# US 10,478,319 B2 · System with tool assembly and expandable spinal implant > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 10,478,319 B2 - Document ID: US10478319B2 - Status: Granted - Kind: B2 - Application number: 16/280,684 - Filed: 2019-02-20 - Published: 2019-06-13 - Granted: 2019-11-19 - Earliest claimed: 2005-04-12 - Assignees: Moskowitz Family LLC - Applicants: Moskowitz Family LLC - Inventors: Ahmnon D. Moskowitz; Pablo A. Valdivia Y. Alvarado; Mosheh T. Moskowitz; Nathan C. Moskowitz - Web page: https://patentgrep.com/patent/US10478319B2 ## CPC - A61F 2/4611: {of spinal prostheses} - A61B 17/0642: {for bones, e.g. for osteosynthesis or connecting tendon to bone} - A61B 17/7064: {Devices acting on, attached to, or simulating the effect of, vertebral facets; Tools therefor} - A61B 17/809: {with bone-penetrating elements, e.g. blades or prongs (bone staples A61B17/0642; intramedullary nails with a plate at an end A61B17/7233)} - A61B 17/8635: {Tips of screws} - A61B 17/8875: {Screwdrivers, spanners or wrenches} - A61B 17/8894: {holding the implant into or through which the screw is to be inserted (A61B17/7082, A61B17/7091 take precedence)} - A61B 17/92: Impactors or extractors, e.g. for removing intramedullary devices {(insertion or extraction of artificial joints A61F2/4603)} - A61F 2/4465: {having a circular or kidney shaped cross-section substantially perpendicular to the axis of the spine} - A61F 2/447: {substantially parallelepipedal, e.g. having a rectangular or trapezoidal cross-section} - A61B 17/0644: {penetrating the tissue, deformable to closed position} - A61B 17/1757: {for the spine} - A61B 17/86: Pins or screws {or threaded wires; nuts therefor (A61B17/72 take precedence)} - A61B 2017/00407: {Ratchet means} - A61B 2017/0641: {having at least three legs as part of one single body} - A61B 2017/0648: {threaded, e.g. tacks with a screw thread} - A61B 2017/922: {Devices for impaction, impact element} - A61F 2002/2835: {Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material} - A61F 2002/30133: {kidney-shaped or bean-shaped} - A61F 2002/30387: {Dovetail connection} - A61F 2002/30448: {using adhesives} - A61F 2002/30507: {using a threaded locking member, e.g. a locking screw or a set screw} - A61F 2002/3055: {for adjusting length} - A61F 2002/30579: {with mechanically expandable devices, e.g. fixation devices} - A61F 2002/30593: {hollow} - A61F 2002/30604: {modular} - A61F 2002/30772: {Apertures or holes, e.g. of circular cross section} - A61F 2002/30878: {with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts} - A61F 2002/30879: {Ribs} - A61F 2002/30904: {serrated profile, i.e. saw-toothed} - A61F 2002/448: {comprising multiple adjacent spinal implants within the same intervertebral space or within the same vertebra, e.g. comprising two adjacent spinal implants} - A61F 2002/4627: {with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument} - A61F 2002/4681: {by applying mechanical shocks, e.g. by hammering} - A61F 2002/4687: {Mechanical guides for implantation instruments} - A61F 2220/0025: Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements - A61F 2220/005: using adhesives - A61F 2230/0015: Kidney-shaped, e.g. bean-shaped - A61F 2250/0007: for adjusting length - A61F: FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS (dental prosthetics A61C) - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) ## Abstract A system includes a tool assembly and an expandable spinal implant. The tool assembly includes a first tool and a second adjusting tool. The first tool has first and second engagement prongs positioned at a first distal end and the first tool defines an adjusting tool passage. The second adjusting tool can extend through the adjusting tool passage of the first tool. The expandable spinal implant includes a first expandable spinal implant structure, a second expandable spinal implant structure, and an adjusting screw having a screw head and a threaded portion. The expandable spinal implant defines first and second tool engagement indentations. The adjusting screw is positioned within the expandable spinal implant such that the second adjusting tool can extend through the adjusting tool passage to engage the screw head while the first and second engagement prongs are engaged with the first and second tool engagement indentations. ## Claims ### Claim 1 A system comprising: a tool assembly which comprises: a first tool having a first proximal end and a first distal end with a first handle and a gripper, the gripper being positioned at the first distal end, cooperating with the first handle, and having first and second engagement prongs positioned at the first distal end, wherein the first tool defines an adjusting tool passage through the first tool; and a second adjusting tool having a second proximal end and a second distal end with a second handle positioned at the second proximal end, a screw engagement portion positioned at the second distal end, and a shaft extending from the second handle to the screw engagement portion, wherein the shaft of the second adjusting tool is sized with a smaller diameter than that of the adjusting tool passage such that the second adjusting tool can extend through the adjusting tool passage of the first tool; and an expandable spinal implant sized and configured to be implanted in a human spine, the expandable spinal implant comprising a first expandable spinal implant structure, a second expandable spinal implant structure, and an adjusting screw having a screw head and a threaded portion, wherein the expandable spinal implant is configured to expand the first expandable spinal implant structure with respect to the second expandable spinal implant structure in response to turning of the adjusting screw, wherein the expandable spinal implant defines first and second tool engagement indentations sized and configured for receiving the first and second engagement prongs of the first tool, wherein the adjusting screw is positioned within the expandable spinal implant in a screw location such that the second adjusting tool can extend through the adjusting tool passage of the first tool to engage the screw head of the adjusting screw while the first and second engagement prongs of the first tool are engaged with the first and second tool engagement indentations of the expandable spinal implant. ### Claim 2 (depends on 1) The system of claim 1, wherein the screw engagement portion of the second adjusting tool comprises a key for engaging the head of the adjusting screw to turn the adjusting screw and controlling height of the expandable spinal implant. ### Claim 3 (depends on 1) The system of claim 1, wherein the expandable spinal implant defines a longitudinal axis, wherein the first and second expandable spinal implant structures have first and second angled wedge surfaces that engage one another, wherein the adjusting screw is connected to the second expandable spinal implant structure so as to move the second expandable spinal implant structure along the longitudinal axis and slide the first angled wedge surface with respect to the second angled wedge surface to push the first expandable spinal implant structure in a direction that is substantially away from the longitudinal axis of the expandable spinal implant. ### Claim 4 (depends on 1) The system of claim 1, wherein the first expandable spinal implant structure defines a first angled wedge portion that comprises a first inwardly-facing rail and a second inwardly-facing rail, wherein a first inwardly-facing slot is defined at a location adjacent the first inwardly-facing rail, wherein a second inwardly-facing slot is defined at a location adjacent the second inwardly-facing rail, wherein the second expandable spinal implant structure defines a second angled wedge portion that comprises a first outwardly-facing rail and a second outwardly-facing rail that faces outwardly in a direction opposite that of the first outwardly-facing rail, wherein a first outwardly-facing slot is defined at a location adjacent the first outwardly-facing rail, wherein a second outwardly-facing slot is defined at a location adjacent the second outwardly-facing rail, wherein the first expandable spinal implant structure is slidably-engaged with the second expandable spinal implant structure such that the first angled wedge portion engages the second angled wedge portion with the first inwardly-facing rail of the first expandable spinal implant structure positioned in the first outwardly-facing slot of the second expandable spinal implant structure, the second inwardly-facing rail of the first expandable spinal implant structure positioned in the second outwardly facing slot of the second expandable spinal implant structure, the first outwardly-facing rail of the second expandable spinal implant structure positioned in the first inwardly-facing slot of the first expandable spinal implant structure, and the second outwardly-facing rail of the second expandable spinal implant structure positioned in the second inwardly-facing slot of the first expandable spinal implant structure. ### Claim 5 (depends on 1) The system of claim 1, and further comprising first and second anchors, wherein the expandable spinal implant comprises first and second anchor guides angled to guide the first and second anchors bidirectionally into first and second vertebral bodies. ### Claim 6 (depends on 5) The system of claim 5, wherein the first tool defines third and fourth anchor guides configured to align with the first and second anchor guides of the expandable spinal implant when the first and second engagement prongs are engaged with the first and second tool engagement indentations so as to guide the first and second anchors through the third and fourth anchor guides into the first and second anchor guides. ### Claim 7 (depends on 1) A method of using the system of claim 1, the method comprising: connecting the first tool to the expandable spinal implant with the first and second engagement prongs engaged with the first and second tool engagement indentations; implanting the expandable spinal implant into a disc space in the human spine via the first tool; extending the second adjusting tool through the first tool to engage the adjusting screw of the expandable spinal implant; and expanding the expandable spinal implant by turning the second adjusting tool to turn the adjusting screw of the expandable spinal implant. ### Claim 8 (depends on 1) The system of claim 1, and further comprising bone graft material configured to be placed inside and outside of the expandable spinal implant. ### Claim 9 A system comprising: a tool assembly comprising: a first tool having a first proximal end, a first distal end, and a first elongate body between the first proximal end and the first distal end, wherein the first tool defines a first tool axis from the first proximal end to the first distal end, wherein the first tool includes first and second engagement prongs positioned at the first distal end on opposite sides of the first tool axis, wherein the first tool defines an adjusting tool passage through the first tool; and a second adjusting tool having a second proximal end and a second distal end, wherein the second adjusting tool includes a second handle positioned at the second proximal end, a screw engagement portion positioned at the second distal end, and a shaft extending from the second handle to the screw engagement portion, wherein the shaft of the second adjusting tool is sized with a smaller diameter than that of the adjusting tool passage such that the second adjusting tool can extend through the adjusting tool passage of the first tool; and an expandable spinal implant sized and configured to be implanted in a human spine, the expandable spinal implant comprising a first expandable spinal implant structure defining a first engagement surface sized and configured to engage a first vertebral body, a second expandable spinal implant structure defining a second engagement surface sized and configured to engage a second vertebral body, and an adjusting screw having a screw head and a threaded shaft, wherein the expandable spinal implant is configured to expand the first expandable spinal implant structure with respect to the second expandable spinal implant structure in response to turning of the adjusting screw, wherein the expandable spinal implant defines first and second tool engagement indentations sized and configured for receiving the first and second engagement prongs of the first tool, wherein the adjusting screw is positioned within the expandable spinal implant in a screw location such that the second adjusting tool can extend through the adjusting tool passage of the first tool to engage the screw head of the adjusting screw while the first and second engagement prongs of the first tool are engaged with the first and second tool engagement indentations of the expandable spinal implant. ### Claim 10 (depends on 9) The system of claim 9, wherein the expandable spinal implant includes ridges on each of the first and second engagement surfaces, wherein the first indentation extends into a first side of the first expandable spinal implant structure, wherein the second indentation extends into a second side of the expandable spinal implant structure. ### Claim 11 (depends on 9) The system of claim 9, wherein the expandable spinal implant comprises first and second angled wedge surfaces, wherein rotation of the adjustment screw by the second adjusting tool drives relative motion of the first angled wedge surface with respect to the second angled wedge surface to expand the expandable spinal implant. ### Claim 12 (depends on 9) The system of claim 9, wherein the first expandable spinal implant structure defines an end gap between the first and second opposing side surfaces at a first end of the first vertebral body engagement surface, wherein the first vertebral body engagement surface comprises a plurality of ridges extending from the first vertebral body engagement surface, wherein at least some of the ridges are positioned on the first vertebral body engagement surface on opposite sides of the end gap. ### Claim 13 (depends on 9) The system of claim 9, and further comprising first and second anchors, wherein the expandable spinal implant comprises first and second anchor guides angled to guide the first and second anchors bidirectionally into the first and second vertebral bodies, wherein the first tool defines third and fourth anchor guides configured to align with the first and second anchor guides of the expandable spinal implant so as to guide the first and second anchors through the third and fourth anchor guides into the first and second anchor guides when the first and second engagement prongs are engaged with the first and second tool engagement indentations. ### Claim 14 (depends on 9) The system of claim 9, wherein a distal end of the adjusting screw has a distal diameter, wherein the head of the adjusting screw has a head diameter, and wherein the distal diameter is larger than the head diameter. ### Claim 15 (depends on 9) The system of claim 9, wherein the first tool comprises a first handle positioned proximate the first proximal end and extending in a direction that is substantially perpendicular to the first proximal axis, wherein the second handle of the second adjusting tool is substantially circular when viewed along the first proximal axis when the second adjusting tool is positioned in the adjusting tool passage. ### Claim 16 (depends on 9) The system of claim 9, wherein the first expandable spinal implant structure and the first engagement surface move with respect to the second expandable spinal implant structure and the second engagement surface at least partially along a direction of the first tool axis when the second adjusting tool turns the adjusting screw. ### Claim 17 (depends on 9) The system of claim 9, wherein the expandable spinal implant has a proximal end, a distal end, and first and second sides, wherein the screw head of the adjusting screw is positioned at the proximal end of the expandable spinal implant, wherein the first and second tool indentations are positioned on the first and second sides proximate to the proximal end, wherein the expandable spinal implant defines a proximal screw hole at the proximal end of the expandable spinal implant and a distal screw hole at the distal end of the expandable spinal implant and wherein the adjusting screw extends through both the proximal and the distal screw holes. ### Claim 18 (depends on 9) The system of claim 9, wherein the first tool indentation extends into a first side of the expandable spinal implant with a first substantially rectangular shape as viewed from a direction perpendicular to the first side and the second tool indentation extends into a second side of the expandable spinal implant with a second substantially rectangular shape as viewed from a direction perpendicular to the second side. ### Claim 19 (depends on 9) A method of using the system of claim 9, the method comprising: connecting the first tool to the expandable spinal implant with the first and second engagement prongs engaged with the first and second tool engagement indentations; implanting the expandable spinal implant into a disc space in the human spine via the first tool; extending the second adjusting tool through the first tool to engage the adjusting screw of the expandable spinal implant; and expanding the expandable spinal implant by turning the second adjusting tool to turn the adjusting screw of the expandable spinal implant. ### Claim 20 A system comprising: a tool assembly comprising: a first tool having a first proximal end, a first distal end, and a first elongate body between the first proximal end and the first distal end, wherein the first tool defines a first tool axis from the first proximal end to the first distal end, wherein the first tool includes a gripper having one or more engagement prongs positioned at the first distal end axially offset from the first tool axis, wherein the first tool defines an adjusting tool passage through the first tool; and a second adjusting tool having a second proximal end and a second distal end, wherein the second adjusting tool includes a screw engagement portion positioned at the second distal end and a shaft extending from the second proximal end to the screw engagement portion, wherein the shaft of the second adjusting tool is sized with a smaller diameter than that of the adjusting tool passage such that the second adjusting tool can extend through and turn within the adjusting tool passage of the first tool; and an expandable spinal implant sized and configured to be implanted in a human spine, the expandable spinal implant comprising a first expandable spinal implant structure defining a first engagement surface sized and configured to engage a first vertebral body, a second expandable spinal implant structure defining a second engagement surface sized and configured to engage a second vertebral body, and an adjusting screw having a screw engagement portion and a threaded portion, wherein the expandable spinal implant is configured to expand the first expandable spinal implant structure with respect to the second expandable spinal implant structure in response to turning of the adjusting screw, wherein the expandable spinal implant defines one or more tool engagement indentations sized and configured for engaging with the gripper of the first tool, wherein the adjusting screw is positioned within the expandable spinal implant in a screw location such that the second adjusting tool can extend through the adjusting tool passage of the first tool to engage the screw engagement portion of the adjusting screw while one or more engagement prongs of the first tool are engaged with the one or more engagement indentations of the expandable spinal implant, wherein at least one of the one or more engagement indentations of the expandable spinal implant is positioned on one or more side surfaces of the expandable spinal implant such that the one or more engagement prongs of the gripper is positioned on the one or more side surfaces of the expandable spinal implant when the first tool is engages with the expandable spinal implant. ### Claim 21 (depends on 20) The system of claim 20, wherein the expandable spinal implant comprises a substantially cylindrical side hole extending through a side of the expandable spinal implant into an interior cavity of the expandable spinal implant and is sized and configured to allow for bone placement through the side hole into the interior cavity, wherein the expandable spinal implant comprises an angled wedge portion having rails and slots configured to allow for relative movement and expansion of the expandable spinal implant during expansion of the expandable spinal implant.