US 5,935,133 AGrant

Surgical Cable System and Method

Issue Date:1999-08-10

•45 Claims

•8 Drawing Sheets

Abstract

A surgical cable system and method for securing surgical cable around a portion of a human element (e.g., bone) is described. The surgical cable system may include a connector and a tensioner. The connector may be adapted to hold a pin, positionable within the connector, such that the pin may secure the cable within the connector. The pin may be repositioned, after securing the cable, to allow the cable to move freely through the connector. The cable may be oriented within the connector such that the ends of the cable are pependicular or parallel with respect to each other. The tensioner is preferably adapted to vary the tension of the cable. The cable may be passed through the connector, around a portion of a human bone, and back through the connector. The cable may be tensioned by use of the tensioner and secured into position within the connector.

Metadata

Assignee

Spinal Concepts, Inc.

Inventors

Erik J. Wagner
Michael C. Dinsdale

Application Information

Application Number:US 2118874

Filing Date:1998-12-15

Priority Date:1997-08-26

Art Unit:371

Classifications

IPC:

A61B 1756

Field of Search:

60661;60;74;86;103

Patent Drawings (8 sheets)

Description

Background of the Invention

1. Field of the Invention

The present invention generally relates to surgical cable systems and the like. More particularly, an embodiment of the invention relates to a method and apparatus for securing surgical cable around a portion of a human bone.

2. Description of the Related Art

Surgical cables are used in a variety of surgical procedures, some examples include: spine surgery; total hip arthroplasty; fracture fixation; closure of the sternum following open heart surgery; and oral/facial surgery to repair mandibular fractures. In these and other surgical procedures the cable may be used to set and secure bone portions in the proper orientation during the healing process.

Fractures of the vertebrae in the spinal column are very difficult to imrnobilize, often requiring the use of internal pins, cables and/or rods. One frequently used procedure involves wiring the fractured vertebra to one or more adjacent vertebrae to secure the vertebra in an ideal position for healing. Another method involves wiring the fractured vertebra to a rod that is similarly joined to other vertebrae. Both of these methods, as well as other techniques for spinal repair, rely on the use of cables which are secured around a portion of a vertebra.

A number of methods for encircling bone portions with surgical cables have been developed. Most of these techniques involve passing a cable around a portion of the bone and securing the cable in position using a crimp. Example of cabling apparatus and methods are illustrated in U.S. Pat. Nos. 4,966,600; 5,395,374; 5,415,658; 5,423,820, and 5,569,253. Each of these patents is incorporated by reference as if fully set forth herein.

The Acromed.TM. Cable System by Songer, as shown in U.S. Pat. No. 4,966,600, represents a cabling system that relies on the use of a metal crimp member to secure a cable in a loop. In one embodiment of the Acromed.TM. system a crimp member is affixed to one end of the cable. The cable may then be passed partially through a connector. The crimp member may inhibit the cable from passing entirely through the connector. The cable may then be looped around the bone portion and passed again through the connector. A tensioning device is used to tighten the cable around the bone portion, and another crimp member is applied to the portion of the wire extending out from the connector to fix the cable in position.

The Acromed.TM. system relies on crimp members to attempt to irreversibly secure the cable in position. This feature may present difficulties if a number of cables are used in series since it is often necessary to retighten some of the cables as other cables are added. To overcome this problem a double crimp technique is commonly used. In this technique the cable is passed through two crimp members before the cable is tensioned. After tensioning, the top crimp member may be affixed to the cable. When the cable becomes loosened, it may be re-tensioned and the lower crimp member affixed to the cable. The upper crimp member may be trimmed off after the second crimp member is fastened to the cable. A disadvantage of this approach is that the number of re-tensions that may be performed is determined by the number of crimp members attached to the cable before the initial tensioning. If additional re-tensioning is required after the last crimp member has been attached to the cable, the cable may need to be removed and a new cable attached.

An orthopedic cable apparatus manufactured by Danek Medical Inc., as shown in U.S. Pat. Nos. 5,395,374 and 5,423,820, appears to overcome these problems. The apparatus consists of three separate parts: a double-apertured L-shaped crimp; a cable clamp; and a tensioning tool. The Danek system affixes one end of the cable to the double-apertured L-shaped crimp. The cable is then looped around the bone portion and passed through the other aperture of the L-shaped crimp. The cable is then passed through a cable clamp, and further through a tensioner. The tensioning device is used to tighten the cable around the vertebra. Once the appropriate tension is achieved the cable clamp is tightened to temporarily fix the cable in position. Since the cable clamp acts as a non-permanent securing device, the user is free to re-tension the cable a number of times during use. When the user is finished, the cable is fixed into position by crimping the second crimp portion of the L-shaped crimp onto the cable. The Danek cabling system avoids the need for multiple crimps, as used by the Acromed.TM. system, however, it still relies on crimps to secure the cable in position.

A disadvantage to the use of crimps for securing a cable in position is that the crimps may be highly unreliable. The crimps are typically compressed by the user to affix them to the cable. However, it may be very difficult to control the percentage of deformation of the crimp such that a predictable and consistent amount of deformation may be produced. If the crimp is over deformed some of the cable strands may be sheared off, reducing the strength of the cable at the connection. Conversely, if the crimp is under deformed, the crimp may be incapable of preventing the cable from loosening after the procedure is finished.

Another problem encountered when using cable systems is that they force the cable into a specific position relative to the point where the cable crosses itself. In some cases there is an advantage for the ends of the cable to be in a parallel orientation. Such an orientation allows a minimal profile of the connector. A low profile width is generally desired to minimize sinus formation and soft tissue irritation. The parallel orientation may sometimes cause a sharp bend in the cable, thereby creating stress in the system. To overcome this stress it is desirable for the ends of the cable to be in a perpendicular orientation relative to each other.

The Acromed.TM. apparatus, as shown in U.S. Pat. No. 4,966,600, may be used in a number of ways in order to achieve the desired cable orientation. In one method the cable comprises a permanently looped eyelet end. The other end of the cable may be through the eyelet to form a loop in which the ends of the cable reoriented perpendicular fashion. In another method the ends of the cable may be held in a parallel orientation by using a special connector designed for this purpose. The Danek system, as shown in U.S. Pat. No. 5,569,253, is also designed for use with the ends of the cable in a parallel or perpendicular orientation. The Danek sytn relies on the use of specially designed connectors for each orientation. Neither the Acromed or the Danek systems describe a single connector which would allow the cable to be positioned in both a parallel and a perpendicular orientation.

The above mentioned methods and systems inadequately address, among other things, the need for an apparatus that allows re-tensioning of the cable, as well as multiple orientations of the cable. The devices abo rely on crimps affixed to the cables to hold the cable in place. As mentioned before, such crimps may be unreliable. It is therefore desirable that a cable system be derived that incorporates, in a single device, the ability to allow the cable to be re-tensioned, a non crimping securing mechanism, and multiple cable orientations.

Summary of the Invention

An embodiment of the invention relates to a surgical cable system that preferably includes a connector adapted to hold a cable in a loop around a human bone element and a tensioner. The connector may include a connector body, a cable, and a pin adapted to secure the cable within the connector body. The term "cable" within the context of this application is taken to mean an elongated flexible member. The term "pin" within the context of this application is taken to mean an elongated inflexible member.

The connector body preferably includes a first arm and a second arm, an internal cavity, and at least two ducts. The first and second arms preferably extend from the same face of the connector body such that the connector body is substantially U-shaped. The internal cavity preferably runs longitudially through the entire connector body and passes in between the two arms. The ducts preferably run transversally through the entire connector body, perpendicular to the internal cavity. The ducts are preferably oriented such that the ends of a cable, when the cable is passed through the ducts to form a loop, may be oriented in a substantially parallel orientation with respect to each other. The ducts are preferably located proximate to the internal cavity. The connector body may contain at least one aperture that is positioned between a duct and the internal cavity. The connector body preferably contains two apertures that connect two separate ducts to the internal cavity. The ducts, the apertures, and the internal cavity are oriented with respect to one another such that a cable passing through the duct may extend through the aperture into the internal cavity.

The cable is preferably substantially flexible such that the cable may form a loop for engaging a portion of a human bone. The cable is preferably of a diameter such that the cable may pass freely through a duct. The cable is also preferably of a diameter such that it may extend from the duct, through the aperture, and into the internal cavity. The cable preferably includes a tip which may inhibit the end of the cable from passing through the duct

The pin comprises an upper portion and a lower portion. The upper portion may have a diameter that is substantially larger than the diameter of the internal cavity such that the upper portion of the pin is inhibited from passing through the internal cavity. The lower portion of the pin may have a diameter that is substantially less than the diameter of the internal cavity such that the lower portion of the pin fits within the internal cavity.

The pin may be positionable within the internal cavity where it may exert a compressive force against the cable to secure the cable within the internal cavity. The cable may be looped around a bone and through the ducts. Subsequently, positioning the pin within the connector body may secure the cable in place. While the cable is secured the cable is no longer able to move within the connector. The bottom edge of the pin may be deformed to secure the pin within the internal cavity.

More preferably, the pin is placed within the internal cavity of the connector body before the cable is threaded. The pin may be secured within the internal cavity by deforming the bottom edge of the pin. Removal of the pin may be inhibited by the deformed bottom edge. The pin may be substantially rotatable while positioned within the internal cavity. The upper portion of the pin may contain at least two flat edges, the edges being oriented on opposing sides of the upper portion of the pin The distance between the two edges may be less than the distance between the two arms extending from the connector body. The arms may interact with the edges such that rotation of the pin is hindered. The pin may be rotatable when sufficient force is applied to overcome the hindering force of the arms.

The pin preferably includes two grooves. The grooves may be aligned with the apertures, when the pin is inserted within the internal cavity, such that the cable may pass freely through the connector body. The pin may also be rotated, while the pin is inserted within the internal cavity, such that the grooves are perpendicular to the apertures. The rotation of the pin, after a cable has been threaded through the connector body, may exert a compressive force against the cable to secure it within the connector body. The pin may be subsequently rotated to allow free movement of the cable through the connector body.

The pin may further include an opening extending longitudinally through the entire pin. The opening preferably includes a top section and a bottom section. The top section preferably has a diameter that is substantially greater than the diameter of the end of the cable. The lower section preferably has a diameter that is substantially less than the diameter of the tip of the cable. The cable may be passed through the opening, with the tip of the cable positioned within the opening, and further through a duct to form a loop. The pin may be positioned within the internal cavity to secure the cable in place, while the cable is passed through the opening and the duct. When secured in this position the cable may be oriented in a substantially perpendicular orientation.

The cable may be passed through the ducts of the connector body such that the ends of the cable are oriented in a substantially parallel orientation. Alternatively the cable may be passed through the opening of the pin and through a duct to form a loop, the ends of the cable being in a substantially perpendicular orientation.

The surgical cable system may also include a tensioner adapted to vary the tension of the cable and secure the cable. The tensioner preferably includes a body, a shaft for contacting the connector, a driver for positioning the pin within the connector body, and an arm for adjusting the shaft.

The shaft is preferably mounted within the body, such that it extends from both sides of the body. The arm and the shaft are preferably connected such that the arm is capable of being adjusted to retract or extend the shaft from an end of the body. The body may include a stopper which secures the position of the shaft with respect to the body.

The shaft preferably includes a tip adapted to hold the connector. The tip may include a recessed opening which is shaped to couple to the connector. The shaft may also include an opening extending longitudinally through the shaft. The opening of the shaft is preferably adapted to allow the driver to pass through the shaft and onto the connector.

The body may include a cable clamp adapted to secure the cable against a portion of the body. The body preferably includes at least two cable clamps. The cable clamps may secure the cable against a portion of the body after the cable is threaded through the connector and around a portion of a human bone. The shaft may engage the connector, after the cable has been secured with respect to the body, such that movement of the shaft causes the tension of the cable to vary.

The driver may include an end adapted to engage the pin of the connector. The driver preferably includes a handle to allow the driver to be moved in a circular motion. The shaft preferably includes an opening, extending longitudinally through the shaft, that allows the driver to engage the pin while the connector is in contact with the shaft. The driver may engage the pin such that rotation of the driver causes the pin to rotate into a position which secures the cable within the connector. While the cable is secured the cable is no longer able to move within the connector. Subsequent to securing the cable, the driver may be rotated to cause the pin to move into a position which allows the cable to once again have mobility within the connector.

An advantage of the present invention is that the cable may be secured or movable within the connector as necessary.

Another advantage of the present invention is that the cable may be secured into position without the use of crimps.

Yet another advantage is that the present invention may allow the ends of the cable to be in a perpendicular orientation with respect to each other or a parallel orientation with respect to each other.

Brief Description of the Drawings

Further advantages of the present invention will become apparent to those skilled in the art with the benefit of the following detailed description of the preferred embodiments and upon reference to the accompanying drawings in which:

FIG. 1 depicts a side view of a connector,

FIG. 2 depicts a perspective view of a cable;

FIG. 3 depicts a cross sectional view of the connector as viewed from the side;

FIG. 4 depicts a cross sectional view of a pin as viewed facing a groove from the front face;

FIG. 5 depicts a side view of the pin;

FIG. 6 depicts a cross sectional view of the pin as viewed from the front;

FIG. 7 depicts a top view of the connector with the cable forming a loop by entering a first face opposite to a second face from which it exits;

FIG. 8 depicts a top view of a connector with the cable forming a loop by entering the same face from which it exits;

FIG. 9 depicts a cross sectional view of the connector in a secured position, with a portion of the cable residing in an opening of the pin, as viewed from the side of the connector;

FIG. 10 depicts a cross sectional view of the connector, with the cable being movable within the connector body, as viewed from the side;

FIG. 11 depicts a cross sectional view of the connector, with the cable being secured in an immobile position within the connector, as viewed from the side;

FIG. 12 depicts a cross sectional view of the connector, with the cable being movable within the connector body, as viewed from the bottom;

FIG. 13 depicts a cross sectional view of the connector, with the cable secured in an immobile position within the connector body, as viewed from the bottom;

FIG. 14 depicts a perspective view of a tensioner;

FIG. 15 depicts a cross sectional view of a body of the tensioner, as viewed from the side;

FIG. 16 depicts a rear view of the body of the tensioner,

FIG. 17 depicts a cross sectional view of the tensioner, as viewed from the side;

FIG. 18 depicts a tip of a shaft of the tensioner, as viewed from the front;

FIG. 19 depicts the tip of the shaft as viewed from the side;

FIG. 20 depicts a cross-sectional view of a bushing cover of the tensioner as viewed from the side of the bushing cover;

FIG. 21 depicts a side view of the bushing cover,

FIG. 22 depicts a top view of the bushing cover, and

FIG. 23 depicts a cross sectional partial view of the bushing cover with a cable clamp, as viewed from the side.

While the invention is susceptible to various modifications and alternative forms, specific embodiments thereof are shown by way of example in the drawings and will herein be described in detail. It should be understood, however, that the drawings and detailed description thereto are not intended to limit the invention to the particular form disclosed, but on the contrary, the intention is to cover all modifications, equivalents and alternatives falling within the spirit and scope of the present invention as defined by the appended claims.

Detailed Description of the Preferred Embodiments

FIG. 1 depicts an embodiment of a connector 20 constructed according to the teachings of the present invention. The connector 20 includes a connector body 24 and a pin 22. A cable 10 may be passed through the ducts 26 to form a loop for engaging a portion of a human bone. The cable 10 may be looped around a variety of human bone portions involved in various surgical procedures. The surgical procedures which may make use of a surgical cable system include, but are not limited to: spine surgery; total hip arthroplasty; fracture fixation; closure of the sternum following open heart surgery; and oral/facial surgery to repair mandibular fractures. The cable 10 is preferably used for engaging a portion of the human spine.

The term "cable" within the context of this application is taken to mean an elongated flexible member. An embodiment of the cable 10 is illustrated in FIG. 2. The cable 10 includes a leader portion 12, a main portion 14, and a tip 16. The main portion 14 is preferably comprised of a substantially flexible stranded metal wire. The main portion 14 may be comprised of any substantially flexible material including, but not limited to, steel, nylon, or various plastics. The main portion 14 is preferably made of titanium or stainless steel.

The cable 10 preferably has a leader portion 12 attached to an end of the cable. The leader portion 12 may comprise a non-stranded wire that is substantially less flexible than the main portion 14. The leader portion 12 may be comprised of any substantially flexible material including, but not limited to, steel, nylon, or various plastics. The leader portion 12 is preferably made of titanium or stainless steel. The leader portion 12 is preferably made of the same material as the main portion 14 of the cable 10. The leader portion 12 may be used to guide the cable 10 around the bone and through the various openings of the connector 20.

The cable 10 may include a tip 16 attached to an end of the cable. The tip 16 is preferably of a diameter that is substantially larger than the diameter of the main portion 14. The tip 16 may be made of the same material as the main portion. The tip 16 is preferably made of titanium or stainless steel. The tip 16 may be larger than the diameter of the ducts 26, (shown in FIG. 1), such that the tip 16 is inhibited from passing through the ducts. Thus, tip 16 may function to prevent the cable 10 from passing entirely through the ducts 26.

The cable 10 is preferably made by twisting together multiple wire strands around a cable core. The wire strands are preferably made by twisting six filaments around a central filament in a helical orientation. The filaments may be made by reducing the diameter of a wire to a thickness of less than 0.005 inches, and more preferably to a diameter of 0.003 inches. The cable core is preferably made by twisting six wire strands over a central strand in a helical orientation. The cable 10 is preferably made by twisting twelve strands over the cable core. After the strands are twisted to form the cable 10, the cable may be hammered repeatedly to give a smooth surface. The cable 10 may be cut into the appropriate length by a cutting apparatus. The cable 10 is preferably cut by a laser. By applying tension on the cable 10 during the cutting process an end of the cable may be formed into an enlarged tip 16. The leader portion 12 may be welded onto an end of the cable 10 before use. The cable may be cleaned repeatedly during the manufacturing procedure.

FIG. 3 depicts a cross sectional view of the connector body 24 of the connector 20. The connector body 24 preferably includes an internal cavity 28 for holding a pin 22 within the connector body 24. The internal cavity 28 may be substantially cylindrical in shape and preferably passes longitudinally through the entire connector body 24. The connector body 24 may include a duct 26 that passes transversally through the entire connector body. The duct 26 is preferably oriented substantially perpendicular to the internal cavity 28. The connector body 24 preferably includes at least two ducts 26 that pass transversally through the entire connector body. The ducts 26 preferably communicate with the internal cavity 28 via an aperture 30. The ducts 26 are preferably positioned such that a cable 10 lying within the duct may extend into the internal cavity 28.

The pin 22 preferably includes an upper portion 36 and a lower portion 40, as depicted in FIG. 4. The pin 22 may also include a transition portion 38 oriented between the upper portion 36 and the lower portion 40. The upper portion 36 is preferably of a diameter substantially larger than the diameter of the lower portion 40. The upper portion 36 is preferably of a diameter such that it is incapable of passing into the internal cavity 28. The lower portion 40 of the pin 22 is preferably of a diameter such that the lower portion may fit into the internal cavity 28 (shown in FIG. 2). The diameter of the transition portion 38 may be variable, becoming narrower in a direction from the upper portion 36 toward the lower portion 40. The bottom of the pin 43 may be deflected outward to substantially secure the pin 22 within the internal cavity 28.

In another embodiment, the pin 22 preferably includes two grooves 42, as depicted in FIG. 5. The grooves 42 may be substantially rectangular in shape, comprising a width that is substantially larger than the diameter of the cable 10. The grooves 42 are preferably oriented on opposing sides of the lower portion 40 of the pin 22. Referring to FIG. 9, the pin 22 may lie within the internal cavity 28 such that the grooves 42 lie in the plane defined by the ducts 26. The grooves 42 may be substantially aligned with the ducts 26, with an aperture 30 positioned between each duct and groove. The pin 22 may be oriented within the internal cavity 28, with the grooves 42 substantially aligned with the ducts 26, such that the cable 10 may pass freely through the connector body 24. The pin 22 may also be oriented within the internal cavity 28, with the grooves 42 positioned substantially perpendicular to the ducts 26, such that the cable 10 is secured within the connector body 24.

In another embodiment, the pin 22 preferably includes an opening 44, as depicted in FIG. 6. The opening 44 is preferably substantially cylindrical in shape and preferably passes longitudinally through the entire pin 22. The pin may surround a portion of the opening such that the opening is U-shaped or V-shaped. The pin preferably surrounds the entire opening. The opening 44 preferably includes an upper portion 46 and a lower portion 48. The pin 22 may also include a transition portion 47 oriented between the upper portion 46 and the lower portion 48. The upper portion 46 is preferably of a diameter substantially larger than the diameter of the lower portion 48. The diameter of the upper portion 46 is preferably substantially larger than the diameter of the tip 16 of cable 10. The diameter of the lower portion 48 is preferably substantially smaller than the diameter of the tip 16 of cable 10. In this manner, the opening 44 may prevent a cable 10, having a tip 16, from passing completely through the opening.

The upper portion 46 of the opening 44 may be chosen to couple with any suitable device adapted to apply a torsional force. The upper portion 46 may be substantially rectangular for receiving a flat head torsioning device, such as a screw driver. The upper portion 46 may also be substantially cross shaped for receiving a cross shaped head of a torsioning device, such as a Phillips head screwdriver. The upper portion 46 is preferably hexagonal in shape for receiving a hexagonal head of a torsioning device, such as an Allen wrench.

FIGS. 7 depicts a connector 20 with a cable 10 threaded through the connector body 24 to form a loop according to one embodiment. The cable 10 is preferably threaded through a duct 26, around a human bone element, and back through a separate duct 26 to form a loop. The loop is formed such that the ends of the cable 10 lie in a substantially parallel orientation with respect to each other. The cable 10 is preferably threaded through a duct 26, around a human bone element, and back through another duct to form a loop, reentering the connector body 24 from the face 35 on the side opposite to the face 33 which the cable initially exited. The pin 22 may be inserted within the connector body 24, after the cable 10 has been looped around a human bone element and passed through the connector body 24 to secure the cable within the connector body. The pin 22 may be removed from the connector body 24, subsequent to securing the cable 10 within the connector body, to allow the cable to be moved within the connector body. Removal of the pin 22 may be prevented by deforming the bottom of the pin.

FIG. 8 depicts another embodiment in which the cable 10 is preferably threaded through a duct 26, around a human bone element, and back through a separate duct to form a loop, reentering the connector body 24 from the same face 33 of the connector body that the cable initially exited. The pin 22 may be inserted within the connector body 24 to secure the cable 10 within the connector body. While the cable 10 is secured the cable is no longer able to move within the connector 20. The pin 22 may be removed from the connector body 24, subsequent to securing the cable 10 within the connector body, to allow the cable to be moved within the connector body.

FIG. 9 depicts another embodiment in which the cable 10 is preferably threaded through the opening 44, around a human bone element, and back through a duct 26 to form a loop. In this manner, the ends of the cable 10 may lie in a substantially perpendicular orientation with respect to each other (not shown). The pin 22 may be inserted within the connector body 24 to secure the cable 10 within the connector body. The pin 22 may be removed from the connector body 24, subsequent to securing the cable 10 within the connector body, to allow the cable to be movable within the connector body. Tension on the cable 10 may pull the tip 16 of the cable against the lower portion 48 of the opening 44. In this manner, the cable 10 may be prevented from moving within the opening 44.

The pin 22 may be positioned within the internal cavity 28 before the cable 10 is threaded through the ducts 26. The cable 10 may be threaded through the ducts 26 of the connector body 24 while the pin 22 is mounted within the internal cavity 28. The pin 22 is preferably oriented such that the grooves 42 of the pin are substantially aligned with the ducts 26, as depicted in FIGS. 10 and 12. The pin 22 may be rotated, subsequent to the cable 10 being passed through the connector body 24, such that the grooves 42 are substantially perpendicular to the ducts 26. As a result, the ungrooved portion of the pin 22 may compress the cable 10 against the connector body 24, securing the cable, as depicted in FIGS. 11 and 13. Subsequent to securing the cable 10 within the connector body 24, the pin 22 may be further rotated such that the grooves 42 are once again aligned with the ducts 26. In this manner, the cable 10 may be repeatedly moved and secured within the connector body 24.

In another embodiment, the cable 10 may be threaded through the pin 22 and through a duct 26 of the connector body 24, as depicted in FIG. 9. The pin 22 may be rotated within the connector body 24 to secure the cable 10 in an immobile position within the connector body. Subsequent to securing the cable 10 in an immobile position within the connector body 24, the pin 22 may be further rotated such that the cable may again be movable within the connector body. Tension on the cable 10 may pull the tip 16 of the cable against the lower portion 48 of the opening 44. In this manner, the cable 10 may be prevented from moving within the opening 44.

The connector body 24 preferably has two substantially flat arms 32 extending out from the top face of the connector body, as depicted in FIG. 9. The arms 32 are preferably oriented opposite to each other, and the internal cavity 28 is preferably located between the two arms. The upper portion 36 of the pin 22 may have at least two substantially flat edges 34. The upper portion 36 of the pin 22 more preferably has four substantially flat edges 34 (shown in FIG. 7). The edges 34 are preferably oriented on opposing sides of the upper portion 36 of the pin 22. The pin 22 may be mounted within the internal cavity 28 such that the edges 34 are contained by the arms 32 of the connector body 24. The arms 32 may interact with the edges 34 such that rotation of the pin 22 is hindered. The pin 22 may be rotatable when sufficient force is applied to the in to overcome the hindering force of the arms 32.

As illustrated in FIG. 10 the pin 22 may be inserted within the internal cavity 28 and the pin bottom 43 deflected outward. The diameter of the bottom 45 of the internal cavity 28 is preferably tapered, becoming wider in a direction toward the bottom 45 of the connector body 24. The deflection of the bottom 43 of pin 22 is tapered to match the tapering of the internal cavity 28. The pin 22 is preferably rotatable within the internal cavity 28. The lower portion 40 of the pin 22 is preferably of a diameter such that, when positioned within the internal cavity 28, the lower portion may compress the cable 10 against the wall of the duct 26, securing the cable in place.

The cable 10 is preferably formed into a loop and tensioned prior to securing the cable within the connector body 24. When the cable 10 is under tension, the comers of the edge 34 of the pin 22 may rest upon the inner faces of the arms 32. The force exerted by the arms 32 upon the corners of the edges 34 may prevent the pin 22 from rotating due to the tension of the cable 10. The pin 22, however, may be rotated by an operator to a position which allows the cable 10 to be movable through the connector body 24. The force required by the operator to move the pin 22 into an unsecured position is preferably greater than the rotational force exerted on the pin by the cable 10 when in a secured position.

The surgical cable system preferably includes a tensioner 50 adapted to vary the tension of the cable 10 and secure the cable within the connector 20. A preferred embodiment of the tensioner 50 is depicted in FIG. 14. The tensioner 50 preferably includes a body 52, a shaft 58 for contacting the connector 20, a driver 56 for positioning the pin 22 within the connector 20, and an arm 54 for adjusting the position of the shaft 58. The parts of the tensioner 50 may be made of a variety of substantially inflexible materials including, but not limited to, instrument grade stainless steel, aluminum, and various plastics.

FIG. 15 depicts a cross sectional side view of the body 52. The body 52 is preferably substantially rectangular and hollow. The body 52 preferably includes a substantially circular front opening 82 and a substantially oval rear opening 84. The body 52 may also include a bushing holder 86 extending from the front edge 81 of the body. The front opening 82 may pass through the bushing holder 86. The front opening 82 and the rear opening 84 may be aligned such that a rigid, elongated member may be passed through both openings. The front edge 81 of the body 52 may be uncovered allowing insertion of the arm 54 within the body.

FIG. 16 depicts a preferred embodiment of the rear opening 84 of the body 52. The rear opening 84 preferably comprises two curved sections and two flat sections. The curved sections may be oriented at the top and the bottom of the rear opening 84. The flat sections may connect the top curved section to the bottom curved section to form a substantially oval opening.

The arm 54 may be substantially hollow and is preferably mounted within the hollow portion of the body 52, as depicted in FIG. 17. The arm 54 may be held in place by the arm pin 72. The arm pin 72 may be substantially cylindrical and hollow. The arm pin 72 may extend through the entire arm 54 and partially into the sides of the body 52. The arm pin 72 may be mounted within the body 52 such that the arm 54 is pivotable about the arm pin in a range of about 45 degrees. The arm 54 may be stopped in a forward position when the top 53 of the arm comes into contact with the body 52, as depicted in FIG. 17. The arm 54 may be similarly stopped in a rear position when the bottom 55 of the arm 54 comes into contact with the body 52. The sides of the arm 54 preferably extend above the top of the arm to form a substantially U-shaped pocket. The U-shaped pocket may be adapted to hold a push tab pin 88 that may be mounted over the top of the arm 54 extending into the sides of the arm.

Turning to FIG. 17, the push tab 64 may be substantially rectangular. The push tab 64 preferably includes a substantially circular aperture. The push tab 64 may rest on the front portion of the push tab pin 88. The aperture of the push tab 64 is preferably sized such that the shaft 58 may be passed through the aperture. The push tab 64 is preferably placed within the hollow portion of the body 52. The shaft 58 is preferably fitted through the aperture of the push tab 64, and the lower portion of the push tab is preferably seated against the push tab pin 88. The arm spring 92 may also lie on the shaft 58, preferably positioned between the push tab 64 and the front 81 of the body 52.

The arm 54 is preferably pivotable about the arm pin 72 such that a bottom portion 55 of the arm may be moved toward the rear 83 of the body 52. Rearward motion of the arm 54 preferably causes the push tab pin 88 to move toward the front 81 of the body 52. Push tab 64 preferably rests against the push tab pin 88. Thus, movement of the push tab 64 toward the front 81 preferably makes the push tab pin 88 move in a similar direction. As a result the push tab 64 may engage the shaft 58, propelling the shaft through the front opening 82 of the body 52. Concurrent with the movement of the arm 54, the push tab 64 may also compress the arm spring 92. In the absence of any pressure on arm 54, the arm spring 92 preferably expands such that the push tab 64, the push tab pin 88, and the arm 54 are returned to their original positions.

The body 52 may further include a lock tab 62 and lock spring 94. The lock tab 62 may be substantially rectangular. The lock tab 62 preferably includes a substantially circular aperture. The lock tab 62 may extend downward from the top of the body 52, as depicted in FIG. 17. The aperture is preferably sized such that the shaft 58 may be passed through the aperture. The lock spring 94 may also lie on the shaft 58, preferably positioned between the lock tab 62 and the body 52. The lock spring 94 preferably exerts a force on the lock tab 62, forcing it away from the rear 83 of the body 52. Movement of the lock tab 62 in this direction is preferably restricted when the lower portion of the aperture comes into contact with the shaft 58. The force exerted by the lock tab 62 upon the shaft 58 may restrict the rearward motion of the shaft through the body 52.

The lock tab 62 may be moved toward the front 81 of the body 52 such that the aperture no longer comes into contact with the shaft 58. When oriented in this forward position the lock tab 62 may no longer restrict the rearward motion of the shaft 58. The lock tab 62 is preferably moved into the forward position to allow the shaft 58 to be moved in a rearward direction within the body 52. Movement of the lock tab 62 toward the front of the body 52 may also compress the lock spring 94. When the pressure being applied to the lock tab 62 is released, the lock spring 94 preferably pushes the lock tab 62 back into its starting position.

The shaft 58 may be a variety of shapes including, but not limited to cylindrical, oval or trapezoidal. The shaft 58 is preferably substantially cylindrical and hollow. The shaft 58 may include two flat edges 59 (shown in FIG. 14) that run longitudinally along the entire length of the shaft 58. The edges 59 are preferably oriented on opposing sides of the shaft 58, giving the shaft a substantially oval shape. Referring back to FIG. 16, the rear opening 84 of the body 52 is preferably shaped to allow a shaft 58 of complimentary shape to pass through the rear opening. The rear opening 84 is preferably shaped to inhibit rotation of the shaft 58 within the body 52. The width of the hollow portion of the shaft 58 is slightly greater than the diameter of the driver 56, thereby allowing the driver to freely pass through the shaft. The shaft 58 may also include a knob 96 at an end of the shaft, as depicted in FIG. 17. The knob 96 may be a threaded nut which is screwed onto the shaft 58. The knob 96 may be used to position the shaft 58 within the body 52.

The shaft 58 preferably includes a tip 80 proximate an end of the shaft which is adapted to hold the connector 20. The tip 80 is preferably located at the end of the shaft 58 which extends from the front 81 of the body 52. FIG. 18 depicts a preferred embodiment of the tip 80. The tip 80 may be slightly larger than the diameter of the shaft 58. The tip 80 preferably includes two indentations 78 running along the outside surface of the tip. The indentations 78 are preferably oriented on opposing sides of the tip 80. The indentations 78 are preferably sized such that the width of the indentations are substantially greater than the width of the cable 10. The depth of the indentations 78 is preferably tapered, becoming shallower in a direction from the end of the shaft 58 toward the body 52.

The tip 80 may include a recessed opening which is adapted to couple with the connector 20. The front of the tip 80 is depicted in FIG. 19. The front of the tip 80 preferably contains a first slot 96 and a second slot 98. The first slot 96 preferably runs across the end of the tip 80, in the plane of the tip 80 formed by the two indentations 78.

The second slot 98 preferably runs in a substantially perpendicular orientation to the first slot 96. The depth of the second slot 98 may be substantially greater than the depth of the first slot 96. The connector 20 may be mounted within the tip 80 such that the ducts 26 are oriented toward the indentations 78 of the tip. This arrangement preferably allows the cable 10 to freely pass through the connector 20 and along the indentations 78 while the connector 20 is mounted within the tip 80. The body 52 may also include a substantially cylindrical and hollow bushing cover 66, as depicted in FIGS. 20, 21, and 22. The bushing cover 66 preferably includes an upper chamber 100, a lower chamber 102, a divider 104 and two arms 106.

The upper chamber 100 is preferably sized such that the bushing cover 66 may be inserted over the bushing holder 86, as depicted in FIG. 17. The distance between the divider 104 and the top 101 of the bushing cover 66 may be substantially less than the distance that bushing holder 86 extends out from the body 52. The distance is set such that a space may exist between the bushing cover 66 and the front edge 81 of the body 52.

The divider 104 preferably extends partially into the interior of the bushing cover 66, at a distance allowing the shaft 58 to pass through the bushing cover. The lower chamber 102 is preferably sized to allow the bushing 60 and the bushing spring 90 to be inserted together within the chamber, as depicted in FIG. 17. The arms 106 preferably extend from opposing sides of the bushing cover 66. The end of each arm 106 is preferably shaped into a substantially U-shaped groove, as depicted in FIG. 22. The bushing spring 90 is preferably sized to fit within the lower chamber 102. The bushing spring 90 is preferably sized to fit over the bushing 60.

Referring back to FIG. 17, the body 52 may include a substantially cylindrical and hollow bushing 60. It is preferred that the width of the hollow portion of the bushing 60 and the diameter of the shaft 58 be substantially equal. The shape of the hollow portion is preferably complimentary to the shape of the shaft 58. The hollow section may extend through the longitudinal axis of the bushing 60. The bushing 60 is preferably mounted within the bushing holder 86. The engagement of the bushing 60 with the shaft 58, while the bushing 60 is mounted within the bushing holder 86, preferably minimizes the lateral movement of the shaft within the body 52. The bushing holder 86 preferably contains female threading. The bushing 60 may include a threaded end, sized to fit the female threading of the bushing holder 86. The threaded end of the bushing 60 preferably engages the bushing holder 86 such that rotation of the bushing in a tightening direction moves the threaded end into the bushing holder.

The bushing 60 is preferably adapted to hold the bushing cover 66 onto the bushing holder 86, whereby the bushing cover is freely rotatable about the bushing holder. The bushing 60 preferably includes a flanged end. The bushing cover 66 and the bushing spring 90 are preferably placed on the bushing holder 86, such that the bushing spring lies within the lower chamber 102 of the bushing cover. The bushing spring 90 may rest against a front edge of the bushing holder 86. The bushing 60 may be fastened by screwing the threaded end into the threaded portion of the bushing holder 86. The flanged end of the bushing 60 preferably presses against the bushing cover 66 to hold the bushing cover against the bushing holder 86. The flanged end of the bushing 60 may also compress the bushing spring 90. The bushing spring 90 is adapted to prevent the bushing 60 from being overtightened. Overtightening of the bushing 60 might hinder or prevent rotation of the bushing cover 66 about the bushing holder 86.

FIG. 23 depicts a portion of the bushing cover 66 which preferably includes a cable clamp 68 adapted to secure a cable 10 against a portion of the bushing cover. The bushing cover 66 preferably includes at least two cable clamps 68. The cable clamp 68 preferably includes a lever 76, a pin 70, and a spring 108. The lever 76 may include a substantially hollowed out portion 109 and a clamping portion 110. The lever 76 is preferably connected to an arm 106 of the bushing cover 66 with a substantially cylindrical pin 70. The pin 70 may extend through both the lever 76 and the U-shaped groove of the arm 106. The pin 70 may be mounted within the U-shaped groove of the arm 106 such that the lever 76 is pivotable about the pin.

The spring 108 preferably lies on the pin 70 and extends into the bushing cover 66 and along the lever 76. The spring 108 preferably extends into the hollow portion of the lever 76. In its resting position spring 108 preferably exerts a force against the inside edge of the hollow portion 109 such that the lever 76 is moved away from the bushing cover 66. When the hollow portion 109 extends away from the bushing cover 66, the clamping portion 110 is preferably disposed against the bushing cover. When pressed with sufficient force the lever 76 may pivot around the pin 70 such that the clamping portion 110 is no longer in contact with the bushing cover 66. The cable 10 may be passed under the lever 76 while the clamping portion 110 is in its raised position. The depression of the clamp lever 76 preferably compresses the spring 108. Removal of the force being applied to the lever 76 preferably allows the spring 108 to expand, thereby forcing the clamping portion 110 to return to the bushing cover 66. If a cable 10 is present when the force is released from the lever 76, the clamping portion 110 may become pressed against the cable, securing it in place against the bushing cover 66.

The arm spring 92 and the lock spring 94 may be compression springs. The spring 108 of the cable lock 68 is preferably a torsion spring. The bushing spring 90 is preferably a spring washer. The term "spring washer" in the context of this application is meant to mean a spring adapted to apply a predetermined force on adjacent members in an assembly.

Referring back to FIG. 17, the driver 56 may include a handle 114 attached to the elongated member 112 of the driver. The handle 114 is preferably a rod that is attached to the elongated member 112 in a perpendicular orientation, such that the driver 56 is substantially T-shaped. The handle 114 may be rotated to allow the driver 56 to be moved in torsionally. The elongated member 112 may be substantially longer than the shaft 58. The driver 56 preferably includes a head 116 adapted to engage the pin 22 of the connector 20. The head 116 is preferably located at an end of the elongated member 112 opposite to the handle 114. The shape of head 116 may be chosen to couple with a pin 22 of suitably recessed shape such that rotation of the handle may apply a tortional force to the pin. The head 116 is preferably hexagonal in shape for coupling with the hexagonal recess of the upper portion 46 of the opening 44 of the pin 22.

The shaft 58 may be substantially cylindrical and hollow. The hollow portion of the shaft 58 is preferably sized such that the elongated portion 112 of the driver 56 may be passed through the center of the shaft. The shaft 58 is configured such that the driver 56 may engage the pin 22 while the connector 20 is in contact with the shaft. The driver 56 may engage the pin 22 such that rotation of the driver 56 causes the pin to rotate. The driver 56 preferably engages the pin 22 such that rotation of the driver causes the pin 22 to rotate into a position which secures the cable 10 within the connector 20. Once the cable 10 has been clamped into this position, the driver 56 may engage the pin 22 such that rotation of the driver causes the pin to rotate into a position which allows movement of the cable within the connector 20.

The surgical procedure for implanting a surgical cable system around a portion of a human bone includes forming a loop around the desired portion, tensioning the cable 10, and securing the cable within the connector 20. The loop is preferably formed by threading the cable 10 through the connector 20, around a portion of the human bone and back through the connector. In an embodiment, the cable 10 may be looped around two or more adjacent vertebra. In another embodiment the cable 10 may be passed around a vertebra and a spinal fixation device. The spinal fixation device is adapted to immobilize a section of the human spine and may be a rod.

As depicted in FIG. 7, the cable 10 may be passed through a duct 26 of the connector 20, around a portion of the human bone, and back through a different duct 26. In an embodiment, the cable 10 may be threaded through the connector 20 exiting from the rear face 33 of the connector body 24. After encircling a bone member the cable 10 may reenter the connector body 24 from the front face 35. In another embodiment, depicted in FIG. 8, the cable 10 may be threaded though the connector 20 exiting from the rear face 33 of the connector body 24. After encircling a bone member the cable 10 may reenter the connector body 24 from the rear face 33, forming a loop around the bone member. The ends of the cable 10 may extend out from the connector body 24. The ends may be in a substantially parallel orientation with respect to each other.

In another embodiment, the cable 10 may include tip 16, as depicted in FIG. 1. Referring again to FIG. 7, the tip 16 is preferably of a diameter that is substantially larger than the diameter of a duct 26. The tip 16 preferably inhibits the cable 10 from passing completely through the duct 26. The cable 10 may be threaded through the connector 20, exiting from the rear face 33 of the connector body 24. The cable 10 is preferably threaded through the connector body 24 until the tip 16 is disposed against the front face 34 of the connector body 24. After encircling a bone member, the cable 10 may reenter the connector body 24 from the front face 35. In another embodiment, the cable 10 may reenter the connector body 24 from the rear face 33 of the connector body. As the cable 10 is tensioned, the tip 16 may be disposed against the front face 35 of the connector body 24. The tip 16 may remain disposed against the face of the connector body 24 until the tension of the cable 10 is released.

In an alternate embodiment, (referring to FIG. 13) the tip 16 is preferably of a diameter that is substantially larger than the diameter of an opening 44 of pin 22. The tip 16 preferably inhibits the cable 10 from passing completely through the opening 44. The cable 10 is preferably threaded through the opening 44 until the tip 16 is disposed against the lower portion 48 of the opening. After encircling a human bone member, the cable 10 may be passed into the connector body 24 through one of the ducts 26. The pin 22 is preferably oriented to allow this passage of the cable 10 through one of the ducts 26. As the cable 10 is tensioned, the tip 16 may be disposed against lower portion 48 of the opening 44. The tip 16 may remain disposed against the lower portion 48 of the opening 44 until the tension of the cable 10 is released.

A tensioner 50 may be used to increase the tension on a cable 10 after it has been encircled around a human bone member. The preferred embodiment of the tensioner 50 is illustrated in FIG. 14. The tensioner 50 may be prepared to receive the connector 20 by positioning the shaft 58 such that the tip 80 is positioned proximate to the front of the bushing 60. The shaft 58 may be positionable within the body 52 while the lock tab 62 is in a forward position. The lock tab 62 may be moved into the forward position by applying pressure to the rear face of the lock tab 62. Pressure on the lock tab 62 may be released allowing the lock tab to move away from the tensioner body 52. In this released position the lock tab 62 may prevent the rearward movement of the shaft 58.

After the cable 10 is looped around a human bone member and through the connector 20, the connector may be engaged by the tip 80 of the tensioner 50. The connector 20 is engaged by the tip 80 such that the front and rear faces of the connector are aligned with the indentations 78 (see FIG. 19). The top of the connector 20 may be substantially positioned within the tip 80. The pin 22 may be mounted within the connector body 24, and the connector body may be engaged by the tip 80.

A cable end is preferably positioned along the indentations 78 of the tip 80. The cable end is preferably clamped to the tensioner 50 by the cable clamp 68. The clamping portion 110 of the cable clamp 68 may be disposed against the side of the bushing cover 66 while in the resting position. When pressed with sufficient force the lever 76 may pivot around the arm pin 72 such that the clamping portion 110 is no longer in contact with the bushing cover 66. The cable 10 may be passed under the lever 76 while the clamping portion 110 is raised. Removal of the force being applied to the lever 76 preferably causes the clamping portion 110 to move toward the bushing cover 66. As a result, the clamping portion 110 may become pressed against the cable, thereby securing it in place against the bushing cover 66. In an embodiment, one end of the cable 10 is preferably secured to the bushing cover 66, using the cable clamps 68. In another embodiment, both ends of the cable 10 are preferably secured to the bushing cover 66.

Pressure may then be applied to the arm 54 of the tensioner 50 to pivot the arm around the arm pin 72 such that the arm moves in a direction toward the body 52 of the tensioner 50. Movement of the arm 54 toward the body 52 may be accompanied by movement of the shaft 58 away from the body 52. The angle to which the arm 54 is pivoted may determine the distance the shaft 58 extends from the body 52. When the pressure on the arm 54 is released, the arm preferably moves away from the body 52. Movement of the arm 54 away from the body 52 preferably does not effect the position of the shaft 58. With the cable 10 secured to the tensioner 50, movement of the shaft 58 away from the body 52 preferably pulls the cable 10 through the connector 20 in a direction away from the connector. As a result, the tension on the cable 10 preferably increases. The arm 54 may be repeatedly pressured and released as many times as necessary to achieve the desired tension.

In one embodiment, a pin 22 may be inserted into the connector body 24, after the cable 10 has been tensioned, to secure the cable within the connector 20. The driver 56 may be used to insert the pin 22 into the connector body 24. In an alternate embodiment, the pin 22 may be placed in the connector body 24 prior to tensioning the cable 10. The pin 22 may be positioned within the tip 80. The driver 56 may be inserted through the center of the shaft 58 until it engages the pin 22. The end of the driver 56 is preferably shaped to fit within the opening 44 of the pin 22. The rotation of the driver 56 may be accompanied by rotation of the pin 22 while the driver is inserted within the opening 44. The pin 22 is preferably oriented such that the cable 10 may pass through one of the ducts 26. Rotation of the pin 22 may alter the orientation of the pin such that the pin secures a portion of the cable 10 within the connector body 24. The pin 22 is preferably rotated 90.degree. into a securing orientation. Rotation of the pin 22 is preferably performed after the cable 10 has been tensioned. In this manner, the diver 56 may rotate the pin 22 to secure a portion of the cable 10 within the connector 20 without removing the connector from the tip 80.

After securing the cable 10 within the connector 20 the tensioner 50 may be disengaged from the connector. The cable 10 may be removed from the cable clamp 68 before disengaging the tensioner 50. To remove the cable 10, pressure may be applied to the lever 76, causing the lever to lift from the bushing cover 66. As a result, the securing force exerted by the clamping portion 110 is removed, allowing the cable 10 to be removed from under the clamping portion. After removal of the cable 10 from the cable clamps 68, the connector 20 may then be removed from the tip 80 of the tensioner 50.

In an embodiment, the cable 10 may need to be retensioned after the connector 20 has been removed from the tensioner 50. In this situation, the connector 20 may be reinserted into the tip 80 of the tensioner 50. The cable 10 may be secured against the tensioner 50 with the cable clamp 68 of the tensioner 50. The driver 56 may be inserted into the opening 44 of the pin 22. Under these circumstances the pin 22 may be rotated by the driver 56 to an orientation which allows movement of the cable 10 through the connector body 24. The cable 10 may be retensioned by operation of the tensioner arm 54. When the desired tension is achieved, the cable 10 may be secured by the rotation of the pin 22 within the connector 20.

Further modifications and alternative embodiments of various aspects of the invention will be apparent to those skilled in the art in view of this description. Accordingly, this description is to be construed as illustrative only and is for the purpose of teaching those skilled in the art the general manner of carrying out the invention. It is to be understood that the forms of the invention shown and described herein are to be taken as the presently preferred embodiments. Elements and materials may be substituted for those illustrated and described herein, parts and processes may be reversed, and certain features of the invention may be utilized independently, all as would be apparent to one skilled in the art after having the benefit of this description of the invention. Changes may be made in the elements described herein without departing from the spirit and scope of the invention as described in the following clams.

Claims

What is claimed is:

1. A tensioner comprising: a body comprising an arm; a shaft adapted to engage a connector during use; and a driver adapted to secure a cable within the connector during use, such that the cable remains secured within the connector after the driver is disengaged from the connector during use, wherein the arm is adapted to vary the tension of the cable as the position of the shaft is altered during use.

2. The tensioner of claim 1 wherein the body comprises a front opening extending through a front portion of the body, and wherein the front opening is of a diameter that is substantially larger than a diameter of the shaft.

3. The tensioner of claim 1 wherein the body comprises a rear opening extending through a rear portion of the body, and wherein the rear opening is of a diameter that is substantially larger than a diameter of the shaft, and wherein the opening is adapted to restrict rotation of the shaft within the body.

4. The tensioner of claim 1 wherein the body comprises a front opening and a rear opening, the front opening extending through a front portion of the body, the rear opening extending through a rear portion of the body, and wherein the shaft is positioned within the front opening and the rear opening.

5. The tensioner of claim 1 wherein the body comprises a front opening and a rear opening, the front opening extending through a front portion of the body, the rear opening extending through a rear portion of the body, and wherein the shaft extends through the front opening and the rear opening.

6. The tensioner of claim 1 wherein the body comprises a hollow section, the hollow section being adapted to hold the arm, and wherein the arm is adapted to pivot within the hollow section.

7. The tensioner of claim 1 wherein the body comprises a hollow section, the hollow section being adapted to hold the arm, and to restrict movement of the arm.

8. The tensioner of claim 1, further comprising a push tab in contact with the arm and the shaft, the push tab being adapted to move the shaft through the body in a forward direction as the arm is moved within the body.

9. The tensioner of claim 1, further comprising an arm spring communicating with the arm, and wherein the arm spring is adapted to compress when the arm is moved during use.

10. The tensioner of claim 1, further comprising an arm spring communicating with the arm, and wherein the arm spring is adapted to return the arm to a starting position during use.

11. The tensioner of claim 1 wherein the body comprises a lock tab, the lock tab being adapted to inhibit movement of the shaft through the body during use.

12. The tensioner of claim 1 wherein the body comprises a lock tab, the lock tab being adapted to inhibit movement of the shaft during use, and wherein the lock tab is positionable along the shaft to allow movement of the shaft through the body during use.

13. The tensioner of claim 1 wherein the body comprises a lock spring and a lock tab, the lock spring being in contact with the lock tab, and wherein the lock spring is adapted to move the lock tab such that the lock tab inhibits movement of the shaft through the body during use.

14. The tensioner of claim 1 wherein the shaft further comprises an opening extending longitudinally through the shaft.

15. The tensioner of claim 1 wherein the shaft further comprises a tip located at an end of the shaft, the tip comprising a tip diameter that is substantially greater than a shaft diameter of the shaft.

16. The tensioner of claim 1 wherein the shaft further comprises a tip, the tip comprising an indentation extending longitudinally along an outside surface of the tip, and wherein the indentation is adapted to contain the cable.

17. The tensioner of claim 1 wherein the shaft further comprises a tip, the tip comprising a recessed opening, the recessed opening comprising a shape complimentary to the connector.

18. The tensioner of claim 1 wherein the shaft further comprises a tip, the tip comprising a first slot and a second slot, the first slot extending substantially across an end of the tip, the second slot extending substantially across the end of the tip in a substantially perpendicular orientation to the first slot, and wherein the slots form a recessed opening adapted to contain the connector.

19. The tensioner of claim 1 wherein the body further comprises a bushing, the bushing being adapted to communicate with the body and the shaft, and wherein the bushing is adapted to minimize the lateral movement of the shaft within the body.

20. The tensioner of claim 1 wherein the body further comprises a bushing cover, the bushing cover comprising a cable clamp, and wherein the bushing cover is adapted to rotate about the body such that the cable clamp is positionable with respect to the body during use.

21. The tensioner of claim 1 wherein the body comprises a cable clamp, and wherein the cable clamp is adapted to inhibit movement of a portion of the cable with respect to the body.

22. The tensioner of claim 1, further comprising a cable clamp adapted to rotate to a securing position for inhibiting movement of the cable with respect to the body during use, and wherein the cable is adapted to rotate to a releasing position for allowing the cable to move with respect to the body during use.

23. The tensioner of claim 1, further comprising a cable clamp spring communicating with a cable clamp, and wherein the cable clamp spring is adapted to fix the cable clamp in a securing position.

24. The tensioner of claim 1 wherein the driver further comprises an end, the end being adapted to vary the position of a pin with respect to the connector during use.

25. The tensioner of claim 1, wherein the driver further comprises an end, the end being substantially hexagonal shaped.

26. The tensioner of claim 1 wherein the driver is adapted to position a pin within the connector in an orientation such that the pin engages a portion of the cable to secure the cable with respect to the connector during use.

27. The tensioner of claim 1 wherein the driver is adapted to position a pin within the connector in an orientation such that a portion of the cable is moveable within the connector during use.

28. A device for tensioning a surgical cable, the device comprising: a body comprising a channel therethrough; a hollow shaft member disposed through the channel in the body during use and configured to engage a cable connector; a driver member disposed inside the hollow shaft member during use and configured to engage a pin in a cable connector during use; one or more locking mechanisms configured to attach a cable to the body during use; and a tensioning mechanism configured to controllably move the shaft with respect to the body during use.

29. The device of claim 28, wherein the channel and the shaft are configured to inhibit rotation of the shaft in the body.

30. The device of claim 28, wherein the tensioning mechanism comprises an arm attached to the body in a pivotable engagement.

31. The device of claim 30, wherein the body comprises a hollow section, the hollow section configured to hold the arm, and wherein the arm is configured to pivot within the hollow section.

32. The device of clam 30, wherein the tensioning mechanism comprises a push tab in contact with the arm and the shaft, the push tab being adapted to move the shaft through the body in a forward direction as the arm is pivoted into the body.

33. The device of claim 30, comprising a spring configured to bias the arm to pivot away from the body.

34. The device of claim 28, wherein the tensioning mechanism comprises a locking tab configured to inhibit movement of the shaft through the body during use.

35. The device of claim 28, wherein the tensioning mechanism comprises a lock spring and a lock tab, the lock spring being in contact with the lock tab during use, and wherein the lock spring is adapted to move the lock tab such that the lock tab inhibits movement of the shaft through the body during use.

36. The device of claim 28, wherein the driver member is configured to position a pin within a cable connector such that the pin reversibly engages and secures a portion of a cable disposed in the cable connector.

37. A cable tensioning device comprising: a body; a shaft disposed through the body and configured to engage a cable connector; a push tab mechanism configured to push the shaft through the body; a trigger mechanism connected to the push tab mechanism configured to activate the push tab mechanism; a locking mechanism configured to inhibit the shaft from moving through the body; and one or more devices for connecting a cable to the body wherein the position of the one or more devices is rotatable with respect to the body; whereby during use, activating the trigger mechanism is effective to move the shaft in a first direction through the body and further whereby the locking mechanism is effective to inhibit movement of the shaft in a second direction in the body, opposite to the first direction, when the trigger mechanism is released.

38. The device of claim 37, wherein the trigger mechanism comprises an arm attached to the body in a pivotable engagement.

39. The device of claim 38, wherein the body comprises a hollow section, the hollow section configured to hold the arm, and wherein the arm is configured to pivot within the hollow section.

40. The device of claim 38, comprising a spring configured to bias the arm to pivot away from the body.

41. The device of claim 37, wherein the locking mechanism comprises one or more lock tabs.

42. The device of claim 37, wherein the locking mechanism comprises a lock spring and a lock tab, the lock spring being in contact with the lock tab during use, and wherein the lock spring is adapted to move the lock tab such that the lock tab inhibits movement of the shaft through the body during use.

43. The device of claim 37, wherein the shaft comprises an indentation extending along an outside surface thereof, configured to contain a cable.

44. The device of claim 37, wherein the one or more devices for connecting a cable to the body are attached to a rotatable member, configured so that a cable connection point is positionable with respect to the body.

45. The device of claim 37, further comprising a driver member disposed in the shaft during use, wherein the driver member is configured to position a pin within a cable connector such that the pin reversibly engages and secures a portion of a cable disposed in the cable connector.

Patent Citations (249)

Patent	Date	Inventor
US3644966	1972-02-01	Higgins
US4401112	1983-08-01	Rezaian
US4433677	1984-02-01	Ulrich et al.
US4492226	1985-01-01	Belykh et al.
US4501269	1985-02-01	Bagby
US4503848	1985-03-01	Caspar et al.
US4570618	1986-02-01	Wu
US4604995	1986-08-01	Stephens et al.
US4641636	1987-02-01	Cotrel
US4643178	1987-02-01	Nastari et al.
US4743256	1988-05-01	Brantigan
US4763644	1988-08-01	Webb
US4805602	1989-02-01	Puno et al.
US4834757	1989-05-01	Brantigan
US4878915	1989-11-01	Brantigan
US4887596	1989-12-01	Sherman
US4946458	1990-08-01	Herma et al.
US4950269	1990-08-01	Gaines, Jr.
US4961740	1990-10-01	Ray et al.
US4966600	1990-10-01	Songer et al.
US4987892	1991-01-01	Krag et al.
US5005562	1991-04-01	Cotrel
US5026373	1991-06-01	Ray et al.
US5047029	1991-09-01	Aebi et al.
US5055104	1991-10-01	Ray
US5074864	1991-12-01	Cozad et al.
US5102412	1992-04-01	Rogozinski
US5108399	1992-04-01	Eitenmuller et al.
US5108446	1992-04-01	Wagner et al.
US5116340	1992-05-01	Songer et al.
US5123926	1992-06-01	Pisharodi
US5127912	1992-07-01	Ray et al.
US5129388	1992-07-01	Vignaud et al.
US5129904	1992-07-01	Illi
US5147359	1992-09-01	Cozad et al.
US5154718	1992-10-01	Cozad et al.
US5171278	1992-12-01	Pisharodi
US5176678	1993-01-01	Tsou
US5176680	1993-01-01	Vignaud et al.
US5181917	1993-01-01	Rogozinski
US5192321	1993-03-01	Strokon
US5192327	1993-03-01	Brantigan et al.
US5201734	1993-04-01	Cozad et al.
US5242445	1993-09-01	Ashman
US5242448	1993-09-01	Pettine et al.
US5246442	1993-09-01	Ashman et al.
US5261909	1993-11-01	Sutterlin et al.
US5263953	1993-11-01	Bagby
US5281222	1994-01-01	Allard et al.
US5282801	1994-02-01	Sherman
US5290312	1994-03-01	Kojimoto et al.
US5290494	1994-03-01	Coombes et al.
US5303718	1994-04-01	Krajicek
US5304179	1994-04-01	Wagner
US5306307	1994-04-01	Senter et al.
US5306309	1994-04-01	Wagner et al.
US5312405	1994-05-01	Korotko et al.
US5312410	1994-05-01	Miller et al.
US5318566	1994-06-01	Miller
US5336223	1994-08-01	Rogers
US5336240	1994-08-01	Metzler et al.
US5344422	1994-09-01	Frigg
US5348026	1994-09-01	Davidson
US5357983	1994-10-01	Mathews
US5360429	1994-11-01	Jeanson et al.
US5360431	1994-11-01	Puno et al.
US5361766	1994-11-01	Nichols et al.
US5364399	1994-11-01	Lowery et al.
US5380325	1995-01-01	Lahille et al.
US5390683	1995-02-01	Pisharodi
US5395374	1995-03-01	Miller et al.
US5397364	1995-03-01	Kozak et al.
US5403315	1995-04-01	Ashman
US5405391	1995-04-01	Hednerson et al.
US5415658	1995-05-01	Kilpela et al.
US5417690	1995-05-01	Sennett et al.
US5423820	1995-06-01	Miller et al.
US5423825	1995-06-01	Levine
US5425772	1995-06-01	Brantigan
US5466237	1995-11-01	Byrd, III et al.
US5474555	1995-12-01	Puno et al.
US5480437	1996-01-01	Draenert
US5484437	1996-01-01	Michelson
US5489307	1996-02-01	Kuslich et al.
US5489308	1996-02-01	Kuslich et al.
US5496318	1996-03-01	Howland et al.
US5505732	1996-04-01	Michelson
US5507746	1996-04-01	Lin
US5514180	1996-05-01	Heggeness et al.
US5520690	1996-05-01	Errico et al.
US5522899	1996-06-01	Michelson
US5527341	1996-06-01	Gogolewski et al.
US5531746	1996-07-01	Errico et al.
US5531751	1996-07-01	Schultheiss et al.
US5536270	1996-07-01	Songer et al.
US5536271	1996-07-01	Daly et al.
US5540698	1996-07-01	Preissman
US5545165	1996-08-01	Biedermann et al.
US5545168	1996-08-01	Burke
US5549608	1996-08-01	Errico et al.
US5549612	1996-08-01	Yapp et al.
US5554157	1996-09-01	Errico et al.
US5563124	1996-10-01	Damien et al.
US5569248	1996-10-01	Mathews
US5569253	1996-10-01	Farris et al.
US5571192	1996-11-01	Schonhoffer
US5575792	1996-11-01	Errico et al.
US5578033	1996-11-01	Errico et al.
US5584834	1996-12-01	Errico et al.
US5586984	1996-12-01	Errico et al.
US5593409	1997-01-01	Michelson
US5601553	1997-02-01	Trebing et al.
US5601556	1997-02-01	Pisharodi
US5603713	1997-02-01	Aust et al.
US5607424	1997-03-01	Tropiano
US5607425	1997-03-01	Rogozinski
US5607426	1997-03-01	Ralph et al.
US5607430	1997-03-01	Bailey
US5609592	1997-03-01	Brumfield et al.
US5609593	1997-03-01	Errico et al.
US5609594	1997-03-01	Errico et al.
US5609596	1997-03-01	Pepper
US5609635	1997-03-01	Michelson
US5609636	1997-03-01	Kohrs et al.
US5611800	1997-03-01	Davis et al.
US5611801	1997-03-01	Songer
US5613967	1997-03-01	Engelhardt et al.
US5616144	1997-04-01	Yapp et al.
US5620443	1997-04-01	Gertzbein et al.
US5624441	1997-04-01	Sherman et al.
US5626579	1997-05-01	Muschler et al.
US5628740	1997-05-01	Mullane
US5628756	1997-05-01	Barker, Jr. et al.
US5630816	1997-05-01	Kambin
US5632747	1997-05-01	Scarborough et al.
US5634925	1997-06-01	Urbanski
US5643260	1997-07-01	Doherty
US5643264	1997-07-01	Sherman et al.
US5643265	1997-07-01	Errico et al.
US5645084	1997-07-01	McKay
US5645544	1997-07-01	Tai et al.
US5645549	1997-07-01	Boyd et al.
US5645598	1997-07-01	Brosnahan, III
US5647873	1997-07-01	Errico et al.
US5649927	1997-07-01	Kilpela et al.
US5651283	1997-07-01	Runciman et al.
US5651789	1997-07-01	Cotrel
US5653708	1997-08-01	Howland
US5653709	1997-08-01	Frigg
US5653763	1997-08-01	Errico et al.
US5658289	1997-08-01	Boucher et al.
US5658337	1997-08-01	Kohrs et al.
US5658516	1997-08-01	Eppley et al.
US5662653	1997-09-01	Songer et al.
US5665088	1997-09-01	Gil et al.
US5665112	1997-09-01	Thal
US5665122	1997-09-01	Kambin
US5667506	1997-09-01	Sutterlin
US5667507	1997-09-01	Corin et al.
US5667508	1997-09-01	Errico et al.
US5668288	1997-09-01	Storey et al.
US5669909	1997-09-01	Zdeblick et al.
US5669910	1997-09-01	Korhonen et al.
US5669911	1997-09-01	Errico et al.
US5671695	1997-09-01	Schroeder
US5672175	1997-09-01	Martin
US5674222	1997-10-01	Berger et al.
US5674295	1997-10-01	Ray et al.
US5674296	1997-10-01	Bryan et al.
US5676665	1997-10-01	Bryan
US5676666	1997-10-01	Oxland et al.
US5676701	1997-10-01	Yuan et al.
US5676703	1997-10-01	Gelbard
US5681311	1997-10-01	Foley et al.
US5681312	1997-10-01	Yuan et al.
US5683391	1997-11-01	Boyd
US5683392	1997-11-01	Richelsoph et al.
US5683393	1997-11-01	Ralph
US5683394	1997-11-01	Rinner
US5688272	1997-11-01	Montague et al.
US5688273	1997-11-01	Errico et al.
US5688274	1997-11-01	Errico et al.
US5688279	1997-11-01	McNulty et al.
US5688280	1997-11-01	Booth, Jr. et al.
US5690629	1997-11-01	Asher et al.
US5690630	1997-11-01	Errico et al.
US5690631	1997-11-01	Duncan et al.
US5690632	1997-11-01	Schwartz et al.
US5690633	1997-11-01	Taylor et al.
US5690842	1997-11-01	Panchison
US5693046	1997-12-01	Songer et al.
US5693053	1997-12-01	Estes
US5693100	1997-12-01	Pisharodi
US5697929	1997-12-01	Mellinger
US5697977	1997-12-01	Pisharodi
US5700291	1997-12-01	Kuslich et al.
US5700292	1997-12-01	Margulies
US5702391	1997-12-01	Lin
US5702392	1997-12-01	Wu et al.
US5702393	1997-12-01	Pfaifer
US5702394	1997-12-01	Henry et al.
US5702395	1997-12-01	Hopf
US5702396	1997-12-01	Hoenig et al.
US5702399	1997-12-01	Kilpela et al.
US5702449	1997-12-01	McKay
US5702450	1997-12-01	Bisserie
US5702451	1997-12-01	Biedermann et al.
US5702452	1997-12-01	Argenson et al.
US5702453	1997-12-01	Rabbe et al.
US5702454	1997-12-01	Baumgartner
US5702455	1997-12-01	Saggar
US5704936	1998-01-01	Mazel
US5704937	1998-01-01	Martin
US5707372	1998-01-01	Errico et al.
US5707395	1998-01-01	Li
US5709681	1998-01-01	Pennig
US5709682	1998-01-01	Medoff
US5709683	1998-01-01	Bagby
US5709684	1998-01-01	Errico et al.
US5709685	1998-01-01	Dombrowski et al.
US5709686	1998-01-01	Talos et al.
US5713841	1998-02-01	Graham
US5713898	1998-02-01	Stucker et al.
US5713899	1998-02-01	Marnay et al.
US5713900	1998-02-01	Benzel et al.
US5713903	1998-02-01	Sander et al.
US5713904	1998-02-01	Errico et al.
US5716355	1998-02-01	Jackson et al.
US5716356	1998-02-01	Biedermann et al.
US5716357	1998-02-01	Rogozinski
US5716358	1998-02-01	Ochoa et al.
US5716359	1998-02-01	Ojima et al.
US5716415	1998-02-01	Steffee
US5716416	1998-02-01	Lin
US5720746	1998-02-01	Soubeiran
US5720747	1998-02-01	Burke
US5720748	1998-02-01	Kuslich et al.
US5720751	1998-02-01	Jackson
US5722977	1998-03-01	Wilhelmy
US5733284	1998-03-01	Martin
US5782831	1998-07-01	Sherman et al.
EPX19062A1	1980-11-01
EPX597258A1	1993-10-01
EPX578320A1	1994-01-01
EPX625336A2	1994-11-01
EPX638292A1	1995-02-01
EPX778007A1	1997-06-01
FRX2732887A1	1996-10-01
FRX2736535A1	1997-01-01

Non-Patent Literature (47)

Danek Group, Inc. Medical Division Publication entitled, "TSRH Spinal System--Unmatched versatility," 1992, pp. 1-4.
Danek Surgical Technique Manual entitled, "TSRH Spinal Implant System," Date Unknown, pp. 1-16.
Danek Surgical Technique Manual entitled, "TSRH Crosslink," Date Unknown, pp. 1-8.
Dickman Curtis A., et al., BNI Quarterly Publication entitled, "Techniques of Screw Fixation of the Cervical Spine," vol. 9. No. 4, Fall 1993, pp. 27-39.
Slone et al., RadioGraphics Publication entitled, "Spinal Fixation," vol. 13 No. 2, Mar. 1993, pp. 341-356.
Synthes Spine Publication entitled, "The Universal Spinal System--Internal Fixation for the Spine," 1994, pp. 1-15.
AcroMed Publication entitled, "The ISOLA Spinal System--Versatility, simplicity and minimal profile in the surgical treatment of the spine," 1994, pp. 1-15.
AcroMed Corporation Publication entitled, "ISOLA.RTM. Transverse Rod Connectors: Principles and Techniques," Date Unknown, pp. i, ii, 1-8.
Danek Publication entitled, "AXIS--Fixation System," 1993, pp. 1-6.
Synthes Publication entitled, "Small Notched Titanium Reconstruction Plate System," 1996, pp. 1-6.
J. Neurosurg Publication entitled, "Posterior plates in the management of cervical instability: long-term results in 44 patients," vol. 81, 1994, pp. 341-349.
BNI Quarterly Publication entitled, "Lateral Mass Posterior Plating and Facet Fusion for Cervical Spine Instability," vol. 7, No. 2, 1991, pp. i, ii, 1-12.
Beadling, Lee, Orthopedics Today Publication entitled, "FDA Clears Spinal Cages for Interbody Lumbar Fusion," pp. 1-2.
MedPro Month Publication entitled, "Trends in Spine & Disk Surgery," vol. VI, No. 11-12, pp. 280-284.
Surgical Dynamics Ray Threaded Fusion Cage Device Surgical Technique Manual, pp. 1-10.
Surgical Dynamics Ray Threaded Fusion Cage, pp. 1-6.
AcroMed Publication entitled, "AcroMed Spinal Solutions for Cervical Pathologies," Jul. 1995, pp. 1-8.
Codman Publication entitled, "Sof'wire Cable System," 6 pp.
Huhn, Stephen L. et al., "Posterior Spinal Osteosynthesis for Cervical Fracture/Dislocation Using a Flexible Multistrand Cable System: Technical Note," Neurosurgery, vol. 29, No. 6, 1991, pp. 943-946.
Dickman, Curtis A. et al., "Wire Fixation for the Cervical Spine: Biomechanical Principles and Surgical Techniques," BNI Quarterly, vol. 9, No. 4, Fall 1993, pp. 2-16.
Publication by AcroMed entitled, "Acromed Cable System by Songer," Sep. 1993, 4 pp.
M. Aebi, MD, et al., "Treatment of Cervical Spine Injuries with Anterior Plating: Indications, Techniques, and Results," vol. 16, No. 3S, Mar., 1991 Supplement, pp. S38-S45.
Foley, M.D. et al., "Aline Anterior Cervical Plating System," Smith & Nephew Richards, Inc. Orthopaedics Catalog Information, Sep. 1996, pp. 1-16.
Lowery, Gary L., M.D., Ph.D., Sofamor Danek Group, Inc. Publication entitled, "Orion Anterior Cervical Plate System: Surgical Technique," 1994, pp. 1-24.
Apfelbaum, R., M.D., Aesculap Scientific Information publication entitled, "Posterior Transarticular C1-2 Screw Fixation for Atlantoaxial Instability," 1993, pp. 1-15.
Danek Titanium Cable System publication by Danek Group, Inc., 1994, 6 pp.
Publication entitled, "Spinal Disorders", 4 pp.
O'Brien, John P., Ph.D., Orthopaedic Product News Article entitled, "Interbody Fusion of the Lumbar Spine," pp. 1-3.
Roy et al., "Variation of Young's Modulus and Hardness in Human Lumbar Vertebrae Measured by Nanoindentation", pp. 1-4.
Sofamor Danek publication entitled, "Atlas Cable System: Evolution of the Cable System for Spinal Applications," 1995, 2 pp.
AcroMed publication entitled, "AcroMed Songer Cable System: Ordering information for Implants and Instruments," Apr. 1996, 4 pp.
Songer, Matthew, M.D., "Acromed Cable System by Songer: Cervical Technique Manual," pp. 1-17.
Songer, Matthew N., M.D., "Acromed Cable System by Songer: Technique Manual," 1993, pp. 1-20.
Oxland, Thomas, R., Ph.D., et al., SpineTech Inc. Publication entitled, "Biomechanical Rationale--The BAK Interbody Fusion System: An Innovative Solution," pp. 1-16.
SpineTech, Inc. publication entitled, "Patient Information on Spinal Fusion Surgery and the BAK Interbody Fusion System," 10 pp.
SpineTech, Inc. publication entitled, "BAK/Cervical Interbody Fusion System," 1994, 2 pp.
SpineTech, Inc. publications entitled, "Instrumentation BAK Interbody Fusion System," "Biomechanics BAK Interbody Fusion System," and "Porosity BAK Interbody Fusion System," 1996, 12 pp.
SpineTech, Inc. publication entitled, "The BAK Interbody Fusion System," 1996, 4 pp.
Depuy Motech, Inc. publication entitled, "Moss Miami 3-Dimensional Spinal Instrumentation: Taking Spinal Instrumentation to a New Dimension," 1995, 8 pp.
Shufflebarger, Harry L., M.D., "Moss Miami Spinal Instrumentation System: Methods of Fixation of the Spondylopelvic Junction," Lumbosacral and Spinopelvic Fixation, 1996 by Raven Publishers, Philadelphia, pp. 381-393.
Shufflebarger, Harry L., M.D., Depuy Motech publication entitled, "Clinical Issue: Rod Rotation in Scoliosis Surgery," 5 pp.
AcroMed publication entitled, "Instruments," 3 pp.
SpineTech, Inc. publication entitled, "The Bone Harvester," 1996, 2 pp.
Wright Medical Technology Publication entitled, "Versalok Low Back Fixation System," 1996, pp. 1-4.
Danek Medical, Inc. Publication entitled, "TSRH Lumbar System," 1991, pp. 1-4.
Spinal Concepts Inc. publication entitled "The BacFix ss--Posterior Lower Back Fixation System--Written Surgical Technique," 1997, pp. 1-11.
Dialog Web results for search for English-language abstract for EPO patent 0019062A1, downloaded and printed Nov. 25, 1998, 1 sheet.

Abstract

Description