Patent Description:
The spine consists of a column of twenty-four vertebrae that extend from the skull to the hips. Discs of soft tissue are disposed between adjacent vertebrae. In addition, the spine encloses and protects the spinal cord, defining a bony channel around the spinal cord, called the spinal canal. There is normally a space between the spinal cord and the borders of the spinal canal so that the spinal cord and the nerves associated therewith are not pinched.

Over time, the ligaments and bone that surround the spinal canal can thicken and harden, resulting in a narrowing of the spinal canal and compression of the spinal cord or nerve roots. This condition is called spinal stenosis, which results in pain and numbness in the back and legs, weakness and/or a loss of balance. These symptoms often increase after walking or standing for a period of time.

There are a number of non-surgical treatments for spinal stenosis. These include non-steroidal anti-inflammatory drugs to reduce the swelling and pain, and corticosteroid injections to reduce swelling and treat acute pain. While some patients may experience relief from symptoms of spinal stenosis with such treatments, many do not, and thus turn to surgical treatment. The most common surgical procedure for treating spinal stenosis is decompressive laminectomy, which involves removal of parts of the vertebrae. The goal of the procedure is to relieve pressure on the spinal cord and nerves by increasing the area of the spinal canal.

Interspinous process decompression (IPD) is a less invasive surgical procedure for treating spinal stenosis. With IPD surgery, there is no removal of bone or soft tissue. Instead, an implant or spacer device is positioned behind the spinal cord or nerves and between the interspinous processes that protrude from the vertebrae in the lower back.

Examples of a particularly useful interspinous process implant and fusion devices are disclosed in commonly assigned <CIT>, <CIT>; <CIT>, <CIT>, and <CIT>.

The invention provides an improvement over prior interspinous implant devices by constructing an implant that is substantially shorter in length than prior devices. This will advantageously reduce the overall size and profile of the device, thereby making implantation safer and easier.

The construction of the implant according to an embodiment of the invention also allows for easier removal of the device after implantation, if desired. The ability of the surgeon to both selectively open and close the wings of the device is another advantage over prior devices. Because the wings can be closed after implantation, the implant of the invention can be removed by the same small lateral incision through which it was originally inserted. Removal of prior devices generally requires an additional posterior incision to manually close the wings before the device can be extracted.

Additionally, the device of the invention does not require a removable end piece. This improves the safety and ease of the procedure by reducing the number of steps in the implantation process. Fewer separable parts of the implant also reduces cost and simplifies manufacturing. <CIT> describes an interspinous process implant that includes a body defining a longitudinal axis, an interior cavity and opposed proximal and distal end portions, a pair of anchor wings operatively associated with the distal end portion of the body and mounted for pivotal movement relative to the longitudinal axis of the body between a first position housed within the interior cavity of the body and a second position extending radially outwardly from the body, an anchor collar operatively associated with the proximal portion of the body and mounted for axial movement relative to the longitudinal axis of the body between a first position spaced apart from the anchor wings and a second position approximated with the anchor wings, a pair of anchor blades operatively associated with the anchor collar and mounted for movement between a first position housed at least partially within the interior cavity of the body and a second position extending radially outwardly from the anchor collar. <CIT> describes a spinal implant which includes an elongated body dimensioned and configured to function as a spacer, for placement in a target interspinous process space, between two adjacent spinous processes, a distal anchor associated with a distal end of the body, and a proximal anchor mounted for longitudinal movement along the body between a first position spaced apart from the head and a second position approximated with the head, adapted to compress the two adjacent spinous processes, in conjunction with the distal anchor.

Embodiments of the invention solve the above-mentioned problems by providing a system for minimally invasive spinal fusion.

A first embodiment of the invention is directed to a spinal implant comprising: a main body, a proximal anchor, a distal anchor, and an internal plunger. The main body has an outer surface, a central bore therein, a proximal end, a distal end, and a longitudinal axis extending therebetween. The proximal anchor comprises a nut having a proximal side, a distal side, and an internal bore. The distal anchor comprises a plurality of wings having a first closed configuration and a second open configuration, wherein the plurality of wings comprises a first wing and a second wing. The internal plunger has a proximal end, a distal end, and is housed within the central bore of the main body. The distal end of the internal plunger is operatively connected to the first wing and the second wing to selectively move the plurality of wings between the first closed configuration and the second open configuration.

A further embodiment of the invention is directed to a spinal implant comprising a main body, a proximal anchor, a distal anchor, and a linkage assembly. The main body has an outer surface, a central bore therein, a proximal end, a distal end, and a longitudinal axis extending therebetween. The main body includes external threads on at a least a portion of the outer surface. The proximal anchor comprises a nut having a proximal side, a distal side, and an internal bore having internal threads. The distal anchor comprises a first wing and a second wing configured to be selectively opened and closed. The linkage assembly connects the first wing and the second wing to the main body.

A method which do not form part of the claimed invention is directed to a method of placing a spinal implant at a treatment site comprising: providing a spinal implant in a first closed configuration; placing the spinal implant in a patient at a desired treatment site; and sliding the internal plunger distally along the longitudinal axis to move the plurality of wings to the second open configuration. The method may further comprise sliding the internal plunger proximally along the longitudinal axis to move the plurality of wings to the first closed configuration to withdraw the spinal implant from the patient.

Other aspects and advantages of the invention will be apparent from the following detailed description of the embodiments and the accompanying drawing figures.

Embodiments of the invention are described in detail below with reference to the attached drawing figures, wherein:.

The drawing figures do not limit the invention to the specific embodiments disclosed and described herein. The drawings are not necessarily to scale, emphasis instead being placed upon clearly illustrating the principles of the invention.

The following detailed description references the accompanying drawings that illustrate specific embodiments in which the invention can be practiced. The embodiments are intended to describe aspects of the invention in sufficient detail to enable those skilled in the art to practice the invention. Other embodiments can be utilized and changes can be made without departing from the scope of the invention. The following detailed description is, therefore, not to be taken in a limiting sense. The scope of the invention is defined only by the appended claims, along with the full scope of equivalents to which such claims are entitled.

In this description, references to "one embodiment," "an embodiment," or "embodiments" mean that the feature or features being referred to are included in at least one embodiment of the technology. Separate references to "one embodiment," "an embodiment," or "embodiments" in this description do not necessarily refer to the same embodiment and are also not mutually exclusive unless so stated and/or except as will be readily apparent to those skilled in the art from the description. For example, a feature, structure, act, etc. described in one embodiment may also be included in other embodiments, but is not necessarily included. Thus, the technology can include a variety of combinations and/or integrations of the embodiments described herein.

Embodiments of the invention are directed to a minimally invasive interspinous-interlaminar fusion device for the temporary fixation of the thoracic, lumbar, and sacral spine while waiting for bony fusion to occur. The implant can be attached to the posterior non-cervical spine at the spinous processes to provide immobilization and stabilization of the spinal segments. A threaded main body of the implant provides controlled distraction.

One embodiment of the invention is shown in <FIG>, which illustrates an interspinous process implant <NUM> in an open configuration. Implant <NUM> may include a main body <NUM> having a distal end <NUM> and a proximal end <NUM>. Implant <NUM> further includes a nut <NUM> on the proximal end <NUM> of main body <NUM> and extendable first and second wings 300a, 300b on the distal end <NUM> of main body <NUM>. As can be seen in the cross-sectional view of <FIG>, implant <NUM> further includes a plunger <NUM> and first and second linkages 500a, 500b for operatively connecting first and second wings 300a, 300b to main body <NUM>, as will be described herein.

<FIG> illustrates an embodiment of main body <NUM>. Distal end <NUM> includes a conical distal tip <NUM> having a rounded distalmost end. In some embodiments, the conical distal tip has a sharp pointed distalmost end. In some embodiments, main body <NUM> includes helical threads <NUM> on an exterior surface thereof. In some embodiments, main body <NUM> may alternatively or additionally include cutting threads or box threads. Helical threads <NUM> may be provided along the entire exterior surface of main body <NUM> or along only a portion of the exterior surface of main body <NUM>. In some embodiments, the threads may have a depth of about <NUM> to about <NUM>, an angle of about <NUM>° to about <NUM>°, and a spacing of about <NUM> to about <NUM>. In some embodiment, the threads may have a depth of about <NUM>, an angle of about <NUM>°, and a spacing of about <NUM>. In some embodiments, distal tip <NUM> has a smooth exterior surface without any threads thereon. In some embodiments, the distal tip <NUM> is a solid tip for providing strength during insertion of the implant <NUM>.

Main body <NUM> further includes a proximal portion <NUM> extending from the proximal end <NUM>, having hollow bore <NUM>. The majority of hollow bore <NUM> may be substantially cylindrical. Proximal end of hollow bore <NUM> may have a particular shape such as a hexagonal perimeter configured to receive an insertion tool therein (not shown). Proximal end of hollow bore <NUM> may also include detents <NUM> adapted for receiving and locking a distal end of an insertion tool therein (not shown).

Main body <NUM> also includes a distal portion <NUM> extending from the distal end <NUM>, having a substantially rectangular window <NUM>. The window <NUM> extends from a first lateral side <NUM> to a second lateral side <NUM>, a top flat interior wall <NUM>, and a bottom flat interior wall <NUM>. At the distal end of the window <NUM>, top wall <NUM> includes an opening 138a therethrough and bottom wall <NUM> includes an opening 138b therethrough. Openings 138a, 138b are configured to receive a bolt <NUM> for mounting wings 300a, 300b, as seen in <FIG>.

<FIG> and <FIG> illustrate implant <NUM> with wings 300a, 300b in a closed configuration. Window <NUM> of main body <NUM> is configured to house a distal portion of the plunger <NUM>, first and second linkages 500a, 500b, and first and second wings 300a, 300b when in the closed configuration.

<FIG> illustrates an embodiment of plunger <NUM>. Plunger <NUM> has a distal end <NUM> and proximal end <NUM>. Proximal end <NUM> is configured to be located within the bore <NUM> of main body <NUM> and distal end <NUM> is configured to be located within the window <NUM> of the main body <NUM>, as seen in <FIG>. Plunger <NUM> can be moved longitudinally within the bore <NUM> and window <NUM> to open and close the wings 300a, 300b, as will be described further below.

With respect to <FIG>, proximal end of plunger <NUM> has a central bore <NUM> for receiving an inserter device (not shown) therein. In some embodiments, central bore <NUM> of plunger <NUM> may be threaded to cooperate with threading on an inserter device. Plunger <NUM> has a substantially Y-shaped construction, having a first arm 408a and a second arm 408b extending from a solid central portion <NUM>. First arm 408a and second arm 408b have a space <NUM> therebetween. Central portion <NUM> has two opposed curved indentations 412a, 412b on an outer side, as can be seen in <FIG>. First arm 408a and second arm 408b each have a hole 414a, 414b extending therethrough for receiving a mounting pin <NUM> therein. In order to connect wings 300a, 300b to the plunger <NUM>, linkages 500a, 500b are mounted within the space <NUM> between the arms 408a, 408b.

In an alternative embodiment, a plunger may have two heads having a T-shape or dove-tail feature that rides in a mating grove on the underside of wings 300a, 300b. In a further alternative embodiment, a plunger may be connected by an umbrella-like feature having linkages that ride within a groove on an underside of the wings 300a, 300b.

<FIG> and <FIG> illustrate an embodiment of first and second linkages 500a, 500b, respectively. First linkage 500a has a first end 502a and a second end 504a. In some embodiments, first linkage 500a is substantially oval shaped with first end 502a having a rounded edge 506a, and second end 504a having a rounded edge 508a. First linkage 500a further includes a straight top edge 510a and an indented curved bottom edge 512a. First end 502a includes a hole 514a extending therethrough and second end 504a includes a hole 516a extending therethrough. Holes 514a and 516a are each configured to receive a mounting pin <NUM> therein. First linkage 500a includes a substantially planar top surface 518a and a substantially planar bottom surface 520a.

As can be seen in <FIG>, second linkage 500b is substantially identical to first linkage 500a. Second linkage 500b has a first end 502b and a second end 504b. In some embodiments, second linkage 500b is substantially oval shaped with first end 502b having a rounded edge 506b, and second end 504b having a rounded edge 508b. Second linkage 500b further includes a straight top edge 510b and an indented curved bottom edge 512b. First end 502b includes a hole 514b extending therethrough and second end 504b includes a hole 516b extending therethrough. Holes 514b and 516b are each configured to receive a mounting pin <NUM> therein. Second linkage 500b includes a substantially planar top surface 518b and a substantially planar bottom surface 520b.

<FIG> shows a perspective view of implant <NUM> in an open configuration, with wing 300a shown in front. As can be seen in <FIG>, first linkage 500a and second linkage 500b are mounted within the space <NUM> between arms 408a, 408b of plunger <NUM>.

<FIG> illustrates a cross-sectional view of implant <NUM> in an open configuration. As can be seen in <FIG>, second end 504a of first linkage 500a is connected to first end 502b of second linkage 500b. Planar bottom surface 520a of first linkage 500a is placed in contact with planar top surface 518b of second linkage 500b. As can be seen in <FIG> and <FIG>, a mounting pin <NUM> is inserted through hole 516a in second end 504a of first linkage 500a, hole 514b in first end 502b of second linkage 500b, hole 414a in first arm 408a of plunger <NUM>, and hole 414b in second arm 408b of plunger <NUM> to allow for rotation of the linkages 500a, 500b thereabout. The opposite ends of linkages 500a, 500b are connected to the wings 300a, 300b to allow for rotation thereof, as will be described further below.

<FIG>, and <FIG> show perspective views of an embodiment of first wing 300a. Wing 300a has a distal end 302a, a proximal end 304a, a first lateral side 306a, and a second lateral side 308a. In some embodiments, distal end 302a includes at least one fang extending therefrom adapted for engaging bone and/or tissue. In other embodiments, a bottom surface of wing 300a may include a flat roughened surface to achieve gripping of the bone and/or tissue.

In some embodiments, distal end 302a includes first and second fangs 310a, 311a having a gap 312a therebetween. In some embodiments, the dimension of the gap 312a may be about <NUM> to about <NUM>. In some embodiments, the gap 312a may be about <NUM>. In some embodiments, first fang 310a has a sharp pointed tip 314a and second fang 311a has a sharp pointed tip 313a. First fang 310a is provided on first lateral side 306a and is connected to first extension 316a. Second fang 311a is provided on second lateral side 308a and is connected to second extension 318a. First extension 316a has a width of d1 and second extension 318a has a width of d2. In some embodiments, width d2 is greater than width d1. In some embodiments, width d1 ranges from about <NUM> to about <NUM>. In some embodiments, width d2 ranges from about <NUM> to about <NUM>. A substantially rectangular slot 320a is provided between first extension 316a and second extension 318a for receiving first end 502a of first linkage 500a therein, as can be seen in <FIG> and <FIG>. First extension 316a includes a hole 322a in an inner wall thereof for receiving a pin <NUM> therein. In some embodiments, hole 322a does not extend fully through the wall of first extension 316a. Second extension 318a includes hole 324a extending therethrough, which is located opposite hole 322a of first extension 316a. A mounting pin <NUM> is inserted into hole 322a of first extension 316a, hole 514a of first linkage 500a, and hole 324a of second extension 318a to allow for rotation of the wing 300a thereabout.

Wing 300a includes a substantially planar top surface 330a, as can be seen in <FIG>. Wing 300a includes a substantially rectangular opening 332a adjacent to top surface 330a. Rectangular opening 332a is adapted to receive first end 502a of first linkage 500a therein in the closed configuration of the wing 300a. Proximal end 304a of wing 300a further includes proximal connector portion 326a having an additional hole 328a for operatively connecting wing 300a to main body <NUM>. Hole 328a is configured to receive a bolt <NUM> therein.

<FIG>, <FIG> show perspective views of an embodiment of second wing 300b. Second wing 300b is substantially identical to first wing 300a. Wing 300b has a distal end 302b, a proximal end 304b, a first lateral side 306b, and a second lateral side 308b. In some embodiments, distal end 302b includes at least one fang adapted for engaging bone and/or tissue. In other embodiments, a bottom surface of wing 300b may include a flat roughened surface to achieve gripping of the bone and/or tissue.

In some embodiments, distal end 302b includes first and second fangs 310b, 311b having a gap 312b therebetween. In some embodiments, the dimension of the gap 312b may be about <NUM> to about <NUM>. In some embodiments, the gap 312b may be about <NUM>. In some embodiments, first fang 310b has a sharp pointed tip 314b and second fang 311b has a sharp pointed tip 313b. First fang 310b is provided on first lateral side 306b and is connected to first extension 316b. Second fang 311b is provided on second lateral side 308b and is connected to second extension 318b. First extension 316b has a width of d1 and second extension 318b has a width of d2. In some embodiments, width d2 is greater than width d1. A substantially rectangular slot 320b is provided between first extension 316b and second extension 318b for receiving second end 504b of second linkage 500b therein, as can be seen in <FIG>. First extension 316b includes a hole 322b in an inner wall thereof for receiving a pin <NUM> therein. Second extension 318b includes hole 324b extending therethrough, which is located opposite hole 322b of first extension 316b. A mounting pin <NUM> is inserted through hole 322b of first extension 316b, hole 516b of second linkage 500b, and hole 324b of second extension 318b to allow for rotation of the wing 300b thereabout, as can be seen in <FIG>.

Wing 300b includes a substantially planar top surface 330b, as can be seen in <FIG>. Wing 300b includes a substantially rectangular opening 332b adjacent to top surface 330b. Rectangular opening 332b is adapted to receive second end 504b of second linkage 500b therein in the closed configuration of the wing 300b. Proximal end 304b of wing 300b further includes proximal connector portion 326b having an additional hole 328b for operatively connecting wing 300b to main body <NUM>. Hole 328b is configured to receive a bolt <NUM> therein.

In some embodiments, in the open position, wings 300a, 300b extend circumferentially a distance of about <NUM> to about <NUM> from the main body <NUM>, which may be referred to as the reach, R<NUM>, of the wings 300a, 300b. In some embodiments, the spacing of the gap 312a between fangs 310a, 311a may be the same as the spacing of the gap 312b between fangs 310b, 311b. In other embodiments, the spacing of the gap 312a between fangs 310a, 311a may be different from the spacing of the gap 312b between fangs 310b, 311b. The fangs 310a, 311a, 310b, 311b are optimally placed to minimize stress on the spinous process and prevent fracture thereof. The length of any of fangs 310a, 311a, 310b, 311b may be about <NUM> to about <NUM>. In some embodiments, each fang can have a different length as desired.

The design of wings 300a, 300b is such that the outer surface acts as a stop relative to main body <NUM> to control the minimum and maximum movement, thereby preventing closing in on themselves inside the main body <NUM> and also preventing over-deployment.

<FIG> illustrates an embodiment of bolt <NUM> and <FIG> illustrates an embodiment of removable head <NUM> for connection to bolt <NUM>. Bolt <NUM> includes a shaft <NUM> having a proximal end <NUM> and a distal end <NUM>. Proximal end <NUM> includes a unitary head <NUM> having a rounded distal end <NUM>, a side circumferential edge <NUM>, and a flat bottom surface <NUM>. Distal end <NUM> includes a reduced diameter cylindrical portion <NUM>. Shaft <NUM> can be inserted through hole 328a of wing 300a, hole 328b of wing 300b, and through openings 138a, 138b of main body <NUM>. Proximal connector portion 326a of wing 300a is thereby adjacent to and connected to proximal connector portion 326b of wing 300b by bolt <NUM>. Shaft <NUM> has a diameter configured to fit through holes 328a, 328b and to allow the wings 300a, 300b to freely rotate thereabout. Once bolt <NUM> is inserted through main body <NUM> and wings 300a, 300b, a removable head <NUM> may be connected to cylindrical portion <NUM> to hold the bolt <NUM> securely in place. The head <NUM> may be connected by any mechanical fastening means. As shown in <FIG>, an embodiment of removable head <NUM> is shaped similarly to unitary head <NUM>, having a rounded distal end <NUM>, a side circumferential edge <NUM>, and a flat bottom surface <NUM>. Head <NUM> and head <NUM> are set within the openings 138a, 138b such that the distal ends <NUM>, <NUM> are recessed and do not extend circumferentially beyond the helical threads <NUM>, as seen in <FIG>.

<FIG> illustrates an embodiment of nut <NUM>. Nut <NUM> can be provided on the proximal end <NUM> of main body <NUM>. Nut <NUM> has a proximal side <NUM>, a distal side <NUM>, and an internal bore <NUM> therethrough. In some embodiments, internal bore <NUM> has interior helical threads <NUM> for cooperating with helical threads <NUM> on the exterior surface of main body <NUM>. In operation, the nut <NUM> can be rotated to move the nut longitudinally along the shaft of main body <NUM> such that the distal side <NUM> engages tissue and/or bone. In some embodiments, proximal side <NUM> has a hexagonal extension <NUM> with flat sides <NUM>. In some embodiments, distal side <NUM> forms a grip plate having a plurality of flex arms <NUM>. In one embodiment, the grip plate includes four flex arms <NUM>. In other embodiments, the grip plate may include two flex arms, three flex arms, or five or more flex arms.

In some embodiments, each flex arm <NUM> may have a fixed portion <NUM> with a smooth top surface <NUM> and a movable portion <NUM> with a textured top surface <NUM>. The movable portion <NUM> may have a space <NUM> therebelow. The textured top surface <NUM> is configured to engage bone or tissue when the implant is placed in the body to help anchor the implant <NUM> in place. The movable portion <NUM> is configured to flex into open space <NUM> when the implant <NUM> is engaged with tissue and/or bone. In some embodiments, the movable portion <NUM> may flex proximally an amount of from about <NUM> degree to about <NUM> degrees. In some embodiments, the movable portion <NUM> may flex proximally an amount of from about <NUM> degree to about <NUM> degrees. In some embodiments, the textured top surface <NUM> may include teeth, spikes, or any other type of mechanical gripping surface. In one embodiment, the textured top surface <NUM> may include three substantially triangular shaped teeth <NUM>. In other embodiments, the distal side <NUM> has a unitary circumferential roughened or textured surface without any flex arms. The nut <NUM> extends circumferentially a distance of about <NUM> to about <NUM> from the main body <NUM>. In some embodiments, the nut <NUM> extends circumferentially a distance of about <NUM> to about <NUM>. This reach allows for sufficient bone fixation while ensuring that the implant <NUM> can be easily inserted through a standard tissue dilation sleeve/tube.

The implant <NUM> may be provided in different selected sizes to properly fit into the desired space of a particular patient. The implant body diameter may provide for a range of about <NUM>-<NUM> spinous process space distraction. In some embodiments, the diameter of the main body <NUM> may be about <NUM>, about <NUM>, about <NUM>, about <NUM>, or about <NUM>. The sizes of the implant may be color-coded to allow the surgeon to easily identify the size of the implant and match the implant with a properly sized insertion tool (not shown), which may have similar size color-coding.

In some embodiments, all or part of the implant may be composed of titanium or a titanium alloy. In other embodiments, all or part of the implant may be composed of stainless steel. In some embodiments, all or part of the implant may be composed of a polymer or a bioabsorbable material. In some embodiments, the implant may be manufactured by an additive manufacturing process. In some embodiments, the implant may be manufactured by machining or molding. In some embodiments, all or part of the implant may include a coating on at least one surface thereof. In some embodiments, at least one outer surface of the implant may be coated with hydroxyapatite (HA).

In some embodiments, the implant may have a total length of about <NUM> to <NUM>. In some embodiments, the implant may have a total length of about <NUM> to about <NUM>. In some embodiments, the implant may have a total length of about <NUM>.

In some embodiments, main body <NUM> may be adapted to contain bone graft material therein. The bone graft material may be added to the implant <NUM> by holding wing 300a open and holding wing 300b closed and injecting bone graft material into the main body <NUM> (or vice versa). Bone graft material may also be applied around the exterior helical threads <NUM> before insertion of the implant <NUM> into the body. In some embodiments, the bone graft material may be viscous to avoid any interference with the proper functioning of the wings 300a, 300b. The volume of the bone graft material may range from about <NUM> cc to about <NUM> cc, or from about <NUM> cc to about <NUM> cc, depending on the size of the implant <NUM>.

The implant <NUM> may be inserted using an inserter device (not shown) into the body of a patient in the closed configuration, as shown in <FIG>, <FIG> and <FIG>. With respect to <FIG> and <FIG>, the plunger <NUM> is in a proximal position, such that the first and second linkages 500a, 500b form a first angle A therebetween and the wings 300a, 300b are in a closed configuration. Once the implant <NUM> is inserted into the desired location in the patient's body, the wings 300a, 300b can be moved to an open configuration, as shown in <FIG>, <FIG> and <FIG>. The plunger <NUM> may be moved distally such that the ends 502a, 504b of the linkages 500a, 500b, respectively, are caused to separate forming a second angle B therebetween, shown in <FIG>. Angle B is greater than angle A. In some embodiments, angle A is about <NUM>° and angle B is about <NUM>°. As the linkages 500a, 500b separate, the wings 300a, 300b rotate around pins <NUM> and bolt <NUM> into an open configuration.

The implant may then be moved proximally to engage the wings 300a, 300b with the bone and/or tissue at the implant site, as can be seen in <FIG>. The nut <NUM> may then be moved proximally, such as by rotation, to engage the bone and/or tissue as well forming a proximal anchor. Specifically, nut <NUM> engages a first lateral surface <NUM> of a first spinous process <NUM> and a second lateral surface <NUM> of a second spinous process <NUM>. In some embodiments, the flex arms <NUM> may be flexed proximally when the nut <NUM> is tightly engaged with bone and/or tissue at the implant site. Additionally, wings 300a, 300b engage a third opposite surface <NUM> of first spinous process <NUM> and a fourth opposite surface <NUM> of second spinous process <NUM>. Specifically, the fangs 310a, 311a, 310b, 311b of wings 300a, 300b may engage with the bone and/or tissue at the implant site forming a distal anchor. In some embodiments, the wings 300a, 300b and the nut <NUM> can be engaged on opposite sides of the spinal process when the implant <NUM> is in place, as seen in <FIG>.

Features described above as well as those claimed below may be combined in various ways without departing from the scope hereof. The following examples illustrate some possible, non-limiting combinations:.

Claim 1:
A spinal implant (<NUM>) comprising:
a main body (<NUM>) having an outer surface, a proximal end (<NUM>), a distal end (<NUM>), and a longitudinal axis extending therebetween, said main body including a central bore therein;
a proximal anchor comprising: a nut (<NUM>) having a proximal side, a distal side, and an internal bore;
a distal anchor comprising: a plurality of wings (300a, 300b) having a first closed configuration and a second open configuration,
wherein the plurality of wings comprises a first wing (300a) having a first end and a second end and a second wing (300b) having a first end and a second end, wherein the first end of the first wing and the first end of the second wing connect to the main body via a bolt (<NUM>); and
an internal plunger (<NUM>) having a proximal end and a distal end, said internal plunger housed within the central bore of the main body, said distal end of the internal plunger operatively connected to the first wing and the second wing by a linkage assembly to selectively move the plurality of wings between the first closed configuration and the second open configuration,
wherein the linkage assembly comprises a first linkage (500a) having a proximal end and a distal end and a second linkage (500b) having a proximal end and a distal end, the distal end of the first linkage connected to the first wing via a first mounting pin (<NUM>) and the distal end of the second linkage connected to the second wing via a second mounting pin (<NUM>).