Expandable fusion device with interdigitating fingers
Expandable spinal fusion devices, systems, and methods of using them are provided, and they can be inserted in a subject in a collapsed state through a small surgical corridor, and the expand cephalocaudal only, transverse only, or in both directions, in which direction of expansion can also be obtained independently, if desired, after the insertion. These inventions are valuable in reducing risk and surgical complexity, allowing for an on-the-fly selection of a desirable width footprint, a desired control of height expansion through a gradual cephalocaudal expansion, and a desired control of the alignment of the adjacent vertebral bodies. Devices, systems, and methods are also offered to provide a desired control of the contact area desired between the device and the upper and lower vertebral endplates achieved, for example, using an interdigitated endplate system.
1. An expandable fusion device, comprising:
an interdigitated endplate system, including
a separable upper endplate assembly having a first endplate and a second endplate, the first endplate having a first plurality of protrusions and the second endplate having a second plurality of protrusions;
a separable lower endplate assembly having a third endplate and a fourth endplate, the third endplate having a third plurality of protrusions and the fourth endplate having a fourth plurality of protrusions;
a transverse expansion assembly to (i) expand the distance between the first endplate and second endplate of the upper endplate assembly and (ii) expand the distance between the third endplate and the fourth endplate of the lower endplate assembly, the transverse expansion assembly includes a wedge assembly that comprises a distal wedge and a proximal wedge that are drawn toward each other a first distance in a first step by applying a first force to the wedges through an actuator; and
a cephalocaudal expansion assembly configured to expand the distance between the upper endplate assembly and the lower endplate assembly, the cephalocaudal expansion assembly includes a ramp assembly comprising a distal ramp and a proximal ramp that are drawn toward each other in a second step by applying a second force to the ramps through the wedges by using the actuator to draw the distal wedge and proximal wedge toward each other a second distance;
wherein,
the first plurality of protrusions are interdigitated with the second plurality of protrusions to telescope upon lateral expansion;
the third plurality of protrusions are interdigitated with the fourth plurality of protrusions to telescope upon lateral expansion;
the interdigitated endplate system distributes the area over which the device contacts the upper and lower vertebral endplates; and,
the device is configured for transverse expansion to occur before cephalocaudal expansion.
2. The expandable fusion device of claim 1 , wherein
the first plurality of protrusions extend medially from the first endplate to nest in grooves on the second endplate; and,
the third plurality of protrusions extend medially from the third endplate to nest in grooves on the fourth endplate.
3. The expandable fusion device of claim 1 , wherein the first endplate, the second endplate, the third endplate, and the fourth endplate are each comprised of a rigid beam having a longitudinal axis.
4. The expandable fusion device of claim 1 , wherein the ramp assembly comprises a first distal ramp, a second distal ramp, a first proximal ramp, and a second proximal ramp.
5. The expandable fusion device of claim 1 , wherein at least one of the second endplate and the fourth endplate is larger than at least one of the first endplate and the third endplate.
6. The expandable fusion device of claim 1 , the device further comprising the actuator, wherein the actuator is threaded.
7. The expandable fusion device of claim 1 , wherein the device further comprises an expansion lock.
8. A method of fusing an intervertebral space of a subject, comprising,
inserting the device of claim 1 into an intervertebral space of the subject with an inserter tool; and,
performing cephalocaudal expansion and transverse expansion of the device.
9. A method of fusing an intervertebral space of a subject, comprising,
inserting the device of claim 2 into an intervertebral space of the subject with an inserter tool; and,
performing cephalocaudal expansion and transverse expansion of the device.
10. A method of fusing an intervertebral space of a subject, comprising,
inserting the device of claim 3 into an intervertebral space of the subject with an inserter tool; and,
performing cephalocaudal expansion and transverse expansion of the device.
11. A method of fusing an intervertebral space of a subject, comprising,
inserting the device of claim 4 into an intervertebral space of the subject with an inserter tool; and,
performing cephalocaudal expansion and transverse expansion of the device.
12. An expandable fusion device that is expandable in length, the device comprising: the expandable device of claim 1 coupled in series to a second expandable device.
13. A method of at least inhibiting subsidence of an intervertebral implant in a subject, the method comprising:
selecting the device of claim 1 ;
inserting the device in the intervertebral space; and,
expanding the device laterally and vertically;
wherein, the interdigitating protrusions slidably translate upon the lateral expansion to provide the larger footprint to distribute forces applied to the upper vertebral endplate and the lower vertebral endplate across the larger footprint upon the vertical expansion.
14. The method of claim 13 , wherein
the first plurality of protrusions extend medially from the first endplate to nest in grooves on the second endplate; and,
the third plurality of protrusions extend medially from the third endplate to nest in grooves on the fourth endplate.
15. The expandable fusion device of claim 1 , wherein
each of the first plurality of protrusions has a mating surface on the second endplate, wherein the mating surface is a recess; and,
each of the third plurality of protrusions has a mating surface on the fourth endplate, wherein the mating surface is a recess.
16. The expandable fusion device of claim 1 , wherein
each of the first plurality of protrusions has a mating surface on the second endplate, wherein the mating surface is a channel; and,
each of the third plurality of protrusions has a mating surface on the fourth endplate, wherein the mating surface is a channel.
17. The expandable fusion device of claim 1 , wherein
each of the first plurality of protrusions has a mating surface on the second endplate, wherein the mating surface is a port; and,
each of the third plurality of protrusions has a mating surface on the fourth endplate, wherein the mating surface is a port.
18. The expandable fusion device of claim 1 , wherein
the first plurality of protrusions and the second plurality of protrusions slidably translate with a tongue-in-groove configuration to provide additional rigidity to the upper endplate assembly upon the lateral expansion; and,
the third plurality of protrusions and the fourth plurality of protrusions slidably translate with a tongue-in-groove configuration to provide additional rigidity to the lower endplate assembly upon the lateral expansion.