Patent Publication Number: US-10765458-B2

Title: Coupling devices and methods of using the same

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This Patent Application is a continuation of U.S. patent application Ser. No. 15/181,450, filed on Jun. 14, 2016 (published as U.S. Patent Publication No. 2016/0317192), which is a continuation of U.S. patent application Ser. No. 14/638,193, filed Mar. 4, 2015 (now U.S. Pat. No. 9,387,012), which is a continuation of U.S. patent application Ser. No. 13/352,711, filed Jan. 18, 2012, (now U.S. Pat. No. 8,998,956), which is a continuation-in-part application of U.S. patent application Ser. No. 13/183,681, filed on Jul. 15, 2011 (now U.S. Pat. No. 9,649136), the entire contents of each of which are incorporated by reference herein in their entireties for all purposes. 
    
    
     TECHNICAL FIELD 
     This disclosure relates generally to medical devices and more particularly to coupling devices configured to couple a first portion of a medical support system to a second portion of a medical support system. 
     BACKGROUND 
     A variety of medical devices and medical device systems are implanted within bodies of patients to provide support to portions of the bodies of the patients. For example, some medical device systems are implanted and coupled to backbones or spines of patients and are configured to provide support to the spinal bone structure of the patient. Some medical device systems that are configured to provide support to the spinal bone structure of a patient include support members or rods that extend between various portions of the medical device system. For example, the support members or rods may extend between portions of the medical device system that are coupled to adjacent vertebrae to provide support to the spinal bone structure to promote healing of the bone structures and/or otherwise maintain alignment and spacing of the spinal bone structures. 
     After implantation, however, the support members or rods of the medical devices or medical device systems may become weakened or break. It then may be necessary to perform an additional medical procedure to replace or repair the broken or weakened support members or rods. Additionally, it may become necessary or desirable to couple various support members or rods together after the implantation of such medical device systems. 
     Accordingly, there is a need for a coupling device that allows various support members or rods to be coupled together. For example, there is a need for a coupling device that is configured to allow broken or weakened rods to be coupled together. Additionally, there is a need for a coupling device that is configured to allow broken or weakened rods to be coupled together without having to replace the support members or rods or perform a more difficult and time consuming procedure to bend or torque the rods to force the support members or rods to conform to the specific configuration of the coupling device. There is also a need for a coupling device that because of its size and profile avoids excessive tissue damage adjacent the surgical site. 
     SUMMARY 
     Systems, devices, and methods related to improved coupling mechanisms are provided. In some embodiments, an implantable system comprises a bottom member having one or more slots for receiving one or more rod members; a top member attachable to the bottom member; and a set screw insertable through both the top member and bottom member, wherein rotation of the set screw results in a secure locking of the system. 
     In other embodiments, an implantable system comprises a bottom member having a pair of slots for receiving two rod members; a top member attachable to the bottom, whereby in a first open orientation, the top member does not obscure openings of the pair of slots, while in a second closed orientation, the top member does obscure openings of the pair of slots; and a set screw insertable through both the top member and bottom member. 
     In other embodiments, an implantable system comprises a bottom member having one or more slots for receiving rod members; a top member attachable to the bottom member, the top member including an upper portion and a lower portion insertable into an aperture formed in the bottom member; and a set screw insertable through both the top member and bottom member. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIGS. 1 and 2  are perspective views of a medical device according to an embodiment of the invention. 
         FIG. 3  is a perspective view of a portion of the medical device of  FIGS. 1 and 2 . 
         FIG. 4  is a perspective view of a medical device according to an embodiment of the invention. 
         FIG. 5  is a perspective view of a coupler of a medical device according to an embodiment of the invention. 
         FIG. 6  is a perspective view of a ring of the coupler of  FIG. 5 . 
         FIG. 7  is an end view of the medical device of  FIG. 5 . 
         FIG. 8  is a cross-sectional view of the medical device of  FIG. 5  taken along line A-A of  FIG. 9 . 
         FIG. 9  is a top view of the medical device of  FIG. 5 . 
         FIG. 10  is a perspective view of a medical device according to an embodiment of the invention. 
         FIG. 11  is an end view of the medical device of  FIG. 10 . 
         FIG. 12  is a top view of the medical device of  FIG. 10 . 
         FIG. 13  is a perspective view of the medical device of  FIG. 10  coupled to a medical device system. 
         FIG. 14  is a perspective view of a medical device coupled to a medical device system. 
         FIGS. 15 and 16  are perspective views of a medical device according to an embodiment of the invention. 
         FIG. 17  is a perspective view of the medical device of  FIGS. 15 and 16  coupled to a medical device system. 
         FIG. 18  is a perspective view of a medical device according to an embodiment of the invention. 
         FIG. 19  is a perspective view of a medical device according to an embodiment of the invention. 
         FIG. 20  is a top view of the medical device of  FIG. 19  coupled to a medical device system. 
         FIG. 21  is a perspective view of a medical device according to an embodiment of the invention. 
         FIG. 22  is a perspective view of a medical device coupled to a medical device system. 
         FIGS. 23-26  are perspective views of medical devices according to embodiments of the invention. 
         FIGS. 27 and 28  are side views of medical devices according to embodiments of the invention. 
         FIGS. 29 and 30  are perspective views of a medical device according to an embodiment of the invention. 
         FIGS. 31 and 32  are perspective views of a medical device according to an embodiment of the invention. 
         FIGS. 33 and 34  are side views of medical devices according to embodiments of the invention. 
         FIG. 35  is an exploded view of a staple stabilization system according to some embodiments of the present application. 
         FIG. 36  is a side view of a staple stabilization system according to some embodiments of the present application. 
         FIG. 37  is a top perspective view of a staple stabilization system having rod members with a top member in an open position according to some embodiments of the present application. 
         FIG. 38  is a top perspective view of a staple stabilization system having rod members with a top member in a closed position according to some embodiments of the present application. 
         FIG. 39  is a top perspective view of a bottom member of a staple stabilization system according to some embodiments of the present application. 
         FIG. 40  is a bottom view of a staple stabilization system according to some embodiments of the present application. 
         FIG. 41  is a top perspective view of an alternative staple stabilizations system according to some embodiments of the present application. 
     
    
    
     DETAILED DESCRIPTION 
     The devices and methods described herein are generally directed to procedures for coupling portions of bodily implants together within a body of a patient. In some embodiments, the implants are configured to provide support to a portion of the body of the patient. For example, in some embodiments, the devices and methods described herein are configured to provide support to a spine or back of a patient. In other embodiments, other portions of the body of the patient are supported by the devices. 
       FIGS. 1 and 2  are perspective views of an apparatus or medical device  100  according to an embodiment of the invention.  FIG. 3  is a perspective view of a portion of the apparatus or medical device  100 . The apparatus or medical device  100  is configured to be coupled to portions of a medical device system to provide support to the medical device system. In the illustrated embodiment, the medical device  100  is configured to be coupled to a first support member SM and a second support member (not illustrated) of a medical device system. For example, in the illustrated embodiment, the medical device  100  is configured to be coupled to support members or rods of a spinal implant. 
     The apparatus or medical device  100  includes an elongate member  110 , couplers  120 ,  130 ,  140 , and  150  of a first type, and couplers  160  and  170  of a second type. The elongate member  110  includes a first end portion  112 , a second end portion  114 , and a side portion  116 . The first end portion  112  is disposed opposite the second end portion  114 . The side portion  116  extends from the first end portion  112  to the second end portion  114 . 
     The side portion  116  defines a first receiving portion  117  and a second receiving portion  118 . The first receiving portion  117  is configured to receive and house a first support member SM or rod of a medical device system (such as a spinal implant system). In the illustrated embodiment, first receiving portion  117  is configured to receive and house a portion of the first support member SM (and a portion of the first support member SM extends from the elongate member  100 ). The second receiving portion  118  is configured to receive and house a second support member of the medical device system or a portion of the second support member of the medical device system. 
     In the illustrated embodiment, the first receiving portion  117  and the second receiving portion  118  each include a cavity and an opening, such as an elongate opening that is in communication with the cavity. The first support member SM may be inserted into or otherwise coupled to the elongate member  110  by moving the first support member SM through the opening and into the cavity of the first receiving portion  117  of the side portion  116 . Similarly, in the illustrated embodiment, the second support member SM may be inserted into or otherwise coupled to the elongate member  110  by moving the second support member through the opening and into the cavity of the second receiving portion  118  of the side portion  116 . 
     In some embodiments, the first support member SM is coupled to a first portion of the medical device system and the second support member is coupled to a second portion of the medical device system. The apparatus  100  may be used to couple the first support member to the second support member to operatively couple the first portion of the medical device system to the second portion of the medical device system. In some embodiments, the first portion of the medical device system is a bone screw that is coupled to a first vertebrae and the second portion of the medical device system is a bone screw that is coupled to a second vertebrae. In some embodiments, the first support member SM and the second support member may be portions of a support member that broke into the first support member SM and the second support member. In such embodiments, the apparatus  100  or coupling device may be used to recouple the first support member SM to the second support member to repair the broken support member. 
     In some embodiments, the first receiving portion  117  and the second receiving portion  118  each include a sloped or ramped surface. The sloped or ramped surfaces are configured to help retain the support members within the receiving portions  117  and  118 . For example, in some embodiments, the sloped or ramped surfaces are configured to help retain the support members within the receiving portions  117  and  118  via a frictional fit. In some embodiments, the lower surfaces  115  and  119  include sloped or ramped surfaces to help retain the support members within the receiving portions  117  and  118 . 
     In the illustrated embodiment, the elongate member  110  is generally tubular in shape and has a relatively low profile. In other words, the cross-sectional sectional shape of the elongate member  110  (taken along a line generally perpendicular to the longitudinal axis LA of the elongate member) is generally circular. The diameter of the elongate member is relatively small to allow the apparatus  100  to avoid unnecessary disruption of the tissue surrounding the surgical site. Although the cross-sectional shape of the elongate member  110  is generally circular in the illustrated embodiment, in other embodiments, the elongate member has a different cross-sectional shape. For example, in some embodiments, the elongate member has an oval, rectangle, or any other cross-sectional shape. 
     In some embodiments, the first receiving portion  117  and the second receiving portion  118  are configured to receive and house support members of the same sizes, dimensions, or shapes. For example, in some embodiments, the first receiving portion  117  and the second receiving portion  118  are of the same size or include openings and cavities of the same size. In other embodiments, the first receiving portion  117  is configured to receive and house a support member of a first size, dimension, or shape and the second receiving portion  118  is configured to receive and house a support member of a second size, dimension, or shape different than the first size, dimension, or shape. For example, in some embodiments, the first receiving portion  117  is of a first width (has an opening or a cavity of a first width) and the second receiving portion  118  has a second width (has an opening or a cavity of a second width) greater than the first width. 
     Couplers  120 ,  130 ,  140 , and  150  are of similar construction and function. Accordingly, only the coupler  120  will be described in detail. The coupler  120  is coupled to the elongate member  110 . The coupler  120  is configured to move from a first position to a second position to engage a support member that is disposed within the first receiving portion  117  to help retain the support member within the first receiving portion  117 . In other words, the coupler  120  is configured to at least contribute to the retention (for example, during normal bodily conditions) of the support member within the first receiving portion  117 . In some embodiments, the coupler  120  is configured to engage the support member such that the frictional fit of the support member within the first receiving portion  117  is increased. In other words, the coupler  120  is configured to apply a pressure to the support member to help retain the support member within the first receiving portion  117 . 
     In other embodiments, the coupler  120  is configured to move from a first position while the support member is being inserted into the receiving portion to a second position after the support member is disposed within the receiving portion to provide a barrier (i.e., to partially close the opening) to help prevent the removal of the support member from the first receiving portion  117 . 
     In the illustrated embodiment, coupler  120  includes a set screw. The set screw of the coupler  120  can be rotated with respect to the elongate member  110  to move the set screw of the coupler  120  from a first position with respect to the elongate member  110  to a second position with respect to the elongate member  110 . When the set screw of the coupler  120  is in its second position a portion of the set screw extends into the first receiving portion  117  and is configured to contact or engage the support member SM disposed within the first receiving portion  117  (as best illustrated in  FIG. 1 ) to help retain the support member within the first receiving portion  117 . 
     Couplers  120 ,  130 ,  140 , and  150  are longitudinally offset from each other. In other words, the couplers  120 ,  130 ,  140 , and  150  are offset from each other along an axis parallel to the longitudinal axis LA of the support member  110 . Couplers  120  and  130  are disposed such that they are configured to contact or engage the support member SM that is disposed within the first receiving portion  117 . Couplers  140  and  150  are disposed such that they are configured to contact or engage a support member that is disposed within the second receiving portion  118 . 
     Couplers  160  and  170  are structurally and functionally similar. Accordingly, only coupler  160  will be discussed in detail. Coupler  160  is coupled to the elongate member  110  and is configured to engage the first support member SM once the support member SM is disposed within the first receiving portion  117 . Specifically, the coupler  160  is configured to move from a first position to a second position to engage a support member that is disposed within the first receiving portion  117  to help retain the support member within the first receiving portion  117 . In some embodiments, the coupler  160  is configured to engage the support member such that the frictional fit of the support member within the first receiving portion  117  is increased. In other words, the coupler  160  is configured to apply a pressure to the support member to help retain the support member within the first receiving portion  117 . 
     Coupler  160  is configured to be disposed at different locations along an axis parallel to the longitudinal axis LA of the elongate member  110 . In the illustrated embodiment, coupler  160  is slidably coupled within a slot  109  defined by the elongate member  110 . In other embodiments, coupler  160  is configured to be removably coupled to the elongate member  110  at different locations along an axis parallel to the longitudinal axis LA of the elongate member  110 . The ability of coupler  160  to slidably move within slot  109  allows coupler  160  to accommodate a variety of differently dimensioned support members as well as accommodate a variety of differently positioned support members. 
     In the illustrated embodiment, coupler  160  includes a screw portion and a cam member. Specifically, the coupler  160  includes a cam member that is configured to extend into the first receiving portion  117  (such as the cavity) to and engage or contact the support member to help retain the support member within the first receiving portion  117 . The cam member may be moved into engagement and out of engagement with the support member by rotating the screw portion with respect to the elongate member  110 . Accordingly, the support member may be inserted into the receiving portion  117  and appropriately positioned while the cam member does not extend into the receiving portion (or is in a location outside of engagement with the support member). Once the support member is inserted into the receiving portion, the screw member may be rotated with respect to the elongate member to cause the cam member to engage the support member and help retain the support member within the first receiving portion  117 . 
     In the illustrated embodiment, coupler  170  is slidably disposed within slot or groove  108  that is defined by the elongate member  110 . Slot  109  and slot  108  are disposed within the same plane. More specifically, slot  109  and slot  108  are offset along an axis that extends parallel to the longitudinal axis LA of the elongate member  110 . 
     In some embodiments, the elongate member defines a single slot in which both coupler  170  and coupler  160  move or slide within. 
     In the illustrated embodiment, coupler  170  and coupler  160  are radially offset from the couplers  120 ,  130 ,  140 , and  150 . 
     The components of the medical device  100  may be made or formed of any biocompatible material. For example, the components of the medial device  100  may be formed of a biocompatible plastic or polymer or a biocompatible metal material. 
     In use, the medical device or coupler  100  may be used to couple various portions of a medical device system together. In one embodiment, the medical device  100  may be used to couple a first support member of a spinal implant to a second portion of the spinal implant. 
     The medical device  100  may be moved with respect to the first portion of the medical device system (such as a support member of the medical device system) to insert the first portion of the medical device system into the first receiving portion  117  of the medical device  100 . As the receiving portion  117  is disposed on a side portion  116  of the elongate member  110 , the first portion of the medical device may be moved laterally into the first receiving portion  117 . In other words, an end-most portion of the first portion of the medical device system does not need to be inserted into the receiving portion first. Rather, the receiving portion  117  may laterally receive the first portion of the medical device system. 
     Coupler  120  and  130  may then be rotated to help retain the first portion of the medical device system within the first receiving portion  117 . Coupler  160  may then be moved or slid along the elongate member  110  to a location appropriate to engage the first portion of the medical device system. Coupler  160  may then be rotated with respect to the elongate member  110  to cause a cam portion of the coupler  160  to engage the first portion of the medical device system to help retain the first portion of the medical device system within the first receiving portion  117 . 
     The above process may be used to couple the medical device  100  to a second portion of the medical device system (such as a second support member of a spinal implant). Specifically, the above process may be used to couple the second portion of the medical device system within the second receiving portion  118 . 
       FIGS. 4-9  illustrate another embodiment of an apparatus or medical device  200 . The apparatus or medical device  200  includes an elongate member  210 , couplers  220  and  230 , and couplers  240  and  250 . In the illustrated embodiment, couplers  220  and  230  are of a first type and couplers  240  and  250  are of a second type different than the first type. 
     The elongate member  210  includes a first end portion  212 , a second end portion  214 , and a side portion  216 . The first end portion  212  is disposed opposite the second end portion  214 . The side portion  216  extends from the first end portion  212  to the second end portion  214 . 
     The side portion  216  defines a first receiving portion  217  and a second receiving portion  218 . The first receiving portion  217  is configured to receive and house a first support member or rod of a medical device system (such as a spinal implant system). In the illustrated embodiment, first receiving portion  217  is configured to receive and house a portion of the first support member. The second receiving portion  218  is configured to receive and house a second support member of the medical device system or a portion of the second support member of the medical device system. 
     In the illustrated embodiment, the first receiving portion  217  and the second receiving portion  218  each include a cavity and an opening, such as an elongate opening that is in communication with the cavity. The first support member may be inserted into or otherwise coupled to the elongate member  210  by moving the first support member through the opening and into the cavity of the first receiving portion  217  of the side portion  216 . Similarly, in the illustrated embodiment, the second support member may be inserted into or otherwise coupled to the elongate member  210  by moving the second support member through the opening and into the cavity of the second receiving portion  218  of the side portion  216 . 
     Couplers  220  and  230  are of similar construction and function. Accordingly, only the coupler  220  will be described in detail. The coupler  220  is coupled to the elongate member  210 . The coupler  220  is configured to move from a first position to a second position to engage a support member that is disposed within the first receiving portion  217  to help retain the support member within the first receiving portion  217 . For example, as illustrated in  FIG. 7 , the coupler  220  includes a contact portion  222  that is configured to extend into the first receiving portion  217  and engage a support member disposed within the first receiving portion  217 . In some embodiments, the coupler  220  is configured to engage the support member such that the frictional fit of the support member within the first receiving portion  217  is increased. In other words, the coupler  220  is configured to apply a pressure to the support member to help retain the support member within the first receiving portion  217 . 
     In the illustrated embodiment, coupler  220  includes a set screw. The set screw of the coupler  220  can be rotated with respect to the elongate member  210  to move the set screw of the coupler  220  from its first position with respect to the elongate member  210  to its second position with respect to the elongate member  210 . As best illustrated in  FIG. 7 , when the set screw of the coupler  220  is in its second position a portion (such as portion  222 ) of the set screw extends into the first receiving portion  217  and is configured to contact or engage the support member disposed within the first receiving portion  217  to help retain the support member within the first receiving portion  217 . 
     Couplers  220  and  230  are laterally offset from each other along an axis parallel to a longitudinal axis of the support member  210 . Coupler  220  is disposed such that it is configured to contact or engage a support member that is disposed within the first receiving portion  217 . Coupler  230  is disposed such that it is configured to contact or engage a support member that is disposed within the second receiving portion  218 . 
     Couplers  240  and  250  are structurally and functionally similar. Accordingly, only coupler  240  will be discussed in detail. Coupler  240  is coupled to the elongate member  210  and is configured to engage the first support member once the support member is disposed within the first receiving portion  217 . Specifically, the coupler  240  is configured to move from a first position to a second position to engage a support member that is disposed within the first receiving portion  217  to help retain the support member within the first receiving portion  217 . In some embodiments, the coupler  240  is configured to engage the support member such that the frictional fit of the support member within the first receiving portion  217  is increased. In other words, the coupler  240  is configured to apply a pressure to the support member to help retain the support member within the first receiving portion  217 . 
     Coupler  240  is configured to be disposed at different locations along an axis parallel to the longitudinal axis of the elongate member  210 . In the illustrated embodiment, coupler  240  is slidably coupled within a slot  209  defined by the elongate member  210 . In other embodiments, coupler  240  is configured to be removably coupled to the elongate member  210  at different locations along an axis parallel to the longitudinal axis of the elongate member  210 . 
     As best illustrated in  FIGS. 4, 7, and 8 , the medical device  200  includes retention rods  280  and  290  that extend through at least a portion of the elongate member  210 . The retention rods  280  and  290  extend along the slot  209  defined by the elongate member  210 . The retention rods  280  and  290  are configured to engage the couplers  240  and  250  to help retain the couplers  240  and  250  within the slot  209 . For example (as best illustrated in  FIG. 8 ), in some embodiments, the couplers  240  and  250  are configured to slide along the retention rods  280  and  290 . 
     In some embodiments, to slidably dispose the couplers  240  and  250  within the slot  209 , the couplers  240  and  250  may be placed within slot  209  and then the retention rods  280  and  290  may be slid into the elongate member  210 . The retention rods  280  and  290  may be slid into the elongate member  210  such that they engage a portion of the couplers  240  and  250  to slidably retain the couplers on the retention rods  280  and  290  and within the slot  209 . 
     In other embodiments, the couplers  240  and  250  may include a retention ring (such as retention ring  242  as illustrated in  FIG. 6 ). The couplers  240  and  250  may be inserted into the slot  209  and the retention rings may be snapped or coupled to the couplers  240  and  250 . The retention rings may then be disposed within slots or grooves defined by the elongate member  210  to slidably couple the couplers  240  and  250  within the slot  209 . 
     In the illustrated embodiment, coupler  240  includes a screw portion  244  and a cam member  246 . Specifically, the coupler  240  includes a cam member  246  that is configured to extend into the first receiving portion  217  and engage or contact the support member to help retain the support member within the first receiving portion  217 . The cam member  246  may be moved into engagement and out of engagement with the support member by rotating the screw portion  244  with respect to the elongate member  210 . Accordingly, the support member may be inserted into the receiving portion  217  while the cam member  246  does not extend into the receiving portion  217  (or is in a location outside of engagement with the support member). Once the support member is inserted into the receiving portion  217 , the screw member  244  may be rotated with respect to the elongate member  210  to cause the cam member  246  to engage the support member and help retain the support member within the first receiving portion  217 . 
     In the illustrated embodiment, coupler  240  and coupler  250  are longitudinally offset from the couplers  220  and  230 . 
       FIGS. 10-12  illustrate another embodiment of an apparatus or medical device  300 . The apparatus or medical device  300  is configured to couple two portions of a medical device system together. Specifically, the medical device  300  is configured to couple various portions of a broken support member or rod of a spinal implant. Such breaks of support members or rods may occur near the bone screws or bone anchors. The medical device  300  is configured to be coupled to the broken support members or rods at locations proximate the bone screws or bone anchors. In one example, medical device  300  may couple broken rods in an end to end or co axial orientation. 
     The medical device  300  includes an elongate member  310  and couplers  320 ,  330 ,  340 , and  350 . The elongate member  310  includes a first end portion  312 , a second end portion  314 , and a side portion  316 . The side portion  316  defines a first receiving portion  317  and a second receiving portion  318 . 
     The receiving portions  317  and  318  are configured to receive and house portions of a medical device system (such as support members or rods of a spinal implant). The couplers  320 ,  330 ,  340 , and  350  are configured to move from first positions to second positions. In their first positions, the couplers  320 ,  330 ,  340 , and  350  are configured to allow the portions of the medical device system to be inserted into the receiving portions  317  and  318 . At their second positions, the couplers  320 ,  330 ,  340 , and  350  are configured to contact or engage the support members or rods to help retain the support members within the receiving portions  317  and  318 . 
     In the illustrated embodiment, the elongate member  310  includes a narrow or thin portion  313 . In some embodiments, the narrow or thin portion  313  may be bent or curved to facilitate the coupling of the medical device  300  to various portions of a medical device system. 
       FIG. 13  illustrates the medical device  300  coupled to portions of a medical device system MDS. The medical device system MDS includes a first support member SM 1 , a second support member SM 2 , a first bone anchor BA 1 , and a second bone anchor BA 2 . The medical device  300  is coupled to the first support member SM 1  and to the second support member SM 2 . In the illustrated embodiment, the elongate member  310  defines an open portion  311 . As best illustrated in  FIG. 13 , the open portion  311  of the elongate member  310  is configured to receive a bone screw or a bone anchor when the medical device is coupled to first support member SM 1  and the second support member SM 2  of the medical device system MDS. 
     As illustrated in  FIG. 14 , in another embodiment, a medical device  400  includes an elongated open portion  411 . The open portion is configured to receive more than one bone screw or bone anchor. 
       FIGS. 15 and 16  illustrate an apparatus or medical device  500 . The apparatus or medical device  500  may be used to couple various portions of a medical device system together. For example, the medical device  500  may be used to couple a first support member or rod and a second support member or rod of a spinal implant together. In some embodiments, the medical device  500  may be used to couple portions of a spinal implant that is currently in place within the body of a patient. In some embodiments, the use of the medical device  500  may provide a less disruptive surgery, decrease the time of surgery, or minimize the dissection area. 
     The medical device  500  includes an elongate member  510 , a first coupler  512 , and a second coupler  514 . The elongate member  510  includes a first end portion  512 , a second end portion  514  opposite the first end portion  512 , a first side portion  516 , and a second side portion  515  opposite the first side portion  516 . In the illustrated embodiment, the first side portion  516  and the second side portion  515  each extend from the first end portion  512  to the second end portion  514 . 
     The first side portion  516  defines a first receiving portion  517  and the second side portion  515  defines a second receiving portion  518 . The receiving portions are configured to receive and house support members or rods of a spinal implant system. In the illustrated embodiment, the first receiving portion  517  is configured to receive a support member of a first size and the second receiving portion  518  is configured to receive a support member of a second size smaller than the first size. Thus, the medical device  500  may be used to couple a support member or rod of a first size to a support member or rod of a second, different size. 
     The coupling members  520  and  530  are screw members that may be placed in a first position (as illustrated in  FIG. 15 ) to allow the support members to be placed or inserted into the receiving portions  517  and  518 . The coupling members  520  and  530  may be placed in a second position (as illustrated in  FIG. 16 ) to contact or engage the support members disposed in the receiving portions  517  and  518  to help retain the support members within the receiving portions  517  and  518 . 
       FIG. 17  illustrates the medical device  500  coupled to a first support member SM 3  and a second support member SM 4 . The first support member SM 3  is disposed within the first receiving portion  517  and the second support member SM 4  is disposed within the second receiving portion  518 . The first support member SM 3  is larger in diameter than the second support member SM 4 .  FIG. 17  illustrates that the support members SM 3  and SM 4  are received in a substantially parallel orientation. 
       FIG. 18  is a perspective view of an embodiment of a medical device  600 . The medical device  600  includes an elongate member  610 , a first coupler  620 , and a second coupler  630 . The elongate member  610  defines a first receiving portion  617  and a second receiving portion  618 . The first receiving portion  617  has a C-shaped and may laterally receive a support member of a spinal implant. In other words, the first receiving portion  617  may receive a support member that is disposed at the side of medical device  600 . The second receiving portion  618  is a lumen that includes a first end portion and opening and a second end portion and opening. The second receiving portion  618  is configured to receive a support member from an end portion of the elongate member  610  (through an end of the lumen). 
       FIG. 19  is a perspective view of an embodiment of a medical device  700 . The medical device  700  includes an elongate member  710 , a first coupler  720  and a second coupler  730 . The elongate member  710  defines two receiving portions  716  and  717  that are lumens that are configured to receive support members from an end portion of the medical device  700 .  FIG. 20  illustrates the medial device  700  coupled to a first support member SM 5  and a second support member SM 6 . The first support member SM 5  is larger in diameter than the second support member SM 6 . 
       FIG. 21  is a perspective view of an embodiment of a medical device  800 . The medical device  800  includes an elongate member  810 , a first coupler  820  and a second coupler  830 . The elongate member  810  defines two receiving portions  817  and  818 . The receiving portions  817  and  818  define lumens that are configured to receive support members from an end portion of the medical device  800 . 
       FIG. 22  is a perspective view of medical devices  900  and  1000  coupled to a support member SM 7 . The medical devices  900  and  1000  are configured to move along the support member SM 7 . For example, the medical devices  900  and  1000  may be configured to slide along the support member SM 7 . Once placed in the correct location along the support member SM 7 , the couplers  920  and  1020  of the medical devices  900  and  1000 , respectively, may be moved or screwed down to fixedly couple the medical devices  900  and  1000  to the support member SM 7 . 
     In some embodiments, the support member SM 7  is prevented from rotating within the receiving portions of the medical devices  900  and  1000 . For example, the receiving portions may have a shape, an engagement member, or other feature that helps prevent the support member SM 7  from rotating within the receiving portions with respect to the medical devices  900  and  1000 . 
     In the illustrated embodiment, the medical devices  900  and  1000  are configured to be coupled to a second support member. As illustrated, medical device  900  is coupled to a second support member SM 8 . 
     In the illustrated embodiment, a medical device  1100  is fixedly coupled to one end portion of the support member SM 7 . In other words, the medical device  1100  is not configured to move along the support member SM 7 . 
       FIGS. 23-26  are perspective views of various embodiments of medical devices  1200 ,  1300 ,  1400 , and  1500 . The medical devices  1200 ,  1300 ,  1400 , and  1500  are configured to couple an end portion of a support member (such as a rod of a spinal implant) to an end portion of another support member. The medical devices  1200 ,  1300 ,  1400 , and  1500  may be configured to be coupled to support members of different sizes. 
     As illustrated in  FIG. 23 , the medical device  1200  includes an elongate member  1210 , a first coupler  1220 , and a second coupler  1230 . The elongate member  1210  defines a first receiving portion  1217  configured to receive a first support member. The elongate member  1210  also defines a second receiving portion (not illustrated) configured to receive a second support member. The elongate member  1210  defines an opening or a window  1203  that is configured allow a user to view the support members (or a portion of the support members) once the support members are disposed within the first receiving portion  1217  and second receiving portion. In the illustrated embodiment, the opening or window  1203  is disposed on a top surface of the elongate member  1210 . Specifically, the opening or window  1203  is disposed between the first coupler  1220  and the second coupler  1230  and is longitudinally offset from the first coupler  1220  and the second coupler  1230 . 
     As illustrated in  FIG. 24 , the medical device  1300  includes an elongate member  1310 , a first coupler  1320 , and a second coupler  1330 . The elongate member  1310  defines a first receiving portion  1317  configured to receive a first support member. The elongate member  1310  also defines a second receiving portion configured to receive a second support member. The elongate member  1310  defines an opening or a window  1303  that is configured allow a user to view the support members (or a portion of the support members) once the support members are disposed within the first receiving portion  1317  and second receiving portion. In the illustrated embodiment, the opening or window  1303  is disposed on a top surface of the elongate member  1310 . 
     As illustrated in  FIG. 25 , the medical device  1400  includes an elongate member  1410 , a first coupler  1420 , and a second coupler  1430 . The support member  1410  defines a first receiving portion  1417  configured to receive a first elongate member. The elongate member  1410  also defines a second receiving portion (not illustrated) configured to receive a second support member. The elongate member  1410  defines an opening or a window  1403  that is configured allow a user to view the support members (or a portion of the support members) once the support members are disposed within the first receiving portion  1417  and second receiving portion. In the illustrated embodiment, the opening or window  1403  is disposed on a side surface of the elongate member  1410  and is radially offset from the first coupler  1417  and the second coupler  1430 . 
     As illustrated in  FIG. 26 , the medical device  1500  includes an elongate member  1510 , a first coupler  1520 , and a second coupler  1530 . The support member  1510  defines a first receiving portion  1517  configured to receive a first elongate member. The elongate member  1510  also defines a second receiving portion (not illustrated) configured to receive a second support member. The elongate member  1510  defines an opening or a window  1503  that is configured allow a user to view the support members (or a portion of the support members) once the support members are disposed within the first receiving portion  1517  and second receiving portion. In the illustrated embodiment, the opening or window  1503  is disposed on a side surface of the elongate member  1510 . 
       FIGS. 27 and 28  illustrate connectors that  1600  and  1700  are configured to connect a rod or support member to a support member or rod of a medical device system (such as a spinal implant). In some embodiments, the connectors  1600  and  1700  allow the support members to be coupled in an offset manner, decrease the time of surgery, and provide less disruptive options for surgery. Additionally, in some embodiments, the connectors  1600  and  1700  provide options for accommodating varying patient anatomy and may help lower morbidity rate in surgeries. 
     As illustrated in  FIG. 27 , connector  1600  includes a connector portion  1610  coupled to a support portion  1620 . In some embodiments, the connector portion  1610  is integral or unitarily formed with the support portion  1620  which may be coupled to another component of a medical device system such as a bone screw. The connector portion  1610  defines a lumen  1612  that is configured to receive a support member of a medical device system. The connector  1600  also includes a set screw  1630  that is configured to engage a support member that is disposed within the lumen  1612  to help retain the support member within the lumen  1612 . 
     As illustrated in  FIG. 28 , connector  1700  includes a connector portion  1710  that defines a cavity  1712  and an opening  1714  that communicates with the cavity  1712 . Accordingly, a support member of a medical device system may be inserted into the cavity  1712  via the opening  1714 . 
       FIGS. 29 and 30  illustrate a medical device  1800  and  FIGS. 31 and 32  illustrate a medical device  1900 . The medical devices  1800  and  1900  are configured to be implanted into a body of a patient and provide support to a body or a portion of the body of the patient. For example, the medical devices  1800  and  1900  may be coupled to a spine of a patient to provide support to the spine of the patient or may be coupled to an existing spinal implant. 
     In some embodiments, the medical devices  1800  and  1900  include connection portions  1810  and  1910  and support rod portions  1820  and  1920  that are integral or unitarily formed. In some embodiments, integral or unitary construction provides a stronger medical device, reduces the number of fixation points of an implant, and reduces construction time. Rod portions  1820  and  1920  are configured and dimensioned to mate with other medical device systems or components such as device connectors or bone screws. 
     In some embodiments, the medical devices are formed of a stiff material such as a metal material. In some embodiments, the medical devices  1800  and  1900  are configured to align with the anatomical location of L 5  pedicles. In such embodiments, the screws may be more easily placed. In other words, the devices  1800  and  1900  may not need to be bent in situ to align the screws. 
     In some embodiments, the medical devices  1800  and  1900  provide a platform for L 5  reduction. 
     As illustrated in  FIGS. 29 and 30 , medical device  1800  includes a connection portion  1810  and a rod portion  1820 . The connection portion  1810  defines openings  1812  and  1814 . The openings  1812  and  1814  are configured to receive bone anchors or bone screws. As illustrated in  FIG. 33 , the bone anchors or bone screws may be retained within the openings  1812  and  1814  via a pair of couplers  1830  and  1840 . In some embodiments, the couplers  1830  and  1840  are screws that are configured to engage the bone screws or bone anchors to help retain such bone anchors or bone screws within the openings  1812  and  1814 . 
     As illustrated in  FIG. 34 , in another embodiment, a cam member  1850  may be used to engage the bone anchors or bone screws to help retain the bone anchors or bone screws within the openings  1812  and  1814 . For example, in some embodiments, the cam member  1850  maybe rotated from a position of disengagement (to allow the bone screws or bone anchors to be inserted into the openings  1812  and  1814 ) to a position of engagement (to help retain the bone screws or bone anchors within the openings  1812  and  1814 ). 
     As illustrated in  FIGS. 31 and 32 , the medical device  1900  includes a coupling portion  1910  and a rod portion  1920 . 
     As best illustrated in  FIG. 29 , the rod portion  1820  curves to the right of the coupling portion  1810 . As best illustrated in  FIG. 31 , the rod portion  1920  curves to the left of the coupling portion  1820 . 
     Additional Embodiments 
     Additional embodiments of coupling systems and devices are now described. In particular,  FIGS. 35-41  show different views of a novel staple stabilization system and individual components for attachment to one or more vertebral members. The staple stabilization system advantageously is of low profile, thereby helping to reduce the risk of tissue abrasion and damage in and around a surgical site. 
       FIG. 35  illustrates an exploded view of a staple stabilization system according to some embodiments of the present application. The staple stabilization system  2000  includes three low-profile components: a top member  1921  in the form of a top plate, a bottom member  1930  in the form of a bottom plate, and a set screw  2010 . 
     The staple stabilization system  2000  is configured to receive and secure one or more rod members (as shown in  FIGS. 37 and 38 ) for stabilization of the spine. When the system is in an “open” configuration, the staple stabilization system  2000  can receive rod members  1950 ,  1952  that rest within slots  1931 ,  1932  formed on the bottom member  1930 , as shown in  FIG. 37 . In the open configuration, the top member  1921  is oriented such that its walls do not obstruct the openings of the slots  1931 ,  1932 . Once the rod members  1950 ,  1950  are deposited in the slots  1931 ,  1932 , the top member  1921  can be rotated and actuated into a “closed” position, whereby the rod members  1950 ,  1952  are securely held within the system, as shown in  FIG. 38 . To further secure the rod members  1950 ,  1952  within the system, the set screw  1912  can be rotated and tightened. Further details regarding the securing of the rod members  1950 ,  1950  to the system  2000  are discussed below. 
     As shown in  FIG. 35 , the bottom member  1930  is in the form of a plate having a pair of slots  1931 ,  1932  formed therein. The slots  1931  and  1932  are configured to receive rod members, as discussed above. The slots  1931  and  1932  include openings  1938  and  1939  (shown in  FIGS. 39 and 40 ) that extend to a bottom surface of the bottom member  1930 . The openings  1938  and  1939  are configured to receive one or more bone screws, such as bone screw  1960  in  FIGS. 37 and 38 , for securing the system to a vertebral body. 
     The bottom member  1930  further includes a middle opening  1933  in between the slots  1931  and  1932  that extends from a top surface to a bottom surface of the bottom member  1930 . The middle opening  1933  of the bottom member  1930  is configured to receive a portion of the top member  1921  therein. The middle opening  1933  of the bottom member  1930  is also configured to have threads  1941  (as shown in  FIG. 39 ) that can mate with threads of a set screw  2010  to secure the rod members within the system. 
     The bottom member  1930  further includes one or more protruding members or prongs  1935  and  1936  that can extend from a bottom surface of the bottom member  1930 . In some embodiments, the protruding members  1935  and  1936  have pointed tips that can advantageously engage a surface of a vertebral body prior to inserting additional bone screws through the system. This way, the protruding members  1935 ,  1936  help to stabilize the system against a vertebral member even before the staple system is secured to the vertebral member. 
     As shown in  FIG. 35 , the top member  1921  is in the form of a plate member having an upper portion  2020  and a lower portion  1924 . The lower portion  1924  is configured to be received within the opening  1933  of the bottom member  1930 . In addition, an opening  1922  (shown in  FIG. 35 ) for receiving a set screw  2010  is formed in the top member  1921  from a top surface to a bottom surface of the top member. While in some embodiments, the opening  1922  is substantially circular, in other embodiments, the opening  1922  is non-circular and can receive a set screw having a variety of different shapes. 
     As shown in  FIG. 35 , the set screw  1912  includes an upper screw portion  2012  and a lower screw portion  1913 . The upper screw portion  2012  can comprise a cylindrical body. In some embodiments, the upper screw portion  2012  includes one or more threads that can mate with a threaded portion of the top and/or bottom member, such as the threaded portion  1941  of the bottom member  1930  in  FIG. 39 . The lower screw portion  1913  can comprise a pointed distal tip that allows the set screw  1912  to engage with a vertebral body. After rod members are received within the system  2000 , the set screw  1912  can be rotated to thereby secure the rod members therein. 
     Advantageously, rotation of the single set screw  1912  provides a locking mechanism for both of the rod members, thereby reducing the time needed to implant a dual rod construct within a body. 
     In some embodiments, the set screw  1912  can include a reverse single or dual outer diameter thread. If a surgeon desires to disassemble an assembled staple stabilization system by unscrewing the set screw  1912 , the addition of the reverse thread can serve as a safety mechanism to limit the complete removal of the set screw from the system within a body of the patient. In some embodiments, if a top portion of the thread is modified, then fully backed up, the set screw and top member will rotate simultaneously, without the need of additional drivers. 
       FIG. 36  illustrates a side view of a staple stabilization system according to some embodiments of the present application. The staple stabilization system  2000  is assembled and ready to receive one or more rod members within the slots  1931  and  1932 . As shown in  FIG. 36 , the top member  1921  is inserted into the bottom member  1930 , while the set screw  2010  is received within an aperture formed through both of the members. 
       FIG. 37  is a top perspective view of a staple stabilization system having rod members with a top member in an “open” position, while  FIG. 38  is a top perspective view of the staple stabilization system having rod members with the top member in a “closed” position, according to some embodiments of the present application. In the open configuration, the top member  1921  is oriented such that its sidewalls  1926  and  1927  do not overlap and/or obstruct the openings of the slots  1931  and  1932 . As such, the staple stabilization system  2000  is capable of receiving both of the rod members  1950  and  1952  therein in the open configuration. In some embodiments, the staple stabilization system  2000  can also receive a single rod member therein. After the rod members  1950  and  1952  are received within the slots  1931  and  1932 , the top member  1921  can be rotated into a “closed” configuration (shown in  FIG. 38 ) whereby each of the sidewalls  1926  and  1927  of the top member  1921  overlay a portion of a rod member, thereby helping to secure both of the rod members within the system. In both the open and closed configurations, the staple stabilization system maintains a low profile, thereby helping to reduce the risk of injury to adjacent tissue in and around a surgical site. 
       FIG. 39  is a top perspective view of a bottom member of a staple stabilization system according to some embodiments of the present application. From this view, the features of the bottom member  1930  are clearly shown. For example,  FIG. 39  illustrates how the slots  1931  and  1932  include textured or ridged features  1934  that serve as non-smooth surfaces to securely hold the rod members. In addition, from this figure, a ramped surface  1937  is visible on the bottom member  1930 . This ramped surface  1937  advantageously helps to retain the top member  1921  in a desired orientation within the bottom member  1930  during use. 
       FIG. 40  is a bottom view of a staple stabilization system according to some embodiments of the present application. In this view, the staple stabilization system is in an “open” configuration, whereby the top member  1921  is oriented to not obscure the slots and openings in the bottom member  1930 . 
       FIG. 41  is a top perspective view of an alternative staple stabilizations system according to some embodiments of the present application. Unlike the staple stabilization systems disclosed in  FIGS. 35-40 , in which the set screw  1912  is “top-loaded” such that the threads of the set screw mate with threads on the bottom member  1930 , the staple stabilization system in  FIG. 41  includes a set screw  1912  that is “bottom-loaded” such that the threads of the set screw mate with threads on the top member  1921 . This system advantageously provides an alternative means to secure the different components of the system in a desirable low-profile. 
     While certain features of the described implementations have been illustrated as described herein, many modifications, substitutions, changes and equivalents will now occur to those skilled in the art. It is, therefore, to be understood that the appended claims are intended to cover all such modifications and changes as fall within the scope of the embodiments.