Patent Publication Number: US-2023157733-A1

Title: Endoscopic interspinous insert

Description:
BACKGROUND OF THE DISCLOSURE 
     Technical Field 
     The present invention relates to an interspinous insert, and more particularly, to an interspinous insert used for a spinal operation using an endoscope. 
     Background Art 
     To solve the instability of spinal segments after discectomy or posterior decompression, interspinous spacer implantation is performed by inserting an interspinous spacer between a patient&#39;s spinous processes. 
     The interspinous spacer implantation includes processes of incising a predetermined section of a surgical site, inserting a spacer between adjacent spinous processes through the incised portion, surrounding the spinous processes with a strap or band, and fixing the spacer between the spinous processes. 
     Recently, even in the case of the interspinous spacer implantation, methods are being studied to form several incision holes at a periphery of a surgical site, insert an endoscope and surgical tools through the incision holes, and fix an interspinous spacer without incising a predetermined section of a surgical site. 
     However, because a size of the interspinous spacer in the related art is larger than a size of the incision hole, there is a problem in that the interspinous spacer cannot pass through the incision hole. 
     RELATED PATENT DOCUMENT 
     (Patent Document 1) Korean Patent No. 10-1661635 
     SUMMARY OF THE DISCLOSURE 
     The present invention has been made in an effort to solve the above-mentioned problem, and an object of the present invention is to provide an endoscopic interspinous insert capable of being inserted into a body through an incision hole during a spinal endoscopic operation. 
     Technical problems of the present invention are not limited to the aforementioned technical problems, and other technical problems, which are not mentioned above, may be clearly understood by those skilled in the art from the following descriptions. 
     To achieve the above-mentioned object, an endoscopic interspinous insert according to an embodiment of the present invention may be configured to be inserted between adjacent spinous processes and include: a first support member including a first support body configured to support any one of the adjacent spinous processes, and a plurality of first support protrusions protruding from two opposite ends of the first support body; a second support member including a second support body configured to support the other of the adjacent spinous processes, and a plurality of second support protrusions protruding from two opposite ends of the second support body; and an adjustment member disposed between the first support member and the second support member and configured to adjust a distance between the first support member and the second support member. 
     The first support member may be disposed at a first position at which the first support member overlaps the second support member or a second position at which the first support member is separated from the second support member and spaced apart from the second support member at a predetermined distance. 
     The adjustment member may be integrated with at least one of the first support member and the second support member. 
     The first support member may include a first frame having a first accommodation portion configured to accommodate one end of the adjustment member, and the second support member may include a second frame having a second accommodation portion configured to accommodate the other end of the adjustment member. 
     The adjustment member may include: a cylindrical adjustment body; and a plurality of adjustment side teeth protruding from an outer peripheral surface of the adjustment body, and the first and second frames may include a plurality of frame side teeth configured to engage with the plurality of adjustment side teeth. 
     The plurality of adjustment side teeth may each include first and second inclined surfaces having different inclination angles. 
     The adjustment member may include a compression spring. 
     The endoscopic interspinous insert may further include: a locking member configured to fix the first support member to the second support member to prevent the first support member from being separated from the second support member. 
     The locking member may include: a hook coupled to the first support member; and a catching portion coupled to the second support member and configured such that a part of the hook is inserted into the catching portion. 
     The adjustment member may be rotatably disposed between the first support member and the second support member. 
     The endoscopic interspinous insert may further include: a locking member configured to maintain a distance between the first support member and the second support member and restrict movements of the first and second support members, in which the locking member includes: a first locking block inserted into the adjustment member; a second locking block inserted between the first support member and the second support member; a connection flange configured to connect the first locking block and the second locking block; and a fixing screw configured to be fixed to the adjustment member while penetrating the first locking block and the second locking block. 
     The adjustment member may include: a screw bevel gear rotatably disposed in the second support member and coupled to the first support member; and an adjustment bevel gear configured to transmit power to the screw bevel gear. 
     The first support member may include a first adjustment groove, the second support member may include a second adjustment groove, and the adjustment member may be screw-coupled to the first adjustment groove and the second adjustment groove. 
     The endoscopic interspinous insert may further include: a locking member configured to maintain a distance between the first support member and the second support member and restrict movements of the first and second support members. 
     According to the embodiment of the present invention, the endoscopic interspinous insert may be inserted into the body through the incision hole and then deformed in the body to have a shape suitable for a surgical operation, which makes it possible to perform the surgical operation through the incision hole without incising a predetermined section of a surgical site. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIGS.  1 A and  1 B  are views illustrating a process of spreading an endoscopic interspinous insert according to an embodiment of the present invention.  FIG.  1 C  is a cross-sectional view taken along line B-B in  FIG.  1 B , and  FIG.  1 D  is a view illustrating a process of spreading the endoscopic interspinous insert according to the embodiment of the present invention. 
         FIGS.  2 A,  2 B, and  2 C  are views illustrating a process of disposing the endoscopic interspinous insert according to the embodiment of the present invention between spinous processes. 
         FIG.  3 A  is a cross-sectional view taken along line A-A in  FIG.  1 B , and  FIG.  3 B  is a view illustrating a process of adjusting a distance between a first frame and a second frame. 
         FIG.  4 A  is a cross-sectional view of a first frame, a second frame, and an adjustment member of an endoscopic interspinous insert according to another embodiment of the present invention, and  FIG.  4 B  is a side view of the second frame and the adjustment member of the endoscopic interspinous insert according to the embodiment of the present invention.  FIG.  4 C  is a view illustrating a process of adjusting a distance between the first frame and the second frame. 
         FIG.  5 A  is a cross-sectional view of a first frame, a second frame, and an adjustment member of an endoscopic interspinous insert according to still another embodiment of the present invention, and  FIG.  5 B  is a side view of the second frame of the endoscopic interspinous insert according to the embodiment of the present invention.  FIG.  5 C  is a view illustrating a process of adjusting a distance between the first frame and the second frame, and  FIG.  5 D  is a view illustrating a state in which the first frame and the second frame are locked by a locking member. 
         FIG.  6 A  is a front view illustrating the locking member, and  FIG.  6 B  is a top plan view of a first locking block and a bottom plan view of a second locking block.  FIG.  6 C  is a cross-sectional view illustrating the locking member, and  FIG.  6 D  is a view illustrating a state in which the locking member and the adjustment member are coupled by a fixing screw. 
         FIG.  7 A  is a top plan view of a first frame, a second frame, and an adjustment member of an endoscopic interspinous insert according to yet another embodiment of the present invention.  FIG.  7 B  is a side view of the first frame, the second frame, and the adjustment member of the endoscopic interspinous insert according to the embodiment of the present invention.  FIGS.  7 C and  7 D  are views illustrating a process of adjusting a distance between the first frame and the second frame. 
         FIG.  8 A  is a top plan view of a first frame, a second frame, and an adjustment member of an endoscopic interspinous insert according to still yet another embodiment of the present invention.  FIG.  8 B  is a side view of the second frame of the endoscopic interspinous insert according to the embodiment of the present invention.  FIG.  8 C  is a cross-sectional view taken along line C-C in  FIG.  8 A .  FIG.  8 D  is a view illustrating a process of adjusting a distance between the first frame and the second frame. 
     
    
    
     DETAILED DESCRIPTION OF THE EMBODIMENT 
     Hereinafter, various exemplary embodiments will be described in more detail with reference to the accompanying drawings. The exemplary embodiments disclosed in the present specification may be variously modified. Specific embodiments will be illustrated in the drawings and described in detail in the detailed description. However, the specific embodiments illustrated in the accompanying drawings are merely intended to facilitate understanding of various embodiments. Therefore, the technical spirit is not limited by the specific embodiments illustrated in the accompanying drawings, and the scope of the present invention should be understood as including all equivalents or substitutes included in the spirit and technical scope of the present invention. 
     The terms including ordinal numbers such as ‘first,’ ‘second,’ and the like may be used to describe various constituent elements, but the constituent elements are not limited by the terms. These terms are used only to distinguish one constituent element from another constituent element. 
     In the present specification, it should be understood the terms “comprises,” “comprising,” “includes,” “including,” “containing,” “has,” “having” or other variations thereof are inclusive and therefore specify the presence of stated features, integers, steps, operations, elements, components, or combinations thereof, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, or combinations thereof. When one constituent element is described as being “coupled” or “connected” to another constituent element, it should be understood that one constituent element can be coupled or connected directly to another constituent element, and an intervening constituent element can also be present between the constituent elements. When one constituent element is described as being “coupled directly to” or “connected directly to” another constituent element, it should be understood that no intervening constituent element is present between the constituent elements. 
     Meanwhile, the term “module” or “unit” used for a constituent element used in the present specification performs at least one function or operation. Further, the “module” or “unit” may perform the function or operation by hardware, software, or a combination of hardware and software. In addition, except for the “module” or “unit” that should be performed in specific hardware or performed by at least one processor, a plurality of “modules” or a plurality of “units” may be integrated into at least one module. Singular expressions include plural expressions unless clearly described as different meanings in the context. 
     In addition, in the description of the present invention, the specific descriptions of related well-known functions or configurations will be summarized or omitted when it is determined that the specific descriptions may unnecessarily obscure the subject matter of the present invention. 
       FIGS.  1 A and  1 B  are views illustrating a process of spreading an endoscopic interspinous insert according to an embodiment of the present invention.  FIG.  1 C  is a cross-sectional view taken along line B-B in  FIG.  1 B , and  FIG.  1 D  is a view illustrating a process of spreading the endoscopic interspinous insert according to the embodiment of the present invention. To help understand the present invention,  FIG.  1 C  additionally illustrates cross-sections of spinous processes between which the interspinous insert is inserted. 
       FIGS.  2 A,  2 B, and  2 C  are views illustrating a process of disposing the endoscopic interspinous insert according to the embodiment of the present invention between spinous processes. 
       FIG.  3 A  is a cross-sectional view taken along line A-A in  FIG.  1 B , and  FIG.  3 B  is a view illustrating a process of adjusting a distance between a first frame and a second frame. 
     Referring to  FIGS.  1 A to  3 B , an endoscopic interspinous insert  100  according to the embodiment of the present invention includes a first support member  110 , a second support member  120 , and an adjustment member  130 . 
     The first support member  110  is configured to come into contact with at least a part of an outer surface of any one S 1  of adjacent spinous processes. The first support member  110  includes a first support body  112 , a plurality of first support protrusions  114 , a first frame  116 , and a first insertion groove  118 . 
     The first support body  112  may support any one S 1  of the spinous processes in a state in which the endoscopic interspinous insert  100  is inserted between the adjacent spinous processes S 1  and S 2 . The first support body  112  may be made of rubber or silicone. In addition, the first support body  112  may be made of various materials having an elastic force. 
     The first support body  112  may include a first contact surface  112   a  configured to come into contact with at least a part of the outer surface of any one S 1  of the spinous processes. 
     The first contact surface  112   a  may have a shape corresponding to at least a part of the outer surface of any one S 1  of the spinous processes. The first contact surface  112   a  may have a mesh structure having relatively higher surface roughness than the other parts of the first support body  112 . 
     Because the first contact surface  112   a  has the mesh structure, a frictional force, which occurs when the first contact surface  112   a  comes into contact with the spinous process S 1 , may prevent the first contact surface  112   a  from slipping from the surface of the spinous process S 1 , such that the interspinous insert  100  may be stably fixed while being disposed between the spinous processes S 1  and S 2 . 
     The plurality of first support protrusions  114  protrudes from two opposite ends of the first support body  112 . Any one  114   a  of the plurality of first support protrusions  114  may extend from one end of the first contact surface  112   a,  and the other  114   b  of the plurality of first support protrusions  114  may extend from the other end of the first contact surface  112   a.  The plurality of first support protrusions  114  may each have a rounded shape to surround the outer surface of any one S 1  of the spinous processes. In the state in which the interspinous insert  100  is disposed between the spinous processes S 1  and S 2 , any one S 1  of the spinous processes is disposed between the plurality of first support protrusions  114  in a state in which the outer surface of any one S 1  of the spinous processes is surrounded by the plurality of first support protrusions  114 . Therefore, the first support member  110  may be prevented from separating from any one S 1  of the spinous processes. 
     The first frame  116  may be coupled to an inner portion of the first support body  112 . The first frame  116  may have a hollow cylindrical shape so that the first frame  116  may engage with the adjustment member  130  and accommodate the adjustment member  130 . 
     The first frame  116  may be made of a material that is harmless to a human body and may be disinfected. For example, the first frame  116  may be made of a metallic material such as stainless steel or a plastic material. In addition, the first frame  116  may be made of various materials having rigidity and high corrosion resistance. 
     The first frame  116  includes a first accommodation portion  116   a  configured to accommodate one end  130   a  of the adjustment member  130 , and a plurality of first teeth  116   b  protruding from an inner surface of the first frame  116  toward the first accommodation portion  116   a.  The plurality of first teeth  116   b  is arranged in a direction in which the first support member  110  moves. 
     The first teeth  116   b  each have a first inclined surface  116   b   1  configured to define a first inclination angle θ 1  with respect to the horizontal plane, and a second inclined surface  116   b   2  configured to define a second inclination angle θ 2  with respect to the horizontal plane. The second inclination angle θ 2  has a larger value than the first inclination angle θ 1 . 
     The first insertion groove  118  has a shape concave from an outer surface of the first support body  112  toward an inner side of the first support body  112  so that a medical surgical instrument (not illustrated) such as Kelly forceps may be inserted and fixed into the first support body  112 . The first insertion groove  118  may have a circular shape, an elliptical shape, or a polygonal shape so that various tools such as medical forceps, pincers, medical drivers, or wrenches may be inserted into the first insertion groove  118 . 
     The second support member  120  is configured to come into contact with at least a part of an outer surface of the other S 2  of the adjacent spinous processes. As illustrated in  FIG.  1 C , the second support member  120  may be configured to overlap the first support member  110 . The overlapping structure may serve as a guide that enables the support members  110  and  120  to move horizontally while moving away from each other and prevent rotational separation in which two opposite wings are twisted. 
     The second support member  120  includes a second support body  122 , a plurality of second support protrusions  124 , a second frame  126 , and a second insertion groove  128 . 
     The second support body  122  may support the other S 2  of the spinous processes in a state in which the endoscopic interspinous insert  100  is inserted between the adjacent spinous processes S 1  and S 2 . The second support body  122  may be made of rubber or silicone. In addition, the second support body  122  may be made of various materials having an elastic force. 
     The second support body  122  may include a second contact surface  122   a  configured to come into contact with at least a part of the outer surface of the other S 2  of the spinous processes. 
     The second contact surface  122   a  may have a shape corresponding to at least a part of the outer surface of the other S 2  of the spinous processes. The second contact surface  122   a  may have a mesh structure having relatively higher surface roughness than the other parts of the second support body  122 . 
     Because the second contact surface  122   a  has the mesh structure, a frictional force, which occurs when the second contact surface  122   a  comes into contact with the spinous process S 2 , may prevent the second contact surface  122   a  from slipping from the surface of the spinous process S 2 , such that the interspinous insert  100  may be stably fixed while being disposed between the spinous processes S 1  and S 2 . 
     The plurality of second support protrusions  124  protrudes from two opposite ends of the second support body  122 . Any one  124   a  of the plurality of second support protrusions  124  may extend from one end of the second contact surface  122   a,  and the other  124   b  of the plurality of second support protrusions  124  may extend from the other end of the second contact surface  122   a.    
     Because the plurality of first support protrusions  114  and the plurality of second support protrusions  124  are made of elastic materials such as sponge, rubber, or silicone, the interspinous insert  100  may be deformed in a streamlined shape, e.g., a shape of a bullet when the interspinous insert  100  is held by a medical surgical instrument (not illustrated) and the plurality of first support protrusions  114  and the plurality of second support protrusions  124  are pressed. 
     Therefore, the interspinous insert  100  may pass through an incision hole (not illustrated) in a state in which the interspinous insert  100  is held by a medical surgical instrument (not illustrated) such as Kelly forceps and deformed in a streamlined shape as illustrated in  FIG.  1 A . 
     The plurality of second support protrusions  124  may each have a rounded shape to surround the outer surface of the other S 2  of the spinous processes. In the state in which the interspinous insert  100  is disposed between the spinous processes S 1  and S 2 , the other S 2  of the spinous processes is disposed between the plurality of second support protrusions  124  in a state in which the outer surface of the other S 1  of the spinous processes is surrounded by the plurality of second support protrusions  124 . Therefore, the second support member  120  may be prevented from separating from the other S 2  of the spinous processes. 
     The second frame  126  may be coupled to the second support body  122 . The second frame  126  may have a hollow cylindrical shape so that the second frame  126  may engage with the adjustment member  130  and accommodate the adjustment member  130 . 
     The second frame  126  may be made of a material that is harmless to a human body and may be disinfected. For example, the second frame  126  may be made of a metallic material such as stainless steel or a plastic material. In addition, the second frame  126  may be made of various materials having rigidity and high corrosion resistance. 
     The second frame  126  includes a second accommodation portion  126   a  configured to accommodate the other end  130   b  of the adjustment member  130 , and a plurality of second teeth  126   b  protruding from an inner surface of the second frame  126  toward the second accommodation portion  126   a.  The plurality of second teeth  126   b  is arranged in a direction in which the second support member  120  moves. 
     The second teeth  126   b  each have a third inclined surface  126   b   1  configured to define a third inclination angle θ 3  with respect to the horizontal plane, and a fourth inclined surface  126   b   2  configured to define a fourth inclination angle θ 4  with respect to the horizontal plane. The fourth inclination angle θ 4  has a larger value than the third inclination angle θ 3 . The third inclination angle θ 3  may be equal to the first inclination angle θ, and the fourth inclination angle θ 4  may be equal to the second inclination angle θ 2 . 
     The plurality of first teeth  116   b  and the plurality of second teeth  126   b  collectively constitute frame side teeth. 
     The second insertion groove  128  has a shape concave from an outer surface of the second support body  122  toward an inner side of the second support body  122  so that a medical surgical instrument may be inserted and fixed into the second support body  122 . The second insertion groove  128  may have a circular shape, an elliptical shape, or a polygonal shape so that various tools such as medical scissors, pincers, medical drivers, or wrenches may be inserted into the second insertion groove  128 . 
     The adjustment member  130  is disposed between the first support member  110  and the second support member  120 . The adjustment member  130  is configured to adjust a distance between the first frame  116  and the second frame  126 . 
     The adjustment member  130  includes a cylindrical adjustment body  132 , and a plurality of third teeth  134  and a plurality of fourth teeth  136  protruding from an outer peripheral surface of the adjustment body  132 . The plurality of third teeth  134  and the plurality of fourth teeth  136  collectively constitute adjustment side teeth. The adjustment member may be made of a material such as silicone, rubber, plastic material, or other synthetic metallic materials having elasticity and strength. 
     The plurality of third teeth  134  respectively engages with the plurality of first teeth  116   b,  and the plurality of fourth teeth  136  respectively engages with the plurality of second teeth  126   b.    
     As described above, the first teeth  116   b  each have the first inclined surface  116   b   1  configured to define the first inclination angle θ with respect to the horizontal plane, and the second inclined surface  116   b   2  configured to define the second inclination angle θ with respect to the horizontal plane, and the second inclination angle θ 2  has a larger value than the first inclination angle θ 1 . Therefore, in the state in which the plurality of third teeth  134  respectively engages with the plurality of first teeth  116   b,  the plurality of third teeth  134  may each move along the first inclined surface  116   b   1  having a relatively gradual inclination angle, but a movement of each of the plurality of third teeth  134  along the second inclined surface  116   b   2  having a relatively steep inclination angle is restricted. 
     Likewise, the second teeth  126   b  each have the third inclined surface  126   b   1  configured to define the third inclination angle θ 3  with respect to the horizontal plane, and the fourth inclined surface  116   b   2  configured to define the fourth inclination angle θ 4  with respect to the horizontal plane, and the fourth inclination angle θ 4  has a large value than the third inclination angle θ 3 . Therefore, in the state in which the plurality of fourth teeth  136  respectively engages with the plurality of second teeth  126   b,  the plurality of fourth teeth  136  may each move along the third inclined surface  126   b   1  having a relatively gradual inclination angle, but a movement of each of the plurality of fourth teeth  136  along the fourth inclined surface  126   b   2  having a relatively steep inclination angle is restricted. 
     As illustrated in  FIGS.  3 A and  3 B , a fastening structure between the adjustment member  130  and the first frame  116  and a fastening structure between the adjustment member  130  and the second frame  126  allow the first support member  110  to move only in a first direction a and allow the second support member  120  to move only in a second direction b opposite to the first direction a. That is, the first support member  110  and the second support member  120  only move in the direction in which the first support member  110  and the second support member  120  move away from each other. 
     Hereinafter, a process of inserting and fixing the interspinous insert  100  between the spinous processes S 1  and S 2  will be described. 
     Referring to  FIG.  2 A , the interspinous insert  100  may pass through the incision hole (not illustrated) and be disposed between the spinous processes S 1  and S 2  in the state in which the interspinous insert  100  is held by the medical surgical instrument (not illustrated) and deformed in a streamlined shape. In this case, the first support member  110  and the second support member  120  of the interspinous insert  100  may overlap each other. A tool, such as medical forceps or pincers, capable of adjusting and decreasing a distance between two opposite ends thereof, may be used as the medical surgical instrument. 
     Referring to  FIGS.  2 B,  2 C,  3 A, and  3 B , when the interspinous insert  100  is released in the state in which the interspinous insert  100  is inserted between the spinous processes S 1  and S 2 , the plurality of first support protrusions  114  and the plurality of second support protrusions  124  protrude by the elastic force. Specifically, the plurality of first support protrusions  114  may protrude in the first direction a, and the plurality of second support protrusions  124  may protrude in the second direction b. 
     Next, two opposite ends of a surgical tool (not illustrated) such as forceps are respectively inserted into the first insertion groove  118  and the second insertion groove  128 , and the two opposite ends of the surgical tool (not illustrated) inserted into the first insertion groove  118  and the second insertion groove  128  are moved away from each other. Therefore, the first support member  110  moves in the first direction a, and the second support member  120  moves in the second direction b, such that a distance between the first support member  110  and the second support member  120  increases. In this case, as described above, the fastening structure between the adjustment member  130  and the first frame  116  and the fastening structure between the adjustment member  130  and the second frame  126  restrict the movement of the first support member  110  in the second direction b and restrict the movement of the second support member  120  in the first direction a. 
     When the first support member  110  and the second support member  120  are spaced apart from each other at a preset distance, the medical surgical instrument (not illustrated) may be separated from the first insertion groove  118  and the second insertion groove  128 . In this state, the first support member  110  and the second support member  120  may be respectively in contact with the spinous processes S 1  and S 2 . 
     Although not illustrated, when the spinous processes S 1  and S 2  are tensely surrounded by a strap (not illustrated) in the state in which the interspinous insert  100  is inserted between the spinous processes S 1  and S 2 , the interspinous insert  100  is securely fixed between the spinous processes S 1  and S 2 , and the interspinous insert  100  is prevented from separating from the spinous processes. In addition, the stability of the corresponding spinal segment including the spinous processes S 1  and S 2  is significantly improved. 
     The structure in which the first support member  110  and the second support member  120  are provided independently of the adjustment member  130  and coupled to the adjustment member  130  has been described above as an example. However, it is possible to adopt a structure in which the adjustment member  130  may be fixed to or integrated with any one of the first and second support members  110  and  120 , and only the other of the first and second support members  110  and  120  may move relative to the adjustment member  130 . 
     In addition, the structure in which the adjustment member  130  has a cylindrical shape has been described as an example, but the present invention is not limited thereto. The shape of the adjustment member  130  and the hollow shapes of the frames may each be a polyhedral shape having a triangular or quadrangular cross-section. In this case, it is possible to adopt a structure in which the teeth configured to engage with the first frame  116  and the second frame  126  may be provided only one surface of the polyhedral shape. 
     In addition, the present invention is not limited to the configuration in which the endoscopic interspinous insert  100  is inserted between the spinous processes of the vertebra. It is possible to adopt a structure in which the endoscopic interspinous insert  100  is inserted between bones existing in the body or between protrusions of other tissue. 
     Hereinafter, an endoscopic interspinous insert  200  according to another embodiment of the present invention will be described. A description of parts identical to the above-mentioned parts of the endoscopic interspinous insert  100  according to the embodiment of the present invention will be omitted, and only parts different from the above-mentioned parts of the endoscopic interspinous insert  100  will be described. 
       FIG.  4 A  is a cross-sectional view of a first frame, a second frame, and an adjustment member of an endoscopic interspinous insert according to another embodiment of the present invention, and  FIG.  4 B  is a side view of the second frame and the adjustment member of the endoscopic interspinous insert according to the embodiment of the present invention.  FIG.  4 C  is a view illustrating a process of adjusting a distance between the first frame and the second frame. 
     Referring to  FIGS.  4 A and  4 C , a first frame  216  may have a hollow cylindrical shape to accommodate an adjustment member  230 . 
     The first frame  216  includes a first accommodation portion  216   a  configured to accommodate one end  230   a  of the adjustment member  230 . 
     The first frame  216  may be made of a material that is harmless to a human body and may be disinfected. For example, the first frame  216  may be made of a metallic material such as stainless steel or a plastic material. In addition, the first frame  216  may be made of various materials having rigidity and high corrosion resistance. 
     A second frame  226  may have a hollow cylindrical shape to accommodate the adjustment member  230 . 
     The second frame  226  includes a second accommodation portion  226   a  configured to accommodate the other end  230   b  of the adjustment member  230 . 
     The second frame  226  may be made of a material that is harmless to a human body and may be disinfected. For example, the second frame  226  may be made of a metallic material such as stainless steel or a plastic material. In addition, the second frame  226  may be made of various materials having rigidity and high corrosion resistance. 
     The adjustment member  230  is disposed between the first frame  216  and the second frame  226 . 
     The adjustment member  230  may be configured as a cylindrical elastic body. Specifically, the adjustment member  230  may include a compression coil spring that resists against a compressive force. A resistive force of the compression coil spring against an external compressive force is proportional to a spring constant value (unit: N/mm) of the compression coil spring. This means that a distance between the first frame  216  and the second frame  226  may be adjusted depending on the spring constant value of the compression coil spring. Therefore, the distance between the first frame  216  and the second frame  226  may be adjusted by adjusting the spring constant value of the compression coil spring. 
     One end  230   a  of the adjustment member  230  is accommodated in the first accommodation portion  216   a  of the first frame  216 , and the other end  230   b  of the adjustment member  230  is accommodated in the second accommodation portion  226   a  of the second frame  226 . 
     One end  230   a  of the adjustment member  230  is coupled and fixed to an inner surface of the first frame  216  in the state in which one end  230   a  of the adjustment member  230  is accommodated in the first accommodation portion  216   a  of the first frame  216 . The other end  230   b  of the adjustment member  230  is coupled and fixed to an inner surface of the second frame  226  in the state in which the other end  230   b  of the adjustment member  230  is accommodated in the second accommodation portion  226   a  of the second frame  226 . 
     A locking member  240  is configured to prevent the first frame  216  from separating from the second frame  226  and includes a hook  242  coupled to the first frame  216 , and a catching portion  244  extending from the second frame  226 . 
     The hook  242  is provided to be tiltable and includes a catching protrusion  242   a  protruding from one end thereof. The hook  242  mounted on a material having an elastic force that may return the hook  242  to an original shape. 
     The catching protrusion  242   a  may be coupled to the catching portion  244  or separated from the catching portion  244  from the state in which the catching protrusion  242   a  is coupled to the catching portion  244 . 
     The catching portion  244  includes a plurality of catching holes  244   a  so that the catching protrusion  242   a  is inserted into and caught by the catching hole  244   a.  The plurality of catching holes  244   a  is disposed to be spaced apart from one another in a direction in which the adjustment member  230  is extended or compressed. 
     When the catching protrusion  242   a  is inserted into or caught by any one of the catching holes  244   a,  the hook  242  is fixed to the catching portion  244 . When the hook  242  is fixed by being caught by the catching portion  244 , the first frame  216  is fixed to the second frame  226 . 
     The locking member  240  may further include an inclined surface  246  concavely formed in the second frame  226 . The inclined surface  246  defines an accommodation space  246   a  between the catching portion  244  and a part of the second frame  226 . One end of the hook  242  including the catching protrusion  242   a  separated from any one of the catching holes  244   a  is accommodated in the accommodation space  246   a.  Therefore, one end of the hook  242  does not interfere with the second frame  226 . 
     Hereinafter, a process of adjusting the distance between the first frame  216  and the second frame  226  will be described. 
     Referring to  FIGS.  4 A to  4 C , when a surgical tool P presses the catching protrusion  242   a  caught by any one of the plurality of catching holes  244   a,  the catching protrusion  242   a  separates from any one of the plurality of catching holes  244   a.  As illustrated in  FIG.  4 B , the catching protrusion  242   a  is disposed to be inclined, and the surgical tool P moves inclinedly and presses the catching protrusion  242   a.    
     One end of the hook  242  including the catching protrusion  242   a  separated from any one of the plurality of catching holes  244   a  is accommodated in the accommodation space  246   a.    
     When one end of the hook  242  is separated from any one of the plurality of catching holes  244   a  and accommodated in the accommodation space  246   a,  the first frame  216  becomes in an unlocked state in which the first frame  216  may freely move from the second frame  226 . 
     In addition, because the elastic force of the adjustment member  230  presses the first frame  216  in the first direction a and presses the second frame  226  in the second direction b, the first frame  216  moves in the first direction a and the second support member  220  moves in the second direction b at the same time when the first frame  216  is unlocked. 
     Once the catching protrusion  242   a  is separated from the plurality of catching holes  244   a,  the first frame  216  and the second frame  226  are moved away from each other by the elastic force of the adjustment member  230 . In this case, the separated catching protrusion  242   a  may be moved by the elastic force of the adjustment member  230  and caught by another catching hole  244   a  by the elastic force that returns the catching protrusion  242   a  to an original shape. In the state in which the first frame  216  is spaced apart from the second frame  226 , the first frame  216  is fixed by the catching protrusion  242   a  caught by another catching hole  244   a.    
     The hook  242  and the catching portion  244  may each be made of a hard material so that the hook  242  and the catching portion  244  are not easily broken. Therefore, it is possible to prevent the hook  242  and the catching portion  244  from being damaged by a patient&#39;s motion such as when the patient repeatedly bends his/her waist. Therefore, it is possible to prevent the catching protrusion  242   a  from separating from the catching hole  244   a  or prevent the catching protrusion  242   a  from colliding with the catching portion  244  and being broken. 
     Hereinafter, an endoscopic interspinous insert  300  according to still another embodiment of the present invention will be described. A description of parts identical to the above-mentioned parts of the endoscopic interspinous insert  100  according to the embodiment of the present invention will be omitted, and only parts different from the above-mentioned parts of the endoscopic interspinous insert  100  will be described. 
       FIG.  5 A  is a cross-sectional view of a first frame, a second frame, and an adjustment member of an endoscopic interspinous insert according to still another embodiment of the present invention, and  FIG.  5 B  is a side view of the second frame of the endoscopic interspinous insert according to the embodiment of the present invention.  FIG.  5 C  is a view illustrating a process of adjusting a distance between the first frame and the second frame, and  FIG.  5 D  is a view illustrating a state in which the first frame and the second frame are locked by a locking member. 
     Referring to  FIGS.  5 A to  5 D , a first frame  316  may have a hollow shape to accommodate a plurality of first teeth  316   b  that engages with an adjustment member  330 . 
     The first frame  316  may be made of a material that is harmless to a human body and may be disinfected. For example, the first frame  316  may be made of a metallic material such as stainless steel or a plastic material. In addition, the first frame  316  may be made of various materials having rigidity and high corrosion resistance. 
     The first frame  316  includes a first accommodation portion  316   a,  and the plurality of first teeth  316   b  protruding from an inner surface of the first frame  316  toward the first accommodation portion  316   a.  The plurality of first teeth  316   b  is arranged in a direction in which the first frame  316  moves. 
     A second frame  326  may have a hollow shape to accommodate a plurality of second teeth  326   b  that engages with the adjustment member  330 . 
     The second frame  326  may be made of a material that is harmless to a human body and may be disinfected. For example, the second frame  326  may be made of a metallic material such as stainless steel or a plastic material. In addition, the second frame  326  may be made of various materials having rigidity and high corrosion resistance. 
     The second frame  326  includes a second accommodation portion  326   a,  and a plurality of second teeth  326   b  protruding from an inner surface of the second frame  326  toward the second accommodation portion  326   a.  The plurality of second teeth  326   b  is arranged in a direction in which the second support member  320  moves. 
     The adjustment member  330  may have a shape of a gear that may engage with the plurality of first teeth  316   b  and the plurality of second teeth  326   b.  The adjustment member  330  may be made of a metallic material such as stainless steel or a plastic material. In addition, the adjustment member  330  may be made of various materials having rigidity and high corrosion resistance. 
     The adjustment member  330  includes a locking groove  330   a  to which a part of a locking member  350  to be described below is coupled. The locking groove  330   a  is formed concavely from one side of the adjustment member  330  to an inner side of the adjustment member  330  so that a tool D such as a medical driver or a wrench may be inserted into the locking groove  330   a.    
     When the tool D such as a medical driver or a wrench is inserted into the locking groove  330   a  and applies torque, a rotational force is transmitted to the adjustment member  330 , such that the adjustment member  330  rotates. When the adjustment member  330  rotates, the plurality of first teeth  316   b  and the plurality of second teeth  326   b  engaging with the adjustment member  330  rectilinearly move in opposite directions and move the first frame  316  and the second frame  326 . 
     In the present embodiment, the locking groove  330   a  having a quadrangular shape has been illustrated and described, but the shape of the locking groove  330   a  is not limited to the quadrangular shape. The locking groove  330   a  may have various shapes such as a circular, elliptical, or polygonal shape in addition to the quadrangular shape. 
     The adjustment member  330  further includes a circular insertion groove  340  into which a fixing screw  358  to be described below may be inserted. 
     A screw thread (not illustrated) is formed on an inner surface of the insertion groove  340 . The fixing screw  358  to be described below may be coupled to the screw thread (not illustrated). 
     The first frame  316  and the second frame  326  are always moved in the opposite directions by the structure in which the plurality of first teeth  316   b  and the plurality of second teeth  326   b  are respectively disposed at upper and lower sides and engage with the adjustment member  330 . That is, the first frame  316  and the second frame  326  may move away from or toward each other depending on a rotation direction of the adjustment member  330 . 
     The adjustment member  330  may be rotatably supported by a rotation support part (not illustrated) coupled to the other end of the adjustment member  330  opposite to one end of the adjustment member  330 . 
     Hereinafter, a process of adjusting a distance between the first frame  316  and the second frame  326  and a process of locking the first frame  316  and the second frame  326  by using the locking member  350  to be described below will be described. 
     Referring to  FIGS.  5 A to  5 D , when the tool D such as a medical driver or a wrench is inserted into the locking groove  330   a  of the adjustment member  330  and applies torque, the adjustment member  330  rotates, and the plurality of first teeth  316   b  and the plurality of second teeth  326   b  engaging with the adjustment member  330  respectively move in the first direction a and the second direction b, such that the distance between the first frame  316  and the second frame  326  increases. As illustrated in  FIG.  5 B , the tool D such as a medical driver or a wrench moves inclinedly and is coupled to the adjustment member  330 . 
     In a state in which the first frame  316  and the second frame  326  are sufficiently spaced apart from each other, the locking member  350  is coupled to the first frame  316 , the second frame  326 , and the locking groove  330   a,  the fixing screw  358  passes through a first through-hole  352   b  of the first locking block  352  and a second through-hole  354   b  of the second locking block  354 , and a screw thread  358   c  of the fixing screw  358  is coupled to the screw thread (not illustrated) of the insertion groove  340 , such that the movements of the first and second frames  316  and  326  in the first direction a or the second direction b are restricted, and the first frame  316  and the second frame  326  may be locked. 
       FIG.  6 A  is a front view illustrating the locking member, and  FIG.  6 B  is a top plan view of a first locking block and a bottom plan view of a second locking block.  FIG.  6 C  is a cross-sectional view illustrating the locking member, and  FIG.  6 D  is a view illustrating a state in which the locking member and the adjustment member are coupled by the fixing screw. 
     Referring to  FIGS.  6 A and  6 C , the locking member  350  includes a first locking block  352 , a second locking block  354 , a connection flange  356 , and the fixing screw  358 . The locking member  350  may be made of a metallic material such as stainless steel or a plastic material. In addition, the locking member  350  may be made of various materials having rigidity and high corrosion resistance. 
     The first locking block  352  has a hollow cylindrical shape to accommodate the fixing screw  358 , and a plurality of first teeth  352   a  may be formed on an upper portion of the first locking block  352  and engage with a plurality of second teeth  354   a  of the second locking block  354 . In addition, the first locking block  352  has the first through-hole  352   b  and a first catching groove  352   c.    
     The first through-hole  352   b  is formed to accommodate a body  358   b  of the fixing screw  358 , and the first through-hole  352   b  communicates with the second through-hole  354   b.    
     The first catching groove  352   c  includes a first catching portion  352   c   1  configured to accommodate one end of the connection flange  356 , and a second catching portion  352   c   2  configured to accommodate a first protruding portion  356   a  protruding and extending from one end of the connection flange  356 . 
     The first catching portion  352   c   1  extends from one side of the second catching portion  352   c   2 . The first catching portion  352   c   1  communicates with a first catching portion  354   c   1  of a second catching groove  354   c  of the second locking block  354 . 
     The second catching portion  352   c   2  has a larger width than the first protruding portion  356   a  of the connection flange  356 . 
     The second locking block  354  has a hollow cylindrical shape to accommodate the fixing screw  358 , and the plurality of second teeth  354   a  may be formed on a lower portion of the second locking block  354  and engage with the plurality of first teeth  352   a  of the first locking block  352 . 
     In addition, the second locking block  354  has the second through-hole  354   b  and the second catching groove  354   c.    
     The second through-hole  354   b  is formed to accommodate a head  358   a  of the fixing screw  358 , and the second through-hole  354   b  communicates with the first through-hole  352   b.    
     The second catching groove  354   c  includes the first catching portion  354   c   1  configured to accommodate the other end of the connection flange  356 , and a second catching portion  354   c   2  configured to accommodate a second protruding portion  356   b  protruding and extending from the other end of the connection flange  356 . 
     The first catching portion  354   c   1  extends from one side of the second catching portion  354   c   2 . The first catching portion  354   c   1  communicates with the first catching portion  352   c   1  of the first catching groove  352   c  of the first locking block  352 . 
     The second catching portion  354   c   2  has a larger width than the second protruding portion  356   b  of the connection flange  356 . 
     The connection flange  356  has a hollow cylindrical shape. 
     The connection flange  356  is accommodated in the first catching groove  352   c  of the first locking block  352  and the second catching groove  354   c  of the second locking block  354 . 
     The connection flange  356  includes the first protruding portion  356   a  and the second protruding portion  356   b.    
     The first protruding portion  356   a  extends and protrudes from one end of the cylindrical connection flange  356  and is accommodated in the second catching portion  352   c   2  of the first catching groove  352   c  of the first locking block  352 . 
     The second protruding portion  356   b  extends and protrudes from the other end of the cylindrical connection flange  356  and is accommodated in the second catching portion  354   c   2  of the second catching groove  354   c  of the second locking block  354 . 
     The fixing screw  358  may be accommodated in the first through-hole  352   b  and the second through-hole  354   b  and include the head  358   a,  the body  358   b,  and the screw thread  358   c.    
     The head  358   a  has a head shape of a flat head screw corresponding to a shape of the second through-hole  354   b.    
     The body  358   b  extends in a cylindrical shape from one end of the head  358   a.    
     The screw thread  358   c  may be formed at an end of the body  358   b,  and the screw thread  358   c  may be screw-coupled to the adjustment member  330 . 
     Hereinafter, a process of locking the first frame  316  and the second frame  326  by using the locking member  350  will be described. 
       FIG.  6 D  is a view illustrating a state in which the locking member and the adjustment member are coupled by the fixing screw. 
     Referring to  FIG.  6 D , the locking member  350  and the fixing screw  358  are inserted and fixed between the first and second frames  316  and  326  between which the distance is adjusted by the adjustment member  330 . Therefore, the first frame  316  and the second frame  326  may be locked in the state in which the distance between the first frame  316  and the second frame  326  is maintained. 
     More specifically, the first locking block  352  is coupled to the locking groove  330   a  of the adjustment member  330  engaging with the first and second frames  316  and  326  between which the distance is maintained. The second locking block  354  is coupled between the first frame  316  and the second frame  326 . 
     When the fixing screw  358  is inserted into and passes through the first through-hole  352   b  and the second through-hole  354   b  in the state in which the first locking block  352  and the second locking block  354  are coupled to each other, the screw thread  358   c  of the fixing screw  358  comes into contact with the insertion groove  340  of the adjustment member  330 . In this state, when the fixing screw  358  is rotated by an adjustment tool (not illustrated) such as a driver or a wrench, the screw thread  358   c  moves along the screw thread  340   a  formed on the insertion groove  340 , such that the fixing screw  358  is screw-coupled to the insertion groove  340 . 
     During the process in which the fixing screw  358  is screw-coupled to the insertion groove  340 , the first locking block  352  and the second locking block  354  move toward each other, and the connection flange  356  moves in a direction in which the fixing screw  358  is inserted, such that the first protruding portion  356   a  of the connection flange  356  moves to the second catching portion  352   c   2  of the first through-hole  352   b,  and the second protruding portion  356   b  moves to the second catching portion  354   c   2  of the second through-hole  354   b.    
     Therefore, when the connection flange  356  moves, the second locking block  354  moves to the first locking block  352 , such that the plurality of first teeth  352   a  and the plurality of second teeth  354   a  engage with one another, and the relative rotation between the first and second locking blocks  352  and  354  is restricted. 
     The first locking block  352  is inserted into the locking groove  330   a  of the adjustment member  330 , and the second locking block  354  engaging with the first locking block  352  is inserted and fixed between the first frame  316  and the second frame  326 , as illustrated in  FIG.  5 D . Therefore, the relative rotation between the first and second locking blocks  352  and  354  is restricted, such that the rotation of the adjustment member  330  is restricted by the locking member  350 . Therefore, the first frame  316  and the second frame  326  may be locked in the state in which the first frame  316  and the second frame  326  are spaced apart from each other. 
     Hereinafter, an endoscopic interspinous insert  400  according to yet another embodiment of the present invention will be described. A description of parts identical to the above-mentioned parts of the endoscopic interspinous insert  100  according to the embodiment of the present invention will be omitted, and only parts different from the above-mentioned parts of the endoscopic interspinous insert  100  will be described. 
       FIG.  7 A  is a top plan view of a first frame, a second frame, and an adjustment member of an endoscopic interspinous insert according to yet another embodiment of the present invention.  FIG.  7 B  is a side view of the first frame, the second frame, and the adjustment member of the endoscopic interspinous insert according to the embodiment of the present invention.  FIGS.  7 C and  7 D  are views illustrating a process of adjusting a distance between the first frame and the second frame. 
     Referring to  FIGS.  7 A and  7 B , a first frame  416  may have a hollow shape to accommodate an adjustment member  430 . 
     The first frame  416  may be made of a material that is harmless to a human body and may be disinfected. For example, the first frame  416  may be made of a metallic material such as stainless steel or a plastic material. In addition, the first frame  416  may be made of various materials having rigidity and high corrosion resistance. 
     The first frame  416  has a first accommodation portion  416   a.    
     The first accommodation portion  416   a  is formed to accommodate a screw  432   ab  of a screw bevel gear  432   a  of the adjustment member  430 . 
     A second frame  426  may have a hollow shape to accommodate the first frame  416 . 
     The second frame  426  may be made of a material that is harmless to a human body and may be disinfected. For example, the second frame  426  may be made of a metallic material such as stainless steel or a plastic material. In addition, the second frame  426  may be made of various materials having rigidity and high corrosion resistance. 
     The second frame  426  includes a second accommodation portion  426   a,  a third accommodation portion  426   b,  and a fourth accommodation portion  426   c.    
     The second accommodation portion  426   a  is formed concavely inward to accommodate the first frame  416 . 
     The third accommodation portion  426   b  accommodates a head portion  432   aa  of the screw bevel gear  432   a  of the adjustment member  430 . 
     The fourth accommodation portion  426   c  accommodates an adjustment bevel gear  432   b  of the adjustment member  430 . 
     The adjustment member  430  is configured to adjust a distance between the first frame  416  and the second frame  426 . 
     The adjustment member  430  is configured to transmit power and includes the screw bevel gear  432   a  rotatably accommodated in the third accommodation portion  426   b  of the second frame  426 , and the adjustment bevel gear  432   b  rotatably accommodated in the fourth accommodation portion  426   c  of the second frame  426 . The adjustment member  430  may be made of a metallic material such as stainless steel or a plastic material. In addition, the adjustment member  430  may be made of various materials having rigidity and high corrosion resistance. 
     The screw bevel gear  432   a  is configured to rotate while engaging with the adjustment bevel gear  432   b.    
     The screw bevel gear  432   a  includes the head  432   aa  and the screw  432   ab.    
     The head  432   aa  may be rotatably supported in the third accommodation portion  426   b.  The screw  432   ab  may be rotatably supported at a predetermined position in the second accommodation portion  426   a  of the second frame  426 . 
     The adjustment bevel gear  432   b  has an insertion groove  432   b   1  and a locking groove  432   b   2 . 
     The insertion groove  432   b   1  is formed concavely from one end of the adjustment bevel gear  432   b  to an inner side of the adjustment bevel gear  432   b  and formed in a circular, elliptical, or polygonal shape. In addition, a screw thread (not illustrated) may be formed on an inner surface of the insertion groove  432   b   1  and coupled to the screw thread  358   c  formed on the fixing screw  358  of the locking member  350 . 
     When the screw thread  358   c  provided on the locking member  350  is coupled to the screw thread (not illustrated) of the insertion groove  432   b   1 , the first frame  416  may be locked in a state in which the first frame  416  is spaced apart from the second frame  426 . 
     The locking groove  432   b   2  is provided at the other end of the adjustment bevel gear  432   b  and has an elliptical or polygonal shape so that various tools such as a medical driver or a wrench may be inserted. 
     The locking groove  432   b   2  is formed concavely from the other end of the adjustment bevel gear  432   b  to the inner side of the adjustment bevel gear  432   b  and formed in a polygonal or elliptical shape. When the tool such as a medical driver or a wrench is inserted into the locking groove  432   b   2  and applies torque, a rotational force is transmitted to the adjustment bevel gear  432   b,  such that the adjustment bevel gear  432   b  rotates, and the screw bevel gear  432   a  engaging with the adjustment bevel gear  432   b  rotates. 
     When the screw bevel gear  432   a  rotates, the first frame  416  moves in the first direction a or a direction opposite to the first direction a, such that the distance between the first frame  416  and the second frame  426  may be adjusted. 
     Hereinafter, a process of adjusting the distance between the first frame  416  and the second frame  426  and a process of locking the first frame  416  and the second frame  426  by using the locking member  350  will be described. 
     Referring to  FIGS.  7 A and  7 B , when the tool (not illustrated) such as a medical driver or a wrench is inserted into the locking groove  432   b   2  of the adjustment bevel gear  432   b  and applies torque, the adjustment bevel gear  432   b  rotates in one direction. When the adjustment bevel gear  432   b  rotates in one direction, the screw bevel gear  432   a  engaging with the adjustment bevel gear  432   b  rotates. When the screw bevel gear  432   a  rotates, the first frame  416  engaging with the screw  432   ab  of the screw bevel gear  432   a  moves in the first direction a, such that the distance between the first frame  416  and the second frame  426  increases. 
     In the state in which the first frame  416  and the second frame  426  are sufficiently spaced apart from each other, the tool (not illustrated) such as a medical driver or a wrench is separated from the locking groove  432   b   2  of the adjustment bevel gear  432   b,  the first locking block  352  of the locking member  350  is coupled to the locking groove  432   b   2 , and the second locking block  354  of the locking member  350  is coupled to the fourth accommodation portion  426   c  of the adjustment bevel gear  432   b.    
     When the fixing screw  358  is inserted into and passes through the first through-hole  352   b  of the first locking block  352  and the second through-hole  354   b  of the second locking block  354  in the state in which the first locking block  352  and the second locking block  354  are loosely coupled by the connection flange  356 , the screw thread  358   c  of the fixing screw  358  comes into contact with the insertion groove  432   b   1  of the adjustment bevel gear  432   b.  In this state, when the fixing screw  358  is rotated by an adjustment tool (not illustrated) such as a driver or a wrench, the screw thread  358   c  of the fixing screw  358  moves along the screw thread (not illustrated) formed on the insertion groove  432   b   1 , such that the fixing screw  358  is screw-coupled to the insertion groove  432   b   1 . 
     During the process in which the fixing screw  358  is screw-coupled to the insertion groove  432   b   1 , the first locking block  352  and the second locking block  354  move toward each other, and the connection flange  356  moves in a direction in which the fixing screw  358  is inserted, such that the first protruding portion  356   a  of the connection flange  356  moves to the second catching portion  352   c   2  of the first through-hole  352   b,  and the second protruding portion  356   b  moves to the second catching portion  354   c   2  of the second through-hole  354   b.    
     Therefore, when the connection flange  356  moves, the second locking block  354  moves toward the first locking block  352 , such that the plurality of first teeth  352   a  and the plurality of second teeth  354   a  engage with one another, and the relative rotation between the first and second locking blocks  352  and  354  is restricted. 
     The first locking block  352  is fixed to the adjustment bevel gear  432   b,  and the second locking block  354  engaging with the first locking block  352  is coupled and fixed to the fourth accommodation portion  426   c.  Therefore, the relative rotation between the first locking block  352  and the second locking block  354  is restricted, such that the rotation of the adjustment bevel gear  432   b  is restricted by the locking member  350 . In addition, the rotation of the screw bevel gear  432   a  engaging with the adjustment bevel gear  432   b  is restricted. Therefore, the first frame  416  may be locked in the state in which the first frame  416  is spaced apart from the second frame  426 . 
     Thereafter, when the distance between the first frame  416  and the second frame  426  is required to be adjusted, the fixing screw  358  is separated, the locking member (not illustrated) inserted and fixed into the locking groove  432   b   2  of the adjustment bevel gear  432   b  and the fourth accommodation portion  426   c  of the second frame is separated, and then the adjustment bevel gear  432   b  is rotated by the tool (not illustrated) such as a medical driver or a wrench, such that the distance between the first frame  416  and the second frame  426  may be adjusted. 
     Hereinafter, an endoscopic interspinous insert  500  according to still yet another embodiment of the present invention will be described. A description of parts identical to the above-mentioned parts of the endoscopic interspinous insert  100  according to the embodiment of the present invention will be omitted, and only parts different from the above-mentioned parts of the endoscopic interspinous insert  100  will be described. 
       FIG.  8 A  is a top plan view of a first frame, a second frame, and an adjustment member of an endoscopic interspinous insert according to still yet another embodiment of the present invention.  FIG.  8 B  is a side view of the second frame of the endoscopic interspinous insert according to the embodiment of the present invention.  FIG.  8 C  is a cross-sectional view taken along line C-C in  FIG.  8 A .  FIG.  8 D  is a view illustrating a process of adjusting a distance between the first frame and the second frame. 
     Referring to  FIGS.  8 A to  8 D , a first frame  516  may have a hollow shape so that the first frame  516  may be coupled to a second frame  526 . 
     The first frame  516  may be made of a material that is harmless to a human body and may be disinfected. For example, the first frame  516  may be made of a metallic material such as stainless steel or a plastic material. In addition, the first frame  516  may be made of various materials having rigidity and high corrosion resistance. 
     The first frame  516  includes a first adjustment groove  516   a  and a first accommodation groove  516   b.    
     The first adjustment groove  516   a  is formed at one end of the first frame  516  and includes a screw thread provided on an outer peripheral surface thereof. The first adjustment groove  516   a  is coupled to the second adjustment groove  526   a  to define a conical shape. That is, the first adjustment groove  516   a  has a shape having a diameter that gradually decreases in a direction in which the adjustment member  530  is inserted. 
     The first accommodation groove  516   b  is angled and formed concavely inward from above to accommodate one end of the second locking block  354  of the locking member  350 . 
     The second frame  526  may have a hollow shape so that the second frame  526  may be coupled to the first frame  516 . 
     The second frame  526  may be made of a material that is harmless to a human body and may be disinfected. For example, the second frame  526  may be made of a metallic material such as stainless steel or a plastic material. In addition, the second frame  526  may be made of various materials having rigidity and high corrosion resistance. 
     The second frame  526  includes a second adjustment groove  526   a  and a second accommodation groove  526   b.    
     The second adjustment groove  526   a  is formed at one end of the second frame  526  and includes a screw thread formed on an outer peripheral surface thereof. The second adjustment groove  526   a  is coupled to the first adjustment groove  516   a  to define the conical shape. That is, the second adjustment groove  526   a  has a shape having a diameter that gradually decreases in the direction in which the adjustment member  530  is inserted. 
     The second accommodation groove  526   b  is angled and formed concavely inward from above to accommodate the other end of the second locking block  354  of the locking member  350 . 
     The adjustment member  530  is disposed between the first adjustment groove  516   a  and the second adjustment groove  526   a  and has a wedge shape. 
     The adjustment member  530  includes an insertion groove  530   a,  a locking groove  530   b,  and an adjustment screw thread  532 . The adjustment member  530  may be made of a metallic material such as stainless steel or a plastic material. In addition, the adjustment member  530  may be made of various materials having rigidity and high corrosion resistance. 
     The insertion groove  530   a  is angled and formed concavely from one side of the adjustment member  530  to an inner side of the adjustment member  530  so that various tools such as a medical driver or a wrench may be inserted into the insertion groove  530   a.    
     When the tool such as a medical driver or a wrench is inserted into the insertion groove  530   a  and applies torque, a rotational force is transmitted to the adjustment member  530 , such that the adjustment member  530  rotates. When the adjustment member  530  rotates, the distance between the first and second frames  516  and  526  screw-coupled to the adjustment member  530  increases, and the first frame  516  and the second frame  526  are moved. 
     In the present embodiment, the insertion groove  530   a  having a quadrangular shape has been illustrated and described, but the shape of the insertion groove  530   a  is not limited to the quadrangular shape. The insertion groove  530   a  may have various shapes such as a circular, elliptical, or polygonal shape in addition to the quadrangular shape. 
     The locking groove  530   b  has an elliptical or polygonal shape so that various tools such as a medical driver or a wrench may be inserted into the locking groove  530   b.  In addition, a screw thread (not illustrated) is formed in the locking groove  530   b.  The screw thread  358   c  of the fixing screw  358  may be coupled to the screw thread (not illustrated). 
     The adjustment screw thread  532  may be provided on the outer peripheral surface of the adjustment member  530  and screw-coupled to the first adjustment groove  516   a  and the second adjustment groove  526   a.    
     Hereinafter, a process of adjusting a distance between the first frame  516  and the second frame  526  and a process of locking the first frame  516  and the second frame  526  by using the locking member  350  will be described. 
     Referring to  FIGS.  8 A to  8 D , when the tool (not illustrated) such as a medical driver or a wrench is inserted into the insertion groove  530   a  of the adjustment member  530  and applies torque, the adjustment screw thread  532  rotates in one direction, and the adjustment member  530  moves to a deep portion between the first frame  516  and the second frame  526 . Therefore, the first frame  516  and the second frame  526  move away from each other, the first frame  516  moves in the first direction a, and the second frame  526  moves in the second direction b, such that the distance between the first frame  516  and the second frame  526  increases. 
     In a state in which the first frame  516  and the second frame  526  are sufficiently spaced apart from each other, the locking member  350  is coupled to the first frame  516 , the second frame  526 , and the insertion groove  530   a,  the fixing screw  358  passes through the first through-hole  352   b  of the first locking block  352  and the second through-hole  354   b  of the second locking block  354 , and the screw thread  358   c  of the fixing screw  358  is coupled to the screw thread (not illustrated) of the locking groove  530   b,  such that the movements of the first and second frames  516  and  526  in the first direction a or the second direction b are restricted, and the first frame  516  and the second frame  526  may be locked. 
     Thereafter, when the distance between the first frame  516  and the second frame  526  is required to be adjusted in accordance with states of the spinous processes S 1  and S 2 , the locking member  350  inserted and fixed into the insertion groove  530   a  is separated, and then the adjustment member  530  is rotated by the tool such as a medical driver or a wrench, such that the distance between the first frame  516  and the second frame  526  may be adjusted. 
     Each of the endoscopic interspinous inserts  100 ,  200 ,  300 ,  400 , and  500  may further include a pressure sensor (not illustrated) and a communication module (not illustrated). The pressure sensor may sense a pressure of each of the endoscopic interspinous inserts  100 ,  200 ,  300 ,  400 , and  500  inserted between the spinous processes. The communication module may be electromagnetically connected to the pressure sensor and transmit an electrical signal, which is received from the pressure sensor, to a device such as an external server or a user terminal through wireless communication. 
     While the exemplary embodiments of the present invention have been illustrated and described above, the present invention is not limited to the specific exemplary embodiments, and various modifications can of course be made by those skilled in the art to which the present invention pertains without departing from the subject matter of the present invention as claimed in the claims. Further, the modifications should not be appreciated individually from the technical spirit or prospect of the present invention.