Patent Publication Number: US-9889018-B2

Title: Expandable vertebral body replacement device and method

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     This application is a continuation-in-part application of U.S. application Ser. No. 14/665,833 filed Mar. 23, 2015 and also claims priority benefit under 35 U.S.C. §119(e) of U.S. provisional patent application No. 62/427,149 filed Nov. 28, 2016, which are each incorporated herein by reference in their entireties. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates generally to a medical implants for insertion in a space between a patient&#39;s vertebrae. More specifically, but not exclusively, the present invention concerns expandable vertebral body replacement devices for implantation in a patient&#39;s spine between the vertebrae. 
     BACKGROUND OF THE INVENTION 
     Trauma or disease, such as, tumors may cause pressure on a patient&#39;s spinal cord. In order to alleviate the pressure and likely the pain it is causing, surgeons may remove part or all of a patient&#39;s vertebral bodies and adjacent vertebral discs in the location of the pressure, during a procedure, such as, a corpectomy. Often implants are used to replace the removed vertebral bodies to maintain the space between the remaining vertebral bodies. 
     SUMMARY OF THE INVENTION 
     Aspects of the present invention provide expanding vertebral body replacement devices for implantation in a patient&#39;s spine between the vertebrae and methods of using the same. 
     In one aspect, provided herein is a vertebral body implant, including a body with a first end and a second end, a first rotating member rotatably coupled to the first end, wherein an end includes a plurality of first notches inset into the first rotating member, a second rotating member rotatably coupled to the second end, wherein an end includes a plurality of second notches inset into the second rotating member, a first extension member moveably coupled to the first end, and a second extension member moveably coupled to the second end. 
     In another aspect, provided herein is an expandable cage system including a vertebral body device and an insertion instrument. The vertebral body device including a body with a first end and a second end, a first rotating member coupled to the first end, a second rotating member coupled to the second end, a first extension member moveably coupled to the first end, and a second extension member moveably coupled to the second end. The body including at least one aperture positioned on the body along a midpoint between the first end and the second end. The body also including at least one first locking hole positioned superior to the at least one aperture and at least one second locking hole positioned inferior to the at least one aperture. The insertion instrument, wherein the at least one aperture, the at least one first locking hole, and the at least one second locking hole are sized to receive the insertion instrument. 
     In yet another aspect, provided herein is a method for using an expandable cage system, including obtaining a vertebral body implant and an insertion instrument. The vertebral body device including a body with a first end and a second end, a first rotating member rotatably coupled to the first end, a second rotating member rotatably coupled to the second end, a first extension member moveably coupled to the first end, and a second extension member moveably coupled to the second end. The method also includes coupling the vertebral body implant to the insertion instrument and inserting the vertebral body implant into a patient between two vertebral bodies. The method further includes expanding the vertebral body implant and removing the insertion instrument. 
     These, and other objects, features and advantages of this invention will become apparent from the following detailed description of the various aspects of the invention taken in conjunction with the accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
       The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate embodiments of the invention and together with the detailed description herein, serve to explain the principles of the invention. The drawings are only for purposes of illustrating preferred embodiments and are not to be construed as limiting the invention. It is emphasized that, in accordance with the standard practice in the industry, various features are not drawn to scale. In fact, the dimensions of the various features may be arbitrarily increased or reduced for clarity of discussion. The foregoing and other objects, features and advantages of the invention are apparent from the following detailed description taken in conjunction with the accompanying drawings in which: 
         FIG. 1  is a top perspective view of a vertebral body device, in accordance with an aspect of the present invention; 
         FIG. 2  is a side view of the vertebral body device of  FIG. 1 , in accordance with an aspect of the present invention; 
         FIG. 3  is a cross-sectional view of the vertebral body device of  FIG. 1  taken along line  3 - 3  in  FIG. 2 , in accordance with an aspect of the present invention; 
         FIG. 4  is an exploded side view of the vertebral body device of  FIG. 1 , in accordance with an aspect of the present invention; 
         FIG. 5  is an exploded perspective view of the vertebral body device of  FIG. 1 , in accordance with an aspect of the present invention; 
         FIG. 6  is a top perspective view of a body of the vertebral body device of  FIG. 1 , in accordance with an aspect of the present invention; 
         FIG. 7  is a side view of the body of  FIG. 6 , in accordance with an aspect of the present invention; 
         FIG. 8  is a perspective cross-sectional view of the body of  FIG. 6  taken along line  8 - 8  in  FIG. 7 , in accordance with an aspect of the present invention; 
         FIG. 9  is a top view of the body of  FIG. 6 , in accordance with an aspect of the present invention; 
         FIG. 10  is a cross-sectional view of the body of  FIG. 6  taken along line  10 - 10  in  FIG. 9 , in accordance with an aspect of the present invention; 
         FIG. 11  is a top perspective view of a rotating member of the vertebral body device of  FIG. 1 , in accordance with an aspect of the present invention; 
         FIG. 12  is a top view of the rotating member of  FIG. 11 , in accordance with an aspect of the present invention; 
         FIG. 13  is a bottom view of the rotating member of  FIG. 11 , in accordance with an aspect of the present invention; 
         FIG. 14  is a side view of an extension member of the vertebral body device of  FIG. 1 , in accordance with an aspect of the present invention; 
         FIG. 15  is a top perspective view of the extension member of  FIG. 14 , in accordance with an aspect of the present invention; 
         FIG. 16  is a bottom perspective view of the extension member of  FIG. 14 , in accordance with an aspect of the present invention; 
         FIG. 17  is a bottom view of the extension member of  FIG. 14 , in accordance with an aspect of the present invention; 
         FIG. 18  is a perspective view of an insertion tool for the vertebral body device of  FIG. 1 , in accordance with an aspect of the present invention; 
         FIG. 19  is a side view of the insertion tool of  FIG. 18 , in accordance with an aspect of the present invention; 
         FIG. 20  is a front view of the insertion tool of  FIG. 18  in a first position, in accordance with an aspect of the present invention; 
         FIG. 21  is a front view of the insertion tool of  FIG. 18  in a second position, in accordance with an aspect of the present invention; 
         FIG. 22  is an exploded view of the insertion tool of  FIG. 18  from a first end, in accordance with an aspect of the present invention; 
         FIG. 23  is an exploded view of the insertion tool of  FIG. 18  from a second end, in accordance with an aspect of the present invention; 
         FIG. 24  is a perspective view of a vertebral body device system including the vertebral body device of  FIG. 1  and the insertion tool of  FIG. 18 , in accordance with an aspect of the present invention; 
         FIG. 25  is a perspective side view of a portion of the system of  FIG. 24  with a rod of the tool engaging the vertebral body device, in accordance with an aspect of the present invention; 
         FIG. 26  is a perspective side view of the system of  FIG. 24  with a rod of the tool engaging the vertebral body device, in accordance with an aspect of the present invention; 
         FIG. 27  is a perspective side view of the system of  FIG. 24  with the tool engaging the vertebral body device in a first position, in accordance with an aspect of the present invention; 
         FIG. 28  is a perspective side view of the system of  FIG. 24  with the first extension member in a deployed position, in accordance with an aspect of the present invention; 
         FIG. 29  is a perspective side view of the system of  FIG. 24  with the rod of the tool engaging the vertebral body device in a first position, in accordance with an aspect of the present invention; 
         FIG. 30  is a perspective side view of the system of  FIG. 24  with the rod of the tool engaging the vertebral body device in a second position, in accordance with an aspect of the present invention; 
         FIG. 31  is a perspective side view of the system of  FIG. 24  with the tool engaging the vertebral body device in a second position, in accordance with an aspect of the present invention; 
         FIG. 32  is a perspective side view of the system of  FIG. 24  with the second extension member in a deployed position, in accordance with an aspect of the present invention; 
         FIG. 33  is a perspective side view of the system of  FIG. 24  with the tool removed from the expanded vertebral body device, in accordance with an aspect of the present invention; 
         FIG. 34  is a partially exploded, perspective top view of another vertebral body device, in accordance with an aspect of the present invention; 
         FIG. 35  is a partially exploded, perspective bottom view of the vertebral body device of  FIG. 34 , in accordance with an aspect of the present invention; 
         FIG. 36  is an assembled, side view of the vertebral body device of  FIG. 34 , in accordance with an aspect of the present invention; 
         FIG. 37  is a perspective top view of a first extension member of the vertebral body device of  FIG. 34 , in accordance with an aspect of the present invention; 
         FIG. 38  is a perspective bottom view of the first extension member of  FIG. 37 , in accordance with an aspect of the present invention; 
         FIG. 39  is a perspective top view of an end cap of the vertebral body device of  FIG. 34 , in accordance with an aspect of the present invention; 
         FIG. 40  is a perspective bottom view of the end cap of  FIG. 39 , in accordance with an aspect of the present invention; 
         FIG. 41  is a side view of the end cap of  FIG. 39 , in accordance with an aspect of the present invention; 
         FIG. 42  is a perspective side view of a first locking member, in accordance with an aspect of the present invention; 
         FIG. 43  is a front view of the first locking member of  FIG. 42 , in accordance with an aspect of the present invention; 
         FIG. 44  is a side view of the first locking member of  FIG. 42 , in accordance with an aspect of the present invention; 
         FIG. 45  is a perspective back view of the first locking member of  FIG. 42 , in accordance with an aspect of the present invention; 
         FIG. 46  is a partially exploded, perspective side view of a vertebral body device and the locking member of  FIG. 42 , in accordance with an aspect of the present invention; 
         FIG. 47  is an assembled, perspective side view of the vertebral body device and locking member of  FIG. 46  with transparent rotating members, in accordance with an aspect of the present invention; 
         FIG. 48  is an assembled, perspective top view of the vertebral body device and locking member of  FIG. 46 , in accordance with an aspect of the present invention; 
         FIG. 49  is a cross-sectional view of the vertebral body device and locking member of  FIG. 46  taken along line  49 - 49  in  FIG. 48 , in accordance with an aspect of the present invention; 
         FIG. 50  is a perspective front view of a second locking member, in accordance with an aspect of the present invention; 
         FIG. 51  is a perspective back view of the second locking member of  FIG. 50 , in accordance with an aspect of the present invention; 
         FIG. 52  is a front view of the second locking member of  FIG. 50 , in accordance with an aspect of the present invention; 
         FIG. 53  is a side view of the second locking member of  FIG. 50 , in accordance with an aspect of the present invention; 
         FIG. 54  is a partially exploded, perspective side view of a vertebral body device and the locking member of  FIG. 50 , in accordance with an aspect of the present invention; 
         FIG. 55  is an assembled, perspective side view of the vertebral body device and locking member of  FIG. 54 , in accordance with an aspect of the present invention; 
         FIG. 56  is a front view of the vertebral body device and locking member of  FIG. 54 , in accordance with an aspect of the present invention; 
         FIG. 57  is a top perspective view of an embodiment of a vertebral body implant, in accordance with an aspect of the present invention; 
         FIG. 58  is a side view of the implant of  FIG. 57 , in accordance with an aspect of the present invention; 
         FIG. 59  is a cross-sectional view of the implant of  FIG. 57  taken along line  59 - 59  in  FIG. 58 , in accordance with an aspect of the present invention; 
         FIG. 60  is an exploded side view of the implant of  FIG. 57 , in accordance with an aspect of the present invention; 
         FIG. 61  is an exploded perspective view of the implant of  FIG. 57 , in accordance with an aspect of the present invention; 
         FIG. 62  is a top perspective view of a body of the vertebral body implant of  FIG. 57 , in accordance with an aspect of the present invention; 
         FIG. 63  is a side view of the body of  FIG. 62 , in accordance with an aspect of the present invention; 
         FIG. 64  is a perspective cross-sectional view of the body of  FIG. 62  taken along line  64 - 64  in  FIG. 63 , in accordance with an aspect of the present invention; 
         FIG. 65  is a top view of the body of  FIG. 62 , in accordance with an aspect of the present invention; 
         FIG. 66  is a cross-sectional view of the body of  FIG. 62  taken along line  66 - 66  in  FIG. 65 , in accordance with an aspect of the present invention; 
         FIG. 67  is a cross-sectional view of the body of  FIG. 62  taken along line  67 - 67  in  FIG. 65 , in accordance with an aspect of the present invention; 
         FIG. 68  is a perspective view of a rotating member of the vertebral body implant of  FIG. 57 , in accordance with an aspect of the present invention; 
         FIG. 69  is a first end view of the rotating member of  FIG. 68 , in accordance with an aspect of the present invention; 
         FIG. 70  is a second end view of the rotating member of  FIG. 68 , in accordance with an aspect of the present invention; 
         FIG. 71  is a first end perspective view of an extension member of the vertebral body implant of  FIG. 57 , in accordance with an aspect of the present invention; 
         FIG. 72  is a side view of the extension member of  FIG. 71 , in accordance with an aspect of the present invention; 
         FIG. 73  is a second end perspective view of the extension member of  FIG. 71 , in accordance with an aspect of the present invention; 
         FIG. 74  is an end view of the extension member of  FIG. 71 , in accordance with an aspect of the present invention; 
         FIG. 75  is a perspective view of one embodiment of an insertion tool for the vertebral body implant of  FIG. 57 , in accordance with an aspect of the present invention; 
         FIG. 76  is a side view of the insertion tool of  FIG. 75 , in accordance with an aspect of the present invention; 
         FIG. 77  is an exploded view of two embodiments of an insertion tool for the vertebral body implant of  FIG. 57 , in accordance with an aspect of the present invention; 
         FIG. 78  is a perspective view of a vertebral body implant system including the implant of  FIG. 57  and a first insertion tool of  FIG. 75 , in accordance with an aspect of the present invention; 
         FIG. 79  is a perspective view of the vertebral body implant system of  FIG. 78  with a tong member of the insertion tool engaging the vertebral body implant of  FIG. 57 , in accordance with an aspect of the present invention; 
         FIG. 80  is a perspective view of a portion of the system of  FIG. 78  with the tool engaging the vertebral body implant in a first position, in accordance with an aspect of the present invention; 
         FIG. 81  is a perspective view of a portion of the system of  FIG. 78  with the tool engaging the vertebral body implant in a second position, in accordance with an aspect of the present invention; 
         FIG. 82  is a perspective view of another embodiment vertebral body implant system including the implant of  FIG. 57  and a second insertion tool in a first position, in accordance with an aspect of the present invention; 
         FIG. 83  is an enlarged perspective view of a portion of the system of  FIG. 82 , in accordance with an aspect of the present invention; 
         FIG. 84  is a top perspective view of the vertebral body implant of  FIG. 57  in a second position and including a locking mechanism engaging the vertebral body implant of  FIG. 57  and a portion of the insertion tool of  FIG. 77 , in accordance with an aspect of the present invention; 
         FIG. 85  is a side view of the vertebral body implant of  FIG. 57  in an expanded position with the locking mechanism engaging at least a portion of the implant, in accordance with an aspect of the present invention; 
         FIG. 86  is a side view of the vertebral body implant of  FIG. 85  with the body of  FIG. 62  removed, in accordance with an aspect of the present invention; 
         FIG. 87  is another embodiment of a vertebral body device system including a vertebral body implant and insertion tool, in accordance with an aspect of the present invention; 
         FIG. 88  is an exploded perspective view of the system of  FIG. 87 , in accordance with an aspect of the present invention; 
         FIG. 89  is a side view of the implant of  FIG. 87  and an end view of the insertion tool of  FIG. 87 , in accordance with an aspect of the present invention; 
         FIG. 90  is a side view of the system of  FIG. 87  showing only a portion of the insertion tool, in accordance with an aspect of the present invention; 
         FIG. 91  is a side view of another embodiment of a vertebral body implant, in accordance with an aspect of the present invention; 
         FIG. 92  is a cross-sectional view of the vertebral body implant of  FIG. 91  showing the angled set screw openings, in accordance with an aspect of the present invention; 
         FIG. 93  is another embodiment of a vertebral body system including an implant and insertion instrument, in accordance with an aspect of the present invention; 
         FIG. 94  is a partially exploded view of the vertebral body system of  FIG. 93 , in accordance with an aspect of the present invention; 
         FIG. 95  is a perspective partially exploded view of another embodiment vertebral body system including an implant and an insertion instrument, in accordance with an aspect of the present invention; 
         FIG. 96  is another perspective partially exploded view of the vertebral body system of  FIG. 95 , in accordance with an aspect of the present invention; and 
         FIG. 97  is perspective view of the system of  FIG. 95  with a transparent insertion instrument, in accordance with an aspect of the present invention. 
     
    
    
     DETAILED DESCRIPTION FOR CARRYING OUT THE INVENTION 
     Generally stated, disclosed herein is an expandable vertebral body replacement device. Further, methods of assembling and using the expandable vertebral body replacement device are discussed. 
     In this detailed description and the following claims, the words proximal, distal, anterior, posterior, medial, lateral, superior, inferior, cephalad, and caudal are defined by their standard usage for indicating a particular part of a bone or implant according to the relative disposition of the natural bone or directional terms of reference. For example, “proximal” means the portion of an implant nearest the insertion instrument, while “distal” indicates the portion of the implant farthest from the insertion instrument. As for directional terms, “anterior” is a direction towards the front side of the body, “posterior” means a direction towards the back side of the body, “medial” means towards the midline of the body, “lateral” is a direction towards the sides or away from the midline of the body, “superior” means a direction above, “inferior” means a direction below another object or structure, “cephalad” means a direction toward the head, and “caudal” means a direction toward the inferior part of the body. 
     Referring to the drawings, wherein like reference numerals are used to indicate like or analogous components throughout the several views, and with particular reference to  FIGS. 1-5 , there is illustrated an exemplary embodiment of an expandable vertebral body replacement device  100 . The terms “expandable vertebral body replacement device,” “vertebral body device,” “device,” “expandable vertebral body replacement implant,” “vertebral body replacement implant,” “vertebral body implant,” “implant,” “expandable cage,” and “cage” may be used interchangeably herein as they essentially describe the same type of device. The vertebral body device  100  may include a body  110 , a first rotating member  130  rotatably coupled to the first end  112  of the body  110 , a second rotating member  140  rotatably coupled to the second end  114  of the body  110 , a first extension member  150  moveably coupled to a first end  112  of the body  110 , and a second extension member  170  moveably coupled to a second end  114  of the body  110 . 
     As shown in  FIGS. 5, 6, and 8-10 , the body  110  may include an opening  116  extending from the first end  112  to the second end  114 , for example, along the longitudinal axis of the body  110 . The opening  116  may include at least two channels  118 ,  119  extending into the body  110  from the opening  116 . At least one first channel  118  may extend from the first end  112  toward the second end  114  and at least one second channel  119  may extend from the second end  114  toward the first end  112 . The channels  118 ,  119  may be, for example, evenly spaced around the opening  116 . As shown, the body  110  may include, for example, three first channels  118  open on the first end  112  and three second channels  119  open on the second end  114 . The channels  118 ,  119  may be spaced evenly apart around the circumference of the opening and may alternate between a first channel  118  and a second channel  119 , as shown in  FIG. 8 . Alternative numbers of channels  118 ,  119  are also contemplated, for example, the body  110  may include the same number of first channels  118  and second channels  119 , more first channels  118  than second channels  119 , or more second channels  119  than first channels  118 . 
     The exterior surface of the body  110  may further include a first groove  120  near the first end  112  and a second groove  122  near the second end  114 , as shown in  FIGS. 4-7 and 10 . The first and second grooves  120 ,  122  may extend around the circumference of the body  110  and be sized to receive the first and second rotating members  130 ,  140 , respectively. The first groove  120  may extend into the first channels  118  to enable the first rotating member  130  to engage the first extension member  150  and the second groove  122  may extend into the channels  119  to enable the second rotating member  140  to engage the second extension member  170 . As shown in  FIGS. 1-8 and 10 , the body  110  may also include a plurality of apertures  124  positioned around the circumference of the exterior surface. The plurality of apertures  124  may be positioned, for example, at a midpoint between the first end  112  and second end  114  of the body  110 . The plurality of apertures  124  may be, for example, threaded openings. The body  110  may also include a plurality of first positioning holes  126  superior to the plurality of apertures  124  and a plurality of second positioning holes  128  inferior to the plurality of apertures  124 . 
     The first rotating member  130  is shown in  FIGS. 1-2, 4-5, and 11-13 . The first rotating member  130  may include a center opening  134  extending through the first rotating member  130 . The exterior surface of the first rotating member  130  may include a plurality of grooves, notches, gear teeth, teeth, or scallops  132 , as best seen in  FIGS. 11 and 13 . The plurality of grooves  132  may be, for example, sized to receive an insertion tool, such as tool  200  described in greater detail below. The first rotating member  130  may also include threads  136  on the interior surface of the member  130 , as shown in  FIGS. 5 and 11 . In addition, the first rotating member  130  may include at least one angled slot  138  to receive a portion of the first extension member  150 , as shown in  FIGS. 11-13 . 
     The second rotating member  140 , as shown in  FIGS. 4 and 5 , may include a plurality of grooves  142 , a center opening  144 , threads  146 , and angled slots  148 . The plurality of grooves  142 , center opening  144 , threads  146 , and angled slots  148  may be of the type described above with reference to the plurality of grooves  132 , center opening  134 , threads  136 , and angled slots  138  of first rotating member  130 , which will not be described again here for brevity&#39;s sake. 
     As shown in  FIGS. 4-5 and 14-17 , the first extension member  150  may include a first end  152  and a second end  154 . The first extension member  150  may also include a top portion or first end cap  156  at the first end  152  and at least one leg member  162  extending away from the top portion  156  and to the second end  154 . The top portion  156  may include a curved top surface  158 , for example, a hemispherical or cylindrical shaped cup, and a center opening  160 , as shown in  FIGS. 5 and 15 . The curved top surface  158  and center opening  160  may be configured to receive autologous bone graft or allograft material which will contact and allow for fusion with the adjacent vertebral bodies and additional graft material positioned between the at least one leg member  162 . The curved surface  158  may be, for example, sized to allow the graft material to be positioned within the first extension member  150  to minimize the height. In addition, the hemispherical shaped cup may be selected, for example, to minimize the amount of graft material necessary to fill the curved surface  158 . The top surface  158  may be, for example, coated, textured, porous, or of a trabecular metal nature to allow for bone growth into the first extension member  150  after implantation. In an alternative embodiment, it is also contemplated that the curved top surface  158  may be, for example, a mesh or open slotted top surface to allow for the bone graft material positioned in the top portion  156  to make contact with bone graft material positioned between the at least one leg member  162 . The top portion  156  may also be configured to receive, for example, end caps (not shown) with lordosis or a larger footprint to contact larger adjacent vertebral bodies at the outer ring of their end plates. 
     The at least one leg member  162  may be, for example, three leg members  162 . The leg members  162  may include threads  164  on an exterior surface and a tab  166  positioned at the second end  154  of the first extension member  150 . The second end  154  of the leg members  162  may be, for example, tapered or angled and the tab  166  may be positioned at the tip of the tapered or angled end. The tabs  166  may be sized and shaped to engage the angled slots  138  on the interior surface of the first rotating member  130 . As the tabs  166  are translated within the slots  138  of the first rotating member  130 , the threads  164  of the leg members  162  engage the interior threads  136  of the first rotating member  130  to couple the first extension member  150  to the first rotating member  130 . The leg members  162  may be curved to enable the leg members  162  to rotate with respect to the first rotating member  130 . The first extension member  150  may also include support members  168  positioned between and connected to the leg members  162 . The support members  168  may be, for example, cross-hatching braces positioned in rings. As depicted in  FIGS. 14-17 , the support members  168  may, for example, extend out from the back side of the leg members  162  and be connected between the leg members  162  in crisscross or “X” shaped arrangements. The crisscross arrangement of the leg members  162  may be, for example, curved between the leg members  162  to form a ring-like shape. 
     The second extension member  170 , as shown in  FIGS. 4 and 5 , may include a first end  172  and a second end  174 . The second extension member  170  may also include a bottom portion or second end cap  176  at the first end  172  and at least one leg member  182  extending away from the bottom portion  176  and to the second end  174 . The bottom portion  176  may include a curved bottom surface  178  and an opening  180 . The curved bottom surface  178  may be of the type described above with respect to the curved top surface  158 , which will not be described again here for brevity&#39;s sake. The curved bottom surface  178  and center opening  180  may also be configured to receive autologous bone graft or allograft material as described in greater detail above with respect to the first extension member  150 . 
     The at least one leg member  182  may be, for example, three leg members  182  and may include threads  184 , tabs  186 , and support members  188 . The threads  184 , tabs  186 , and support members  188  may be of the type described above with reference to threads  164 , tabs  166 , and support members  168 , which will not be described again here for brevity&#39;s sake. The tabs  186  may be sized and shaped to engage the angled slots  148  on the interior surface of the second rotating member  140 . As the tabs  186  are translated within the slots  148  of the second rotating member  140 , the threads  184  of the leg members  182  engage the interior threads  146  of the first rotating member  140  to couple the second extension member  170  to the second rotating member  140 . The leg members  182  may be curved to enable the leg members  182  to rotate with respect to the second rotating member  140 . 
     The vertebral body replacement device  100  may be assembled by obtaining a body  110  with a first rotating member  130  positioned in the first groove  120  and a second rotating member  140  positioned in the second groove  122 . Next, the first and second extension members  150 ,  170  may be inserted into the channels  118  in the opening  116  of the body  110 . The first extension member  150  may be inserted into the channels  118  from the first end  112 . During insertion into the channels  118 , the tabs  166  of the first extension member  150  may be aligned with the angled slots  138  on the interior surface of the first rotating member  130 . The tabs  166  may be translated within the angled slots  138  by rotating the first extension member  150  until the threads  164  of the leg members  162  engage the interior threads  136  of the first rotating member  130 . The first extension member  150  may be rotated until the member  150  engages the first end  112  of the body  110 . Once the first extension member  150  is positioned in the body  110 , then, the second extension member  170  may be inserted into the opening  116 . The second extension member  170  may be inserted into the channels  119  from the second end  114 . During insertion into the channels  119 , the tabs  186  of the second extension member  170  may be aligned with the angled slots  148  on the interior surface of the second rotating member  140 . The tabs  186  may be translated within the angled slots  148  by rotating the second extension member  170  until the threads  184  of the leg members  182  engage the interior threads  146  of the second rotating member  140 . The second extension member  170  may be rotated until the member  170  engages the second end  114  of the body  110 . 
     Referring now to  FIGS. 18-23 , an insertion instrument or inserter tool  200  is shown. The tool  200  includes a first end  202  and a second end  204 . The tool  200  may include a deployment handle  210  at the first end  202 , a position selector member  220  rotatably coupled to the handle  210 , a rod  240  extending through the member  220 , an implant attachment member  250  coupled to a portion of the rod  240 , and a tension adjustment member  260  at the second end  204  and rotatably coupled to the rod  240 . 
     As shown in  FIGS. 22 and 23 , the deployment handle  210  may include a passageway  212  extending along the longitudinal axis of the handle  210  from a first end to a second end. The handle  210  may also include a neck  214  near the first end. The neck  214  may, for example, increase the diameter of the handle from a body portion  215  to the engagement end  216 . The engagement end  216  may include a plurality of projections  218  for engaging the grooves  132 ,  142  in the rotating members  130 ,  140 . The plurality of projections  218  may be, for example, cone shaped or angled toward the point of attachment with the handle  210  to allow for the projections  218  to engage the grooves or teeth  132 ,  142  of the rotating members  130 ,  140 . The teeth  132 ,  142  may have, for example, an undercut or angled shape to lock the plurality of projections  218  into the teeth  132 ,  142  and prevent jumping of the projections  218  with respect to the teeth  132 ,  142  as the handle  210  is rotated. 
     The position selector member  220  may include a first portion  222 , a second portion  224 , and an opening  226  extending through the entire member  220 , as shown in  FIGS. 22 and 23 . The opening  226  may be offset from the center of the member  220  and extend in a longitudinal direction. The opening  226  may be configured to receive the rod  240 . The first portion  222  may also have, for example, a smaller diameter than the second portion  224 . The first portion  222  may be sized to fit in the passageway  212  of the handle  210 . The first portion  222  may further include a pin  228  extending away from a first end of the first portion  222 . The pin  228  may be shaped and sized to fit in the first and second positioning holes  126 ,  128  of a vertebral body device  100 . In addition, the first portion  222  may include a plurality of grooves  230  positioned around the exterior surface. The second portion  224  may include a plurality of holes  232  extending through the second portion  224  in a longitudinal direction and aligning with the grooves  230  in the first portion  222 . The second portion  224  may also include a flange  234  surrounding the opening  226 . The flange  234  may be configured or sized and shaped to be received within the attachment member  250 . 
       FIGS. 22 and 23  show the rod  240 . The rod  240  includes a threaded section  242  at a first end and a cutout portion  244  and a threaded portion  246  at a second end. The threaded portion  246  may extend along the rod  240 , for example, a shorter, the same, or a longer distance than the length of the cutout portion  244 . The cutout portion  244  may be, for example, a flat or planar portion of the circular rod  240 . The rod  240  may be inserted into the opening  226  in the position selector member  220  and extend out the first end  202  of the tool  200 . 
     The implant attachment member  250 , as shown in  FIGS. 22 and 23 , may include an opening  252  which may be shaped, for example, to receive the cutout portion  244 . The opening  252  may include, for example, a planar portion and a circular portion to correspond to the planar section and circular section of the cutout portion  244  of the rod  240 . The opening  252  may extend through the member  250  in a longitudinal direction. A flange  254  may be positioned around the opening  252  at a first end of the member  250 . The second end of the member  250  may include a coupling cavity  258  recessed within the member  250 . The cavity  258  may be sized to receive the flange  234  extending away from the position selector member  220  to rotatably couple the implant attachment member  250  to the position selector member  220 . The attachment member  250  may also include a grooved exterior surface  256 . The grooved surface  256  may, for example, assist the user with turning the member  250 . 
     Referring to  FIGS. 22 and 23 , the tension adjustment member  260  includes an opening  262  extending through the member  260  in a longitudinal direction. The opening  262  may be threaded with threads corresponding to the threads  246  on the rod  240 . As shown in  FIG. 22 , the adjustment member  260  may also include a coupling cavity  264  which is configured or sized and shaped to receive the flange  254  of the attachment member  250  to rotatably couple the attachment member  250  to the adjustment member  260 . Further, the adjustment member  260  may have a textured surface  266  on the exterior of the adjustment member  260  to assist with rotation of the member  260  during use. 
     With continued reference to  FIGS. 18-23 , the inserter tool  200  may be assembled by inserting the first portion  222  of the position selector member  220  into the opening  212  in the handle  210 . The position selector member  220  may be inserted with the pin  228  in a superior or inferior position. Next, the rod  240  may be inserted into the opening  226  in the second portion  224  of the position selector member  220 . The opening  252  of the attachment member  250  may be aligned with the cutout portion  244  of the rod  240  and the attachment member  250  may be inserted over the rod  240 . The attachment member  250  may be translated down the rod  240  until it engages the second portion  224  of the position selector member  220 . Finally, the adjustment member  260  may be threaded onto the threads  246  of the rod  240  until the adjustment member  260  engages the attachment member  250 . 
     Referring now to  FIGS. 24-33  with continued reference to  FIGS. 1-23 , a method of using the vertebral body device  100  and insertion instrument  200  is shown. The method includes obtaining a vertebral body device  100  and an insertion instrument  200 . The vertebral body  100  and insertion instrument  200  may be assembled as described in greater detail above, which will not be described again here for brevity&#39;s sake. The instrument  200  may then be coupled to the vertebral body device  100  by aligning the threaded section  242  of the rod  240  with one of the plurality of openings  124 , as shown in  FIG. 24 . 
     Once aligned the attachment member  250  may be rotated to turn the rod  240  and engage the threaded section  242  with the threads in the selected opening  124 , as shown in  FIGS. 25 and 26 . The attachment member  250  may be, for example, rotated in a clockwise direction to engage the threaded opening  124 . Next, the adjustment member  260  may be rotated to translate the deployment handle  210 , the position selector member  220 , the attachment member  250 , and the adjustment member  260  toward the threaded section  242  of the rod  240 . The adjustment member  260  translates by the threads in opening  262  engaging the threaded portion  242  of the rod  240 . As the adjustment member  260  is rotated the pin  228  is also moved relative to the rod  240  to engage one of the first positioning holes  126  or one of the second positioning holes  128 . The pin  228  is shown positioned in a first positioning hole  126  in  FIG. 27 .  FIG. 21  illustrates the pin  228  in a position to engage one of the first positioning holes  126  and  FIG. 20  illustrates the pin  228  in a position to engage one of the second positioning holes  128 . In addition, as adjustment member  260  is rotated, the plurality of projections  218  on the handle  210  are moved into engagement with the plurality of grooves  132 ,  142  on the first or second rotating member  130 ,  140 . As shown in  FIG. 28 , the plurality of projections  218  engage the grooves  132  on the first rotating member  130 . 
     After the pin  228  is positioned in a first positioning hole  126  and projections  218  are positioned in the grooves  132  of the first rotating member  130 , the handle  210  may be rotated. As the handle  210  is rotated the projections  218  engage the grooves  132  to rotate the first rotating member  130 . As the first rotating member  130  spins, the first extension member  150  may translate in a superior-inferior direction. As shown in  FIG. 28 , if the handle  210  is rotated in a clockwise direction, the rotating member  130  will spin in a counterclockwise direction, and the first extension member  150  will translate in a superior direction increasing the height of the vertebral body device  100 . Alternatively, if the handle  210  is rotated in a counterclockwise direction, the rotating member  130  will spin in a clockwise direction, and the first extension member  150  will translate in an inferior direction decreasing the height of the vertebral body device  100 . The amount of superior-inferior translation is limited by the length of the leg members  162 . 
     Once the first extension member  150  is deployed to a desired position, the adjustment member  260  may be rotated in, for example, a counterclockwise direction to disengage the projections  218  from the grooves  132  and the pin  228  from the first positioning hole  126 , as shown in  FIG. 29 . Next, the second extension member  170  may be deployed to a desired position. To deploy the second extension member  170 , the position of the pin  228  may be moved to an inferior position. The pin  228  may be moved by holding the attachment member  250  and simultaneously rotating the position selector member  220  to rotate the pin  228  to an inferior position, as shown in  FIG. 30 . The position selector member  220  may be rotated in a counterclockwise direction to rotate the pin  228  from a superior position to an inferior position and vice versa. The pin  228  may be rotated until it is aligned with one of the second positioning holes  128 . 
     Next, the adjustment member  260  may be rotated to again translate the deployment handle  210 , the position selector member  220 , the attachment member  250 , and the adjustment member  260  toward the threaded section  242  of the rod  240 . The adjustment member  260  may be rotated until the pin  228  engages a second positioning hole  128  and the projections  218  engage the grooves  142  in the second rotating member  140 , as shown in  FIG. 31 . The handle  210  may then be rotated to engage the projections  218  in the grooves  132  causing the second rotating member  140  to turn. As the second rotating member  140  spins, the second extension member  170  may translate in a superior-inferior direction. As shown in  FIG. 32 , if the handle  210  is rotated in a clockwise direction, the rotating member  140  will spin in a clockwise direction, and the second extension member  170  will translate in an inferior direction increasing the height of the vertebral body device  100 . Alternatively, if the handle  210  is rotated in a counterclockwise direction, the rotating member  140  will spin in a counterclockwise direction, and the second extension member  170  will translate in a superior direction decreasing the height of the vertebral body device  100 . The amount of superior-inferior translation is limited by the length of the leg members  182 . Once the desired configuration and height of the vertebral body device  100  is achieved, the attachment member  250  may be rotated to disengage the thread section  242  from the opening  124 . After the rod  240  is removed from the vertebral body device  100 , the instrument  200  may be removed from the implant  100 , as shown in  FIG. 33 . 
     Another expandable vertebral body replacement device  300  is shown in  FIGS. 34-36 . The device  300  includes a body  110 , a first rotating member  130 , a second rotating member  140 , a first extension member  310 , a second extension member  340 , and an end cap  370 . The body  110 , first rotating member  130 , and second rotating member  140  are as described above with reference to  FIGS. 1-13 , which will not be described again here for brevity&#39;s sake. The first extension member  310  is shown in  FIGS. 35, 37, and 38 . The first extension member  310  includes a first end  312  and a second end  314 . The first extension member  310  may also include a top portion  316  at the first end  312  and at least one leg member  326  extending away from the top portion  316  and to the second end  314 . The top portion  316  may include a curved top surface  318 , for example, a hemispherical or cylindrical shaped cup. The top portion  316  may also include a center opening  320 , a plurality of grooves  322 , and a plurality of openings  324 . The plurality of grooves  322  may be, for example, inset into the top surface  318  and surrounding the center opening  320 . The plurality of openings  324  may, for example, extend through the top portion  316  from the top surface  318  entirely through the top portion  316  and may surround the center opening  320 . The top surface  318  and center opening  320  may be, for example, configured to receive an end cap  370  with lordosis or a larger footprint to contact larger adjacent vertebral bodies at the outer ring of their end plates. The center opening  320  may also be configured to receive autologous bone graft or allograft material which will contact and allow for fusion with the adjacent vertebral bodies and additional graft material positioned between the at least one leg member  326 . 
     The at least one leg member  326  may be, for example, three leg members  326 , as shown in  FIGS. 35, 37, and 38 . The leg members  326  may include threads  328  on an exterior surface, a tab  330  on each leg member  326  positioned at the second end  314  of the first extension member  310 , and support members  332  positioned between and connected to the leg members  326 . The leg members  326  may be of the type described above with respect to leg members  162 ,  182 , which will not be described again here for brevity&#39;s sake. 
     The second extension member  340  is similar to the first extension member  310  of  FIGS. 37 and 38 . As shown in  FIG. 35 , the second extension member  340  may include a first end  342  and a second end  344 . The second extension member  340  may also include a bottom portion  346  at the first end  342  and at least one leg member  356  extending away from the bottom portion  346  and to the second end  344 . The bottom portion  346  may include a curved bottom surface  348 , for example, a hemispherical or cylindrical shaped cup. The bottom portion  346  may also include a center opening  350 , a plurality of grooves  352 , and a plurality of openings  354 . The plurality of grooves  352  may be, for example, inset into the bottom surface  348  and surrounding the center opening  350 . The plurality of openings  354  may, for example, extend through the bottom portion  346  from the bottom surface  348  entirely through the bottom portion  346  and may surround the center opening  350 . The bottom surface  348  and center opening  350  may be, for example, configured to receive an end cap  370  with lordosis or a larger footprint to contact larger adjacent vertebral bodies at the outer ring of their end plates. The center opening  350  may also be configured to receive autologous bone graft or allograft material which will contact and allow for fusion with the adjacent vertebral bodies and additional graft material positioned between the at least one leg member  356 . 
     The at least one leg member  356  may be, for example, three leg members  356 . The leg members  356  may include threads  358  on an exterior surface, a tab  360  on each leg member  356  positioned at the second end  344  of the second extension member  340 , and support members  362  positioned between and connected to the leg members  356 . The leg members  356  may be of the type described above with respect to leg members  162 ,  182 , which will not be described again here for brevity&#39;s sake. 
     As shown in  FIGS. 39-41 , the end cap  370  may include a top surface  372 , a bottom surface  376 , and an opening  378  extending through the end cap  370  from the top surface  372  to the bottom surface  376 . The top surface  372  may have a textured surface  374 , for example, grooves, teeth, ridges, or another coated, textured, or porous surface. The end cap  370  may also include an engagement portion  380  extending away from the bottom surface  376  and configured to engage at least one of the first and second extension members  310 ,  340 . The engagement portion  380  may include teeth  382  positioned around the opening  378  and sized to fit into the grooves  322 ,  352  of the first and second extension members  310 ,  340 . The engagement portion  380  may also include at least one engagement member  384  extending away from the bottom surface  376 . The at least one engagement member  384  may be coupled to the bottom edge of the opening  378  at a first end. The at least one engagement member  384  may be, for example, five engagement members  384  as shown in  FIGS. 35 and 40 . Although alternative numbers of engagement members  384  are also contemplated. The engagement members  384  may be positioned, for example, circumferentially around the opening  378  and be sized to fit into the openings  320 ,  350  of the first and second extension members  310 ,  340 . Each engagement member  384  may include a projection  386  at the second end extending away from the opening  378 . The projections  386  may be sized and shaped to engage the top portion  316  of the first extension member  310  or the bottom portion  346  of the second extension member  340 . The projections  386  may engage a bottom surface of the top portion  316  of the first extension member  310  and/or a top surface the bottom portion  346  of the second extension member  340  to secure the end cap  370  to at least one of the first extension member  310  and second extension member  340 . Although the end cap  370  is shown with a relatively rectangular shape, the end cap  370  may have any shape desired to correspond to the shape of the vertebral body being contacted by the end cap  370 . 
     The vertebral body replacement device  300  may be assembled as described in greater detail above with respect to vertebral body replacement device  100  and which will not be described again here for brevity&#39;s sake. Assembly of the device  300  may also include inserting the engagement members  384  of the end cap  370  into the opening  320 ,  350  of at least one of the first and second extension members  310 ,  340 . The method of using the device  300  may be the same or similar to the method of using the device  100  and may include use of the insertion instrument  200 , as described in greater detail above and which will not be described again here for brevity&#39;s sake. 
     The expandable vertebral body replacement devices  100 ,  300  may also include a locking member, for example, locking member  400  shown in  FIGS. 42-49  or locking member  450  shown in  FIGS. 50-56 . As shown in  FIGS. 42-45 , the locking member  400  may include a base  402  with at least one opening  404  positioned on a side of the base and a first recess  406  and a second recess  408  positioned on the front of the base  402 . The at least one opening  404  may be, for example, four openings  404  with two openings  404  positioned on opposite sides, near a top of the base  402  and two openings  404  positioned on opposite sides, near a bottom of the base  402 . The base  402  may also include a hole  418  for receiving a coupling member  410 . The first recess  406  may be positioned above the hole  418  and the second recess  408  may be positioned below the hole  418 . The recesses  406 ,  408  may be sized to engage an instrument for inserting the locking member  400  into the patient to engage an expandable vertebral body replacement device  100 ,  300 . The coupling member  410  may include a tool opening  412  positioned on the front, at least one cutout  414  on the side, and an engagement member  416  extending away from a back side. The engagement member  416  may be, for example, threaded to couple to the threads in the insertion tool opening  124  of the body  110  of the devices  100 ,  300 . The tool opening  412  may be sized to receive a tool to rotate the coupling member  410  to insert the engagement member  416  into the opening  124  to secure the locking member  400  to the body  110 . The base  402  may also include a first alignment projection  420  extending away from a back side of the base  402  and a second alignment projection  422  extending away from the back side of the base  402 . The first alignment projection  420  may be positioned above the hole  418  and the second alignment projection  422  may be positioned below the hole  418 . The first alignment projection  420  may be positioned to engage a first positioning hole  126  and the second alignment projection  422  may be positioned to engage a second positioning hole  128  or vice versa. 
     The locking member  400  may also include a first wing member  430  rotatably coupled to a top of the base  402  and a second wing member  440  rotatably coupled to a bottom of the base  402 . The first wing member  430  may include a first hinge  432  and a second hinge  434  on a first end of the first wing member  430 . The first hinge  432  may be positioned on a first side of the wing member  430  and the second hinge  434  may be positioned on a second side of the wing member  430  opposite the first side. The first and second hinges  432 ,  434  may engage openings  404  positioned near the top of the base  402 . The first wing member  430  may also include, for example, a tapered end  436  positioned on a second end of the first wing member  430  opposite the first end. The tapered end  436  may be sized to extend between the body  110  and one of the first rotating member  130  and second rotating member  140 , as shown in  FIGS. 47-49 . The second wing member  440  may include a first hinge  442  and a second hinge  444  on a first end of the second wing member  440 . The first hinge  442  may be positioned on a first side of the wing member  440  and the second hinge  444  may be positioned on a second side of the wing member  440  opposite the first side. The first and second hinges  442 ,  444  may engage openings  404  positioned near the bottom of the base  402 . The second wing member  440  may also include, for example, a tapered end  446  positioned on a second end of the second wing member  440  opposite the first end. The tapered end  446  may be sized to extend between the body  110  and one of the first rotating member  130  and second rotating member  140 , as shown in  FIGS. 47-49 . 
     With continued reference to  FIGS. 47-49 , once the device  300  is in the desired position, a locking member  400  may be inserted to secure the device  300  in the desired position. The locking member  400  may be inserted by coupling the locking member  400  to an insertion tool (not shown) with the wing members  430 ,  440  in an angled position. The first alignment projection  420  may be, for example, aligned with alignment opening  126  and the second alignment projection  422  may be, for example, aligned with alignment opening  128 . The projections  420 ,  422  of the locking member  400  may then be inserted into the openings  126 ,  128  of the body  110 , as shown in  FIG. 47 . Then, a driver (not shown) may be inserted into the tool opening  412  and the coupling member  410  may be rotated to secure the locking member  400  to the body  110 . As the coupling member  410  is rotated the wing members  430 ,  440  engage the side of the body  110 , the first wing member  430  may, for example, slide between the body  110  and the first rotating member  130  and the second wing member  440  may slide between the body  110  and the second rotating member  140 . The tapered ends  436 ,  446  of the wing members  430 ,  440  may, for example, act as wedges to secure the rotating members  130 ,  140  and prevent them from rotating in order to secure the extension members  310 ,  340  in the desired position. 
     As shown in  FIGS. 50-56 , the locking member  450  may include a body  452  with a first recess  454 , a second recess  456 , and a hole  457 . The first and second recess  454 ,  456  may be positioned on the front of the body  452 . The hole  457  may be sized to receive a coupling member  470 . The first recess  454  may be positioned above the hole  457  and the second recess  456  may be positioned below the hole  457 . The recesses  454 ,  456  may be sized to engage an instrument for inserting the locking member  450  into the patient to engage an expandable vertebral body replacement device  100 ,  300 . The body  452  may also include a first alignment projection  458  extending away from a back side of the body  452  and a second alignment projection  460  extending away from the back side of the body  452 . The first alignment projection  458  may be positioned above the hole  457  and the second alignment projection  460  may be positioned below the hole  457 . The first alignment projection  458  may be positioned to engage a first positioning hole  126  and the second alignment projection  460  may be positioned to engage a second positioning hole  128  or vice versa. 
     The body  452  may also include a first extension member  462  extending away from a top of the body  452  and a second extension member  466  extending away from a bottom of the body  452 . The first extension member  462  may include a first channel  464  for engaging at least one groove  132 ,  142  of a rotating member  130 ,  140  to secure the device  100 ,  300  in the desired position. The second extension member  466  may include a second channel  468  for engaging at least one groove  132 ,  142  of a rotating member  130 ,  140  to secure the device  100 ,  300  in the desired position. The extension members  462 ,  466  may have, for example, a generally triangular shape, although other shapes are also contemplated. 
     The coupling member  470  may include a tool opening  472  positioned on the front and an engagement member  474  extending away from a back side. The engagement member  474  may be, for example, threaded to couple to the threads in the insertion tool opening  124  of the body  110  of the devices  100 ,  300 . The tool opening  472  may be sized to receive a tool to rotate the coupling member  470 . As the coupling member  470  is rotated the engagement member  474  is inserted into the opening  124  and the locking member  450  is secured to the body  110 . 
     As shown in  FIGS. 54-56 , once the device  300  is in the desired position, a locking member  450  may be inserted to secure the device  300  in the desired position. The locking member  450  may be inserted by coupling the locking member  450  to an insertion tool (not shown). The first alignment projection  458  may be, for example, aligned with alignment opening  126  and the second alignment projection  460  may be, for example, aligned with alignment opening  128 . The projections  458 ,  460  of the locking member  450  may then be inserted into the openings  126 ,  128  of the body  110 , as shown in  FIG. 55 . Next, a driver (not shown) may be inserted into the tool opening  472  and the coupling member  470  may be rotated to secure the locking member  450  to the body  110 . As the coupling member  470  is rotated the channels  464 ,  468  engage the gears  132 ,  142  of the first and second rotating members  130 ,  140 . A tooth of the gears  132 ,  142  may be, for example, positioned within the channels  464 ,  468  of the locking member  450  or the end of the locking member  450  with the channels  464 ,  468  may be positioned in the groove of the gears  132 ,  142  to secure the rotating members  130 ,  140  and lock the device  300  in the desired position. 
     Referring now to  FIGS. 57-61 , there is illustrated another embodiment of a vertebral body replacement implant  500 . The vertebral body implant  500  may include a body  510 , a first rotating member  530  rotatably coupled to the first end  512  of the body  510 , a second rotating member  540  rotatably coupled to the second end  514  of the body  510 , a first extension member  550  moveably coupled to a first end  512  of the body  510 , and a second extension member  570  moveably coupled to a second end  514  of the body  510 . 
     As shown in  FIGS. 60-67 , the body  510  may include an opening  516  extending from the first end  512  to the second end  514 , for example, along the longitudinal axis of the body  510 . The opening  516  may include at least two channels  517 ,  518 ,  519  extending into the body  510  from the opening  516 . At least one first channel  517  may extend from the first end  512  toward the second end  514  and at least one second channel  518  may extend from the second end  514  toward the first end  512 . At least one third channel  519  may extend from the first end  512  to the second end  514 . In the depicted embodiment, the at least one first channel  517  may be one first channel  517 , the at least one second channel  518  may be one second channel  518 , and the at least one third channel  519  may be, for example, four channels  519 . The channels  517 ,  518 ,  519  may be, for example, evenly spaced around the opening  516 . As shown, the body  510  may include, for example, one first channel  517  open on the first end  512 , one second channel  518  open on the second end  514 , and four third channels  519  open on both the first and second ends  512 ,  514 . Alternative numbers of channels  517 ,  518 ,  519  are also contemplated, for example, the body  510  may include more or less channels  517 ,  518 ,  519 . 
     The exterior surface of the body  510  may further include a first groove  520  near the first end  512  and a second groove  522  near the second end  514 , as shown in  FIGS. 60-63 . The first and second grooves  520 ,  522  may extend around the circumference of the body  510  and be sized to receive the first and second rotating members  530 ,  540 , respectively. Each groove  520 ,  522  may include an opening  521  for receiving a pin  506 . As shown in  FIGS. 60-62 , the body  510  may also include at least one aperture  524  positioned around the circumference of the exterior surface. The at least one aperture  524  may be positioned, for example, at a midpoint between the first end  512  and second end  514  of the body  510 . The at least one aperture  524  may be, for example, a threaded opening. The body  510  may also include at least one first locking hole  526  superior to the aperture  524  and at least one second locking hole  528  inferior to the aperture  524 . The aperture  524 , first locking hole  526 , and second locking hole  528  may be sized and shaped to receive a locking insert  590 , as shown in  FIGS. 84-86 . In the depicted embodiment, the body  510  may include, for example, three apertures  524 , three first locking holes  526 , and three second locking holes  528 . The three sets of openings  524 ,  526 ,  528  may be positioned adjacent to each other. The body  510  may further include openings  523  positioned around the circumference of the body  510 . The openings  523  may each include at least one gripping surface or region  525  on each side of the opening  523  to couple to an insertion tool, such as, tool  600  described in greater detail below. As depicted, the three sets of openings  524 ,  526 ,  528  may be positioned between the openings  523  and adjacent to each other, such that, there are three solid portions of the body  510  positioned between the openings  523 . 
     A rotating members  530 ,  540  are shown in  FIGS. 60 and 61  and the rotating member  530  is shown in greater detail in  FIGS. 68-70 . The first rotating member  530  may include a center opening  534  extending through the first rotating member  530 . The exterior surface of the first rotating member  530  may include a plurality of grooves, notches, gear teeth, teeth, or scallops  532 , as best seen in  FIGS. 68 and 69 . The plurality of notches  532  may be, for example, sized to receive an insertion tool, such as tool  600  described in greater detail below. The first rotating member  530  may also include threads  536  on the interior surface of the member  530 , as shown in  FIGS. 61 and 68 . In addition, the first rotating member  530  may include at least one protrusion  538  positioned between each notch  532  to engage the groove  520  in the body  510 . 
     The second rotating member  540 , as shown in  FIGS. 60 and 61 , may include a plurality of notches  542 , a center opening  544 , threads  546 , and at least one protrusion  548 . The plurality of notches  542 , center opening  544 , threads  546 , and at least one protrusion  548  may be of the type described above with reference to the plurality of grooves  532 , center opening  534 , threads  536 , and at least one protrusion  538  of first rotating member  530 , which will not be described again here for brevity&#39;s sake. 
     Referring now to  FIGS. 60 and 61 , the extension members  550 ,  570  are shown.  FIGS. 71-74  show the first extension member  550 . The first extension member  550  may include a first end  552  and a second end  554 . The first extension member  550  may also include a top portion or first end cap  556  at the first end  552  and at least one leg member  562  extending away from the top portion  556  and toward the second end  554 . The top portion  556  may include a curved top surface  558 , for example, a hemispherical or cylindrical shaped cup, and a center opening  560 , as shown in  FIGS. 61 and 71 . The top surface  558  may also include grooves  559 . The curved top surface  558 , grooves  559 , and center opening  560  may be configured to receive autologous bone graft or allograft material which will contact and allow for fusion with the adjacent vertebral bodies and additional graft material positioned between the at least one leg member  562 . The curved surface  558  may be, for example, sized to allow the graft material to be positioned within the first extension member  550  to minimize the height. In addition, the hemispherical shaped cup may be selected, for example, to minimize the amount of graft material necessary to fill the curved surface  558 . The top surface  558  may be, for example, coated, textured, porous, or of a trabecular metal nature to allow for bone growth into the first extension member  550  after implantation. In an alternative embodiment, it is also contemplated that the curved top surface  558  may be, for example, a mesh or open slotted top surface to allow for the bone graft material positioned in the top portion  556  to make contact with bone graft material positioned between the at least one leg member  562 . The top portion  556  may also be configured to receive, for example, end caps (not shown) with lordosis or a larger footprint to contact larger adjacent vertebral bodies at the outer ring of their end plates. 
     The at least one leg member  562  may be, for example, three leg members  562 , as shown in  FIGS. 71-74 . The leg members  562  may include threads  564  on an exterior surface. The second end  554  of the leg members  562  may be, for example, tapered or angled. The leg members  562  may include a short leg member  562  and two longer leg members  562 . The short leg member  562  may be received within the channel  517 . A first longer leg member  562  may include a protrusion or hook  566  for engaging a channel  519  in the body  510 . The protrusion  566  may include an angled end, as shown in  FIG. 72 , to engage at least one retention pin  506  during use. A second longer leg member  562  may include, for example, a recessed region  567 . The threads  564  on the legs  562  engage the threads  536  on an interior surface of the first rotating member  530  to translate the leg member  562  with respect to the body  510 . The threads  564  may extend from the second end  554  to a bottom surface of the first end cap  556 . The leg members  562  may be curved to enable the leg members  562  to rotate with respect to the first rotating member  530 . The first extension member  550  may also include support members  568  positioned between and connected to the leg members  562 . The support members  568  may be, for example, cross-hatching braces positioned in rings. As depicted in  FIGS. 71-74 , the support members  568  may, for example, extend out from the back side of the leg members  562  and be connected between the leg members  562  in “Y” or “T” shaped arrangements. The support member  568  may also form an inner cylinder aligned with the opening  560  to form an inner channel through the implant  500 . The arrangement of the leg members  562  may be, for example, curved between the leg members  562  to form a ring-like shape. 
     The second extension member  570 , as shown in  FIGS. 60 and 61 , may include a first end  572  and a second end  574 . The second extension member  570  may also include a bottom portion or second end cap  576  at the first end  572  and at least one leg member  582  extending away from the bottom portion  576  and to the second end  574 . The bottom portion  576  may include a curved bottom surface  578  and an opening  580 . The curved bottom surface  578  may be of the type described above with respect to the curved top surface  558 , which will not be described again here for brevity&#39;s sake. The curved bottom surface  578  and center opening  580  may also be configured to receive autologous bone graft or allograft material as described in greater detail above with respect to the first extension member  550 . 
     The at least one leg member  582  may be, for example, three leg members  582  and may include threads  584 , protrusion or hook  586 , and support members  588 . The threads  584 , protrusions  586 , and support members  588  may be of the type described above with reference to threads  564 , protrusion or hook  566 , and support members  568 , which will not be described again here for brevity&#39;s sake. The first end  572  of the leg members  582  may be, for example, tapered or angled. The leg members  582  may include a short leg member  582  and two longer leg members  582 . The short leg member  582  may be received within the channel  518 . A first longer leg member  582  may include a protrusion or hook  586  for engaging a channel  519  in the body  510 . The protrusion  586  may include an angled end, as shown in  FIG. 61 , to engage at least one retention pin  506  during use. A second longer leg member  582  may include, for example, a recessed region  587 . The threads  584  on the legs  582  engage the threads  546  on an interior surface of the second rotating member  540  to translate the leg member  582  with respect to the body  510 . The threads  584  may extend from the first end  572  to a bottom surface of the second end cap  576 . The leg members  582  may be curved to enable the leg members  582  to rotate with respect to the second rotating member  540 . The first extension member  550  may also include support members  588  positioned between and connected to the leg members  582 . The support members  588  may be, for example, cross-hatching braces positioned in rings. As depicted in  FIGS. 71-74 , the support members  588  may, for example, extend out from the back side of the leg members  582  and be connected between the leg members  582  in “Y” or “T” shaped arrangements. The support member  588  may also form an inner cylinder aligned with the opening  580  to form an inner channel through the implant  500 . The arrangement of the leg members  582  may be, for example, curved between the leg members  582  to form a ring-like shape. 
     The implant  500  may also include a locking mechanism  590 , as shown in  FIGS. 84-86 . The locking mechanism  590  may include a plate  592  with a first locking pin or post  594 , a second locking pin or post  596  and an opening (not shown), for example, a threaded opening. The first locking post  594  is coupled to and extending away from the back surface of the plate  592 . The second locking post  596  coupled to and extending away from the back surface of the plate  592 . The locking posts  594 ,  596  are sized and shaped to engage the legs  562 ,  582  of the extension members  550 ,  570 . The threaded opening (not shown) may be centered in the middle of the plate  592  and sized and shaped to receive a fastener  598  to lock the implant  500  in a desired position. 
     The vertebral body replacement device  500  may be assembled by obtaining a body  510  with a first rotating member  530  positioned in the first groove  520  and a second rotating member  540  positioned in the second groove  522 . Next, the first and second extension members  550 ,  570  may be inserted into the channels  517 ,  518 ,  519  in the opening  516  of the body  510 . The first extension member  550  may be inserted into the channels  517 ,  519  from the first end  512 . During insertion into the channels  517 ,  519 , the protrusion  566  of the first extension member  550  may be aligned with at least one channel  519  on the interior surface of the body  510 . The first extension member  550  may be translated until the threads  564  of the leg members  562  engage the interior threads  536  of the first rotating member  530 . The first rotating member  530  may be rotated until the first extension member  550  engages the first end  512  of the body  510 . Once the first extension member  550  is positioned in the body  510 , then, the second extension member  570  may be inserted into the opening  516 . The second extension member  570  may be inserted into the channels  518 ,  519  from the second end  514 . During insertion into the channels  518 ,  519 , the protrusion  586  of the second extension member  570  may be aligned with at least one channel  519  on the interior surface of the body  510 . The second rotating member  540  may be rotated until the second extension member  570  engages the second end  514  of the body  510 . The locking plate may be coupled to the implant  500  using the aperture  524  and locking holes  526 ,  528 . The fastener  598  may be partially screwed into place, so that the locking plate is coupled to the implant  500 . 
     An embodiment of an insertion tool  600  is shown in  FIGS. 75-77 . The insertion tool  600  may include a gripping member or tong member  610 , a compression sleeve  630 , a first deployment handle  640  and a second deployment handle  650 . The gripping member  610  has a first end  612  and a second end  614  opposite the first end  612 . The second end  614  may include a handle portion  616 . The first end  612  may include two gripping arms  618  and each gripping arm  618  may include a channel  620  on an interior surface of the gripping arms  618 . The gripping arms  618  sized and shaped to engage the gripping surfaces  525  on the body  510 . The gripping arms  618  are also sized and shaped to grasp gripping surfaces  525  on body  510  while a locking member  590  is attached to or assembled to the body  510 . The gripping arms  618  may be used to remove and reposition the locking member  590 . The gripping member  610  may also include an opening extending along the longitudinal axis of the member  610  from the first end  612  to the second end  614 . The compression sleeve  630  including a first end  632  and a second end  634  opposite the first end  632 . The compression sleeve  630  also including an opening  636  extending from the first end  632  to the second end  634  and sized to receive the gripping member  610  and clamp the gripping arms  618  together to secure the implant  500  to the insertion tool  600 . 
     As shown in  FIGS. 75-81 , the first deployment handle  640  includes a first end  642  and a second end  644  opposite the first end  642 . The first deployment handle  640  also includes an opening  646  extending from the first end  642  to the second end  644 . The first end  642  may also include a plurality of projections  648  sized and shaped to rotate the two rings  530  and  540  simultaneously to translate both extension members  550 ,  570  simultaneously. The plurality of projections  648  may be, for example, cone shaped or angled toward the point of attachment with the first end  642  of the handle  640  to allow for the projections  648  to engage the grooves or teeth  532 ,  542  of the rotating members  530 ,  540 . The teeth  532 ,  542  may have, for example, an undercut or angled shape to lock the plurality of projections  648  into the teeth  532 ,  542  and prevent jumping of the projections  648  with respect to the teeth  532 ,  542  as the handle  610  is rotated. 
     Referring now to  FIGS. 77, 82, and 83 , the second deployment handle  650  includes a first end  652  and a second end  654  opposite the first end  652 . The second deployment handle  650  also including an opening  656  extending between the first end  652  and the second end  654 . The first end  652  may also include a semi-circular protrusion  658  and the end of the protrusion  658  may include a plurality of projections  660 . The plurality of projections  660  may be, for example, cone shaped or angled toward the point of attachment with the semi-circular protrusion  658  at the first end  652  of the handle  650  to allow for the projections  660  to engage the grooves or teeth  532 ,  542  of the rotating members  530 ,  540 . The teeth  532 ,  542  may have, for example, an undercut or angled shape to lock the plurality of projections  660  into the teeth  532 ,  542  and prevent jumping of the projections  660  with respect to the teeth  532 ,  542  as the handle  650  is rotated. The second end  654  may also include a semi-circular protrusion  662  aligned with the semi-circular protrusion  658  on the first end  652 . 
     Referring now to  FIGS. 78-86 , methods of using the vertebral body implant  500  and insertion instruments  600  are shown. The method includes obtaining a vertebral body implant  500  and an insertion instrument  600 . The vertebral body implant  500  and insertion instrument  600  may be assembled as described in greater detail above, which will not be described again here for brevity&#39;s sake. The instrument  600  may then be coupled to the vertebral body device  500  by inserting the gripping arms  618  of the gripping member  610  into the openings  523  to engage the gripping surfaces  525 , as shown in  FIG. 79 . The gripping member  610  may be pre-loaded with a locking member  590  positioned between the gripping arms  618 . The locking mechanism  590  may engage the aperture  524  and locking holes  526 ,  528  of the body  510 . 
     Once the gripping member  610  is coupled to the implant  500 , the compression sleeve  630  may be inserted over the gripping member  610 . The compression sleeve  630  may engage the gripping member  610  to secure the gripping arms  618  to the implant  500  for insertion into the patient. Next, a deployment handle  640 ,  650  may be selected. If the surgeon wants to simultaneously extend both the expansion members  550 ,  570 , then the first deployment handle  640  may be selected. Alternatively, if the surgeon wants to extend only one expansion member  550 ,  570  at a time, then the second deployment handle  650  may be selected. 
     After the deployment handle  640 ,  650  is selected it may be slid over the coupled gripping member  610  and compression sleeve  630 . The plurality of projections  648 ,  660  of the selected deployment handle  640 ,  650  may be aligned with at least one set of the plurality of notches  532 ,  542  in at least one of the rotating members  530 ,  540 . Once aligned the selected deployment handle  640 ,  650  may be rotated to turn at least one of the rotating members  530 ,  540 . As at least one of the rotating members  530 ,  540  turns, at least one of the expansion members  550 ,  570  translates in a superior-inferior direction to expand the size of the implant  500 . The first extension member  550  will translate in a superior direction increasing the height of the vertebral body implant  500 . The second extension member  570  will translate in an inferior direction increasing the height of the vertebral body implant  500 . The amount of superior-inferior translation is limited by the length of the leg members  562 ,  582 . Alternatively, if the deployment handle  640 ,  650  is rotated in the reverse direction, at least one of the rotating members  530 ,  540  may be rotated in the reverse direction and at least one of the extension members  550 ,  570  will translate in the superior-inferior direction to decrease the height of the vertebral body implant  500 . Once the desired configuration and height of the vertebral body implant  500  is achieved, the locking mechanism  590  may be tightened to lock the vertebral body implant  500  by inserting a driver through the insertion instrument  600 . The locking mechanism  590  may be tightened with, for example, a hex wrench inserted through the center opening  524  of the instrument  600  to tighten the fastener  598  and secure the locking plate  592  in place on the implant  500 . The locking mechanism  590  may engage the aperture  524  and locking holes  526 ,  528  of the body  510 . Alternatively, the locking mechanism  590  may be inserted through the opening  622  in the gripping member  610  once the desired expansion is achieved. After the implant  500  is secured in the desired expanded position, the insertion tool  600  may be removed from the vertebral body implant  500 . 
     Another embodiment vertebral body replacement device  700  and insertion instrument  800  are shown in  FIGS. 87-90 . The vertebral body device  700  may include a body  710 , a first rotating member  730  rotatably coupled to the first end  712  of the body  710 , a second rotating member  740  rotatably coupled to the second end  714  of the body  710 , a first extension member  750  moveably coupled to the first end  712  of the body  710 , and a second extension member  770  moveably coupled to a second end  714  of the body  710 . 
     As shown in  FIG. 88 , the body  710  may include an opening (not shown) extending from the first end  712  to the second end  714 , for example, along the longitudinal axis of the body  710 . The opening (not shown) may include at least two channels (not shown) extending into the body  710  from the opening. The opening and channels may be of the type described above with reference to opening  516  and channels  517 ,  518 ,  519 , which will not be described again here for brevity&#39;s sake. The exterior surface of the body  710  may further include a first groove  720  near the first end  712  and a second groove  722  near the second end  714 , as shown in  FIG. 88 . The first and second grooves  720 ,  722  may extend around the circumference of the body  710  and be sized to receive the first and second rotating members  730 ,  740 , respectively. As shown in  FIGS. 88 and 90 , the body  710  may also include at least one driver slot  726 ,  728  positioned on at least one section of the exterior surface. In one embodiment the driver slots  726 ,  728  may be located on three faces of the body  710  each spaced 60° apart from each other. The body  710  may also include at least one driver hole  724  positioned between the driver slots  726 ,  728 . Further, the locking faces may include openings  727 ,  729  for receiving set screws (not shown) to secure the implant  700  in the desired expansion. The openings  727 ,  729  may be threaded. A first opening  727  may be positioned superior to the driver slots  726 ,  728  and the second opening  729  may be positioned inferior to the driver slots  726 ,  728 . The body  710  may also include at least one opening  729  positioned on the non-locking faces. The at least one opening  729  may be sized and shaped to optimize bone grafting. 
     Rotating members  730 ,  740  are shown in  FIG. 88  and the first rotating member  730  may include a center opening (not shown) extending through the first rotating member  730 . The exterior surface of the first rotating member  730  may include a plurality of grooves, notches, gear teeth, teeth, or scallops  732 , as best seen in  FIGS. 88-90 . The plurality of notches  732  may be, for example, sized to receive an insertion tool, such as tool  800  described in greater detail below. The first rotating member  730  may also include threads (not shown) on the interior surface of the member  730 . 
     The second rotating member  740 , as shown in  FIG. 88 , may include a plurality of notches  742 , a center opening (not shown), and threads (not shown). The plurality of notches  542 , center opening (not shown), and threads (not shown) may be of the type described above with reference to the plurality of grooves  732 , center opening (not shown), and threads (not shown) of first rotating member  730 , which will not be described again here for brevity&#39;s sake. 
     Referring now to  FIG. 88 , the extension members  750 ,  770  are shown. The first extension member  750  may include a first end  752  and a second end  754 . The first extension member  750  may also include a top portion or first end cap  756  at the first end  752  and at least one leg member  762  extending away from the top portion  756  and toward the second end  754 . The top portion  756  may include a top surface  758  and a center opening  760 . The top surface  758  may also include grooves  759 . The top surface  758 , grooves  759 , and center opening  760  may be configured to receive autologous bone graft or allograft material which will contact and allow for fusion with the adjacent vertebral bodies and additional graft material positioned between the at least one leg member  562 . The surface  758  may be, for example, sized to allow the graft material to be positioned within the first extension member  750  to minimize the height. In addition, the top surface  758  may be shaped, for example, to receive graft material to allow for bone ingrowth to achieve the desired fusion. The top surface  758  may be, for example, coated, textured, porous, or of a trabecular metal nature to allow for bone growth into the first extension member  750  after implantation. In an alternative embodiment, it is also contemplated that the curved top surface  758  may be, for example, a mesh or open slotted top surface to allow for the bone graft material positioned in the top portion  756  to make contact with bone graft material positioned between the at least one leg member  762 . The top portion  756  may also be configured to receive, for example, end caps (not shown) with lordosis or a larger footprint to contact larger adjacent vertebral bodies at the outer ring of their end plates. 
     The at least one leg member  762  may be, for example, three leg members  762 , as shown in  FIGS. 88-90 . The leg members  762  may include threads  764  on an exterior surface. The leg members  762  may include a short leg member  762  and two longer leg members  762 . The short leg member  762  may be received within a channel which does not extend the entire length of the body  710 . In one embodiment, as shown in  FIG. 88 , the shorter leg member  762  may include a protrusion or hook  766  positioned on the distal portion of the leg member  762 . The protrusion or hook  766  may be sized and shaped to engage a retention pin, for example, the protrusion  766  may include a proximal portion that is angled toward the leg member  762  creating a recess for receiving the retention pin. The longer leg members  762  may each be received within a channel which extends through the entire length of the body  710 . The longer leg members  762  may each include, for example, a recessed region  765 . In an alternative embodiment, for example, one of the longer leg members  762  may include the protrusion or hook  766  and the shorter leg member  762  and the second longer leg member  762  may each include a recessed region  765 . The threads  764  on the legs  762  engage the threads  736  on an interior surface of the first rotating member  730  to translate the leg member  762  with respect to the body  710 . The threads  764  may extend from the second end  754  to a bottom surface of the first end cap  756 . The leg members  762  may be curved to enable the leg members  762  to rotate with respect to the first rotating member  730 . The first extension member  750  may also include support members  768  positioned between and connected to the leg members  762 . The support members  768  may be, for example, cross-hatching braces positioned in rings. As depicted in  FIG. 88 , the support members  768  may, for example, extend out from the back side of the leg members  762  and be connected between the leg members  762  in “Y” or “T” shaped arrangements. The support member  768  may alternatively form an inner cylinder aligned with the opening  760  to form an inner channel through the implant  700 . The arrangement of the leg members  762  may be, for example, curved between the leg members  762  to form a ring-like shape. 
     The second extension member  770 , as shown in  FIG. 88 , may include a first end  772  and a second end  774 . The second extension member  770  may also include a bottom portion or second end cap  776  at the first end  772  and at least one leg member  782  extending away from the bottom portion  776  and to the second end  774 . The bottom portion  776  may include a curved bottom surface  778  and an opening  780 . The curved bottom surface  778  may be of the type described above with respect to the curved top surface  758 , which will not be described again here for brevity&#39;s sake. The curved bottom surface  778  and center opening  780  may also be configured to receive autologous bone graft or allograft material as described in greater detail above with respect to the first extension member  750 . 
     The at least one leg member  782  may be, for example, three leg members  782  and may include threads  784 , protrusion or hook  786 , and support members  788 . The threads  784 , protrusions  786 , and support members  788  may be of the type described above with reference to threads  764 , protrusion or hook  766 , and support members  768 , which will not be described again here for brevity&#39;s sake. The leg members  782  may include a short leg member  782  and two longer leg members  782 . The short leg member  782  may be received within a channel which extends along a portion of the length of the body  710 . A first longer leg member  782  may include a protrusion or hook  786  for engaging a channel  719  in the body  710 . A second longer leg member  782  may include, for example, a recessed region  787 . The threads  784  on the legs  782  engage the threads  746  on an interior surface of the second rotating member  740  to translate the leg member  782  with respect to the body  710 . The threads  784  may extend from the first end  772  to a bottom surface of the second end cap  776 . The leg members  782  may be curved to enable the leg members  782  to rotate with respect to the second rotating member  740 . The first extension member  750  may also include support members  788  positioned between and connected to the leg members  782 . The support members  788  may be, for example, cross-hatching braces positioned in rings. As depicted in  FIG. 88 , the support members  788  may, for example, extend out from the back side of the leg members  782  and be connected between the leg members  782  in “Y” or “T” shaped arrangements. The support member  788  may alternatively form an inner cylinder aligned with the opening  780  to form an inner channel through the implant  700 . The arrangement of the leg members  782  may be, for example, curved between the leg members  782  to form a ring-like shape. 
     As shown in  FIGS. 88-89 , the insertion instrument  800  may include shifter  810 , a gripper member  820 , a locking sleeve  840 , and a driver sleeve  850 . The shifter  810  includes a first end  812 , a second end  814 , an extension member  816  and a handle  818 . The gripper member  820  includes a first end  822 , a second end  824  and an opening  828 ,  830 ,  832  extending between the first end  822  and the second end  824 . The gripper member  820  may also include at least two gripper arms  826  sized and shaped to engage the body  710  of the implant  700 . The opening  828 ,  830 ,  832  may include a slot  828  extending in a superior-inferior direction, a first opening  830  positioned at the superior end of the slot  828  and a second opening  832  positioned at the inferior end of the slot  828 . The opening  828 ,  830 ,  832  may be shaped to receive the shifter  810 . 
     With continued reference to  FIG. 88 , the locking sleeve  840  may include an opening  842  extending from a first end to a second end of the locking sleeve  840 . The opening  842  may be sized and shaped to receive the gripper member  820  to secure the gripping arms  826  to the implant  700 . The drive sleeve  850  may include a first end  852  and a second end  854 . The driver sleeve  850  may also include an opening  856  extending from the first end  852  to the second end  854  and a plurality of projections, protrusions, teeth, or gear members  858  for engaging the rotating members  730 ,  740 . The plurality of projections  858  may be, for example, cone shaped or angled toward the point of attachment with the first end of the drive sleeve  850  to allow for the projections  858  to engage the grooves or teeth  732 ,  742  of the rotating members  730 ,  740 . The teeth  732 ,  742  may have, for example, an undercut or angled shape to lock the plurality of projections  858  into the teeth  732 ,  742  and prevent jumping of the projections  858  with respect to the teeth  732 ,  742  as the drive sleeve  850  is rotated. 
     Referring now to  FIGS. 89-90 , the extension member  816  of the shifter  810  engages the slots  726 ,  728  to move the driver sleeve  850  from engagement with the first rotating member  730  to the second rotating member  740  and vice versa. The shifter  810  may be positioned in the first opening  830  to engage the second rotating member  740 , as shown in  FIG. 89 , and in the second opening  832  to engage the first rotating member  730 . Once an extension member  750 ,  770  is positioned at the desired extension a set screw may be inserted into the respective opening  727 ,  729  to secure the extended extension member  750 ,  770 . After one extension member  750 ,  770  is expanded and secured, the second extension member  750 ,  770  may be extended and secured. 
       FIGS. 91-92  show another embodiment of a vertebral body replacement implant  900 . The implant  900  may include a body  910 , a first rotating member  930  rotatably coupled to the first end  912  of the body  910 , a second rotating member  940  rotatably coupled to the second end  914  of the body  910 , a first extension member  950  moveably coupled to the first end  912  of the body  910 , and a second extension member  970  moveably coupled to a second end  914  of the body  910 . The body may include a first end  912  and a second end  914 . As shown in  FIG. 92 , the body  910  may include a first angled opening  916  and a second angled opening  918 . The angled openings  916 ,  918  may be, for example, threaded openings. The first angled opening  916  may extend in a superior direction and the second angled opening  918  may extend in an inferior direction. The first rotating member  930  and the second rotating member  940  may be of the type described above with reference to rotating members  730 ,  740  and which will not be described again here for brevity&#39;s sake. The first extension member  950  and second extension member  970  may be of the type described above with reference to extension members  750 ,  770  and which will not be described again here for brevity&#39;s sake. 
     Another embodiment vertebral body replacement system  1000  is shown in  FIGS. 93-94 . The system  1000  includes an implant  1002  and a driver sleeve  1100 . The implant  1002  may include a body  1010 , a first rotating member  1030  rotatably coupled to the first end  1012  of the body  1010 , a second rotating member  1040  rotatably coupled to the second end  1014  of the body  1010 , a first extension member  1050  moveably coupled to the first end  1012  of the body  1010 , and a second extension member  1070  moveably coupled to a second end  1014  of the body  1010 . The body may include a first end  1012  and a second end  1014 . As shown in  FIGS. 93-94 , the body  1010  may include at least one opening  1012 . The openings  1012  may be, for example, threaded openings. The first rotating member  1030  and the second rotating member  1040  may be of the type described above with reference to rotating members  730 ,  740 ,  930 ,  940  and which will not be described again here for brevity&#39;s sake. The first extension member  1050  and second extension member  1070  may be of the type described above with reference to extension members  750 ,  770 ,  950 ,  970  and which will not be described again here for brevity&#39;s sake. 
     The driver sleeve  1100  may include a body  1102  and a driver head  1120  at a first end of the body  1102 . The driver head  1120  may include a pivoting member  1110  coupled to the body  1102  and a plurality of projections, protrusions, teeth, gear members  1122  for engaging the rotating members  1030 ,  1040 . The plurality of projections  1122  may be, for example, cone shaped or angled toward the point of attachment with the first end of the driver head  1120  to allow for the projections  1122  to engage the grooves or teeth  1032 ,  1042  of the rotating members  1030 ,  1040 . The teeth  1032 ,  1042  may have, for example, an undercut or angled shape to lock the plurality of projections  1122  into the teeth  1032 ,  1042  and prevent jumping of the projections  1122  with respect to the teeth  1032 ,  1042  as the driver head  1120  and body  1102  are rotated. The pivoting member  1110  may be, for example, a splined end that allows for the driver  1100  to pivot at an angle while being rotated to turn the rotating members  1030 ,  1040 . 
       FIGS. 95-97  illustrate another embodiment of a vertebral body replacement system  1200 . The system  1200  includes an implant  1202  and a drive mechanism  1300 . The implant  1202  may include a body  1210 , a first rotating member  1230  rotatably coupled to the first end  1212  of the body  1210 , a second rotating member  1240  rotatably coupled to the second end  1214  of the body  1210 , a first extension member (not shown) moveably coupled to the first end  1212  of the body  1210 , and a second extension member (not shown) moveably coupled to a second end  1214  of the body  1210 . The body  1210  include at least one opening  1212 . The opening  1212  may be sized to engage the drive sleeve  1300 . The first rotating member  1230  and the second rotating member  1240  may be of the type described above with reference to rotating members  730 ,  740 ,  930 ,  940  and which will not be described again here for brevity&#39;s sake. The first extension member  1250  and second extension member  1270  may be of the type described above with reference to extension members  750 ,  770 ,  950 ,  970  and which will not be described again here for brevity&#39;s sake. 
     The drive sleeve  1300  may include a body  1302  and a coupling protrusion  1304 . The coupling protrusion engages the opening  1212  in the body  1210 . The drive sleeve  1300  is then positioned for engagement with one of the rotating members  1230 ,  1240  to expand the implant  1202 . Although not shown, a deployment handle, such as deployment handles  640 ,  650  as described in greater detail above, may be slid over the body  1302  to engage one of the rotating members  1230 ,  1240  to expand the implant  1202 . Once a first rotating member  1230 ,  1240  is expanded, then the deployment handle (not shown) may be disengaged from the teeth  1232 ,  1242 . Next, the drive sleeve  1300  may be rotated to a second position and the deployment handle (not shown) positioned to engage the second rotating member  1230 ,  1240  to expand the implant  1200 . 
     The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprise” (and any form of comprise, such as “comprises” and “comprising”), “have” (and any form of have, such as “has”, and “having”), “include” (and any form of include, such as “includes” and “including”), and “contain” (and any form of contain, such as “contains” and “containing”) are open-ended linking verbs. As a result, a method or device that “comprises,” “has,” “includes,” or “contains” one or more steps or elements possesses those one or more steps or elements, but is not limited to possessing only those one or more steps or elements. Likewise, a step of a method or an element of a device that “comprises,” “has,” “includes,” or “contains” one or more features possesses those one or more features, but is not limited to possessing only those one or more features. Furthermore, a device or structure that is configured in a certain way is configured in at least that way, but may also be configured in ways that are not listed. 
     The invention has been described with reference to the preferred embodiments. It will be understood that the architectural and operational embodiments described herein are exemplary of a plurality of possible arrangements to provide the same general features, characteristics, and general system operation. Modifications and alterations will occur to others upon a reading and understanding of the preceding detailed description. It is intended that the invention be construed as including all such modifications and alterations.