SPRING SCREW APPARATUSES AND METHODS OF USING SAME

Abstract

A locking spring screw, comprising a screw body having a flexible spring member positionable within a screw head. The screw head comprises a tool slot adapted for receipt of a spring member and includes at least one outlet adjacent to the tool slot adapted for passage therethrough of a tongue of the spring member. A slotted aperture located opposite the outlet from the screw head is positioned at least partially around the circumference of the screw head for engaging the tongue and securing the screw body to an implant when the spring member is in an unbiased condition.

Claims

1. A spring screw for use in combination with an implant screw hole, said screw hole having an inner sidewall with a slotted aperture formed along the inner sidewall comprising: a screw defined by a head portion and a threaded cylindrical body extending therefrom, said head portion having an outer sidewall constructed and arranged to interface with the inner sidewall of the implant screw hole; a tool slot formed in an upper surface of said head portion, said tool slot having a centrally disposed aperture extending to the cylindrical body with a slot extending from said aperture to said sidewall; a first outlet formed at a first end and a second outlet formed at a second end of said slot, said first and second outlet are adjacent said slotted aperture when said spring screw is inserted into said implant screw hole; a spring member positionable within said tool slot, said spring member ends extending through said outlets to engage said slotted aperture when said spring member is in a natural state; wherein a tool threaded into said top opening flexes the spring member, forcing the ends of said spring member to retract into said outlets allowing insertion of the screw head into the implant screw hole, and upon removal of the tool the ends of said spring member extend through said outlets to engage said slotted aperture to maintain an outer side wall of said screw body to an inner edge of the implant screw hole thereby locking said spring screw to the implant.

2. The spring screw according to claim 1, wherein said tool slot includes a cross slot formed perpendicular to said tool slot.

3. The spring screw according to claim 1, wherein the maximum flex of said spring member is about 20 thousandths of an inch.

4. The spring screw according to claim 1, wherein the tool slot and the spring member are formed as counterparts.

5. The spring screw according to claim 1, wherein the implant screw hole inner surface is sloped, increasing in size moving away from the cylindrical screw body constructed and arranged to engage an outer surface of the screw head, said outer surface having a sloped surface forming a reciprocal surface.

6. The spring screw according to claim 1, wherein at least one of the flexible spring member, cylindrical screw body and screw head are constructed of at least one of titanium, stainless steel, cobalt chrome, ceramic, polymer, or PEEK Optima.

7. The spring screw according to claim 1, wherein the screw length along a central axis is 8.0 mm-60.0 mm.

8. The spring screw according to claim 1, wherein the screw head is 3.5 mm-9.0 mm in diameter.

9. The spring screw according to claim 1, wherein said spring member is substantial flat in a natural unbiased condition and is a leaf spring when biased.

10. A system for interlocking a screw and an implant wherein the screw has motion in only one degree of freedom, comprising: an implant provided with at least one screw hole having a sloped surface with a slotted aperture; and a screw having a cylindrical screw body with a head having an outer side wall constructed and arranged to fit within the implant screw hole, said head having an outer sidewall sized to engage said inner sidewall of the implant screw hole, said head having an upper surface including a tool slot and a centrally disposed threaded top opening with at least two outlets formed through said outer side wall adjacent the opening; a spring member disposed within said tool slot having a first and second tongue extendable through said two outlets when said spring member is in a natural state; wherein said spring member can be retracted into said outlets allowing insertion of the screw body into the implant screw hole, and said spring member can be relaxed with said tongues of said spring member extending through said outlet to engage said slotted aperture to maintain an outer side wall of said screw body to an inner edge of the implant screw hole thereby locking said spring screw to the implant.

11. The system according to claim 10, further comprising a tool adapted to be a counterpart to the tool slot.

12. The system according to claim 11, wherein the tool is provided with a tool hub for flexing the spring member upon insertion of the tool into the tool slot.

13. The system according to claim 10, wherein the tool is provided with teeth for providing torque to the spring screw for attaching a spring screw to the implantation site.

14. The system according to claim 10, wherein the one degree of freedom is around a central axis of the spring screw.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0036] Embodiments of the invention are herein described, by way of example only, with reference to the accompanying drawings. In this regard, the description taken along with the drawings makes apparent to those skilled in the art how embodiments of the invention may be practiced. It should also be understood that drawings may not be to scale. In the figures,

[0037] FIG. 1 is a perspective view of a spring screw with a flexed spring member, in accordance with an exemplary embodiment of the invention;

[0038] FIG. 2 is a perspective view of a spring screw with an expanded spring member, in accordance with an exemplary embodiment of the invention;

[0039] FIG. 3 is a cross-sectional view of a spring screw with an expanded spring member, in accordance with an exemplary embodiment of the invention;

[0040] FIG. 4 is a top, perspective view of a sliding spinal implant used in conjunction with at least one spring screw, in accordance with an exemplary embodiment of the invention;

[0041] FIG. 5 is a side view of a sliding spinal implant used in conjunction with at least one spring screw, in accordance with an exemplary embodiment of the invention;

[0042] FIG. 6 is a cross-sectional view of a sliding spinal implant used in conjunction with at least one spring screw, in accordance with an exemplary embodiment of the invention;

[0043] FIG. 7 is a flowchart showing a method of using a spring screw in conjunction with a spinal implant, in accordance with an exemplary embodiment of the invention;

[0044] FIG. 8 is a perspective view of a spring screw and a tool used for locking and/or unlocking the spring screw, in accordance with an exemplary embodiment of the invention;

[0045] FIG. 9 is a cross-sectional view of a spring screw and a tool used for locking and/or unlocking the spring screw, flexing the spring member to unlock the spring screw, in accordance with an exemplary embodiment of the invention;

[0046] FIG. 10 is a perspective view of another embodiment having a spring screw with a spring member;

[0047] FIG. 11 is a cross sectional side view of the spring screw with a spring member;

[0048] FIG. 12 is a cross sectional side view of the spring screw with the spring member expanded by a mounting tool;

[0049] FIG. 13 is a cross sectional side view of the spring screw with spring member mounted in spinal implant;

[0050] FIG. 14 is a perspective view of the spring screw with spring member attached to the mounting tool;

[0051] FIG. 15 is a cross sectional side view of the spring screw with spring member attached to the mounting tool;

[0052] FIG. 16 is a side view of the mounting tool indicating a mounting end; and

[0053] FIG. 17 is an enlarged view of the mounting end of FIG. 16.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS

[0054] Throughout the application, reference is made to flexed spring member 106A and/or un-flexed spring member 106B; it should be understood that these references are to the same structural element which takes two forms depending on its current state of usage with spring screw 100. In some portions of the application, the spring member is assigned reference number 106; it should be understood that in such instances spring member 106 is referring to the element generally, whether flexed 106A or un-flexed 106B.

[0055] FIG. 1 is a perspective view of a spring screw 100 with a flexed spring member 106A, in accordance with an exemplary embodiment of the invention. In an embodiment of the invention, spring screw 100 is comprised of at least two general sections, a screw head 102 and a cylindrical body 104. The cylindrical body 104, as with most conventional screws, is the portion of the screw which is driven into a specific attachment location at the implantation site. In some embodiments of the invention, cylindrical body 104 is provided with threading. Optionally, the threading is adapted for the type of material into which the screw will be driven.

[0056] Screw head 102 is provided with a tool slot 114 which is adapted for receipt of spring member 106A and/or to interface with a tool used for tightening and/or loosening the screw with respect to the attachment location, in an embodiment of the invention. Spring member 106A is shown flexed in FIG. 1, but it should be understood that, in an embodiment of the invention, the spring member is adapted to be elastically deformed for insertion into tool slot 114 during manufacture and/or flexing during the insertion of the spring screw 100 into a spinal implant 400, shown and described in more detail with respect to FIG. 4. In an embodiment of the invention, upon insertion into tool slot 114, the spring member 106 returns to its un-flexed form 106B, such as shown and described with respect to FIGS. 2 and 3.

[0057] In an embodiment of the invention, spring member 106 is provided with an enlarged portion, shaped like a circle in FIGS. 1 and 2, which prevents spring member 106 from sliding out of the at least one outlet 110. Alternatively, additionally and/or optionally, spring member 106 is designed to be wider than outlet 110, except the tongue 108, which prevents spring member 106 from sliding out of outlet 110. In an embodiment of the invention, the spring screw 100 is designed with a tight tolerance between the tool slot 114 and the enlarged portion of spring member 106. Optionally, the tolerance is about +/1.5 thousands of an inch, to make sure that the screw will lock on both sides. Other shapes are usable, besides circular, in alternative embodiments of the invention.

[0058] A ridge 112 is provided to screw head 102 at a level where it is desired that the screw be prevented from any further insertion into the screw hole 402, in an embodiment of the invention. In some embodiments of the invention, the ridge 112 is shaped to match a flange 404 of the screw hole 402, the flange 404 shown and described in more detail with respect to FIGS. 4 and 6. For example, in an embodiment of the invention, the ridge 112 and flange 404 of the screw hole 402 are each sloped to act as complementary parts, preventing over-insertion of the spring screw 100 through the screw hole 402 and/or also providing a slidable interface between the two to allow for rotation of the spring screw 100 about its vertical axis 116.

[0059] Spring member 106 is provided with at least one tongue 108 which is adapted for insertion into an outlet 110 located on screw head 102, in an embodiment of the invention. Outlet 110 is positioned on screw head 102 such that, when screw head 102 is advanced fully into the screw hole 402, the outlet 110 is positioned below the level of ridge 112, in an embodiment of the invention. Thus, in an embodiment of the invention, when tongue 108 protrudes out of outlet 110 it creates a space between the tongue 108 and the ridge 112. In an embodiment of the invention, tongue 108 is narrower than the outlet 110, but overall spring member 106 is wider than outlet 110 so that spring member 106 cannot completely slide out of outlet 110, only tongue 108 can.

[0060] FIG. 2 is a perspective view of spring screw 100 with an expanded spring member 106B placed within slot 114, in accordance with an exemplary embodiment of the invention. From this perspective, it can be seen that in some embodiments of the invention, slot 114 and spring member 106 are shaped as counterparts such that spring member 106 fits snugly within the slot 114, particularly when the spring member is in its un-flexed form 106B. Also seen from this perspective view is the ridge 112 on the screw head 102. In some embodiments of the invention, the ridge 112 only extends partially around the circumference of the screw head 102, such as depicted in FIG. 2; however in some embodiments of the invention, the ridge 112 could extend fully around the circumference of the screw head 102.

[0061] FIG. 3 is a cross-sectional view of spring screw 100 with an expanded and/or un-flexed spring member 106B, in accordance with an exemplary embodiment of the invention. Shown in more detail is the relationship between spring member 106B, the at least one tongue 108 of the spring member 106 and the outlet 110 adapted for passage of the tongue 108 therethrough, in an embodiment of the invention. The at least one tongue 108 transits through the outlet 110 when spring member 106A un-flexes to form spring member 106B after insertion of the spring member 106 sufficiently deep into the slot 114. The expansion of the spring member 106 urges the at least one tongue 108 into and/or extending out of the outlet 110. It can be seen that, once the at least one tongue 108 is extended through the outlet 110, a space 302 is created between the ridge 112 of the screw head 102 and the tongue 108, the space being adapted and/or sized for receipt of the flange 404, shown in more detail in FIGS. 4 and 6.

[0062] In an embodiment of the invention, spring member 106 is located above the floor 304 of the tool slot 114 to allow for the flexing of spring member 106 during placement of the spring screw 100 into the implant 400. In an embodiment of the invention, spring member 106 flexes approximately 20 thousands of an inch towards floor 304 during compression of spring member 106 by tool 800 (FIGS. 8 and 9).

[0063] In an embodiment of the invention, at least a portion of spring screw 100, including spring member 106, is comprised of at least one of titanium, stainless steel, cobalt chrome, ceramic, polymer (e.g. PLA, PGA), or PEEK Optima. In some embodiments of the invention, the spring screw is 8.0 mm-60.0 mm in length along the central axis 116 and/or 3.5 mm-9.0 mm in diameter (i.e. the screw head 102). It should be understood, however, that the spring screw 100 can be scalably sized for any application, and that these size ranges are merely examples.

[0064] FIG. 4 is a top, perspective view of a sliding spinal implant 400 used in conjunction with at least one spring screw 100, in accordance with an exemplary embodiment of the invention. In an embodiment of the invention, flange 404 is a part of spinal implant 400, for example as shown in FIG. 4, where the flange 404 is provided around the inner circumference of screw hole 402 so that the spring screw 100 is inserted therein until the ridge 112 hits the flange 404, in an exemplary embodiment of the invention. Also shown is a spring screw 100 inserted into a screw hole 402, in an exemplary embodiment of the invention.

[0065] FIG. 5 is a side view of a sliding spinal implant 400 used in conjunction with at least one spring screw 100, in accordance with an exemplary embodiment of the invention. From this side view, a cross-sectional view is taken, which is reflected in FIG. 6.

[0066] FIG. 6 is a cross-sectional view of a sliding spinal implant 400 used in conjunction with at least one spring screw 100, in accordance with an exemplary embodiment of the invention. From this view, it can be seen that the spring member 106B and the ridge 112 form a space wherein the flange 404 of the spinal implant 400 is accommodated, in an embodiment of the invention. The ridge 112 prevents the spring screw 100 from being over-inserted into the screw hole 402 and the spring member 106 prevents the spring screw 100 from being withdrawn, in essence locking the spring screw 100 into a plane relative to the spinal implant 400.

[0067] FIG. 7 is a flowchart 700 showing a method of using a spring screw 100 in conjunction with a spinal implant 400, in accordance with an exemplary embodiment of the invention. In an embodiment of the invention, spring screw 100 is inserted (702) into screw hole 402 with the spring member 106 flexed by the tool 800, shown and described in more detail with respect to FIG. 8. Spring screw 100 is advanced (704) into screw hole 402 until ridge 112 of screw head 102 abuts flange 404 of implant 400. As described elsewhere in the application, spring screw 100 is adapted so that when ridge 112 abuts flange 404, outlet 110 is properly aligned such that, when tongue 108 of un-flexed spring member 106B extends out of outlet 110, flange 404 is bracketed by tongue 108 and ridge 112.

[0068] In some embodiments of the invention, spring screw 100 is driven (706) into the hard tissue at the implantation site to attach the implant 400 to the patient, for example by using tool 800 to screw spring screw 100 into place. Optionally, spring member 106 remains flexed during the driving; although in some embodiments of the invention, the tool is retracted slightly prior to commencing the driving. Tool 800 is retracted (708) from tool slot 114, causing spring member 106 to un-flex and project at least one tongue 108 through outlet 110, locking spring screw 100 into a plane corresponding to the flange 404, in an embodiment of the invention.

[0069] In some embodiments of the invention, depending on how many screw holes are present on the implant and/or depending on the specific implantation needs of the implant with respect to the patient, more than one screw is used to secure the implant to the patient. Accordingly, inserting (702), advancing (704), driving (706) and retracting (708) are optionally repeated (710) for each screw in some embodiments of the invention.

[0070] It should be understood that in some embodiments of the invention, screw is not necessarily advanced (704) until ridge 112 abuts flange 404, but rather is advanced (704) only as far as required to place outlet 110 past flange 404 such that, when tongue protrudes out of screw head 102, the flange 404 is bracket by tongue 108 and ridge 112. It should also be understood that implant 400 is merely exemplary and that spring screw 100 could be used with any implant or device adapted for use with the spring screw 100; for example, any implant or device with a flange in a screw hole which could be bracketed by ridge 112 and tongue 108.

[0071] Referring to FIG. 8, a perspective view of spring screw 100 and a tool 800 used for locking and/or unlocking spring screw 100 is shown, in accordance with an exemplary embodiment of the invention. In an embodiment of the invention, tool 800 is adapted to act as a counterpart to tool slot 114 in spring screw head 102 to tighten and/or loosen spring screw 100 and/or to flex spring member 106 for locking spring screw 100 to implant 400. For example, a tool nub 802 is provided to tool 800, wherein tool nub 802 is sized to fit within tool slot 114 located in spring screw 100 and extend at least as far into tool slot 114 as is required to flex spring member 106 to floor 304, in an exemplary embodiment of the invention. Ridges 804 may also be provided to tool 800 which assist in applying torque to spring screw 100 during tightening and/or loosening of the spring screw 100 from the implantation site. It should be understood that tool 800 is merely an example of what could be used for flexing the spring member 106 and/or driving the screw into the implantation site. For example, any tool which fits within the slot (which as described above is variable in shape), is capable of extending into the slot far enough to flex the spring and/or is capable of applying torque to the screw sufficient for securing it to the implantation site, could be used.

[0072] FIG. 9 is a cross-sectional view of spring screw 100 and tool 800 used for locking and/or unlocking spring screw 100 by flexing the spring member 106 to unlock the spring screw 100 from implant 400, in accordance with an exemplary embodiment of the invention. It can be seen that tool nub 802 of tool 800 exerts a force on spring member 106 such that it flexes towards floor 304. The flexing of spring member 106 causes its overall length relative to spring screw 100 to shorten, withdrawing the at least one tongue 108 from outlet 110, but not so far as to cause spring member 106 to become dislodged from the outlet 110. The retraction of spring member 106 allows for outlet 110 of spring screw 100 to be inserted into implant 400 past flange 404, in an embodiment of the invention.

[0073] In another embodiment of the invention as depicted by FIGS. 10-17, set forth is a spring screw 200 with a spring member 206. In an embodiment of the invention, spring screw 200 is comprised of at least two general sections, a screw head 202 and a cylindrical body 204. The cylindrical body 204, as with most conventional screws, is the portion of the screw which is driven into a specific attachment location at the implantation site. In the preferred embodiment, the cylindrical body 204 is a threaded shank.

[0074] Screw head 202 is provided with a tool slot 214 which is adapted for receipt of spring member 206 to interface with a tool 500 used for tightening and/or loosening the screw 200 with respect to the attachment location. Spring member 106 is shown un-flexed in FIG. 1, but it should be understood that the spring member is adapted to be elastically deformed for insertion into tool slot 214 during manufacture. During the insertion of the spring screw 200 into a spinal implant 450, a tool 500 is first attached to the screw 200. The tool 500 has an outer shaft 248 rigidly secured to a handle 244 with a first end 230 having a serrated edge 232 that operate as teeth for engaging the tool slot 214 on the top surface of the screw 200. The tool slot 214 is available to receive the spring member 206 and serrated edge 232 with a cross tool slot 215, forming a cross slot for ease of engagement with the serrated edge 232. The tool has a centrally disposed engagement rod 234 having a threaded end 236. The engagement rod 234 is rotated by the end of the handle 238. The threaded end 236 is threaded into the screw head 202, meeting reciprocal screw head thread 240. As the threaded end 236 engages the screw head thread 240, the spring member 206 is drawn into the cavity 242 to a point where the tongues 208 and 208 are drawn into the outlets 210 and 210. The distal end 250 of the tool end 230 engages the top surface 252 of the screw head 202 once the threaded end 236 is threaded into the cavity 242, causing the spring member 206 to draw the tongues 208 and 208 into the outlets 210 and 210. The handle 244 of tool 500 can then be used to rotate the screw 204 into position, wherein the cylindrical body 204 engages bone and the angular surface of the sidewall 212. Once placed into position, the end of the handle 238 is then counter rotated, opposite rotation to the attachment of the screw, wherein the spring member 206 is returned to its relaxed state with tongues 208 and 208 protruding through outlets 210 and 210 and into the slotted aperture 454 of the spinal implant 450. The screw 200 is thereby locked to the spinal implant to prevent removal. The handle 244 of tool 500 can then be used as a driver to insert the screw. In a preferred embodiment, the slotted aperture 454 is essentially a groove formed around the perimeter of the inner sidewall. Alternatively, the slotted aperture may consist of spaced apart apertures positioned around the perimeter of the inner sidewall allowing positional placement of the spring member tongues.

[0075] Upon insertion of the end 230 of the tool 500 into tool slot 214, the spring member 206 is engaged to flex for temporary placement while the screw is being inserted. The spring member 206 can be provided with an enlarged portion, shaped like a circle in FIGS. 1 and 2, which prevents spring member 206 from sliding out of the at least one outlet 210. Alternatively, the spring member 206 can be inserted from either outlet 210 and held in place while an installation tool 500 is attached to the screw 200 which prevents the spring member 206 from sliding out of outlet 210. In an embodiment of the invention, the spring screw 200 is designed with a tight tolerance between the tool slot 214 and the enlarged portion of spring member 206.

[0076] A sidewall 212 is provided to screw head 202 at a level where it is desired that the screw be prevented from any further insertion into the screw hole 402, in an embodiment of the invention. In some embodiments of the invention, the sidewall 212 is shaped to match the screw hole 452 sidewall of the screw hole 402. For example, in an embodiment of the invention, the sidewall 452 is sloped to act as complementary parts preventing over-insertion of the spring screw 200 through the screw hole 452 and/or also providing a slidable interface between the two to allow for rotation of the spring screw 200 about its vertical axis 216.

[0077] Spring member 206 is provided with at least one tongue 208 which is adapted for insertion into an outlet 210 located on screw head 202, in an embodiment of the invention. Outlet 210 is positioned on screw head 202 such that when screw head 202 is advanced fully into the screw hole 402, the outlet 210 is positioned below the level angular shape of the sidewall 212. The spring member 206 operates as a leaf spring when placed biased, and is substantially flat when in a natural state extended position.

[0078] FIG. 13 is a cross sectional side view of spring screw 200 with an expanded spring member 206 placed within slot 214, in accordance with an exemplary embodiment of the invention. In this figure, the expanded and/or un-flexed spring member 206, depicts at least tongue 208 of the spring member 206 and the outlet 210 adapted for passage of the tongue 208 therethrough. The at least one tongue 208 transits through the outlet 210 when spring member 206 un-flexes after insertion of the spring member 206 sufficiently deep into the slot 214. The expansion of the spring member 206 urges the at least one tongue 208 into and/or extending out of the outlet 210.

[0079] In an embodiment of the invention, spring member 206 is located above the cavity 242 of the tool slot 214 to allow for the flexing of spring member 206 during placement of the spring screw 200 into the implant 450. In an embodiment of the invention, spring member 206 flexes approximately 20 thousands of an inch towards cavity 242 during compression of spring member 206 by tool 500.

[0080] In an embodiment of the invention, at least a portion of spring screw 200, including spring member 206, is comprised of at least one of titanium, stainless steel, cobalt chrome, ceramic, polymer (e.g. PLA, PGA), or PEEK Optima. In some embodiments of the invention, the spring screw is 8.0 mm-60.0 mm in length along the central axis 216 and/or 3.5 mm-9.0 mm in diameter (i.e. the screw head 202). It should be understood, however, that the spring screw 200 can be scalably sized for any application, and that these size ranges are merely examples.

[0081] Unless otherwise defined, all technical and/or scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the invention pertains. Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of embodiments of the invention, exemplary methods and/or materials are described below. In case of conflict, the patent specification, including definitions, will control. In addition, the materials, methods, and examples are illustrative only and are not intended to be necessarily limiting.

[0082] The terms comprises, comprising, includes, including, having and their conjugates mean including but not limited to. This term encompasses the terms consisting of and consisting essentially of.

[0083] The phrase consisting essentially of means that the composition or method may include additional ingredients and/or steps, but only if the additional ingredients and/or steps do not materially alter the basic and novel characteristics of the claimed composition or method.

[0084] As used herein, the singular form a, an and the include plural references unless the context clearly dictates otherwise. For example, the term a compound or at least one compound may include a plurality of compounds, including mixtures thereof.

[0085] Throughout this application, various embodiments of this invention may be presented in a range format. It should be understood that the description in range format is merely for convenience and brevity and should not be construed as an inflexible limitation on the scope of the invention. Accordingly, the description of a range should be considered to have specifically disclosed all the possible subranges as well as individual numerical values within that range. For example, description of a range such as from 1 to 6 should be considered to have specifically disclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from 2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numbers within that range, for example, 1, 2, 3, 4, 5, and 6. This applies regardless of the breadth of the range.

[0086] Whenever a numerical range is indicated herein, it is meant to include any cited numeral (fractional or integral) within the indicated range. The phrases ranging/ranges between a first indicated number and a second indicated number and ranging/ranges from a first indicated number to a second indicated number are used herein interchangeably and are meant to include the first and second indicated numbers and all the fractional and integral numerals therebetween.

[0087] As used herein the term method refers to manners, means, techniques and procedures for accomplishing a given task including, but not limited to, those manners, means, techniques and procedures either known to, or readily developed from known manners, means, techniques and procedures by practitioners of the chemical, pharmacological, biological, biochemical and medical arts.

[0088] It is appreciated that certain features of the invention, which are, for clarity, described in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the invention, which are, for brevity, described in the context of a single embodiment, may also be provided separately or in any suitable subcombination or as suitable in any other described embodiment of the invention. Certain features described in the context of various embodiments are not to be considered essential features of those embodiments, unless the embodiment is inoperative without those elements.

[0089] Although the invention has been described in conjunction with specific embodiments thereof, it is evident that many alternatives, modifications and variations will be apparent to those skilled in the art. Accordingly, it is intended to embrace all such alternatives, modifications and variations that fall within the spirit and broad scope of the appended claims.

[0090] All publications, patents and patent applications mentioned in this specification are herein incorporated in their entirety by reference into the specification, to the same extent as if each individual publication, patent or patent application was specifically and individually indicated to be incorporated herein by reference. In addition, citation or identification of any reference in this application shall not be construed as an admission that such reference is available as prior art to the present invention. To the extent that section headings are used, they should not be construed as necessarily limiting

[0091] Those familiar with implantable devices and apparatuses and methods for attaching them to a patient's anatomy will appreciate that many modifications and substitutions can be made to the foregoing preferred embodiments of the present invention without departing from the spirit and scope of the present invention, defined by the appended claims.