Systems and methods for delivering an implant between adjacent vertebras using endoscopy   

Abstract: An optical intervertebral implantation system can be used for a method of implanting an intervertebral implant into an intervertebral space with visualization. The system can include an elongate light guide and an intervertebral implant operably coupled with the elongate light guide. The elongate light guide can be configured as a guide wire and received through an aperture of the implant. The elongate light guide can be configured as a guide wire and the implant is received over and slides along on outside surface of the elongate light guide. The elongate light guide can be configured as a cannula having an internal conduit and the implant is received within the conduit. The elongate light guide can be configured as a cannula with an internal conduit and the implant is slidably coupled with an internal surface of the internal conduit of the cannula.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent application Ser. No. 13/370,925 filed Feb. 10, 2012 and continuation-in-part of U.S. patent application Ser. No. 13/478,870 filed May 23, 2012, which are continuation-in-parts of U.S. patent application Ser. No. 13/199,324 filed Aug. 26, 2011 [P12], which is a continuation-in-part of U.S. patent application Ser. No. 13/065,291, filed Mar. 18, 2011 [P11], which patent applications are incorporated herein by specific reference in their entirety.

An intervertebral disc is a soft tissue compartment connecting the vertebra bones in a spinal column. Each healthy disc consists of two parts, an outer annulus fibrosis (hereinafter “the annulus”) and an inner nucleus pulposes (hereinafter “the nucleus”). The annulus completely circumscribes and encloses the nucleus. The annulus is connected to its adjacent associated pair of vertebrae by collagen fibers. The intervertebral disc is an example of a soft tissue compartment adjoining first and second bones (vertebra) having an initial height and an initial width. Other joints consisting of a soft tissue compartment adjoining at least first and second bones having an initial height and an initial width include the joints of the hand, wrist, elbow, shoulder, foot, ankle, knee, hip, and the like.

Typically, when a disc is damaged, the annulus ruptures and the nucleus herniates. Discectomy surgery removes the extruded nucleus, leaving behind the ruptured annulus. The ruptured annulus is, by itself, ineffective in controlling motion and supporting the loads applied by the adjacent pair of vertebrae. With time, the disc flattens, widens, and bulges, compressing nerves and producing pain. Uncontrolled loads are transmitted to each vertebra. Each vertebra tends to grow wider in an attempt to distribute and compensate for higher loads. When a vertebra grows, bone spurs form. The bone spurs further compress nerves, producing pain. In response to damaged discs, especially herniated disks, a variety of intervertebral devices are disclosed in the art to replace the intervertebral disc. Such devices are implanted intermediate an adjacent pair of vertebra, and function to assist the vertebra. These devices do not assist the intervertebral disc. In fact, in many cases the disc is removed. Insertion of these devices has heretofore been complicated, problematic, and usually performed blindly or with only fluoroscopy or other radioimaging techniques.

In one embodiment, a system of the present invention can include a cannula, which may be an elongate light guide having an implant in a lumen therein, or may be configured to receive an elongated light guide having an implant thereon. The cannula can include a distal end with a pointed, canted end configured to push a nerve laterally with respect to the cannula when the pointed, canted distal end contacts the nerve and the cannula is rotated. That is, the distal end can have a sloped surface that extends from a tip to a more proximal portion, where the sloped surface extends from one side of the cannula to the other side of the cannula, such as shown in FIGS. 232-235 and 235F-235I. Accordingly, the distal end of the cannula includes an asymmetrical end or point from one side to the other, and the distal end can also be blunt or flat and inserted on an angle.

In one embodiment, a method of implanting an intervertebral implant can use the cannula having the pointed, canted distal end. In one aspect, this cannula and/or implant can be used to pass by a nerve without severing or injuring the nerve. The pointed end can be passed by the nerve so that the sloped surface of the pointed, canted end contacts the nerve. In one aspect, the sloped surface can be pushed past the nerve so that the nerve moves laterally and onto a side surface of the cannula and/or implant, where the side surface of the cannula and/or implant can be a longitudinally extending surface that extends between a distal and a proximal end. In another aspect, the nerve can be moved laterally around the distal end of the cannula and/or implant by contacting the sloped surface of the pointed, canted distal end of the cannula and/or implant with a nerve; and rotating the pointed, canted distal end of the cannula and/or implant so as to push the nerve laterally with respect to the cannula and/or implant until the nerve no longer contacts a side surface of the cannula. That is, the rotation of the cannula moves the nerve laterally from the sloped surface to the side surface of the cannula and/or implant, such as the side surface of the cannula and/or implant has a longitudinally extending surface that extends between a distal and a proximal end.

In view of the foregoing, it would be advantageous to have implantation devices, systems, and methods that allow for visualization of the disc as well as the implantation of a medical device between adjacent vertebra using endoscopy.

SUMMARY

In one embodiment, an optical intravertebral implantation system can include: an elongate light guide; and an intravertebral implant slideably coupled with the elongate light guide. The elongate light guide can be configured as a guide wire and received through an aperture of the implant. The elongate light guide can be configured as a guide wire and the implant is received over and slides along on outside surface of the elongate light guide. The elongate light guide can be configured as a cannula having an internal conduit and the implant is received within the conduit. The elongate light guide can be configured as a cannula with an internal conduit and the implant is slidably coupled with an internal surface of the internal conduit of the cannula.

The system can have various configurations, such as: the elongate light guide is bendable or rigid; the elongate light guide can be operably coupled to a image sensor; the elongate light guide can be operably coupled with a monitor; the elongate light guide can be coupled to one or more imaging focusing elements.

In one embodiment, the system can include a coloring agent.

In one embodiment, an implant delivery device, such as a push member or the like can be coupled with the implant and the implant delivery device is slidably coupled with the elongate light guide.

In one embodiment, the elongate light guide includes a first optical fiber operably coupled with a light source and a second optical fiber coupled to an image sensor. Additional optical fibers may be used.

In one embodiment, the implant is not rotatable with respect to the elongate light guide.

In one embodiment, the elongate light guide can be configured as a guide wire and the implant is received over and slides along on outside surface of the elongate light guide, and can also include a cannula having an internal conduit adapted to receive the implant and elongate light guide therethrough.

In one embodiment, the elongate light guide can be configured as a cannula with an internal conduit and the implant is slidably coupled with an internal surface of the internal conduit of the cannula, and can also include a guide wire slidably received through an aperture of the implant.

In one embodiment, a method of implanting an intravertebral implant with visualization can include: obtaining the implant system having an elongate light guide with an intravertebral implant slidably coupled therewith; inserting the elongate light guide into an intravertebral space; sliding the intravertebral implant along the elongate light guide, the implant being slideably coupled with the elongate light guide; implanting the implant in the intravertebral space after sliding the implant off of the elongate light guide; and visualizing the implant in the intravertebral space with the elongate light guide.

In one embodiment, the method can also include: obtaining the elongate light guide configured as a guide wire; inserting the elongate light guide through an aperture of the implant; and pushing the implant off of a distal end of the elongate light guide.

In one embodiment, the method can also include obtaining the elongate light guide configured as a guide wire; operably coupling the implant with the elongate light guide such that the implant is received over and slides along on outside surface of the elongate light guide; and pushing the implant off of a distal end of the elongate light guide.

In one embodiment, the method can also include: obtaining the elongate light guide configured as a cannula having an internal conduit; operably coupling the implant with the cannula so as to be received within the conduit; and pushing the implant out of the conduit.

In one embodiment, the method can also include: obtaining the elongate light guide configured as a cannula with an internal conduit; operably coupling the implant with the cannula so as to be slidably coupled with an internal surface of the internal conduit of the cannula; and pushing the implant out of the conduit.

In one embodiment, the method can also include: operably coupling the elongate light guide a image sensor; and viewing the implantation of the implant into the intravertebral space.

In one embodiment, the method can also include: creating internal traction within a disc between adjacent vertebras with the implant by implantation such that the adjacent vertebras are separated from an initial distance apart to a longer distance apart by the implant; and visualizing the internal traction.

In one embodiment, the method can also include: injecting a coloring agent into the intravertabral space; and visually distinguishing between healthy tissue portions and damaged tissue portions with the coloring agent.

In one embodiment, the method can also include: injecting a coloring agent into the intravertabral space; and visually distinguishing between a first tissue type and a second tissue type with the coloring agent.

In one embodiment, the method can also include: obtaining the implant so as to be coupled to an implant delivery device; sliding the implant along the elongate light guide with the implant delivery device; and uncoupling the implant from the implant delivery device for implantation of the implant into the intravertebral space.

In one embodiment, the method can also include: obtaining the elongate light guide to include a first optical fiber operably coupled with a light source and a second optical fiber coupled to an image sensor; and observing an image of the implant in the intravertebral space on a monitor, the image being provided to the monitor from the image sensor.

In one embodiment, the method can also include: rotating the elongate light guide so as to correspondingly rotate the implant.

The foregoing summary is illustrative only and is not intended to be in any way limiting. In addition to the illustrative aspects, embodiments, and features described above, further aspects, embodiments, and features will become apparent by reference to the drawings and the following detailed description.

The foregoing and following information as well as other features of this disclosure will become more fully apparent from the following description and appended claims, taken in conjunction with the accompanying drawings. Understanding that these drawings depict only several embodiments in accordance with the disclosure and are, therefore, not to be considered limiting of its scope, the disclosure will be described with additional specificity and detail through use of the accompanying drawings, in which:

FIG. 1 is a perspective view illustrating an intervertebral device constructed in accordance with the principles of the invention;

FIG. 1A is a perspective view of a tool that can be utilized in the practice of the invention;

FIG. 2 is a perspective—partial section view of the device of FIG. 1 illustrating additional construction details thereof;

FIG. 3 is an exploded view of certain components of the device of FIG. 1:

FIG. 4 is a perspective view further illustrating the device of FIG. 1;

FIG. 5 is a perspective view of the device of FIG. 1 illustrating certain components in ghost outline;

FIG. 6 is a top view illustrating the insertion of the device of FIG. 1 in an intervertebral disc adjacent the spinal column;

FIG. 7 is a side elevation view further illustrating the insertion of the device of FIG. 1 in the spinal column;

FIG. 8 is a top view illustrating a damaged intervertebral disc with a portion thereof bulging and pressing against the spinal column;

FIG. 9 is a top view illustrating the disc of FIG. 8 manipulated with a device constructed in accordance with the invention to alter the shape and dimension of the disc to revitalize the disc and take pressure off the spinal column;

FIG. 10 is a top view illustrating the disc of FIG. 8 manipulated with an alternate device constructed in accordance with the invention to alter the shape and dimension of the disc to revitalize the disc and take pressure off the spinal column;

FIG. 11 is a top view illustrating the disc of FIG. 8 manipulated in accordance with the invention to alter the shape of the disc from a normal “C-shape” to an oval shape;

FIG. 12 is a side elevation view illustrating a bulging disc intermediate a pair of vertebrae;

FIG. 13 is a side elevation view illustrating the disc and vertebrae of FIG. 12 after internal traction;

FIG. 14 is a side elevation view illustrating a rubber band or string that has a bulge similar to the bulge formed in a intervertebral disc;

FIG. 15 is a side elevation view illustrating the rubber band of FIG. 14 after it has been tensioned to remove the bulge;

FIG. 16 is a perspective view illustrating a spring apparatus in accordance with an alternate embodiment of the invention;

FIG. 17 is a front elevation view illustrating the embodiment of the invention of FIG. 16;

FIG. 18 is a perspective view illustrating an insertion member utilized to implant the spring apparatus of FIG. 16 in a spinal disc;

FIG. 19 is a top view illustrating the insertion member of FIG. 18 after the spring apparatus is implanted in a spinal disc;

FIG. 20 is a top view of a portion of a spinal column illustrating the spring of FIG. 16 inserted in a disc;

FIG. 21 is a perspective view illustrating a spring apparatus constructed in accordance with a further embodiment of the invention;

FIG. 22 is a perspective view illustrating a spring apparatus constructed in accordance with another embodiment of the invention;

FIG. 23 is a side section view illustrating the mode of operation of the spring apparatus of FIG. 21 when interposed between an opposing pair of vertebra in a spinal column;

FIG. 24 is a side view further illustrating the mode of operation of the spring apparatus of FIG. 21 when compressed between an opposing pair of vertebra in a spinal column;

FIG. 25 is a perspective view illustrating still another spring apparatus constructed in accordance with the invention;

FIG. 26 is a side section view of a portion of the spring apparatus of FIG. 25 illustrating the mode of operation thereof;

FIG. 27 is a side section view of a portion of the spring apparatus of FIG. 25 further illustrating the mode of operation thereof;

FIG. 28 is a perspective view illustrating a constant force coil leaf spring used in still a further embodiment of the invention;

FIG. 29 is a side view illustrating the mode of operation of a constant force spring inserted between an opposing pair of vertebra;

FIG. 30 is a side section view illustrating still another embodiment of the spring apparatus of the invention;

FIG. 30A is a front perspective view of the spring apparatus of FIG. 30;

FIG. 31 is a side section view illustrating the mode of operation of the spring apparatus of FIG. 30;

FIG. 31A is a front perspective view of the spring apparatus of FIG. 31;

FIG. 32 is a perspective view illustrating the manufacture of the spring apparatus of FIG. 16;

FIG. 33 is a perspective view illustrating a spring apparatus producing in accordance with the manufacturing process illustrating in FIG. 32;

FIG. 34 is a perspective view illustrating the general relationship of the spine and anatomical planes of the body;

FIG. 35 is a perspective view illustrating the use of an apparatus to pivot in one rotational direction one member with respect to another adjacent member;

FIG. 36 is a perspective view illustrating the use of the apparatus of FIG. 35 to pivot in one rotational direction one vertebra with respect to an adjacent vertebra;

FIG. 37 is a perspective view illustrating the use of an apparatus to pivot in at least two rotational directions one member with respect to another adjacent;

FIG. 38 is a perspective view illustrating the use of the apparatus of FIG. 37 to pivot in at least two rotational directions one vertebra with respect to an adjacent vertebra;

FIG. 39 is a perspective view illustrating the use of apparatus to pivot in at least two rotational directions and to rotate one member with respect to another adjacent member;

FIG. 40 is a perspective view illustrating the use of the apparatus of FIG. 39 to pivot in at least two rotational directions and to rotate one vertebra with respect to an adjacent vertebra;

FIG. 41 is a side elevation view of a portion of a spine illustrating principal nerves that exit the spine;

FIG. 42 is a side view illustrating an instrument constructed in accordance with the principles of the invention to minimize the risk of injury to soft tissue and hard tissue while producing an opening in the tissue;

FIG. 43 is a front view of a portion of a spine illustrating the insertion along a wire of an instrument constructed in accordance with the invention;

FIG. 44 is a top view illustrating the mode of operation of the instrument of FIG. 42;

FIG. 45 is a front view further illustrating the mode of operation of the instrument of FIG. 42;

FIG. 46 is a top view illustrating an instrument construction that is to be avoided in the practice of the invention;

FIG. 46A is a section view illustrating the instrument of FIG. 46 and taken along section line 46A-46A;

FIG. 47 is a top view illustrating an instrument construction that can be utilized in the practice of the invention;

FIG. 47A is a section view illustrating the instrument of FIG. 47 and taken along section line 47A-47A;

FIG. 47B is a top view illustrating another instrument constructed in accordance with the invention;

FIG. 47C is a side view illustrating the instrument of FIG. 47B;

FIG. 47D is a top view illustrating a further instrument constructed in accordance with the invention;

FIG. 47E is a perspective view illustrating the mode of operation of the instrument of FIG. 47D;

FIG. 48 is a top view illustrating another instrument construction that can be utilized in accordance with the invention;

FIG. 48A is a section view illustrating the instrument of FIG. 48 and taken along section line 48A-48A;

FIG. 49 is a top view illustrating a further instrument construction that can be utilized in the invention;

FIG. 49A is a section view illustrating the instrument of FIG. 49 and taken along section line 49A-49A;

FIG. 50 is a top view further illustrating the insertion of the instrument of FIG. 43 in an intervertebral disc along a wire;

FIG. 51 is a side view further illustrating the instrument of FIG. 43;

FIG. 52 is a side view of an instrument that functions both to produce an opening in the tissue and to insert an implant once the opening has been produced;

FIG. 53 is a side view illustrating the apex of a misaligned spine;

FIG. 54 is a side view illustrating the apex of another misaligned spine;

FIG. 55 is an end view illustrating an intervertebral implant;

FIG. 56 is a side view illustrating the implant of FIG. 55;

FIG. 57 is a top view illustrating an intervertebral implant;

FIG. 58 is a front view illustrating the implant of FIG. 57;

FIG. 59 is a bottom view illustrating the implant of FIG. 57;

FIG. 60 is a side view illustrating the implant of FIG. 57;

FIG. 61 is a back view of the implant of FIG. 57;

FIG. 62 is a top view illustrating an intervertebral implant;

FIG. 63 is a side view illustrating the implant of FIG. 62;

FIG. 64 is a bottom view illustrating the implant of FIG. 62;

FIG. 65 is a back view illustrating the implant of FIG. 62;

FIG. 66 is a section view illustrating the implant of FIG. 63 and taken along section line a-a in FIG. 63;

FIG. 67 is a top perspective view illustrating the implant of FIG. 62;

FIG. 68 is a bottom perspective view illustrating the implant of FIG. 62;

FIG. 69 is a bottom view illustrating an intervertebral implant;

FIG. 70 is a left hand side view illustrating the implant of FIG. 69;

FIG. 71 is a right hand side view illustrating the implant of FIG. 69;

FIG. 72 is a top view illustrating the implant of FIG. 69;

FIG. 73 is a perspective view illustrating an intervertebral implant having an aperture formed therethrough to receive slidably a guide wire;

FIG. 74 is a top view illustrating the implant of FIG. 73;

FIG. 75 is a side view illustrating the implant of FIG. 73;

FIG. 76 is an end view illustrating the implant of FIG. 73;

FIG. 77 is a perspective view illustrating an intervertebral implant;

FIG. 78 is a side view illustrating the implant of FIG. 77;

FIG. 79 is a top view illustrating the implant of FIG. 77;

FIG. 80 is an end view illustrating the implant of FIG. 77;

FIG. 81 is a side view illustrating an intervertebral implant;

FIG. 82 is an end view illustrating the implant of FIG. 81;

FIG. 83 is a top view illustrating the implant of FIG. 81;

FIG. 84 is a perspective view illustrating the implant of FIG. 81;

FIG. 85 is a back view illustrating the implant of FIG. 81;

FIG. 86 is a perspective view illustrating an intervertebral implant;

FIG. 87 is a side view of the implant of FIG. 86;

FIG. 88 is a perspective view illustrating an intervertebral implant;

FIG. 89 is a side view of the implant of FIG. 88;

FIG. 90 is an exploded perspective view illustrating an intervertebral implant;

FIG. 91 is a side view illustrating a unitary intervertebral implant;

FIG. 92 is an end view illustrating the implant of FIG. 91;

FIG. 93 is a side view illustrating a unitary intervertebral implant;

FIG. 94 is a left hand end view illustrating the implant of FIG. 93;

FIG. 95 is a perspective view illustrating a portion of an articulating intervertebral implant;

FIG. 96 is a back view illustrating the implant portion of FIG. 95;

FIG. 97 is a top view illustrating the implant portion of FIG. 95;

FIG. 98 is an end view illustrating the implant portion of FIG. 95;

FIG. 99 is a side view illustrating the implant portion of FIG. 95;

FIG. 100 is a perspective view illustrating a unitary intervertebral implant;

FIG. 101 is an end view illustrating the implant of FIG. 100;

FIG. 102 is a side view illustrating the implant of FIG. 100;

FIG. 103 is a side view illustrating an intervertebral implant;

FIG. 104 is an end view illustrating the implant of FIG. 103;

FIG. 105 is a perspective view illustrating an intervertebral implant;

FIG. 106 is a side view illustrating the implant of FIG. 105;

FIG. 107 is a top view illustrating the implant of FIG. 105;

FIG. 108 is an end view illustrating the implant of FIG. 105;

FIG. 109 is a front view illustrating the implant of FIG. 105;

FIG. 110 is a top view illustrating an articulating intervertebral implant;

FIG. 111 is a side view illustrating the implant of FIG. 110 in alignment to slide down a guide wire;

FIG. 112 is a top section view of the implant of FIG. 110 illustrating internal construction details thereof;

FIG. 113 is perspective view illustrating a unitary intervertebral implant;

FIG. 114 is a side view illustrating the implant of FIG. 113;

FIG. 115 is a top view illustrating the implant of FIG. 113;

FIG. 116 is an end view illustrating the implant of FIG. 113;

FIG. 117 is a perspective view illustrating a unitary intervertebral implant;

FIG. 118 is a side view illustrating the implant of FIG. 117;

FIG. 119 is a top view illustrating the implant of FIG. 117;

FIG. 120 is an end view illustrating the implant of FIG. 117;

FIG. 121 is a perspective view illustrating a unitary intervertebral implant;

FIG. 122 is a top view illustrating the implant of FIG. 121;

FIG. 123 is a side view of the implant of FIG. 122;

FIG. 124 is an end view illustrating the implant of FIG. 123;

FIG. 125 is a perspective view illustrating an intervertebral implant;

FIG. 126 is a top view illustrating the implant of FIG. 125;

FIG. 127 is a side view illustrating the implant of FIG. 125;

FIG. 128 is a left hand side view illustrating the implant of FIG. 127;

FIG. 129 is a right hand side view illustrating the implant of FIG. 127;

FIG. 130 is an exploded ghost view further illustrating the implant of FIGS. 57 to 61;

FIG. 131 is a perspective view illustrating a component of the implant of FIG. 130;

FIG. 132 is a top view illustrating the component of FIG. 131;

FIG. 133 is a section view further illustrating the component of FIG. 132 and taken along section line A-A thereof;

FIG. 134 is a front view illustrating the component of FIG. 132;

FIG. 135 is a side view illustrating the component of FIG. 134;

FIG. 136 is a bottom view of the component of FIG. 134;

FIG. 137 is a perspective view illustrating a component of the implant of FIG. 130;

FIG. 138 is a side view illustrating the component of FIG. 137;

FIG. 139 is a front view illustrating the component of FIG. 138;

FIG. 140 is a bottom view illustrating the component of FIG. 138;

FIG. 141 is a bottom perspective view illustrating a component of the implant of FIG. 130;

FIG. 142 front view illustrating the component of FIG. 141 inverted;

FIG. 143 is a side view illustrating the component of FIG. 142;

FIG. 144 is a section view illustrating the component of FIG. 143 and taken along section line A-A thereof;

FIG. 145 is a bottom view illustrating the component of FIG. 142;

FIG. 146 is a front view illustrating a component of the implant of FIG. 130;

FIG. 147 is a top view illustrating the component of FIG. 146;

FIG. 148 is a side view illustrating the component of FIG. 146;

FIG. 149 is a perspective view illustrating the implant of FIG. 130 assembled and illustrating the mode of operation thereof;

FIG. 150 is a side view illustrating another implant constructed in accordance with the invention;

FIG. 151 is a top view illustrating the implant of FIG. 150;

FIG. 152 is an end view illustrating the implant of FIG. 151;

FIG. 153 is a perspective view illustrating the rocker component of the implant of FIG. 150;

FIG. 154 is a side view illustrating the rocker component of FIG. 153;

FIG. 155 is a bottom view illustrating the rocker component of FIG. 154;

FIG. 156 is a front view illustrating the rocker component of FIG. 154;

FIG. 157 is a perspective view illustrating the base component of the implant of FIG. 150;

FIG. 158 is a top view illustrating the base component of FIG. 150;

FIG. 159 is an end view illustrating the base component of FIG. 158;

FIG. 160 is a side view illustrating the base component of FIG. 158;

FIG. 161 is a top view illustrating a further implant, which implant is similar to the implant of FIG. 150;

FIG. 162 is a side view of the implant of FIG. 161;

FIG. 163 is a side view rotated ninety degrees clockwise of the implant of FIG. 161;

FIG. 164 is a perspective view illustrating still another intervertebral implant;

FIG. 165 is a perspective view illustrating still a further intervertebral implant constructed in accordance with the invention to displace transversely one spinal vertebra with respect to an adjacent spinal vertebra;

FIG. 166 is a top view illustrating the implant of FIG. 165;

FIG. 167 is an end view rotated ninety degrees clockwise illustrating the implant of FIG. 166;

FIG. 168 is a side view illustrating the implant of FIG. 167;

FIG. 169 is a bottom view illustrating the implant of FIG. 167;

FIG. 170 is an exploded ghost view illustrating further construction details of the implant of FIG. 165;

FIG. 171 is a perspective ghost view illustrating the implant of FIG. 165 and the mode of operation thereof;

FIG. 172 is a perspective view illustrating yet another implant;

FIG. 173 is bottom view illustrating the implant of FIG. 172;

FIG. 174 is a back or rear view rotated ninety degrees clockwise illustrating the implant of FIG. 173;

FIG. 175 is a front end view rotated ninety degrees counterclockwise illustrating the implant of FIG. 173;

FIG. 176 is a side view illustrating the implant of FIG. 173;

FIG. 177 is a perspective view illustrating the mode of operation of the implant of FIG. 173;

FIG. 178 is a perspective view illustrating an instrument constructed in accordance with the invention;

FIG. 179 is a perspective view illustrating the mode of operation of the instrument;

FIG. 180 is a perspective view illustrating a floating implant constructed in accordance with the invention;

FIG. 181 is an end view further illustrating the implant of FIG. 180;

FIG. 182 is a top view further illustrating the implant of FIG. 180;

FIG. 183 is a side view of the implant of FIG. 180 illustrating additional construction details thereof;

FIG. 184 is a perspective exploded view illustrating an orthogonal implant system constructed in accordance with the invention;

FIG. 185 is a perspective view illustrating an implant insertion instrument;

FIG. 186 is a perspective view illustrating an implant utilized to separate a pair of opposing vertebrae;

FIG. 187 is a top view illustrating the mode of operation of an instrument constructed in accordance with another embodiment of the invention;

FIG. 188 is a perspective view further illustrating the use of the instrument of FIG. 187;

FIG. 189 is a side view of a portion of a spine illustrating the use of implants to pivotally adjust vertebrae;

FIG. 190 is a front view illustrating an implant inserted between a pair of opposing spinous processes;

FIG. 191 is a front view illustrating another implant inserted between a pair of opposing spinous processes;

FIG. 192 is a front view illustrating a further implant inserted between a pair of opposing spinous processes;

FIG. 193 is a perspective view illustrating an implant inserted between a pair of opposed, adjacent spinous processes;

FIG. 194 is a top view of the spinous processes/implant of FIG. 193 illustrating further details thereof;

FIG. 195 is a front view of the spinous processes/implant of FIG. 193 illustrating additional construction details thereof;

FIG. 196 is a side view of the spinous processes/implant of FIG. 193 illustrating additional construction details thereof;

FIG. 197 is a perspective view illustrating an implant including a deployable wing component;

FIG. 198 is a perspective view illustrating an alternate embodiment of an implant with a deployable wing component;

FIG. 199 is an exploded perspective view illustrating an alternate embodiment of an implant constructed in accordance with the invention;

FIG. 200 is a bottom view further illustrating the implant of FIG. 199;