Patent Publication Number: US-2023157838-A1

Title: Implant, system including implant, and method of using system

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     The present disclosure claims priority to U.S. provisional Application No. 63/144,082 filed on Feb. 1, 2021, which is incorporated by reference herein for all purposes. 
    
    
     BACKGROUND 
     The present disclosure relates to an implant for treating spinal disorders, a system including the implant, and a method of using the system during surgery. 
     An implant may be used to fuse a pair of adjacent vertebrae in a cervical spine. An inserting device may be used to place the implant in a treatment region (e.g., a gap between the adjacent vertebrae). When the inserting device is coupled to the implant, for example, by gripping both sides of the implant, the treatment region may not be sufficiently visible to a surgeon during surgery. After placing the implant in the gap between the vertebrae and inserting screws through the implant to fix it to the vertebrae, the surgeon may place a screw lock for keeping the inserted screws in place over the fixed implant to combine the screw lock with the implant. 
     SUMMARY 
     Embodiments of the present disclosure relates to an implant and a system thereof 
     In an embodiment, an implant includes a plate having a plurality of fastener holes, the plurality of fastener holes being configured to receive a plurality of fasteners, respectively; a spacer coupled to the plate and configured to be inserted into a treatment region; and a fastener lock movably coupled to the plate and configured to lock the plurality of fasteners. The fastener lock may include a ring portion rotatably coupled to a hole of the plate disposed substantially at the central location of the plate. 
     In an embodiment, a system includes an implant; and an inserter configured to be removably coupled to the implant and insert the implant into a treatment region. The implant includes a plate having a plurality of fastener holes, the plurality of fastener holes being configured to receive a plurality of fasteners, respectively; a spacer coupled to the plate; and a fastener lock movably coupled to the plate and configured to lock the plurality of fasteners. The fastener lock may include a ring portion rotatably coupled to a hole of the plate disposed substantially at the central location of the plate. 
     In an embodiment, a method includes coupling an inserter to a plate of an implant by rotating the inserter; inserting the implant into a treatment region; fastening the implant using a plurality of fasteners; and securing the plurality of fasteners with a fastener lock of the implant by rotating the inserter. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIGS.  1 A,  1 B, and  1 C  illustrate a perspective view, a top view, and an exploded view of an implant, respectively, according to an embodiment of the present disclosure. 
         FIG.  2    illustrates a perspective view of an implant according to an embodiment of the present disclosure. 
         FIG.  3    illustrates a perspective view of an implant according to an embodiment of the present disclosure. 
         FIG.  4    illustrates a perspective view of an implant according to an embodiment of the present disclosure. 
         FIGS.  5 A and  5 B  illustrate a front view and a side view of an implant, respectively, according to an embodiment of the present disclosure. 
         FIG.  6    illustrates a front view of an implant according to an embodiment of the present disclosure. 
         FIG.  7    illustrates a front view of an implant according to an embodiment of the present disclosure. 
         FIGS.  8 A and  8 B  illustrate a perspective view and an exploded view of an inserter, respectively, according to an embodiment of the present disclosure.  FIG.  8 C  illustrates the inserter attached to an implant according to an embodiment. 
         FIGS.  9 A and  9 B  illustrate an upper portion and a lower portion of a tray, respectively, according to an embodiment. 
         FIG.  10    illustrates a plate caddy according to an embodiment. 
         FIG.  11    illustrates a spacer caddy according to an embodiment. 
         FIG.  12    illustrates a screw caddy according to an embodiment. 
         FIG.  13    illustrates a process of using an implant and an inserter during surgery according to an embodiment. 
     
    
    
     DESCRIPTION 
     In the following description, certain illustrative embodiments have been illustrated and described. As those skilled in the art would realize, these embodiments may be modified in various different ways without departing from the scope of the present disclosure. Accordingly, the drawings and description are to be regarded as illustrative in nature and not restrictive. Like reference numerals designate like elements in the specification. 
       FIG.  1 A  illustrates a perspective view of an implant (e.g., a cervical spine implant)  100  according to an embodiment of the present disclosure. The implant  100  may be inserted in a gap of a patient&#39;s spine and can occupy the gap. For example, the implant  100  may occupy a gap between adjacent cervical vertebrae with a spacer and be anchored to each vertebra with fasteners (e.g., screws). The implant  100  may have a plate  102 , a spacer  104 , and a fastener lock (e.g., a screw lock)  108 . 
     The plate  102  may have at least two fastener holes (e.g., screw holes)  110 . The screw holes  110  may be angled such that each of the screw holes  110  directs a corresponding screw (not shown) into a vertebra in a specific direction. In the embodiment shown in  FIG.  1 A  with two screw holes  110 , one of two screws may be screwed into an upper vertebra and the other of the screws may be screwed into a lower vertebra. The screws may be inserted into the screw holes  110  from a first end (e.g., a proximal end)  112  of the plate  102 . The spacer  104  may be attached to a second end (e.g., a distal end)  120  of the plate  102 . 
     The plate  102  may further have a hole  114 . In an embodiment, the hole  114  may be threaded. The hole  114  may engage with an inserter (e.g., an inserter  800  shown in  FIG.  8   ) that is used to insert the implant  100  between the vertebrae. In an embodiment, the hole  114  is disposed at the center or substantially at the central location of the plate  102 . Such an inserter may engage with the hole  114  that is disposed substantially at the central location of the plate  102  and has a relatively small size, thereby increasing visibility of a treatment region (e.g., the gap between the vertebrae) during surgery compared to when a conventional inserter grips both sides of a conventional implant to insert the conventional implant during surgery. For illustrative convenience, the hole  114  may be referred to as a “central hole.” 
     The screw lock  108  may be movably coupled to the plate  102  such that the screw lock  108  may be disposed over the central hole  114  at the proximal end  112  of the plate  102 . The screw lock  108  may be movably coupled to the plate  102  in advance to form an integrated unit together, thereby obviating the need to combine a separate screw lock with the plate  102  during surgery. 
     In an embodiment, the screw lock  108  may have a ring portion  116  and a plurality of flaps  118 . The ring portion  116  may be rotatably coupled to the central hole  114 , and may have a plurality of protrusions  113 . 
     The flaps  118  may extend from the ring portion  116  in a given direction (e.g., a radial direction). The flaps  118  may be positioned over the screws by rotating the ring portion  116  using the inserter. For example, when the inserter is used to rotate the ring portion  116  in a given rotational direction (e.g., a counter clockwise direction), a portion of each of the flaps  118  may be positioned over each of the screws  106 , thereby substantially prevent the screws from coming out in a proximal direction. 
     In an embodiment, the number of the flaps  118  may correspond to that of the screw holes  110  and be spaced apart from each other at regular intervals. For example, in the embodiment of  FIG.  1 A , the number (e.g., two) of the flaps  118  may correspond to that of the screw holes  110 , respectively, and the flaps  118  may be disposed opposite to each other with respect to a center of the ring portion  116 . In an embodiment, the flaps  118  and the protrusions  113  may be arranged to define a plurality of recesses that match an engaged portion (e.g., a second hollow end  820  in  FIG.  8 B ) of the inserter to facilitate rotation of the ring portion  116  by the inserter. For example, in the embodiment of  FIG.  1 A , two flaps  118  and four protrusions  113  may be disposed along a circumference of the ring portion  116  at regular intervals. 
       FIG.  1 B  illustrates a top view of the implant  100  according to an embodiment of the present disclosure. The plate  102  may have a relatively small thickness T 1  between the distal end  120  and the proximal end  112 . For example, when the hole  114  of the plate  102  has a substantially cylindrical shape, the thickness T 1  of the plate may be defined in an axial direction of the hole  114  of the plate  102 . The screw lock  108  may also have a relatively small thickness between a distal end (not shown) and a proximal end  111 , a portion including the distal end of the screw lock  108  being inserted into an opening of the plate  102 . For example, when the ring portion  116  of the screw lock  108  has a substantially annular cylindrical shape, the thickness of the screw lock  108  may be defined in an axial direction of the ring portion  116 . In an embodiment, a ratio of the thickness of the screw lock  108  over the thickness T 1  of the plate  102  may be between 0.15 to 0.35. When the ratio is greater than 0.35, the implant  101  including the plate  102  and the screw lock  108  may not have a sufficiently small thickness to be properly installed into the treatment region. In contrast, when the ratio is smaller than 0.15, the flaps  118  may not have structural properties (e.g., e.g., bending modulus to resist a bending moment resulting from a screw loosened in the proximal direction) sufficient to properly keep the screw in place. In an embodiment, the screw lock  108  may have the thickness sufficient to make a proximal end  111  of the screw lock  108  protrude from the proximal end  112  of the plate  102  by a given length (e.g., less than 1 mm) PL 
     In the embodiment of  FIG.  1 B , the spacer  104  may be U-shaped. The spacer  104  may include a first leg  124  having a first end  128  and a second leg  126  having a second end  130 . The spacer  104  may be coupled to the plate  102 . For example, the first end  128  and the second end  130  of the spacer  104  may directly contact the distal end  120  of the plate  102 . Although the U-shaped spacer  104  is shown in  FIG.  1 B , embodiments of the present disclosure are not limited thereto, and the spacer  194  may have various shapes according to embodiments. 
       FIG.  1 C  illustrates an exploded view of the implant  100  according to an embodiment of the present disclosure. The spacer  104  may have an upper surface  132  and a lower surface  134 . The upper surface  132  and the lower surface  134  may directly contact an upper vertebra and a lower vertebra, respectively, once the implant  100  is implanted. The upper surface  132  and the lower surface  134  may be rough. For example, the upper surface  132  and the lower surface  134  may be jagged, serrated, or knurled, thereby substantially preventing slippage of the spacer  104  between the vertebrae with sufficient friction. For example, the spacer  104  may include polyetheretherketone (PEEK), hydroxyapatite (HA)-PEEK, titanium (Ti), or the like. The plate  102  may have a pair of first coupling parts (e.g., male fastener parts)  136   a  and  136   b  respectively extending from a first end  138  and a second end  140  of the plate  102  in a distal direction. Each of the male fastener parts  136  may be a clip, a hook, a pin, or the like. The first and second legs  124  and  126  of the spacer  104  may have a pair of second coupling parts (e.g., female fastener parts)  141   a  and  141   b  to be removably coupled to the pair of first coupling parts  136   a  and  136   b.  The female fastener parts  141   a  and  141   b  may be shaped and sized to receive the male fastener parts  136   a  and  136   b,  respectively. Although the female fastener parts  141   a  and  141   b  may be on an exterior  142  of the spacer  104  as shown in  FIG.  1 C , embodiments of the present disclosure are not limited thereto. For example, the female fastener parts  141   a  and  141   b  may be on an interior  144  of the spacer  104 . Although the plate  102  has the male fastener parts  136   a  and  136   b  and the spacer  104  has the female fastener parts  141   a  and  141   b,  as shown in the embodiment of 
       FIG.  1 C , embodiments of the present disclosure are not limited thereto. In other embodiments, the spacer  104  may have the male fastener parts and the plate  102  may have the female fastener parts. 
       FIG.  2    illustrates a perspective view of an implant  200  according to an embodiment of the present disclosure. The implant  200  may have substantially the same features as those of the implant  100  of  FIGS.  1 A- 1 C , except that the implant  200  has a plate  202  different from the plate  102  of the implant  100  shown in  FIGS.  1 A- 1 C . Specifically, the implant  200  in  FIG.  2    may have the plate  202  having two offset screw holes  210 . The screw holes  210  may be disposed symmetrically with respect to a center of the plate  202 . For example, the screw holes  210  may located in diagonally opposite corners of the plate  402 , respectively. The screw holes  210  may be positioned with respect to the vertebrae such that a single screw (not shown) is screwed into each vertebra. For example, the screw holes  210  may direct a pair of screws may be screwed into an adjacent pair of vertebrae, respectively. 
     The plate  202  may have one or more recesses  211  on its proximal end  212  to allow each flap  218  of the screw lock  208  to rotate through a corresponding one of the recesses  211 . 
     The recesses  211  may be contiguous to the screw holes  210 , respectively, to allow the flaps  218  to be positioned over respective screws (not shown) when the screw lock  208  rotates in a given rotational direction (e.g., a counter clockwise direction), thereby locking the screws in place. 
       FIG.  3    illustrates a perspective view of an implant  300  according to an embodiment of the present disclosure. The implant  300  may have substantially the same features as those of the implant  100  of  FIGS.  1 A- 1 C , except that the implant  300  has a plate  302  different from the plate  102  of the implant  100  shown in  FIGS.  1 A- 1 C . Specifically, the implant  300  in  FIG.  3    may have the plate  302  having three screw holes  310   a  to  310   c.  The screw holes  310   a  to  310   c  may be arranged such that first and second screw holes  310   a  and  310   b  are located in adjacent corners of the plate  302  and a third screw hole  310   c  is located centrally and opposite from the first and second screw holes  310   a  and  310   b.  The first and second screw holes  310   a  and  310   b  may direct two screws (not shown) into a first vertebra (e.g., an upper vertebra), and the third screw hole  310   c  may direct a screw (not shown) into a second vertebra (e.g., a lower vertebra) that is adjacent to the first vertebra. 
     The plate  302  may have one or more recesses  311  on its proximal end  312  to allow each flap  318  of the screw lock  308  to rotate through a corresponding one of the recesses  311 . The recesses  311  may be contiguous to the screw holes  310   a  to  310   c,  respectively, to allow the flaps  318  to be positioned over respective screws (not shown) when the screw lock  308  rotates in a given rotational direction (e.g., a counter clockwise direction), thereby locking the screws in place. In the embodiment shown in  FIG.  3   , the number of the flaps  318  may be three to correspond to that of the screw holes  310   a  to  310   c,  and each of three protrusions  313  is disposed between a corresponding pair of adjacent flaps  318 . 
       FIG.  4    illustrates a perspective view of an implant  400  according to an embodiment of the present disclosure. The implant  400  may have substantially the same features as those of the implant  100  of  FIGS.  1 A- 1 C , except that the implant  400  has a plate  402  different from the plate  102  shown in  FIGS.  1 A- 1 C . Specifically, the implant  400  in  FIG.  4    may have the plate  402  having first to fourth screw holes  410   a  to  410   d.  Each of the screw holes  410   a  to  410   d  may be located at a corresponding one of the four corners of the plate  402 . The screw holes  410   a  to  410   d  may be aligned with the vertebrae such that two screws (not shown) are screwed into each vertebra. For example, the first and second screw holes  410   a  and  410   b  may direct two screws (not shown) into a first vertebra (e.g., an upper vertebra), and the third and fourth screw holes  410   c  and  410   d  may direct the remaining two screws (not shown) into a second vertebra (e.g., a lower vertebra) that is adjacent to the first vertebra. The screw holes  410   a  to  410   d  may be symmetrical and mirror each other. 
     The plate  402  may have one or more recesses  411  on its proximal end  412  for each flap  418  of the screw lock  408  to rotate through a corresponding one of the recesses  411 . The recesses  411  may be contiguous to the screw holes  410   a  to  410   d,  respectively, to allow the flaps  418  to be positioned over respective screws (not shown) when the screw lock  408  rotates in a given rotational direction (e.g., a counter clockwise direction), thereby locking the screws in place. In the embodiment shown in  FIG.  4   , the number of the flaps  418  may be four to correspond to that of the screw holes  410   a  to  410   d,  and each of four protrusions  413  is disposed between a corresponding pair of adjacent flaps  418 . 
       FIGS.  5 A and  5 B  illustrate a front view and a side view of an implant  500 , respectively, according to an embodiment of the present disclosure. The implant  500  may have substantially the same features as those of the implant  200  of  FIG.  2   , except that the implant  500  has a spacer  504  with a height greater than that of the spacer  204  of  FIG.  2    and has a plate  502  is different from the plate  202  of  FIG.  2   . For example, the spacer  504  in  FIG.  5 B  may have a height between upper and lower surfaces  532  and  534  greater than that between upper and lower surfaces  232  and  234  of the spacer  204  of  FIG.  2   . The plate  502  may have two offset screw holes  510  spaced apart from each other by a distance greater than that of the offset screw holes  210  of  FIG.  2   . For example, a distance between two centers of the offset screw holes  510  may be greater than that between two centers of the offset screw holes  210  of  FIG.  2   . In addition, the plate  502  may have a fastener lock  508  with two flaps  518  longer than the flaps  218  of  FIG.  2   . For example, each of the flaps  518  in  FIG.  5 A  may have a longitudinal length greater than that of each of the flaps  218  of  FIG.  2   . 
     The plate  502  may have one or more recesses  511  on its proximal end  512  to allow each flap  518  of the screw lock  508  to rotate through a corresponding one of the recesses  511 . The recesses  511  may be contiguous to the screw holes  510 , respectively, and the length of the flaps  518  may be sufficiently long to allow the flaps  518  to be positioned over respective screws (not shown) when the screw lock  508  rotates in a given rotational direction (e.g., a counter clockwise direction), thereby locking the screws in place. In an embodiment, a longitudinal length of each of the flaps  518  may be sufficiently long to cover a given portion of a corresponding one of the screw holes  510  when the flap  518  is in a locking position. For example, a portion of each of the flaps  518  may overlap a corresponding one of the screw holes  510 , such that a longitudinal length of the overlapped portion of the flap  518  may be in a range from 10% to 30% of a diameter of each of the screw holes  510  when seen in the front view of  FIG.  5 A . When the length of the overlapped portion of the flap  518  is smaller than 10% of the diameter of each of the screw holes  510 , the flap  518  may not sufficiently cover the corresponding one of the screw holes  510  to ensure sufficient locking of a screw (not shown) inserted into the screw hole  510 . When the length of the overlapped portion of the flap  518  is greater than  30 % of the diameter of each of the screw holes  510 , the flap  518  may not have structural properties (e.g., bending modulus to resist a bending moment resulting from a screw loosened in a proximal direction) sufficient to properly keep the screw in place. 
     Although  FIGS.  5 A and  5 B  show the flap  518  having a substantially beam structure with the longitudinal length significantly greater than each of a width and a thickness thereof, embodiments of the present disclosure are not limited thereto. For example, each flap (not shown) may have a substantially plate structure with a first length in a radial direction of a ring portion  516  and a second length in a circumferential direction of the ring portion  516 , each of the first length and the second length being significantly greater than a thickness of the flap in an axial direction of the ring portion  516 . 
       FIG.  6    illustrates a front view of an implant  600  according to an embodiment of the present disclosure. The implant  600  may have substantially the same features as those of the implant  300  of  FIG.  3   ., except that the implant  600  has a spacer (e.g., the spacer  504  in  FIG.  5 B ) with a height greater than that of the spacer  304  of  FIG.  3    and has a plate  602  is different from the plate  302  of  FIG.  3   . For example, the spacer of the implant  600  may have a height greater than that between upper and lower surfaces  332  and  334  of the spacer  304  of  FIG.  3   . The plate  602  may have upper offset screw holes  610   a  and  610   b  and a lower offset screw hole  610   c,  and one of the upper screw holes  610   a  and  610   b  and the lower screw hole  610   c  may be spaced apart from each other by a distance greater than that between one of upper offset screw holes  310   a  and  310   b  and a lower offset screw hole  310   c  of  FIG.  3   . For example, a distance between centers of the upper screw hole  610   a  and the lower screw hole  610   c  may be greater than that between centers of the upper screw hole  310   a  and the lower screw hole  310   c  of  FIG.  3   . In addition, the plate  602  may have a fastener lock  680  with three flaps  618  longer than the flaps  318  of  FIG.  3   . For example, each of the flaps  618  may have a longitudinal length greater than that of each of the flaps  318  of  FIG.  3   . 
     The plate  602  may have one or more recesses  611  on its proximal end  612  to allow each flap  618  of the screw lock  608  to rotate through a corresponding one of the recesses  611 . The recesses  611  may be contiguous to the screw holes  610   a  to  610   c,  respectively, and the length of each of the flaps  618  may be sufficiently long to allow the flaps  618  to be positioned over respective screws (not shown), thereby ensuring secure locking of the screws. 
       FIG.  7    illustrates a front view of an implant  700  according to an embodiment of the present disclosure. The implant  700  may have substantially the same features as those of the implant  400  of  FIG.  4   , except that the implant  700  has a spacer (e.g., the spacer  504  in  FIG.  5 B ) with a height greater than that of the spacer  404  of  FIG.  4    and has a plate  702  is different from the plate  402  of  FIG.  4   . For example, the spacer of the implant  700  may have a height greater than that between upper and lower surfaces  432  and  434  of the spacer  404  of  FIG.  4   . The plate  702  may have first and second upper offset screw holes  710   a  and  710   b  and first and second lower offset screw holes  710   c  and  710   d.  The first upper screw hole  710   a  and the first lower screw hole  710   c  may be spaced apart from each other by a distance greater than that between a first upper offset screw holes  410   a  and a first lower offset screw hole  410   c  of FIG. 
       4 . The second upper screw hole  710   b  and the second lower screw hole  710   d  may be spaced apart from each other by a distance greater than that between a second upper offset screw holes  410   b  and a second lower offset screw hole  410   d  of  FIG.  4   . For example, a distance between centers of the first upper screw hole  710   a  and the first lower screw hole  710   c  may be greater than that between centers of the first upper screw hole  410   a  and the first lower screw hole  410   c  of  FIG.  4   . In addition, the plate  702  may have a fastener lock  708  with four flaps  718  longer than the flaps  418  of  FIG.  4   . For example, each of the flaps  718  may have a longitudinal length greater than that of each of the flaps  418  of  FIG.  4   . 
     The plate  702  may have one or more recesses  711  on its proximal end  712  to allow each flap  718  of the screw lock  708  to rotate through a corresponding one of the recesses  711 . 
     The recesses  711  may be contiguous to the screw holes  710   a  to  710   d,  respectively, and the length of each of the flaps  718  may be sufficiently long to allow the flaps  718  to be positioned over respective screws (not shown), thereby ensuring secure locking of the screws. 
       FIG.  8 A  illustrates a perspective view of an inserter  800  according to an embodiment of the present disclosure. The inserter  800  may be a tool used to insert an implant (e.g., the implant  100  in  FIGS.  1 A to  1 C,  200    in  FIG.  2 ,  300    in  FIG.  3 ,  400    in  FIG.  4 ,  500    in  FIGS.  5 A and  5 B,  600    in  FIGS.  6 , and  700    in  FIG.  7   ) into a treatment region (e.g., a gap between two adjacent vertebrae). The inserter  800  may be removably coupled to the implant. For example, the inserter  800  may be attached to the implant prior to insertion and removed following the insertion. The inserter  800  may have an inner shaft  802 , an outer shaft  804 , a first handle (e.g., a proximal handle)  806 , and a second handle (e.g., a distal handle)  808 . 
     The inner shaft  802  may inserted into a bore (e.g., a bore  810  in  FIG.  8 B ) of the outer shaft  804 . The outer shaft  804  may have one or more windows  816  along its longitudinal length. The windows  816  may allow for visibility and cleaning purposes of the inner shaft  802 . The inner shaft  802  may be longer than the outer shaft  804 . As such, a first end (e.g., a first end  812  in  FIG.  8 B ) and a second end (a second end  814  in  FIG.  8 B ) of the inner shaft  802  may protrude from the outer shaft  804 . In an embodiment, the second end  814  may be threadedly coupled to mate with a threaded central hole (e.g., the central hole  114  in  FIG.  1 A ) of the implant. The mating may be facilitated by turning the proximal handle  806 . The proximal handle  806  and the inner shaft  802  may be coupled to each other such that the proximal handle  806  turns with the inner shaft  802 . The proximal handle  806  and the distal handle  808  may be adjacent to each other when the inner shaft  802  is inserted into the outer shaft  804 . The proximal handle  806  and the distal handle  808  may rotate substantially independently of each other. The proximal handle  806  and the distal handle  808  may have cylindrical bodies. Both of the proximal handle  806  and the distal handle  808  may each have a rough surface (e.g., grooves, bumps, protrusions) for facilitating gripping of each of the proximal and distal handles  806  and  808 . The proximal handle  806  and the distal handle  808  may be sized differently. In the embodiment shown in  FIG.  8 A , the distal handle  808  may have a length (e.g., a longitudinal length) greater than that of the proximal handle  806 . In other embodiments, the proximal handle  806  may have a length greater than that of the distal handle  808 . The proximal handle  806  and the distal handle  808  may have substantially the same diameter or different diameters. 
       FIG.  8 B  illustrates an exploded view of the inserter  800  in  FIG.  8 A  according to an embodiment of the present disclosure. As shown in the embodiment of  FIG.  8 B , the first end  812  of the inner shaft  802  may be threaded to mate with a hole  817  of the proximal handle  806 . As shown in the embodiment of  FIG.  8 B , the hole  817  may entirely extend through the proximal handle  806 . In some embodiments, the hole  817  may partially extend through the proximal handle  806 . The hole  817  may be threaded to mate with the threaded first end  812  of the inner shaft  802 . 
     The outer shaft  804  may have a first hollow end  818  and a second hollow end  820 . As shown in the embodiment of  FIG.  8 B , the first hollow end  818  may be threaded to mate with a hole  821  of the distal handle  808 . The hole  821  may extend through an entirety of the distal handle  808 . The hole  821  may be threaded to mate with the first hollow end  818 . The second hollow end  820  may have grooves  822  along its circumference. The grooves  822  may be equally spaced apart from each other along the circumference of the second hollow end  820 . For example, each of the grooves  822  may extend in a longitudinal direction of the outer shaft  804 . The grooves  822  may engage with protrusions (e.g., the protrusions  113  in  FIG.  1 A ) and flaps (e.g., the flaps  118  in  FIG.  1 A ) of a screw lock (e.g., the screw lock  108  in  FIG.  1 A ). For example, the groves  822  may be formed to match recesses formed by the protrusions and flaps of the screw lock. The distal handle  808  and the outer shaft  804  may be engaged such that the distal handle  808  turns with the outer shaft  804 . As a result, once engaged with the second end  820  of the outer shaft  804 , the flaps may be rotated to be positioned over a screw (e.g., a screw  807  in  FIG.  8 C ) by turning the distal handle  508 . 
       FIG.  8 C  shows a perspective view of the inserter  800  in  FIG.  8 A  attached to the implant  100  in  FIG.  1 A  according to an embodiment. Referring to  FIG.  1 A  together, the flaps  118  of the implant  100  are positioned over respective screws  807 , thereby substantially preventing the screws  807  from coming out in a proximal direction. Hence, after the screw  807  is screwed into a vertebra, the screw  807  may be substantially prevented from slipping out of the vertebra. 
     The inserter  800  may include the inner shaft  802  to couple the inserter  800  to the central hole  114  of the implant  100  prior to insertion of the implant  100  into a treatment region, by rotating the proximal handle  806  in a first rotational direction (e.g., a clockwise direction). The inserter  800  may further include the outer shaft  804  to place the flaps  118  of the screw lock  108  in a locking position by rotating the distal handle  808  in a second rotational direction (e.g., a counter clockwise direction). After placing the flaps  118  in the locking position, the inserter  800  may be decoupled from the implant  100  by rotating the proximal handle  806  in the second rotational direction. The inserter  800  may include the inner shaft  802  and the outer shaft  804  that perform the insertion process and the locking process together, thereby obviating the need to use two separate devices to perform the insertion and the locking process respectively during surgery. 
       FIGS.  9 A and  9 B  illustrate perspective views of an upper portion and a lower portion of a tray  900 , respectively, according to an embodiment. The tray  900  may include a plate caddy  950 , a spacer caddy  960 , and a screw caddy  970  that accommodate a plurality of plates (e.g., the plate  102  in  FIG.  1 A ), a plurality of spacers (e.g., the spacer  104  in  FIG.  1 A ), and a plurality of screws (e.g., the screw  807  in  FIG.  8 C ), respectively. For example, a user (e.g., a surgeon) may intraoperatively select a plate from the plate caddy  950 , a spacer from the spacer caddy  960 , and two or screws from the screw caddy  970  and combine the selected plate, spacer, and screws to make a specific implant. In the embodiment of  FIG.  9 A , the plate caddy  950  is disposed proximate to a top edge of the tray  900 , the screw caddy  970  is disposed proximate to a bottom edge of the tray  900 , and the spacer caddy  960  is disposed between the plate caddy  950  and the screw caddy  970 . However, embodiments of the present disclosure are not limited thereto. In other embodiments, the plate caddy  950 , the spacer caddy  960 , and the screw caddy  970  may be arranged in an order different from that of the embodiment of  FIG.  9 A  from the top edge to the bottom edge of the tray  900 . 
     The tray  900  may further include other devices for performing cervical discectomy and fusion. In the embodiment of  FIGS.  9 A and  9 B , the tray  900  may include trials, an inserter, Rasp, drivers, a graft impactor, and drills over a top surface of the tray  900 , and awls over a bottom surface of the tray  900 . 
       FIG.  10    illustrates a plate caddy  1050  suitable for use as the plate caddy  950  in FIG. 
       9 A according to an embodiment. The plate caddy  1050  may include two recessed structures  1052   a  and  1052   b,  each of which accommodates a plurality of plates (e.g., the plate  102  in  FIG.  1 A ). In the embodiment of  FIG.  10   , the plurality of plates may be arranged in an increasing order of size in a specific direction (e.g., a horizontal direction from a left end to a right end with respect to the orientation of  FIG.  10   ) of each of the recessed structures  1052   a  and  1052   b.  However, embodiments of the present disclosure are not limited thereto. In another embodiment, the plurality of plates may be arranged in a decreasing order of size in the specific direction. Each of the recessed structures  1052   a  and  1052   b  may be further configured to accommodate an extra plate at the right end. 
       FIG.  11    illustrates a spacer caddy  1160  suitable for use as the spacer caddy  960  in  FIG.  9 A  according to an embodiment. The spacer caddy  1160  may include two row structures, each of which includes a plurality of recesses  1162   a  to  1162   g.  The plurality of recesses  1162   a  to  1162   g  may be arranged in a specific direction (e.g., a horizontal direction from a left end to a right end with respect to the orientation of  FIG.  11   ) and accommodate a plurality of spacers (e.g., the spacer  104  in  FIG.  1 A ), respectively. In the embodiment of  FIG.  11   , the plurality of spacers may be arranged in an increasing order of size in the specific direction. However, embodiments of the present disclosure are not limited thereto. In another embodiment, the plurality of spacers may be arranged in a decreasing order of size in the specific direction. Each row structure of the spacer caddy  160  may further include a recess  1162   h  for accommodating an extra spacer at the right end. 
       FIG.  12    illustrates a screw caddy  1270  suitable for use as the screw caddy  970  in  FIG.  9 A  according to an embodiment. The screw caddy  1270  may include a first region  1272  and a second region  1274 , each of which has a plurality of recesses arranged in a matrix form. For example, the plurality of recesses may include a first group of recesses and a second group of recesses, each of the first and second groups of recesses being arranged in a matrix (e.g., 8×5 matrix in  FIG.  12   ), each of the rows (e.g., eight rows in  FIG.  12   ) of the matrix including a plurality of recesses (e.g., five recesses in  FIG.  12   ) to accommodate screws in an increasing order of size in a specific direction (e.g., a left end to a right end of the row in  FIG.  12   ). However, embodiments of the present disclosure are not limited thereto. In another embodiment, each of the rows of the matrix may include a plurality of recesses to accommodate screws in a decreasing order of size in the specific direction. The screw caddy  1270  may further include a third region  1276  having a plurality of recesses to accommodate a plurality of extra screws, respectively. In the embodiment of  FIG.  12   , the plurality of recesses may be arranged in a 2×10 matrix, each of the two rows of the matrix including recesses to accommodate screws having substantially the same size. However, embodiments of the present disclosure are not limited thereto. For example, each of the rows of the matrix in the third region  1276  may include a plurality of recesses to accommodate screws having different sizes. The screws accommodated in the first, second, and third regions  1272 ,  1274 ,  1276  may vary according to embodiments. For example, the screws may include self-drilling screws, self-tapping screws, fixed screws, and variable screws. 
       FIG.  13    illustrates a process  1300  of using an implant (e.g., the implant  100  in  FIG.  1 A ) and an inserter (e.g., the inserter  800  in  FIG.  8 A ) during surgery according to an embodiment. 
     At S 1310 , a plate (e.g., the spacer  104  in  FIG.  1 A ), a spacer (e.g., the spacer  104  in  FIG.  1 A ), and two or more screws (e.g., the screw  106  in  FIG.  8 C ) may be selected to form a specific implant (e.g., the implant  100  in  FIG.  1 A ). In an embodiment, the plate may be selected from a plurality of plates accommodated in a plate caddy (e.g., the plate caddy  1050  in  FIG.  10   ), the spacer may be selected from a plurality of spacers accommodated in a spacer caddy (e.g., the spacer caddy  1160  in  FIG.  11   ), and the selected plate may be coupled to the selected spacer in the spacer caddy without removing it from the caddy, thereby forming the implant intraoperatively. In an embodiment, a selected spacer may be coupled to a selected plate in a plate caddy to form an implant. Moreover, the two or more screws may be selected from a plurality of screws accommodated in a screw caddy (e.g., the screw caddy  1270  in  FIG.  12   ). 
     At S 1320 , the implanter may be coupled to the inserter. In an embodiment, an end of the inserter may engage with a central hole (e.g., the central hole  114  in  FIG.  1 A ) of the plate. For example, the inserter may include an inner shaft (e.g., the inner shaft  802  in  FIG.  8 B ) having a distal end (e.g., the second end  814  in  FIG.  8 B ) threaded to mate with the central hole, and the inner shaft may be rotated in a first rotational direction (e.g., a clockwise direction) to insert the distal end of the inner shaft into the central hole of the plate. 
     At S 1330 , one or more materials may be injected into the implant. In an embodiment, these materials may include bone graft material, bone morphogenic protein, or other materials, or a combination thereof, that may be used to facilitate the fusing of the implant to adjacent vertebrae. 
     At S 1340 , the implant may be inserted into a treatment region. In an embodiment, the implant may be inserted into a gap between the adjacent vertebrae using the inserter. 
     At S 1350 , pilot holes may be prepared using one or more hole preparation devices. 
     In an embodiment, one or more awls (e.g., a straight awl, a sleeved awl, and an angled awl) may be used to penetrate screws holes (e.g., the screw holes  110  in  FIG.  1 A ) and portions of the vertebrae, thereby forming the pilot holes. 
     At S 1360 , the implant may be fastened using a plurality of fasteners (e.g., screws). In an embodiment, the screws may be inserted into the screw holes of the plate to fasten the implant to the vertebrae. For example, a first one of the screws may be screwed into a first vertebra (e.g., an upper vertebra) and a second one of the screws may be screwed into a second vertebra (e.g., a lower vertebra), the first and second vertebrae being adjacent to each other. 
     At S 1370 , the screws may be secured using a fastener lock (e.g., the screw lock  108  in  FIG.  1 A ). In an embodiment, the fastener lock may include a plurality of flaps (e.g., the flaps  118  in  FIG.  1 A ) each configured to cover a portion of a corresponding one of the screws when the flaps are in a locking position. For example, the inserter may further include an outer shaft (e.g., the outer shaft  504  in  FIG.  8 B ) having an end (e.g., the second hollow end  520  in  FIG.  8 B ) with grooves (e.g., the grooves  522  in  FIG.  8 B ), and the grooves may engage with the plurality of flaps and a plurality of protrusions (e.g., the protrusions  113  in  FIG.  1 A ) to rotate the flaps in a second rotational direction (e.g., a counter clockwise direction), thereby placing the flaps in the locking position. 
     At S 1380 , the inserter may be released from the plate. In an embodiment, the inner shaft of the inserter may be rotated in the second rotational direction to release the end of the inner shaft from the central hole of the plate. 
     While this invention has been described in connection with what is presently considered to be practical embodiments, embodiments are not limited to the disclosed embodiments, but, on the contrary, may include various modifications and equivalent arrangements included within the spirit and scope of the appended claims. The order of operations described in a process is illustrative and some operations may be re-ordered. Further, two or more embodiments may be combined.