Patent Publication Number: US-2022211515-A1

Title: Intravertebral implant system and methods of use

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation application of co-pending U.S. patent application Ser. No. 17/347,492, filed on Jun. 14, 2021, entitled “INTRAVERTEBRAL IMPLANT AND METHODS OF USE”; this application is also a continuation application of co-pending PCT Patent App. No. US2021/037285 filed on Jun. 14, 2021 entitled “INTRAVERTEBRAL IMPLANT AND METHODS OF USE”; U.S. patent application Ser. No. 17/347,492 claims benefit of U.S. Patent App. No. 63/039,242, filed on Jun. 15, 2020, entitled “INTRAVERTEBRAL IMPLANT AND METHODS OF USE”; PCT Patent App. No. US2021/037285 claims benefit of U.S. Patent App. No. 63/039,242; and the entire content of these applications are incorporated herein by reference. 
    
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
     Not Applicable. 
     REFERENCE TO SEQUENCE LISTING, A TABLE, OR A COMPUTER PROGRAM LISTING COMPACT DISC APPENDIX 
     Not Applicable. 
     BACKGROUND 
     1. Field of the Invention 
     This invention relates to spinal implants, in particular an intravertebral implant configured to alter the alignment of a mammalian spine. 
     2. Background 
     In the field of spinal correction, available literature supports that trauma and degenerative spinal conditions resulting in back pain and leg pain lead to debilitation, loss of work and life happiness. 
     Compression fractures account for more than 60% of thoracolumbar fractures. Types of injuries associated with this type of injury may include: endplate impaction, wedge impaction fractures, vertebral body collapse, split fractures and coronal split fractures. 
     Patients with spine issues all start with collapsing of the disc, which happens due to loss of nutrition as aging occurs, which leads to loss of normal cushioning. Next, the endplates can no longer handle normal stress on the endplates, which leads to microfractures in the adjacent vertebral bodies. The chronic factures in a collapsed or fractured vertebral body may then create a cascade of other conditions in the spine, including (but not limited to) degenerative scoliosis, facet joint subluxation and facet joint degeneration , nerve root compression, and further vertebral body collapse. 
     Studies have also shown that degenerative disc disease and degenerative scoliosis may be associated with significant pain, mental anguish, anxiety, and functional disability as well as diminished self-perception/mental health and decreased function. 
     Patients with degenerative disc disease associated with degenerative scoliosis many times have a collapsing foramen on the concave slide of the spine. As this happens the superior facet of the vertebra below slides cephalad and pinches the nerve root in the now narrowed foramen. There is no good minimal surgical treatment with lasting symptom relief available in 2021. Common treatments are decompression without fusion, decompression with limited fusion, and extended (extensive) fusion and reconstruction. 
     Decompression without Fusion Treatments: A collapsing disc and Vertebral body collapse, which allows the facet from below to come up into the foramen. and cause compression of the nerve root. Some surgeons take a minimalist approach and try to open the foramen by surgically removing parts of the facet joint and some disc to give the nerve root space. While the conservative decompressive procedure without a fusion may be appropriate for selected patients, studies have demonstrated “greater risk of deformity progression, poor outcomes, and higher rates of reoperations” in these cases. It is believed that this is due to failure to address the cause of the narrowed foramen that being subluxation of the facet joints secondary to further disc collapse and further microfractures in the vertebral body leading to further wedging, and the foramen gets narrower again. 
     Decompression with Limited Fusion Treatments: Decompression with limited fusion is applicable for patients whose symptoms are limited to specific and short segments (1-3 levels), but care must be taken in assessing and correcting the sagittal and coronal alignment. 2 Patients with uncorrected misalignment many times have poor outcomes after decompression with limited fusion. Fusions of any kind in the lumbar spine can many times start a cascade of events by putting increase stress through transferring lumbar spine motion to the unfused segments of the spine resulting in more deterioration of the adjacent levels requiring further treatment which is usually additional fusion. This is referred to in the literature as adjacent level disease. 
     Extended Reconstruction Treatments: Extended reconstruction (&gt;3 levels) of the lumbar spine has been a foundation of correction for adult degenerative scoliosis. Fusions of this scope starts a cascade of events by putting increase stress through transferring lumbar spine motion to the unfused segments of the spine resulting in more deterioration of the adjacent levels requiring further treatment which is usually additional fusion. Clinical presentation of adjacent segment deterioration, with coronal, sagittal or both deformities above or below causing severe back pain often occur necessitating further additional levels requiring fusion. 
     Accordingly, there is need for an intravertebral implant system and methods of use to treat chronic trauma and fractures resulting in collapsed vertebra and causing back pain and or leg pain that addresses the above shortcomings. 
     BRIEF SUMMARY OF THE INVENTION 
     The following summary is included only to introduce some concepts discussed in the Detailed Description below. This summary is not comprehensive and is not intended to delineate the scope of protectable subject matter, which is set forth by the claims presented at the end. 
     The disclosed intravertebral implant system is intended to treat collapse of the vertebral body wedging, which is the result of microfractures of the vertebral body endplates. These microfractures occur because of the collapsed disc creates abnormal stress areas in the vertebral body. The vertebral body wedging, secondary to the microfractures, creates a coronal deformity and causing back pain thru misaligned facet joints. The source of the back pain can be confirmed by diagnostic local anesthetic agents around the painful facet joint. Correction of the coronal deformity in the vertebral body will reduce the back pain by realigning the facet joints in this select group of patients. This is analogous to the use of high tibial osteotomies for treatment of knee arthritis. The implant design allows for careful and patient-specific sagittal and coronal alignment to prevent the clinical outcomes of misalignment 
     This osteotomy procedure and intravertebral implant device can relieve pain symptoms while maintaining lumbar spine mobility and prevent or delay adjacent level disease. The implant device does not have any motion itself. The implant device stabilizes a corrected vertebral body for 12 weeks while it heals. 
     With the disclosed intravertebral implant system, a vertebral body osteotomy with the intravertebral implant device can correct the wedged segment of the spine through the vertebral body. This opens the foramen and relieves the pinched nerve and therefore relieves the patient&#39;s radiculopathy symptoms. The implant design allows for careful and patient-specific sagittal and coronal alignment to prevent the clinical outcomes of misalignment. 
     This technology will lead to an improved quality of life when compared to current standard surgical techniques and technology when used as part of a decompression strategy. The patient will have relief from back and/or leg pain without a loss of spine mobility, which can significantly reduce or eliminate the risk of adjacent level accelerated degeneration in the other levels of the spine. The custom alignment that can be created with the implant device can prevent the clinical outcomes of misalignment. 
     In one embodiment, an intravertebral implant configured to alter an alignment of a spine is provided comprising a wedge, a plate having an external surface configuration and one or more plate tine, a coupling device, a staple having one or more staple tine, the one or more plate tine and the one or more staple tine are configured to frictionally engage a vertebral body, and the coupling device is configured to couple the wedge, the plate and the staple whereby when the vertebral implant is secured in the vertebral body, the external surface configuration of the plate alters a relative orientation of a superior endplate surface plane and an inferior endplate surface plane of the vertebral body and alters the alignment of the spine. In some embodiments, the coupling device is configured to adjust a device length of the vertebral implant device whereby an adjustment of the device length secures the one or more staple tine to a side wall of the vertebral body and secures the one or more plate tine to an opposing side wall of the vertebral body. In some embodiments, the coupling device comprises a screw and a nut, the screw further comprises a screw swivel coupler, and the staple comprises a staple swivel coupler to mate with the screw swivel coupler whereby the staple is configured to swivel about a longitudinal axis of the screw. In some embodiments, the external surface configuration of the plate is defined by a plate longitudinal angle between a longitudinal surface plane of a superior surface of the plate and a longitudinal surface plane of an inferior surface of the plate, and a plate height proximal to the one or more plate tine. In some embodiments, the external surface configuration of the plate is further defined by a plate transverse angle between a transverse surface plane of a superior surface of the plate and a transverse surface plane of an inferior surface of the plate. In some embodiments, an external surface configuration of the wedge is defined by a wedge longitudinal angle between a longitudinal surface plane of a superior surface of the wedge and a longitudinal surface plane of an inferior surface of the wedge, and a wedge height proximal to the one or more wedge tine. In some embodiments, the external surface configuration of the wedge is further defined by a wedge transverse angle between a transverse surface plane of a superior surface of the wedge and a transverse surface plane of an inferior surface of the wedge. In some embodiments the screw further comprises a drive portion configured to be engaged by a drive tool, the screw further comprises a distal threaded portion, the plate further comprises a threaded through hole to engage the distal threaded portion of the screw whereby when the drive portion is rotated in a first rotation direction by the drive, the screw adjusts the device length to a shorter length, and the staple further comprises a proximal end having a radiused corner profile whereby when the drive portion is rotated in the first rotation direction by the drive, the proximal end of the staple engages the vertebral body to position the one or more staple tine to engage the side wall of the vertebral body. In some embodiments, the coupling device is configured to adjust a device height of the vertebral implant device whereby an adjustment of the device height alters the external surface configuration of the plate and alters the relative orientation of a superior endplate surface plane and an inferior endplate surface plane of the vertebral body. In some embodiments, the coupling device comprises a screw and a nut, the plate further comprises a two-pronged u-shaped body defining a cavity configured to receive the wedge and the screw, the screw is configured to be received in a bore of the wedge, and the nut is configured to be received in the bore of the wedge and couple to the screw whereby the screw and the nut secure the wedge in the cavity of the plate. In some embodiments, the two-pronged u-shaped body comprises an angularly flexible body, and the device height is affected by an external surface configuration of the wedge. 
     In some embodiments, the screw further comprises a screw swivel coupler and a drive portion, the staple comprises a staple swivel coupler to mate with the screw swivel coupler whereby the staple is configured to swivel about a longitudinal axis of the screw, and the staple further comprises a proximal end having a radiused corner profile whereby when the drive portion is rotated in a first rotation, the proximal end of the staple engages the vertebral body to stop a further rotation of the staple. 
     In some embodiments, the wedge comprises a plurality of wedges configured to be exchangeable with the plate, and each of the plurality of wedges having a different external surface configuration. 
     In some embodiments, a vertebral implant system configured to alter an alignment of a spine is provided comprising a nut, a screw, a staple having one or more tine, a plate having a cavity configured to receive a wedge and the screw, the wedge selected from a set of wedges, the set of wedges comprising at least a first wedge and a second wedge wherein the first wedge has a first external dimension and the second wedge has a second external dimension, and the plate configured to receive either the first wedge or the second wedge whereby: when the first wedge is received in the plate, a first implant device external dimension is created to alter a relative orientation of a superior endplate surface plane and an inferior endplate surface plane of a vertebral body and alter the alignment of the spine to a first degree, and when the second wedge is received in the plate, a second implant device external dimension is created to alter the relative orientation of a superior endplate surface plane and an inferior endplate surface plane of the vertebral body and alter the alignment of the spine to a second degree. In some embodiments, the plate comprises at least a first plate and a second plate wherein, the first plate has a first external dimension, the second plate has second external dimension, and the first plate and the second plate are exchangeable whereby: when the first wedge is received in the first plate, a third implant device external dimension is created to alter the relative orientation of a superior endplate surface plane and an inferior endplate surface plane of the vertebral body and alter the alignment of the spine to a third degree, and when the first wedge is received in the second plate, a forth implant device external dimension is created to alter the relative orientation of a superior endplate surface plane and an inferior endplate surface plane of the vertebral body and alter the alignment of the spine to a forth degree. In some embodiments, the plate comprises at least a first plate and a second plate, the first implant device external dimension is defined by: a first plate longitudinal angle between a longitudinal surface plane of a superior surface of the plate and a longitudinal surface plane of an inferior surface of the plate, and a first plate height; and the second implant device external dimension is defined by: a second plate longitudinal angle between a longitudinal surface plane of a superior surface of the plate and a longitudinal surface plane of an inferior surface of the plate, and a second plate height. In some embodiments, the first implant device external dimension is defined by: a first wedge longitudinal angle between a longitudinal surface plane of a superior surface of the first wedge and a longitudinal surface plane of an inferior surface of the first wedge, a plate thickness, and a plate height; and the second implant device external dimension is defined by: a second wedge longitudinal angle between a longitudinal surface plane of a superior surface of the second wedge and a longitudinal surface plane of an inferior surface of the second wedge, the plate thickness, and the plate height. 
     A method to alter an alignment of a spine is provided comprising performing an osteotomy procedure through a vertebral body inferior to a pedicle of the vertebral body, inserting a plate and a staple into a vertebral opening created by the osteotomy procedure, deploying the staple whereby the staple extends outside of the vertebral opening, rotating the staple whereby one or more staple tines are positioned general perpendicular to the osteotomy to engage a side wall of the vertebral body, tightening a screw coupled to the staple whereby the staple tines are drawn towards the plate and engage the side wall of the vertebral body, positioning a wedge over a proximal end of the screw and into a cavity of the plate, coupling a nut on the proximal end of the screw and into a bore of the wedge, tightening the nut on the screw whereby the plate is distracted by the wedge as it is drawn into the vertebral body, and further tightening the nut onto the screw whereby the wedge is secured within the cavity of the plate defining an external surface configuration of the plate to alter a relative orientation of a superior endplate surface plane and an inferior endplate surface plane of the vertebral body and alter the alignment of the spine. In some embodiments, the implant device is inserted from a lateral approach. In some embodiments, the implant device is inserted from an anterior approach. In some embodiments, the implant device is inserted from an oblique approach. 
     Other objects, features, and advantages of the techniques disclosed in this specification will become more apparent from the following detailed description of embodiments in conjunction with the accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS 
       In order that the manner in which the above-recited and other advantages and features of the invention are obtained, a more particular description of the invention briefly described above will be rendered by reference to specific embodiments thereof which are illustrated in the appended drawings. Understanding that these drawings depict only typical embodiments of the invention and are not therefore to be considered to be limiting of its scope, the invention will be described and explained with additional specificity and detail through the use of the accompanying drawings in which: 
         FIGS. 1A through 1K  show example embodiments of an intravertebral implant device and example components; 
         FIGS. 2A-2I  show another example embodiment of a an intravertebral implant device showing additional details for the screw; 
         FIG. 3  shows the planes of the human body; 
         FIG. 4  shows a lateral plane section of the human body at mid-lumbar level; 
         FIGS. 5A-5C  shows example embodiments of the intravertebral implant device inserted from different insertion angles where  FIG. 5A  shows a top view of an an example embodiment of an intravertebral implant device inserted from a lateral approach,  FIG. 5B  shows a top perspective view of an intravertebral implant device inserted from a lateral approach, and  FIG. 5C  shows a top view of an example embodiment an intravertebral implant device inserted from an oblique approach; 
         FIG. 6  includes Table A showing example characteristics of the intravertebral implant device components for use in correcting the coronal alignment of the spine; 
         FIGS. 7A-7B  illustrate example embodiments of components for use when inserting and securing the intravertebral implant device; and 
         FIGS. 8A-8G  illustrate example methods of inserting the an intravertebral implant device. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     COPYRIGHT NOTICE: A portion of the disclosure of this patent document contains material which is subject to copyright protection. The copyright owner has no objection to the facsimile reproduction by anyone of the patent document or the patent disclosure, as it appears in the Patent and Trademark Office patent file or records, but otherwise reserves all copyright rights whatsoever. The following notice applies to any software and data as described below and in the drawings hereto: Copyright © 2020-2021, NOFUSCO Corporation, All Rights Reserved. 
     Intravertebral implant systems and methods of use will now be described in detail with reference to the accompanying drawings. Notwithstanding the specific example embodiments set forth below, all such variations and modifications that would be envisioned by one of ordinary skill in the art are intended to fall within the scope of this disclosure. 
     Some embodiments of the intravertebral implant system is intended for use in the thoracolumbar spine (T11-L5) to replace a portion of and/or restore height of a collapsed, damaged, or unstable vertebral body due to trauma (i.e., fracture) or osteotomy. The system is to be placed unilaterally and used with autograft or allograft and may be used with supplemental spinal fixation as part of the device. 
     Some embodiments of the intravertebral implant system are intended to treat collapse of the vertebral body wedging, which is the result of microfractures of the vertebral body endplates. These microfractures occur because of the collapsed disc. The vertebral body wedging, secondary to the microfractures, creates a coronal deformity and causing back pain thru malaligned facet joints. The source of the back pain can be confirmed by diagnostic local anesthetic agents around the painful facet joint. Correction of the coronal deformity will reduce the back pain by realigning the facet joints in this select group of patients. This is analogous to the use of high tibial osteotomies for treatment of knee arthritis. The intravertebral implant system may be used as an adjunct to correct the spine coronal deformity in patients diagnosed with degenerative scoliosis. 
     This coronal deformity of the vertebrae may or may not be associated with leg radiculopathy from a narrowed foramen in addition to back pain as above or as a separate clinical problem. When the vertebra is wedged and the disc space collapses the facet joints sublux with the superior facet of the lower vertebra riding high in the foramen (narrowed foramen) pinching the exiting nerve root. This radiculopathy pain would be relieved by indirect decompression thru the osteotomy, placement of the intravertebral implant device indirectly opens the foramen through reducing the subluxed facet joints and then stabilizes the correction until healing of the vertebral body occurs in 12 weeks. 
     The disclosed intravertebral implant systems and methods will lead to an improved quality of life when compared to current standard surgical techniques and technology when used as part of a decompression strategy. The patient will have relief from back and/or leg pain without a loss of spine mobility, which will significantly reduce or eliminate the risk of adjacent level accelerated degeneration in the other levels of the spine. The custom alignment that can be created with the implant device can prevent the problematic clinical outcomes of misalignment. 
     When used as an intravertebral body fusion device the intravertebral implant system is intended for use in skeletally mature patients who have had six months of non-operative treatment. The implant device is intended for use at one level or two levels for the treatment of degenerative disc disease (DDD) with up to Grade I spondylolisthesis. This procedure and the intravertebral implant device treat some cases of back pain caused by malalignment of the facet joints secondary to collapse of degeneration of the disc confirmed by history , radiographic studies, and diagnostic facet joint injections with local anesthetic to confirm source of pain being from the malaligned facet joints. This is analogous to the use of high tibial osteotomies for treatment of knee arthritis. Additionally, the intravertebral implant system can be used as an adjunct to correct the spine coronal deformity in patients diagnosed with degenerative scoliosis. The intravertebral implant system is intended for use with or without supplemental fixation. 
     The intravertebral implant system is intended to treat collapse of the disc and vertebral body creating a coronal deformity and causing back pain thru malaligned facet joints. The source of the back pain can be confirmed by diagnostic local anesthetic agents around the painful facet joint. This coronal deformity may or may not be associated with leg radiculopathy from a narrowed foramen. This radiculopathy pain could be relieved by indirect decompression thru the osteotomy and placement of intravertebral implant system which opens the foramen and then stabilizes the correction until healing of the vertebral body occurs in 12 weeks. 
     One Example Embodiment of the Intravertebral Implant System: 
     In some embodiments, the intravertebral implant system comprises an intravertebral implant device. For illustration purposes and not for limitation, one example embodiment of the intravertebral implant device is shown in  FIGS. 1A-1K . 
     As shown in  FIG. 1A , the intravertebral implant system generally comprises an intravertebral implant device comprising, from a distal end to a proximal end, a staple  140 , a plate  120 , a wedge  150  and a coupling device. In the embodiment shown, the coupling device is a screw  160  that mates with a nut  130 . 
       FIG. 1B  shows a perspective view of an example embodiment of the intravertebral implant device assembled as in an inserted position. The intravertebral implant device is configured to be inserted completely within a vertebral body. As shown, the staple  140  is rotatably coupled to the distal end of the screw (see  FIG. 1A   160 ). The distal end of the screw is positioned through an opening (not shown) on the distal end of the plate  120 . The screw is also positioned through a bore (not shown) in the wedge  150 . The nut  130  is also positioned through the bore of the wedge  150  so that its distal end can be coupled with the proximal end of the screw  160 . 
     In one example embodiment, all of the components of the intravertebral implant device are made of a surgical grade metal such as Titanium (e.g., ASTM F136 Wrought 6Al4V Ti for Implant). The intravertebral implant device may be manufactured utilizing conventional machining technology i.e. milling and turning, mass media and/or electropolish finishing, color anodizing and passivation. 
     When assembled and implanted in the vertebral body, the external surface dimensions and configuration of the intravertebral implant device is able to correct the relative orientation of a superior endplate surface plane and an inferior endplate surface plane of a vertebral body to alter the alignment of the spine. The external surface configuration of the intravertebral implant device may be altered by using different configuration of intravertebral implant device components. For example, the wedge may be configured to have different surface angles to create different external surface configuration when mated with the plate. And sets of multiple exchangeable wedge configurations can provide implant device options to accommodate different vertebrae, different sized patients and different orientations of insertion. 
     Referring to  FIG. 1C , the staple  140  is generally a device coupled to the distal end of the screw  160  to frictionally engage the external surface of the vertebral body to secure one end of the implant device to the body. In the example embodiment shown, the staple  140  has staple tines  142  to function as barbs to secure the implant device  100  to the external surface of the vertebra. The staple  140  and screw  160  are coupled with a swivel coupler  168  which allows some movement of the staple to better accommodate the anatomical shape of the vertebra. The swivel coupler  168  may comprise a screw swivel coupler that mates with a staple swivel coupler. The staple  140  may articulate relative to the screw  160  by means of material deformation or a mechanical joint feature to accommodate anatomical variance. In one example embodiment, the screw  160  is coupled with a swivel coupling that secures the staple  140  on the distal end of the screw  160  but also allows the staple  140  to rotate about the screw  160 . 
     Referring to  FIG. 1C , the staple  140  is free to move and rotate on the distal end of the screw  160 , but, the swivel coupling of the staple  140  has some friction to allow the staple  140  to rotate when the screw  160  rotates. When the staple  140  is rotated while the implant device is in the vertebral opening of the osteotomy (see  FIG. 8C ), and the screw  160  is rotated and the staple  140  rotates with it (based on swivel coupling friction) until it hits a stop (overcoming swivel coupling friction) leaving it in the deployed position (see  FIG. 8D ). Further rotation of the screw  160  draws the staple  140  and the plate  120  together allowing the staple tines  142  and the plate tines  122  to engage the bone of the vertebral body and secure the implant device. In one embodiment, the stop is created by a proximal end of the staple having a radiused corner profile that allows the staple to rotate until the larger radius section engages the internal surface of the vertebral body and stopping further rotation of the staple (see  FIG. 2D ). In this embodiment, the radiused corner profile of the staple also helps support the opening in the vertebral body. 
     Referring to  FIG. 1C , the screw  160  is generally an elongated member configured to couple the staple  140  with the nut  130  so that all of the implant device components may be coupled together. As shown in  FIG. 1C , the screw  160  comprises swivel coupler  168 , a distal portion  162 , a proximal portion  164  and a drive portion  166 . The distal portion  162  and the proximal portion  164  may be threaded (see  FIG. 2A ). In an embodiment with threaded portions, the externally threaded distal portion  162  is configured to mate and engage an internally threaded portion of the hole in the distal end of the plate  120  and an externally threaded proximal portion  164  is configured to mate and engage an internally threaded portion of an internal bore in the nut  130 . In embodiments, the threaded portions of the screw may have the threads configured to work in different directions to allow for different engagement of the screw when the screw is rotated in different directions. For example, the externally threaded distal portion  162  may be threaded with left-handed threading (see.  FIG. 2B ) to draw the distal end of the screw closer to the distal end of the plate  120  when the screw is turned clockwise and the externally threaded proximal portion  164  may have right-handed external threading (see  FIG. 2C ) to mate with the internal right-handed threading of the nut to allow the nut to be secured and brought further onto the screw when the nut is turned in the counter-clockwise direction. In this example, the screw is turned/tightened in the body by a drive tool that mates with the drive portion  166  of the screw  160  and the nut is turned/tightened on the screw  160  by a drive tool that mates with the proximal end of the nut. 
     The threaded portions of the screw may have a locking thread profile to mate and lock with the mating threads. For example, a locking thread profile may be created when tapping the female thread and is created by a sloped surface which taper-locks the apex of the external/male thread. For example, when the screw or nut is tightened, the crests of the male threads on the bolt are pulled up against the sloped surface of the female threads and wedged into place creating a locking thread. 
     During insertion of the intravertebral implant device, the staple  140  is configured in a horizontal position, generally parallel with transverse surface planes of the plate  120 , for ease of insertion. The staple  140  is then configured to be rotated by a rotation of the screw  160  into a vertical/perpendicular position (see  FIG. 1G ) once it extends beyond the far side of a vertebral body. Once the staple  140  is in the correct position, the staple  140  and plate  120  are then stabilized together. This stabilization may be done by rotating the drive portion  166 , such as a hex shaped profile on the proximal end of the screw  160 . Generally, this would be done in the same rotational direction as was used to position the staple to ensure the stop engages the vertebra and keeps the staple tines engaged with the vertebral body. By rotating the screw  160  with the drive portion  166  in a clockwise rotation, the screw in the plate draws the staple and plate together, engaging the tines of the staple and the plate into the cortical shell of the vertebral body. This can occur because of staple prongs of the plate capture the ipsilateral vertebra body cortex, as shown in  FIGS. 8C-8E  and described in methods of using the intravertebral implant device. 
     The plate generally provides the structure to secure the implant device to both sides of the vertebra. The plate is configured to adjustably couple with the screw and staple to secure the implant device to one side wall of the vertebra and the plate has tines on a proximal end to secure the implant device to the other side wall of the vertebra. 
     Referring to  FIG. 1D , the plate  120  is generally an angularly flexible device with plate tines  122  at the end of prongs  124  to engage the two vertebral body portions superior and inferior to the osteotomy. The plate tines  122  can be made to accommodate anatomical variance. The plate may be a two-pronged u-shaped angularly flexible body defining a cavity  128  configured to receive the wedge and the screw. The cavity  128  may be configured to receive and be used with multiple shapes of wedges. This allows multiple configurations of the intravertebral implant device to be provided by altering the wedge used with the plate  120 . The plate also has a through hole  126  at its distal end to receive and engage the distal end of the screw. In some embodiments, the through hole  126  is threaded to mate with the distal threaded portion of the screw. In some embodiments, the threads of the through hole  126  are configured to have a locking profile to lock with the screw threads. 
     Referring to  FIG. 1E , the wedge  150  is generally a triangle shaped element used to distract the plate and influence the external surface configuration of the implant device and effect correction to the vertebral body. The wedge has variable dimension along its longitudinal axis which defines a wedge longitudinal angle between a wedge top surface plane  157 A and a wedge bottom surface plane  157 B. The wedge  150  may also have variable dimension along its transvers axis to provide a wedge transverse angle between the wedge top surface plane  157 A and the wedge bottom surface plane  157 B. The wedge  150  is also configured to fit within the cavity of the plate. This allows for multiple configurations of the wedge  150  to be used with a common plate so that the implant device can be configurable. 
     The wedge tines  152  on the wedge  150  engage the plate tines to prevent them from separating. This resists tensile forces, bending forces and resists the osteotomy from opening further. The wedge tines  152  may also engage the bone to further secure the implant device to the vertebra. 
     The wedge  150  also has a through bore  154  extending along its length and shaped to receive the screw and the nut. The wedge  150  may also have a concave recess  156  at its proximal end to receive and countersink the head of the nut when the implant device is secured to the vertebra. 
     Referring to  FIG. 1F , the nut  130  is generally an internally threaded tubular element with a head  132  and is used to engage a mating threaded recess in the wedge draw the wedge into the plate/cage and secure the implant assembly. In the embodiment shown, the nut has a recess  134  with internal threads configured to couple with the external threads of the screw. The recess  134  of the nut is also shaped to receive the drive portion of the screw. In some embodiments, the threads have a locking profile to lock with the mating threads of the screws. In some embodiments, the direction of the threading is opposite to the threading direction of the distal end of the screw. This opposing threading direction is to allow the distal end of the screw to be secured in the plate while also allowing the nut  130  to be secured to the proximal portion of the screw by rotating in a direction that doesn&#39;t loosen the engagement of the screw with the plate. 
       FIG. 1G  shows the embodiment of  FIG. 1B , as assembled, from a side-view. Shown is the implant device length  100 L and the plate height  100 H, corresponding to the implant device height as measured at the proximal end of the plate prongs  124  proximal to the plate tines  122 . 
       FIG. 1H  shows the embodiment of  FIG. 1B , as assembled, from a top view. 
       FIG. 1I  shows the embodiment of  FIG. 1B , as assembled, from a side view illustrating the longitudinal angles between surface planes of implant device components. As shown, the external surface of the prongs  124  define exterior surface planes of the plate and the device. The exterior surface planes extend along the length of the prong  124  and transverse along the width of the prong. Along the length of the plate prongs  124 , the exterior surfaces superior and inferior surface) define two exterior surface planes, a top exterior surface plane  127 A and a bottom exterior surface plane  127 B. Along the length of the plane, the two exterior surface planes define a longitudinal angle  129 L between the two longitudinal surface planes  127 A and  127 B. Similarly, along the length of the wedge  150 , the exterior surfaces (superior and inferior surface) of the wedge define two exterior surface planes. These two exterior surface planes define a wedge longitudinal angle  159 L between the two surface planes along their length. When assembled, the plate surface planes  127 A and  127 B cooperate with the dimensions and surface planes of the wedge  150  to create an implant device longitudinal angle, here  129 L. 
     In some embodiments, an additional plate longitudinal angle (not shown) is formed by a change of thickness of the plate prongs along their longitudinal axis creating an angle between the exterior surface planes of the plate prongs and interior surface planes of the plate prongs. 
       FIG. 1J  shows the embodiment of  FIG. 1I , as assembled, from a cut-away view A-A illustrating possible transverse angles of implant device components. As shown, a wedge transverse exterior surface plane angle  159 T (of the exterior surface planes) is defined by the angular relationship of the transverse surface planes of the wedge. An implant device transverse exterior surface plane angle  129 T (of the device/plate exterior surface planes) defines the resulting transverse angle of the outer surface planes of the plate in the transverse direction. The plate transverse exterior surface plane angles  127 T-A and  127 T-B (of the plate exterior surface planes) are formed by the thickness of the plate prongs  124  along the transverse axis and defines the transverse angle of the outer surface plans of the plate prongs  124 . 
       FIG. 1K  shows a plate illustrating an example of transverse angles of the plate prongs  124  resulting from a change in the plate thickness in a transverse direction.  FIG. 1K  shows an example of the plate transverse exterior surface plane angles  127 T-A and  127 T-B defined by the different orientations of the plate surface planes of the prongs  124  to create the implant device transverse exterior surface plane angle  129 T. The plate thickness may be varied to create these angles. 
       FIGS. 2A-2I  show example embodiments detailing features of the intravertebral implant device. As shown in  FIGS. 2A-2C , the distal portion  262  of the screw  160  is threaded in a first direction (see  FIG. 2B ) and the proximal portion  264  of the screw  260  is threaded in an opposite direction (see  FIG. 2C ). As shown in  FIGS. 2E and 2F , the threads of the distal portion  262  of the screw engage the hole in the distal end of the plate  220 .  FIG. 2E  shows a perspective view of the implant device with the distal threaded portion of the screw.  FIGS. 2F and 2G  show a side view and cross-sectional view of the implant device.  FIG. 2H  shows a view of the implant device from a distal end showing an implant device with transverse angles on the wedge.  FIG. 21  shows a cross-sectional view of the implant device along the cross-section A-A of  FIG. 2H  which is a cross-section along the length of the implant device. 
     Consistent with the screw  260  embodiments shown in  FIGS. 2A-2C ,  FIG. 2D  illustrates an example embodiment of the radiused corner profile on the proximal end of the staple  240 . In one embodiment, the stop is created by a proximal end of the staple having a radiused corner profile with a rounded profile section  244  that creates a smaller radius about the screw and a larger profile section  246  that creates a larger radius about the screw. This profile allows the staple to rotate until the larger profile section engages the internal surface of the vertebral body and stops further rotation of the staple. 
     Configurable Features of Embodiments of the Intravertebral Implant System: 
     The ability to mix plate components and wedge components allows for multiple implant device dimensions to be created so that different alterations can be made to the alignment of the spine. These different implant device dimensions can be made to be suitable to support insertion from different angles and use in different regions of the spine. In addition, devices sizes may vary for use with different patients. 
     As shown in the examples of Table A of  FIG. 6 , many different configurations of the implant device may be created. Use of the implant device may be used to create a wedged vertebrae correction (WVC) or a foraminal stenosis correction (FSC). 
     Examples of general sizes of the implant device are also shown in Table A of  FIG. 6 . Final sizes for the vertebral implant device in length, width and height are generally based on dimensions of human vertebrae. Configurations of the vertebral implant device angles, longitudinal and transverse, are selected based on the correction desired in the sagittal and coronal plane. The vertebral implant device dimensions are a result of the dimensions of wedge and the plate. Limits of correction angles will be formulated using Finite Element Analysis (FEA) and design analysis based on anatomical ranges. 
     Examples of sizes and configurations for the vertebral implant device are illustrated in the following description of embodiments in operation. 
     One Embodiment of the Intravertebral Implant System in Operation: 
     The vertebral implant device generally uses the exterior surface planes of the implant device to alter the alignment of skeletal components of a mammalian body. Referring to  FIG. 3 , the disclosed vertebral implant device primarily provides adjustment of the spine in the coronal plane  301  and the sagittal plane  302  and combinations of the two planes. 
     Referring to  FIG. 4  showing a cross-section of the human body, the vertebral implant device is intended to be used on the vertebra  401  of a body  406  and may be inserted from different orientations. As shown, the implant device may be inserted from a lateral position  407 , from an anterior position  409  or from an oblique position  408 . The intravertebral implant system may also be applied to different portions of the spine. 
       FIGS. 5A-5C  further illustrate the ability for multiple embodiments of the vertebral implant device to be inserted.  FIG. 5A  shows a top view of an example embodiment of an intravertebral implant device  500  inserted in a vertebra  501  from a lateral approach with the longitudinal axis of the implant device generally in the coronal plane.  FIG. 5B  shows a top perspective view of an intravertebral implant device  500  inserted in a vertebra  501  from a lateral approach.  FIG. 5C  shows a top view of an example embodiment an intravertebral implant device  500  inserted in a vertebra  501  from an oblique approach at an angle A from a normal lateral approach. 
     Described below in detail is a lateral approach for creating a vertebral body osteotomy and then for placing the implant totally within the vertebral body for correction in the coronal plane. With the disclosed systems and methods, spine correction is established, while the spine flexibility thru the disc and facet joints is retained, and the vertebral body then fuses in a period of time, such as 12 weeks, for a solid corrected vertebral structure. 
     Referring to  FIGS. 8A-8G , the operation of one embodiment of the intravertebral implant system generally comprises the following sequence of steps. 
     As shown in  FIGS. 8A and 8B , an osteotomy  804  is made through the vertebral body  801  from the concave side and inferior to the inferior aspect of the pedicle. 
     As shown in  FIG. 8C , a plate  820  with staple  840  is inserted into the osteotomy. As shown, the staple  840  is in an inserted orientation to pass through the osteotomy. 
     As shown in  FIG. 8D , the staple  840  rotated with the screw  860  to engage the far side vertebra cortex wall. The staple  840  is rotated in a first direction by having a drive tool engage the drive portion  866  of the screw  860 . With rotation, the staple  840  is stopped by the radiused corner profile of the staple proximal end. 
     Referring to  FIG. 8E , with the staple  840  inserted and stopped, the staple  840  and plate  820  are tightened by rotating the drive portion  866  further in the first direction to draw the screw  860  and staple  840  towards the plate  820 . Rotating the screw  860  engages all the staple tines into the side wall of the vertebral body as well as draws the plate tines into the opposing side wall of the vertebral body. With the staple tines and plate tines engaged with the vertebral body, the implant device is secured to the vertebral body. 
     Referring to  FIG. 8F , the wedge  850  is then inserted into the cavity of the plate  820  and the nut (not shown) is coupled to the proximal threaded portion of the screw. With the tightening of the nut to draw the nut onto the screw  860  (using the right-hand threads on the screw) the wedge  850  slides into the cavity, distracting the plate  820 , distracting the exterior surface planes of the implant and correcting the vertebral body coronal angle. 
     Referring to  FIG. 8G , the wedge  850  is then secured into position by a tightening of the nut. When the wedge  850  is fully in place, it engages the plate  820  providing a solid construct. The securing of the wedge  850  creates the correction and the wedge tines engage the plate tines and secures the upper and lower prongs of the plate  820  together. The result is an alteration of the relative orientation of a superior endplate surface plane  805  and an inferior endplate surface plane  806  of the vertebral body to alter the alignment of the spine. 
     For safety purposes, locking thread profiles may be provided on internal machine screw threads of the hole in the plate and the internal threads of the nut to prevent loosening or disengagement of the vertebral implant device once it is implanted. 
     In some embodiments, the vertebral implant device may provide additional correction in the sagittal plane. In these embodiments, the wedge surfaces will have a single angle and the inside of the plate will have a single angle and there will be transverse angles on the outside of the plate. This transverse angle of the plate additionally provides some correction in the sagittal plane and when implanted from a lateral approach. 
     In some embodiments, the vertebral implant device may be inserted from other approaches or may be used to alter alignment in other planes. With other approaches, the general method of inserting and securing the implant device is similar to the methods above. The different approach direction will require different configurations of the implant device so that the exterior surface planes provide the desired alteration in superior endplate surface plane and the inferior endplate surface plane of the vertebra in the appropriate plane. 
     Example Embodiments of Implant Devices to be Used with Lateral Insertion: 
     Example embodiments of intravertebral implant devices suitable for insertion from a lateral approach will be described below. Because the implant device is configurable, many of the implant device components are the same; the difference is in selecting different sized components to suit the direction of insertion, the spinal plane to be corrected and the area of the spine to be corrected. The descriptions below utilize an implant device consistent with the embodiments described above and shown in  FIGS. 2A and 2E . The descriptions below will utilize the dimensional examples shown in Table A of  FIG. 6 . It is understood that although Table A identifies dimensions and angles in logical increments, these increments are illustrative only of values within a range encompassing those values. 
     Lateral Insertion to Adjust Coronal Alignment 
     One example embodiment of an intravertebral implant device suitable for insertion from a lateral approach to correct vertebral alignment in the coronal plane is described above and shown in  FIGS. 2A and 2E . 
     For insertion from the lateral direction to correct spinal alignment in the coronal plane, an intravertebral implant device will be selected that has a suitable implant device longitudinal angle. In most embodiments, this implant device longitudinal angle is dictated by the wedge longitudinal angle. For example, referring to Table A in  FIG. 6 , for a lateral insertion to correct a lumbar area vertebra in the coronal plane, an implant device can be selected that has a wedge longitudinal angle in the range of about 5-20 degrees which will provide an overall alignment effect in the coronal plane of about 5-20 degrees. In some embodiments, the implant device and wedge longitudinal angle is in the range of about 10-15 degrees and in some embodiments, the implant device and wedge longitudinal angle is about 10 degrees. 
     For use in the thoracic area, the intravertebral implant device will be similarly configured but will generally have smaller dimensions. For example, referring to Table A in  FIG. 6 , for a lateral insertion to correct a thoracic area vertebra in the coronal plane, an implant device can be selected that has a wedge longitudinal angle in the range of about 5-15 degrees which will provide an overall alignment effect in the coronal plane of about 5-15 degrees. In some embodiments, the implant device and wedge longitudinal angle is in the range of about 10-15 degrees and in some embodiments, the implant device and wedge longitudinal angle is about 10 degrees. 
     It is understood, that if additional alignment correction is desired in the sagittal plane, the intravertebral implant device may be selected with implant device transverse angles to provide this correction. This implant device transverse angle may be provided by either a plate transverse angle or a wedge transverse angle. For example, referring to Table A in  FIG. 6  and utilizing the plate to provide the implant device transverse angle, for a lateral insertion to correct a lumbar area vertebra in the sagittal plane, an implant device can be selected that has a plate transverse angle in the range of about 1-20 degrees which will provide an overall alignment effect in the sagittal plane of about 1-20 degrees. In some embodiments, the implant device and plate transverse angle is in the range of about 10-15 degrees and in some embodiments, the implant device and plate transverse angle is about 10 degrees. Similarly, referring to Table A in  FIG. 6 , for a lateral insertion to provide additional correction for a thoracic area vertebra in the sagittal plane, an implant device can be selected that has a plate transverse angle in the range of about 1-10 degrees which will provide an overall alignment effect in the sagittal plane of about 1-10 degrees. In some embodiments, the implant device and plate transverse angle is in the range of about 5-10 degrees and in some embodiments, the implant device and plate transverse angle is about 5 degrees. 
     Lateral Insertion to Adjust Sagittal Plane Alignment 
     One example embodiment of an intravertebral implant device suitable for insertion from a lateral approach to correct vertebral alignment in the sagittal plane is described above and shown in  FIGS. 2A and 2E . 
     For insertion from the lateral direction to correct spinal alignment in the sagittal plane, an intravertebral implant device will be used that has a suitable implant device transverse angle. In most embodiments, this implant device transverse angle is dictated by the plate transverse angle. For example, referring to Table A in  FIG. 6 , for a lateral insertion to correct a lumbar area vertebra in the sagittal plane, an implant device can be selected that has a plate transverse angle in the range of about 1-20 degrees which will provide an overall alignment effect in the sagittal plane of about 1-20 degrees. In some embodiments, the implant device and plate transverse angle is in the range of about 5-15 degrees and in some embodiments, the implant device and plate transverse angle is about 10 degrees. 
     For use in the thoracic area, the intravertebral implant device will be similarly configured but will generally have smaller dimensions. For example, referring to Table A in  FIG. 6 , for a lateral insertion to correct a thoracic area vertebra in the sagittal plane, an implant device can be selected that has a plate transverse angle in the range of about 1-10 degrees which will provide an overall alignment effect in the sagittal plane of about 1-10 degrees. In some embodiments, the implant device and plate transverse angle is in the range of about 5-10 degrees and in some embodiments, the implant device and plate transverse angle is about 10 degrees. 
     It is understood that although the above example shows the implant device transverse angle being provided by the plate transverse angle, a wedge transverse angle, or a combination of the wedge transverse angle and the plate transverse angle may provide the device transverse angle. 
     It is understood, that if additional alignment correction is desired in the coronal plane, the intravertebral implant device may be selected with implant device longitudinal angles to provide this additional correction. As described above for correction in the coronal plane, the implant device longitudinal angle may be provided by either a plate longitudinal angle or a wedge longitudinal angle or a combination of the them. For example, referring to Table A in  FIG. 6  and utilizing the wedge to provide the device longitudinal angle, for a lateral insertion to provide additional correction for a lumbar area vertebra in the coronal plane, an implant device can be selected that has a wedge longitudinal angle in the range of about 5-20 degrees which will provide an overall alignment effect in the coronal plane of about 5-20 degrees. In some embodiments, the implant device and wedge longitudinal angle is in the range of about 10-15 degrees and in some embodiments, the implant device and wedge longitudinal angle is about 10 degrees. Similarly, referring to Table A in  FIG. 6 , for a lateral insertion to provide additional correction for a thoracic area vertebra in the coronal plane, an implant device can be selected that has a wedge longitudinal angle in the range of about 5-15 degrees which will provide an overall alignment effect in the sagittal plane of about 5-15 degrees. In some embodiments, the implant device and wedge longitudinal angle is in the range of about 10-15 degrees and in some embodiments, the implant device and plate transverse angle is about 10 degrees. 
     Example Embodiments of Implant Devices to be Used with Anterior Insertion: 
     Example embodiments of intravertebral implant devices suitable for insertion from an anterior approach will be described below. Similar to the devices embodiments described above for lateral insertion, the difference in the devices used is in selecting different sized components to suit the direction of insertion, the spinal plane to be corrected and the area of the spine to be corrected. The descriptions below utilize an implant device consistent with the embodiments described above and shown in  FIGS. 2A and 2E . The descriptions below will utilize the dimensional examples shown in Table A of  FIG. 6 . 
     Anterior Insertion to Adjust Coronal Plane Alignment 
     One example embodiment of an intravertebral implant device suitable for insertion from an anterior approach to correct vertebral alignment in the coronal plane is described above and shown in  FIGS. 2A and 2E . 
     For insertion from the anterior direction to correct spinal alignment in the coronal plane, an intravertebral implant device will be used that has a suitable implant device transverse angle. This device transverse angle may be provided by either a plate transverse angle or a wedge transverse angle. For example, referring to Table A in  FIG. 6  and utilizing the plate to provide the device transverse angle, for a anterior insertion to correct a lumbar area vertebra in the coronal plane, an implant device can be selected that has a plate transverse angle in the range of about 1-20 degrees which will provide an overall alignment effect in the coronal plane of about 1-20 degrees. In some embodiments, the implant device and plate transverse angle is in the range of about 5-15 degrees and in some embodiments, the implant device and plate transverse angle is about 10 degrees. 
     For use in the thoracic area, the intravertebral implant device will be similarly configured but will generally have smaller dimensions. For example, referring to Table A in  FIG. 6 , for an anterior insertion to provide correction for a thoracic area vertebra in the coronal plane, an implant device can be selected that has a plate transverse angle in the range of about 1-10 degrees which will provide an overall alignment effect in the coronal plane of about 1-10 degrees. In some embodiments, the implant device and plate transverse angle is in the range of about 5-10 degrees and in some embodiments, the implant device and plate transverse angle is about 5 degrees. 
     Similarly, for use in the cervical area, the intravertebral implant device will be similarly configured but will generally have smaller dimensions. For example, referring to Table A in  FIG. 6 , for an anterior insertion to provide correction for a cervical area vertebra in the coronal plane, an implant device can be selected that has a plate transverse angle in the range of about 1-5 degrees which will provide an overall alignment effect in the coronal plane of about 1-5 degrees. In some embodiments, the implant device and plate transverse angle is in the range of about 2.5-5 degrees and in some embodiments, the implant device and plate transverse angle is about 2.5 degrees. 
     It is understood, that if additional alignment correction is desired in the sagittal plane from this angle of insertion, the intravertebral implant device may be selected with implant device longitudinal angles to provide this correction. This implant device longitudinal angle may be provided by either a plate longitudinal angle or a wedge longitudinal angle. In most embodiments, this implant device longitudinal angle is provided by the wedge longitudinal angle. For example, referring to Table A in  FIG. 6 , for an anterior insertion to correct a lumbar area vertebra in the sagittal plane, an implant device can be selected that has a wedge longitudinal angle in the range of about 5-20 degrees which will provide an overall alignment effect in the sagittal plane of about 5-20 degrees. In some embodiments, the implant device and wedge longitudinal angle is in the range of about 10-15 degrees and in some embodiments, the implant device and wedge longitudinal angle is about 10 degrees. Similarly, referring to Table A in  FIG. 6 , for an anterior insertion to also correct a thoracic area vertebra in the sagittal plane, an implant device can be selected that has a wedge longitudinal angle in the range of about 5-15 degrees which will provide an overall alignment effect in the sagittal plane of about 5-15 degrees. In some embodiments, the implant device and wedge longitudinal angle is in the range of about 10-15 degrees and in some embodiments, the implant device and wedge longitudinal angle is about 10 degrees. Similarly, referring to Table A in  FIG. 6 , for an anterior insertion to also correct a cervical area vertebra in the sagittal plane, an implant device can be selected that has a wedge longitudinal angle in the range of about 2.5-7.5 degrees which will provide an overall alignment effect in the sagittal plane of about 2.5-7.5 degrees. In some embodiments, the implant device and wedge longitudinal angle is in the range of about 5-7.5 degrees and in some embodiments, the implant device and wedge longitudinal angle is about 5 degrees. 
     Anterior Insertion to Adjust Sagittal Plane Alignment 
     One example embodiment of an intravertebral implant device suitable for insertion from an anterior approach to correct vertebral alignment in the sagittal plane is described above and shown in  FIGS. 2A and 2E . 
     For insertion from the anterior direction to correct spinal alignment in the sagittal plane, an intravertebral implant device will be used that has a suitable implant device longitudinal angle. In most embodiments, this implant device longitudinal angle is provided by the wedge longitudinal angle. For example, referring to Table A in  FIG. 6 , for an anterior insertion to correct a lumbar area vertebra in the sagittal plane, an implant device can be selected that has a wedge longitudinal angle in the range of about 5-20 degrees which will provide an overall alignment effect in the sagittal plane of about 5-20 degrees. In some embodiments, the implant device and wedge longitudinal angle is in the range of about 10-15 degrees and in some embodiments, the implant device and wedge longitudinal angle is about 10 degrees. 
     For use in the thoracic area, the intravertebral implant device will be similarly configured but will generally have smaller dimensions. For example, referring to Table A in  FIG. 6 , for an anterior insertion to correct a thoracic area vertebra in the sagittal plane, an implant device can be selected that has a wedge longitudinal angle in the range of about 5-15 degrees which will provide an overall alignment effect in the sagittal plane of about 5-15 degrees. In some embodiments, the implant device and wedge longitudinal angle is in the range of about 10-15 degrees and in some embodiments, the implant device and wedge longitudinal angle is about 10 degrees. 
     Similarly, for use in the cervical area, the intravertebral implant device will be similarly configured but will generally have smaller dimensions. For example, referring to Table A in  FIG. 6 , for an anterior insertion to provide correction for a cervical area vertebra in the sagittal plane, an implant device can be selected that has a wedge longitudinal angle in the range of about 2.5-7.5 degrees which will provide an overall alignment effect in the coronal plane of about 2.5-7.5 degrees. In some embodiments, the implant device and plate transverse angle is in the range of about 5-7.5 degrees and in some embodiments, the implant device and plate transverse angle is about 5 degrees. 
     It is understood, that if additional alignment correction is desired in the coronal plane, the intravertebral implant device may be selected with implant device transverse angles to provide this correction. This implant device transverse angle may be provided by either a plate transverse angle or a wedge transverse angle. For example, referring to Table A in  FIG. 6  and utilizing the plate to provide the implant device transverse angle, for an anterior insertion to correct a lumbar area vertebra in the sagittal plane, an implant device can be selected that has a plate transverse angle in the range of about 1-20 degrees which will provide an overall alignment effect in the sagittal plane of about 1-20 degrees. In some embodiments, the device and plate transverse angle is in the range of about 5-15 degrees and in some embodiments, the device and plate transverse angle is about 10 degrees. Similarly, referring to Table A in  FIG. 6 , for a lateral insertion to provide additional correction for a thoracic area vertebra in the coronal plane, an implant device can be selected that has a plate transverse angle in the range of about 1-10 degrees which will provide an overall alignment effect in the coronal plane of about 1-10 degrees. In some embodiments, the implant device and plate transverse angle is in the range of about  5 -10 degrees and in some embodiments, the implant device and plate transverse angle is about 5 degrees. Similarly, referring to Table A in  FIG. 6 , for a lateral insertion to provide additional correction for a cervical area vertebra in the coronal plane, an implant device can be selected that has a plate transverse angle in the range of about 1-5 degrees which will provide an overall alignment effect in the coronal plane of about 1-5 degrees. In some embodiments, the implant device and plate transverse angle is in the range of about 2.5-5 degrees and in some embodiments, the implant device and plate transverse angle is about 2.5 degrees. 
     Example Embodiments of Implant Devices to be Used with Oblique Insertion: 
     Example embodiment of intravertebral implant devices suitable for insertion from an oblique approach will be described below. Similar to the devices embodiments described above for lateral and anterior insertion, the difference in the devices used is generally in selecting different sized components to suit the direction of insertion, the spinal plane to be corrected and the area of the spine to be corrected. The uniqueness of insertion from an oblique direction is that the implant device must accommodate more complicated implant device surface plane angles. 
     The descriptions below utilize an implant device consistent with the embodiments described above and shown in  FIGS. 2A and 2E . The descriptions below will utilize the dimensional examples shown in Table A of  FIG. 6 . 
     Oblique Insertion to Adjust Coronal Plane Alignment 
     One example embodiment of an intravertebral implant device suitable for insertion from an anterior approach to correct vertebral alignment in the coronal plane is described above and shown in  FIGS. 1A and 1B . 
     For insertion from the oblique direction to correct spinal alignment in the coronal plane, an intravertebral implant device will be used that has a suitable implant device transverse and longitudinal angles to alter the vertebra surface planes as desired. These implant device surface plane angles may be provided by either transverse or longitudinal angles of the wedge or plate exterior surfaces or some combinations of these angles. For example, for a primarily coronal plane adjustment, the implant device surface plane angles are configured to primarily alter the vertebra surface planes in the coronal plane. With the oblique orientation of the implant device, to only alter the vertebra surface planes in the coronal plane, the plate transverse angle may vary along its length and the longitudinal angle may vary along its width. Similarly, the wedge may have a longitudinal angle that varies along its width and may have a wedge transverse angle that varies along its length. The resulting dimensions of the implant device, for a primarily coronal correction, should be configured to primarily alter the vertebra surface planes in the coronal plane. 
     For a simple illustration, without accounting for the variations of the plate and wedge angles along their width and length, an example of suitable dimensions is shown in Table A in  FIG. 6 . Utilizing the plate and the wedge to provide the implant device surface angles, for an oblique insertion to correct a lumbar area vertebra in the coronal plane, an implant device can be selected that has a plate transverse angle in the range of about 1-20 degrees and a wedge longitudinal angle in the range of about 5-20 degrees which will provide an overall alignment effect in the coronal plane of about 5-30 degrees. In some embodiments, the device and plate transverse angle is in the range of about 5-15 degrees and the implant device and wedge longitudinal angle is in the range of about 10-15 which will provide an overall alignment effect in the coronal plane of about 10-25 degrees. In some embodiments, the implant device and plate transverse angle is about 10 degrees and the wedge longitudinal angle is about 15 degrees which will provide an overall alignment effect in the coronal plane of about 20 degrees. 
     For use in the thoracic area, the intravertebral implant device will be similarly configured but will generally have smaller dimensions. For example, referring to Table A in  FIG. 6 , for an oblique insertion to provide correction for a thoracic area vertebra in the coronal plane, an implant device can be selected that has a plate transverse angle in the range of about  1 -10 degrees and a wedge longitudinal angle in the range of about 5-15 degrees which will provide an overall alignment effect in the coronal plane of about 5-25 degrees. In some embodiments, the implant device and plate transverse angle is in the range of about 5-10 degrees and the longitudinal angle is in the range of about 10-15 degrees which will provide an overall alignment effect in the coronal plane of about 15-25 degrees. And in some embodiments, the implant device and plate transverse angle is about 5 degrees and the wedge longitudinal angle is about 10 degrees which will provide an overall alignment effect in the coronal plane of about 15 degrees. 
     Similarly, for use in the cervical area, the intravertebral implant device will be similarly configured but will generally have smaller dimensions. For example, referring to Table A in  FIG. 6 , for an oblique insertion to provide correction for a cervical area vertebra in the coronal plane, an implant device can be selected that has a plate transverse angle in the range of about 1-5 degrees and a wedge longitudinal angle in the range of about 2.5-7.5 degrees which will provide an overall alignment effect in the coronal plane of about 2.5-12.5 degrees. In some embodiments, the implant device and plate transverse angle is in the range of about 2.5-5 degrees and the longitudinal angle is in the range of about 5-7.5 degrees which will provide an overall alignment effect in the coronal plane of about 7.5-12.5 degrees. And in some embodiments, the implant device and plate transverse angle is about 2.5 degrees and the wedge longitudinal angle is about 5 degrees which will provide an overall alignment effect in the coronal plane of about 7.5 degrees. 
     For additional correction in the sagittal plane, the configuration of the implant device surface planes, as effected by the plate and wedge surface planes, can be selected to also alter the implant device and vertebra surface planes in the sagittal plane. 
     Oblique Insertion to Adjust Sagittal Plane Alignment 
     One example embodiment of an intravertebral implant device suitable for insertion from an anterior approach to correct vertebral alignment in the sagittal plane is described above and shown in  FIGS. 2A and 2E . 
     As described above for insertion from the oblique direction to correct spinal alignment in the sagittal plane, for altering spinal alignment in the sagittal plane, an intravertebral implant device will be used that has a suitable device transverse and longitudinal angle to alter the vertebra surface planes as desired. These implant device surface plane angles may be provided by either transverse or longitudinal angles of the wedge or plate or combinations of these angles. For example, for a primarily sagittal plane adjustment, the implant device surface plane angles are configured to primarily alter the vertebra surface planes in the sagittal plane. With the oblique orientation of the implant device, to only alter the vertebra surface planes in the sagittal plane, the plate transverse angle may vary along its length and its longitudinal angle may vary along its width. Similarly, the wedge may have a longitudinal angle that varies along its width and may have a wedge transverse angle that varies along its length. The resulting dimensions of the implant device, for a primarily sagittal correction, should be configured to primarily alter the vertebra surface planes in the sagittal plane. 
     For a simple illustration, without accounting for the variations of the plate and wedge angles along their width and length, an example of suitable dimensions is shown in Table A in  FIG. 6 . Utilizing the plate and the wedge to provide the implant device surface angles, for an oblique insertion to correct a lumbar area vertebra in the sagittal plane, an implant device can be selected that has a plate transverse angle in the range of about 1-20 degrees and a wedge longitudinal angle in the range of about 5-20 degrees which will provide an overall alignment effect in the sagittal plane of about 5-30 degrees. In some embodiments, the implant device and plate transverse angle is in the range of about 5-15 degrees and the implant device and wedge longitudinal angle is in the range of about 10-15 which will provide an overall alignment effect in the sagittal plane of about 10-25 degrees. In some embodiments, the implant device and plate transverse angle is about 10 degrees and the wedge longitudinal angle is about 15 degrees which will provide an overall alignment effect in the sagittal plane of about 20 degrees. 
     For use in the thoracic area, the intravertebral implant device will be similarly configured but will generally have smaller dimensions. For example, referring to Table A in  FIG. 6 , for an oblique insertion to provide correction for a thoracic area vertebra in the sagittal plane, an implant device can be selected that has a plate transverse angle in the range of about 1-10 degrees and a wedge longitudinal angle in the range of about 5-15 degrees which will provide an overall alignment effect in the sagittal plane of about 5-25 degrees. In some embodiments, the implant device and plate transverse angle is in the range of about 5-10 degrees and the longitudinal angle is in the range of about 10-15 degrees which will provide an overall alignment effect in the sagittal plane of about 15-25 degrees. And in some embodiments, the implant device and plate transverse angle is about 5 degrees and the wedge longitudinal angle is about 10 degrees which will provide an overall alignment effect in the sagittal plane of about 15 degrees. 
     Similarly, for use in the cervical area, the intravertebral implant device will be similarly configured but will generally have smaller dimensions. For example, referring to Table A in  FIG. 6 , for an oblique insertion to provide correction for a cervical area vertebra in the sagittal plane, an implant device can be selected that has a plate transverse angle in the range of about 1-5 degrees and a wedge longitudinal angle in the range of about 2.5-7.5 degrees which will provide an overall alignment effect in the sagittal plane of about 2.5-12.5 degrees. In some embodiments, the implant device and plate transverse angle is in the range of about 2.5-5 degrees and the longitudinal angle is in the range of about 5-7.5 degrees which will provide an overall alignment effect in the sagittal plane of about 7.5-12.5 degrees. And in some embodiments, the implant device and plate transverse angle is about 2.5 degrees and the wedge longitudinal angle is about 5 degrees which will provide an overall alignment effect in the sagittal plane of about 7.5 degrees. 
     For additional correction in the coronal plane, the configuration of the device surface planes, as effected by the plate and wedge surface planes, can be selected to also alter the vertebra surface planes in the coronal plane. 
     Additional Features of Embodiments of the Intravertebral Implant System: 
       FIGS. 7A and 7B  show example embodiments of other components for the intravertebral implant system.  FIG. 7A  illustrates an example embodiment of a supplemental fixation device  702 . As shown, the fixation device  702  comprises a securing plate and screws that may be secured to the bone to further secure the implant device  700  to the vertebra  701 . 
       FIG. 7B  illustrates an example embodiment of another supplemental device to couple to the implant system. For example, a connector  703  may be coupled to the implant device  700  by the nut or a screw to allow the implant system to be used as part of a larger construct. For example, as shown, the connector  703  may be coupled to the implant device  700  and configured to receive another device or component such that the intravertebral implant device  700  may be included in a longer construct such as a anterior rod or flexible cord (tether) anterior instrumentation system for correction of a longer multivertebra deformity. 
     In some embodiments, the wedge tines may be configured to provide supplemental fixation of the implant device to the vertebra. For example, the wedge tines may be extended and longer along the height of the wedge and through holes may extend through the wedge tine to allow a device such as a screw to further secure and affix the wedge and the implant device to the vertebra. In some embodiments, the intravertebral implant system further includes one or more navigation and robotic connections. 
     In some embodiments, the intravertebral implant system further includes one or more osteotomy guides. 
     In some embodiments, the intravertebral implant system further includes electro-field mechanisms. In these embodiments, a mechanism within the intravertebral implant may be activated by electromagnetic field, RFID, or other external field to cause the implant to produce a force on the fused vertebral body to change correction. This employs the effect of Wolff&#39;s Law where the bone responds to force to attain a level of stress, similar to orthodontia. 
     In some embodiments, the intravertebral implant system further includes percutaneous mechanisms. In these embodiments, a mechanism within the intravertebral implant may be activated by a percutaneous puncture of a tool to engage with the implant and cause the implant to create a force on the fused vertebral body to change correction. This also employs the effect of Wolff&#39;s Law where the bone responds to force to attain a level of stress, similar to orthodontia. 
     In some embodiments of the intravertebral implant system may be configured to provide non-surgical adjustment after the original surgery for further additional correction of the spine. These adjustments may be applied:
         In the immature developing spine, as growth can be accommodated, and correction adjusted.   Where additional foraminal indirect decompression is needed.   Where additional correction may be desired after the patient stands up.       

     In some embodiments, two implants can be placed side by side for increased strength and sagittal correction. 
     In some embodiments, a cortical bone graft can be placed alongside the implant(s) for a stronger fusion. 
     Although this invention has been described in the above forms with a certain degree of particularity, it is understood that the foregoing is considered as illustrative only of the principles of the invention. Further, since numerous modifications and changes will readily occur to those skilled in the art, it is not desired to limit the invention to the exact construction and operation shown and described, and accordingly, all suitable modifications and equivalents may be resorted to, falling within the scope of the invention which is defined in the claims and their equivalents. 
     REFERENCES: 
     Ahn, J., Tabaraee, E., Bohl, D. D., &amp; Singh, K. (2017). Surgical management of adult spinal deformity: Indications, surgical outcomes, and health-related quality of life. Seminars in Spine Surgery, 29(2), 72-76. https://doi.org/10.1053/j.semss.2016.12.001. 
     Magerl, F., Aebi, M., Gertzbein, S. D., Harms, J., &amp; Nazarian, S. (1994). A comprehensive classification of thoracic and lumbar injuries. European Spine Journal, 3(4), 184-201. https://doi.org/10.1007/BF02221591