73  and inferior ramps  74 , the superior and inferior endplates  10 ,  20  are pushed apart at the distal end  100   d . For example, superior ramps  73  may slide along distal ramps  19  of superior endplate  10  and inferior ramps  74  may slide along distal ramps  29  of inferior endplate  20 . In this way, set screw  50  linearly translates distal wedge  70  such that superior and inferior ramps  74 ,  73  act against the superior and inferior endplates  10 ,  20  to urge them apart from one another at the distal end  100   p  of implant  100 . Additionally, as shown in  FIG. 18 , lower distal catches  19   a  may also serve as an extended ramp portion that facilitates maintaining the distal wedge  70  moving in a proximal-to-distal direction, i.e., lower distal catches  19   a  may constrain distal wedge  70  such that it does not slide off track during expansion and/or contraction. In various embodiments, superior endplate  10  may include a first ramp extension  15   d  and inferior endplate  20  may include a second ramp extension  25   d . Ramp extensions  15   d  and  25   d  may be positioned on an interior of endplates  10 ,  20 , respectively, at a distal end such that they may allow implant  100  to further expand. In some embodiments, ramp extensions  15   d  and  25   d  may include a stop block or protrusion to prevent implant  100  from over expanding. For example, ramp extensions  15   d ,  25   d  prevent distal wedge  70  from moving too far in the distal direction. Those with skill in the art will appreciate that the particular location of ramp extensions  15   d ,  25   d  may be positioned to lengthen and/or shorten the corresponding ramps as needed. 
     In some methods of operation, it may be advantageous to determine a target range of expansion and position a stop block or protrusion as explained above in a position where a surgeon may fully expand the implant  100  with the confidence that the fully expanded position is the target expansion range. For example still, a plurality of implants  100  may be manufactured, each with a different maximum and/or target expansion range in the form of a stop block or surface at different positions along the corresponding ramp, and an end user such as a surgeon may select one of the plurality of implants  100  corresponding to the target expansion range for a particular patient&#39;s target alignment and/or corrective procedure. In some embodiments, welding, swagging, adhesive such as epoxy, etc. may be disposed around an end portion of set screws  40 ,  50  to stop the advancement of set screws  40 ,  50  at a predetermined range. Similarly, in some embodiments, welding, swagging, adhesive&#39;s such as epoxy, etc. may be disposed around an end portion of the threaded portion of support body  30  to stop the advancement of set screws  40 ,  50  at a predetermined range. For example, an epoxy may be disposed within the threaded portions of engagement prongs  32  at the proximal end to stop the advancement of set screw  40  at a predetermined distance corresponding to the target expansion range. 
     With reference to  FIGS. 16 and 19 , it is illustrated that the proximal wedge  60  has moved towards the proximal end  100   p  of implant  100  in the proximal-to-distal direction P-D, for example. Although not visible in  FIG. 16 , proximal wedge  60  may have moved towards the proximal end  100   p  from a medial position due to proximal set screw  40  being rotated within proximal screw guide  31   p  such that proximal set screw  40  is linearly translated towards proximal end  100   p  of implant  100  (for example, compare a position of set screw  40  in  FIG. 15  to that of  FIG. 16 ). In doing so, proximal set screw  40  pushes proximal wedge  60  towards proximal end  100   p . Due to the inclination of superior ramps  63  and inferior ramps  64 , the superior and inferior endplates  10 ,  20  are pushed apart at the proximal end  100   p . For example, superior ramps  63  may slide along proximal ramps  18  of superior endplate  10  and inferior ramps  64  may slide along proximal ramps  28  of inferior endplate  20 . In this way, set screw  40  linearly translates proximal wedge  60  such that superior and inferior ramps  64 ,  63  act against the superior and inferior endplates  10 ,  20  to urge them apart from one another at the proximal end  100   p  of implant  100 . 
     In various embodiments, implant  100  may be distracted in a parallel manner where the superior and inferior endplates  10 ,  20  are substantially parallel to one another and/or a height between superior and inferior endplates  10 ,  20  is about the same at the proximal end  100   p  and distal end  100   d  of implant  100 , for example. The distal end  100   d  of implant  100  may be expanded due to distal wedge  70  moving towards the distal end  100   d  of implant  100  in the proximal-to-distal direction P-D, for example. Distal wedge  70  may move towards the distal end  100   d  from a medial position due to distal set screw  50  being rotated within distal screw guide  31   d  such that distal set screw  50  is linearly translated towards distal end  100   d  of implant  100 . In doing so, distal set screw  50  may push distal wedge  70  towards distal end  100   d . Due to the inclination of superior ramps  73  and inferior ramps  74 , the superior and inferior endplates  10 ,  20  are pushed apart at the distal end  100   d . For example, superior ramps  74  may slide along distal ramps  19  of superior endplate  10  and inferior ramps  73  may slide along distal ramps  29  of inferior endplate  20 . In this way, set screw  50  linearly translates distal wedge  70  such that superior and inferior ramps  74 ,  73  act against the superior and inferior endplates  10 ,  20  to urge them apart from one another at the distal end  100   d  of implant  100 . 
     Referring generally to  FIGS. 17-19 , various cross section views of an expandable implant  100  in a contracted configuration and an expanded configuration are shown. As shown in  FIG. 17 , implant  100  is in a contracted position and each of the proximal wedge  60  and distal wedge  70  are in a medial position. Furthermore, posts  34 ,  33  of support frame  30  are engaged with the superior and inferior endplates  10 ,  20  by extending through slots  14 ,  23 , respectively. As shown in  FIG. 18 , posts  34 ,  33  of support frame  30  have changed a relative position within slots  14 ,  23  (relative to  FIG. 17 ) to accommodate the increase in height at the proximal end  100   p . For example, posts  34 ,  33  may be fixed to support frame  30  and the superior and inferior endplates  10 ,  20  may have expanded relative to support frame  30  and therefore posts  34 ,  33  are shown in a different position relative to slots  14 ,  23 . In  FIG. 18 , proximal wedge  60  may have moved towards the proximal end  100   p  due to proximal set screw  40  being rotated and thereby pushing proximal wedge  60  towards proximal end  100   p , for example. Additionally, superior ramps  63  and inferior ramps  64 , may act against the superior and inferior endplates  10 ,  20  to push them apart. For example, superior ramps  63  may slide along proximal ramps  18  of superior endplate  10  and inferior ramps  64  may slide along proximal ramps  28  of inferior endplate  20 . In this way, set screw  40  linearly translates proximal wedge  60  towards proximal end  100   p  such that superior and inferior ramps  63 ,  64  act against the superior and inferior endplates  10 ,  20  to urge them apart from one another. Additionally, in some embodiment&#39;s lower proximal catches  18   a  of superior endplate  10  may be provided at the proximal end of superior endplate  10 . Lower proximal catches  18   a  may act as a catch surface such that when set screw  40  is rotated in the opposite direction a lower surface of superior ramps  63  may push against lower proximal catches  18   a  to facilitate closing of the implant  100 , for example. Additionally, in some embodiments the combination of a ramp  18  and a catch  18   a  may be referred to as a channel in which a corresponding portion of a wedge is disposed within. Furthermore, in some embodiment&#39;s upper proximal catches  28   a  of inferior endplate  20  may be provided at the proximal end of inferior endplate  20 . Upper proximal catches  28   a  may act as a catch surface such that when set screw  40  is rotated in the opposite direction an upper surface of inferior ramps  64  may push against upper proximal catches  28   a  to facilitate closing of the implant  100 , for example. Additionally, in some embodiments the combination of a ramp  28  and a catch  28   a  may be referred to as a channel in which a corresponding portion of a wedge is disposed within. 
     As shown in  FIG. 19 , posts  34 ,  33  of support frame  30  have changed a relative position within slots  14 ,  23  (relative to  FIG. 18 ) to accommodate the increase in height at the distal end  100   d . For example, post  34  has moved through slot  14  to a lower position and post  33  has moved to an upper position within slot  23 . With reference back to  FIG. 17 , slots  14 ,  23  extend in a lateral direction and posts  34 ,  33  are engaged within slots  14 ,  23  throughout the full range of expansion (although it may appear that in  FIG. 19  slot  14  is open at a bottom end this is due to where the section is taken through, for example). In this way, support frame  30  may remain coupled to implant  100 . Additionally, distal wedge  70  may have moved towards the distal end  100   d  due to distal set screw  50  pushing distal wedge  70  towards distal end  100   d . Additionally, superior ramps  74  and inferior ramps  73  may act against the superior and inferior endplates  10 ,  20  and push them apart at the distal end  100   d . For example, set screw  50  linearly translates distal wedge  70  such that superior and inferior ramps  73 ,  74  act against the superior and inferior endplates  10 ,  20  to urge them apart from one another at the distal end  100   d  of implant  100 . In some embodiments, upper distal catches  29   a  of inferior endplate  20  may act as a catch surface such that when set screw  50  is rotated in the opposite direction an upper surface  74   a  of inferior ramps  74  may push against upper distal catches  29   a  to facilitate closing of the implant  100 , for example. Similarly, lower distal catches  19   a  of superior endplate  10  may act as a catch surface such that when set screw  50  is rotated in the opposite direction a lower surface  73   a  of superior ramps  73  may push against lower distal catches  19   a  to facilitate closing of the implant  100 , for example. 
     Referring generally to  FIGS. 20A and 20B , various top down views of a disc space and an expandable spinal implant in a first position ( FIG. 20A ) and a second position ( FIG. 20B ) are illustrated. As shown in  FIG. 20A , implant  100  may be inserted within the disc space in a first orientation where the tip portion  104  may provide for additional anterior rim engagement. For example, the elongated tip of implant  100  extends in a widthwise direction farther than the width of implant  100  at the proximal end, for example. Additionally, as shown in  FIG. 20B , implant  100  may be inserted within the disc space in a second orientation where the tip portion  104  may still provide for additional anterior rim engagement. Accordingly, embodiments in accordance with the principles of this disclosure may be insert within a disc space in a multitude of orientations where tip portion  104  may increase a surface area of implant  100  that may contact and/or support the anterior rim. For example still, tip portion  104  may hook around the vertebral foramen VF in a multitude of viable positions, thereby avoiding interference with the neural elements, particularly the spinal cord, located in the vertebral foramen VF, for example while also supporting the anterior rim. Those with skill in the art will readily appreciate that not all embodiments of implant  100  need have an angled tip portion  104 . For example, in some embodiments (not illustrated) implant  100  may extend in a proximal-to-distal direction and have a straight tip portion  104 . For example still, implant  100  may extend in a longitudinal direction and in a plan view the left and right sides of implant  100  may be roughly symmetrical, i.e., a longitudinal axis extending in the longitudinal direction may bisect implant  100  into two substantially equal and symmetrical halves. Furthermore, consistent with the disclosure herein, tip portion  104  may be extend for various lengths and at various angles relative to a longitudinal axis of implant  100  as disclosed in U.S. application Ser. No. 15/818,395, the contents of which are incorporated herein by reference in entirety. 
     Referring generally to  FIGS. 21-32  various views of an inserter tool  200  and a drive tool  300  for use with disclosed expandable implants  100  are shown. Inserter tool  200  may extend from a proximal end to distal end and include a hollow outer shaft  201  and a hollow inner shaft  203 . The hollow outer shaft  201  may include support walls  207  at a distal end thereof having a size and shape that may be configured to close the flexible tip of shaft  203 . For example, seam  203   s  may enable the distal end of shaft  203  to be compressed together when shaft  203  is insert within outer shaft  201  such that engagement arms  204  are moved closer together. Hollow outer shaft  201  may include a gripping handle  202  extending therefrom and in various embodiments, gripping handle  202  may be a stationary handle or a movable handle (not illustrated), for example. In various embodiments, handle  202  may be disposed in line with the body  201 , overlapping with the body  201 , on a top portion of handle body  201 , and/or offset to one side of body  201 . For example still, handle  202  may take such ergonomic preferences of a particular surgeon in mind and be generally adaptable to any of the prior disclosed positions. Additionally, hollow inner shaft  203  may include engagement arms  204  at a distal end thereof, for example. Engagement arms  204  may be used to grip implant  100  at engagement prongs  32 , for example (see  FIGS. 24A and 24B  and  FIG. 1 ). Additionally, engagement arms  204  may have a size and shape generally corresponding to a size and shape of engagement prongs  32 . For example, engagement arms  204  may surround (or at least partially surround) engagement prongs  32  and securely grip engagement prongs  32  such that implant  100  may be retained by inserter tool  200  and inserted into a disc space. In various embodiments, engagement arms  204  may have outdents and/or protrusions that engage corresponding grooves and/or recesses of engagement prongs  32  (not illustrated) or vice versa. Inserter tool  200  may include a hollow outer shaft  201  and a hollow inner shaft  203 . 
     As shown in  FIG. 22 , hollow inner shaft  203  may be inserted within and disposed within hollow outer shaft  201 , for example. Hollow inner shaft  203  may include a threaded end  205  at a proximal end thereof. Threaded end  205  may extend beyond the proximal end of hollow outer shaft  201  such that a coupling member  206  having an internal thread pattern corresponding to the threaded end  205  may be attached to a proximal end of hollow inner shaft  203 . Once coupling member  206  is sufficiently tightened the hollow outer shaft  201  and hollow inner shaft  203  may be securely coupled. Additionally, as coupling member  206  is rotated, the inner shaft  203  may be pulled deeper within outer shaft  205  such that a compressive force may be applied at the engagement arms  204  via interior surfaces of support walls  207  thereby providing a strong clamping force around engagement prongs  32  of implant  100  (see  FIGS. 21-25 ). 
     Once the coupling member  206  is sufficiently tightened such that engagement arms  204  are secured to engagement prongs  32 , a drive tool  300  may be inserted through an aperture of coupling member  206  and into the hollow interior of inner shaft  203  (see  FIG. 26 ). Drive tool  300  may extend in a proximal to distal direction and include a handle  302  at a proximal end and a drive end  301  at a distal end, for example (see  FIG. 27 ). Additionally, drive tool  300  may include a first circumferential channel  303  and a second circumferential channel  304  that may be indented along an outside surface of drive tool  300 . In the example, embodiment, a depressible lock  207  of coupling member  206  may selectively engage and disengage with either one of the first circumferential channel  303  and a second circumferential channel  304  to position drive tool  300  at relative axially aligned positions within the interior of hollow interior shaft  203 . For example, as shown in  FIG. 28A  depressible lock  207  is disengaged and as shown in  FIG. 28B  depressible lock  207  is depressed such that an indent or the like may retain circumferential channels  303  or  304 . A relative distance between the first circumferential channel  303  and second circumferential channel  304  may correspond to a distance between the proximal set screw  40  and distal set screw  50 , for example, and of course may be adjusted for implants of different lengths. 
     In this way, toggling between engaging the depressible lock  207  with either one of the first and second circumferential channels  303 ,  304  may affect whether drive end  301  engages with both the distal set screw  50  and proximal set screw  40  or alternatively just the proximal set screw  40  or just the distal set screw  50 , for example. As shown in  FIG. 29 , the depressible lock  207  may be engaged with the second circumferential channel  304  such that drive end  301  may simultaneously drive both the distal set screw  50  and proximal set screw  40 . As shown in  FIG. 30 , the depressible lock  207  may be engaged with the first circumferential channel  303  (not visible) such that drive end  301  is only engaged with the proximal set screw  40 . At least one advantage of this configuration is that an end user such as a surgeon may simultaneously rotate the proximal and distal set screws  40 ,  50  to cause parallel distraction or rotate only the proximal set screw  40  to cause lordosis, for example. 
     As illustrated in  FIG. 30  and  FIG. 31 , in at least some embodiments, drive tool  300  may include a necked down portion  305  having a size and shape suitable for only engaging one of the proximal set screw  40  or distal set screw  50  at a time. For example, the necked down portion  305  may have a smaller cross sectional diameter (thickness) than the drive end  301   a . This arrangement may be particularly advantageous for engaging only the distal set screw  50  to change a relative height between the superior and inferior endplates  10 ,  20  at the distal end  100   d  only, for example. Similarly, this arrangement may be particularly advantageous for engaging only the proximal set screw  40  to change a relative height between the superior and inferior endplates  10 ,  20  at the proximal end  100   p  only, for example. Furthermore, when engaging only distal set screw  50 , a relative height between the superior and inferior endplates  10 ,  20  at the distal end  100   d  may be changed, for example to create kyphosis. 
     In some embodiments, after implant  100  is expanded into a target configuration suitable for a particular patient, bone graft material (BGM) may be injected into implant  100 . For example, flowable bone graft material may be injected under pressure. For example, as shown in  FIG. 32 , the drive tool  300  may be removed from within the hollow interior of inner shaft  203 . Thereafter, bone growth promoting material (BGM) may be injected through the hollow interior of inner shaft  203  and into the interior of implant  100 . For example, bone growth promoting material may flow through shaft  203 , through set screw  40 , through a superior aperture  36  and inferior aperture  37  of support frame  30  (see  FIG. 6 ) and into contact with the endplates of adjacent vertebrae. Additionally, lateral aperture  35  adjacent posts  34 ,  33  of support frame  30  may allow additional bone growth promoting material to flow out in a lateral direction and into the interior of implant  100  and to surround wedges  60 ,  70 . In this way, the entire interior space of implant  100  may be filled with bone growth promoting material to promote fusion. In some embodiments, flexible curtains (not illustrated) may extend from superior endplate  10  and/or inferior endplate  20  across gaps that may be created between endplates  10 ,  20  due to expanding the endplates. In some embodiments, a distal most end of distal set screw  50  may also be closed to prevent material from flowing out of distal set screw  50 . Additionally, and depending on the type of surgery performed and the various patient anatomy that may contact the implant  100 , curtains may not be required, as the patient anatomy would provide a retaining surface to keep material within implant  100 . Furthermore, support frame  30  may include a lateral aperture  35  on the lateral side thereof corresponding to the extension direction of tip portion  104  and lateral apertures  16  and  26  of the superior and inferior endplates  10 ,  20 , for example (see also  FIGS. 15 and 16 ). Additionally, in various embodiments, and as explained above, superior endplate  10  may include a lateral aperture  16  (not labeled in  FIG. 32 ) and inferior endplate  20  may include a lateral aperture  26  for allowing BGM material and/or channeling BGM material into the central portion of the disc space away from the anterior rim (see also  FIGS. 20A and 20B ). For example, BGM material may generally flow in the direction indicated by arrows through implant  100 , through lateral aperture  35  of support frame  30 , and through lateral apertures  16 ,  26  of the superior and inferior endplates  10 ,  20 . In this way, BGM may be routed through implant  100  into a central portion of the disc space to facilitate a fusion process due to the lateral apertures  16 ,  26 ,  35  all being positioned to allow BGM material to flow into the disc space. 
       FIG. 33  is a reference drawing showing the human spine of which various disclosed implant embodiments may be installed in.  FIG. 34  is a reference drawing showing various planes and reference directions of which the various disclosed implant embodiments may move in or act in with reference to a patient  1 . 
     It should be understood that various aspects disclosed herein may be combined in different combinations than the combinations specifically presented in the description and accompanying drawings. For example, features, functionality, and components from one embodiment may be combined with another embodiment and vice versa unless the context clearly indicates otherwise. Similarly, features, functionality, and components may be omitted unless the context clearly indicates otherwise. It should also be understood that, depending on the example, certain acts or events of any of the processes or methods described herein may be performed in a different sequence, may be added, merged, or left out altogether (e.g., all described acts or events may not be necessary to carry out the techniques). 
     Unless otherwise specifically defined herein, all terms are to be given their broadest possible interpretation including meanings implied from the specification as well as meanings understood by those skilled in the art and/or as defined in dictionaries, treatises, etc. It must also be noted that, as used in the specification and the appended claims, the singular forms “a.” “an” and “the” include plural referents unless otherwise specified, and that the terms “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, elements, and/or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups thereof.