CROSS-REFERENCE TO RELATED APPLICATIONS This application claims benefit of U.S. Provisional Application No. 62/355,619, filed June 28, 2016, the entirety of which is herein incorporated by reference.

FIELD

The present disclosure relates to orthopedic implantable devices, and more particularly implantable devices for stabilizing the spine. Even more particularly, the present disclosure is directed to expandable, angularly adjustable intervertebral cages comprising articulating mechanisms that allow expansion from a first, insertion configuration having a reduced size to a second, implanted configuration having an expanded size. The intervertebral cages are configured to adjust and adapt to lodortic angles, particularly larger lodortic angles, while restoring sagittal balance and alignment of the spine.

BACKGROUND

The use of fusion-promoting interbody implantable devices, often referred to as cages or spacers, is well known as the standard of care for the treatment of certain spinal disorders or diseases. For example, in one type of spinal disorder, the intervertebral disc has deteriorated or become damaged due to acute injury or trauma, disc disease or simply the natural aging process. A healthy intervertebral disc serves to stabilize the spine and distribute forces between vertebrae, as well as cushion the vertebral bodies. A weakened or damaged disc therefore results in an imbalance of forces and instability of the spine, resulting in discomfort and pain. A typical treatment may involve surgical removal of a portion or all of the diseased or damaged intervertebral disc in a process known as a partial or total discectomy, respectively. The discectomy is often followed by the insertion of a cage or spacer to stabilize this weakened or damaged spinal region. This cage or spacer serves to reduce or inhibit mobility in the treated area, in order to avoid further progression of the damage and/or to reduce or alleviate pain caused by the damage or injury. Moreover, these type of cages or spacers serve as mechanical or structural scaffolds to restore and maintain normal disc height, and in some cases, can also promote bony fusion between the adjacent vertebrae.

However, one of the current challenges of these types of procedures is the very limited working space afforded the surgeon to manipulate and insert the cage into the intervertebral area to be treated. Access to the intervertebral space requires navigation around retracted adjacent vessels and tissues such as the aorta, vena cava, dura and nerve roots, leaving a very narrow pathway for access. The opening to the intradiscal space itself is also relatively small. Hence, there are physical limitations on the actual size of the cage that can be inserted without significantly disrupting the surrounding tissue or the vertebral bodies themselves. Further complicating the issue is the fact that the vertebral bodies are not positioned parallel to one another in a normal spine. There is a natural curvature to the spine due to the angular relationship of the vertebral bodies relative to one another. The ideal cage must be able to accommodate this angular relationship of the vertebral bodies, or else the cage will not sit properly when inside the intervertebral space. An improperly fitted cage would either become dislodged or migrate out of position, and lose effectiveness over time, or worse, further damage the already weakened area.

Thus, it is desirable to provide intervertebral cages or spacers that not only have the mechanical strength or structural integrity to restore disc height or vertebral alignment to the spinal segment to be treated, but also be configured to easily pass through the narrow access pathway into the intervertebral space, and then accommodate the angular constraints of this space, particularly for larger lodortic angles. BRIEF SUMMARY

The present disclosure describes spinal implantable devices that address the aforementioned challenges and meet the desired objectives. These spinal implantable devices, or more specifically intervertebral cages or spacers, are configured to be expandable as well as angularly adjustable. The cages may comprise upper and lower plate components connected by articulating expansion or adjustment mechanisms that allow the cage to change size and angle as needed, with little effort. In some embodiments, the cages may have a first, insertion configuration characterized by a reduced size at their insertion ends to facilitate insertion through a narrow access passage and into the intervertebral space. The cages may be inserted in a first, reduced size and then expanded to a second, expanded size once implanted. In their second configuration, the cages are able to maintain the proper disc height and stabilize the spine by restoring sagittal balance and alignment. It is contemplated that, in some embodiments, the intervertebral cages may also be designed to allow the cages to expand in a freely selectable (or stepless) manner to reach its second, expanded configuration. The intervertebral cages are configured to be able to adjust the angle of lordosis, and can accommodate larger lodortic angles in their second, expanded configuration. Further, these cages may promote fusion to further enhance spine stability by immobilizing the adjacent vertebral bodies. Additionally, the implantable devices may be manufactured using selective laser melting (SLM) techniques, a form of additive manufacturing. The devices may also be manufactured by other comparable techniques, such as for example, 3D printing, electron beam melting (EBM), layer deposition, and rapid manufacturing. With these production techniques, it is possible to create an all-in-one, multi-component device which may have interconnected and movable parts without further need for external fixation or attachment elements to keep the components together. Accordingly, the intervertebral cages of the present disclosure are formed of multiple, interconnected parts that do not require additional external fixation elements to keep together.

Even more relevant, devices manufactured in this manner would not have connection seams whereas devices traditionally manufactured would have joined seams to connect one component to another. These connection seams can often represent weakened areas of the implantable device, particularly when the bonds of these seams wear or break over time with repeated use or under stress. By manufacturing the disclosed implantable devices using additive manufacturing, one of the advantages is that connection seams are avoided entirely and therefore the problem is avoided. Another advantage of the present devices is that, by manufacturing these devices using an additive manufacturing process, all of the components of the device (that is, both the intervertebral cage and the pins for expanding and blocking) remain a complete construct during both the insertion process as well as the expansion process. That is, multiple components are provided together as a collective single unit so that the collective single unit is inserted into the patient, actuated to allow expansion, and then allowed to remain as a collective single unit in situ. In contrast to other cages requiring external expansion screws or wedges for expansion, in the present embodiments the expansion and blocking components do not need to be inserted into the cage, nor removed from the cage, at any stage during the process. This is because these components are manufactured to be captured internal to the cages, and while freely movable within the cage, are already contained within the cage so that no additional insertion or removal is necessary.

In some embodiments, the cages can be made with an engineered cellular structure that includes a network of pores, microstructures and nanostructures to facilitate osteosynthesis. For example, the engineered cellular structure can comprise an interconnected network of pores and other micro and nano sized structures that take on a mesh-like appearance. These engineered cellular structures can be provided by etching or blasting to change the surface of the device on the nano level. One type of etching process may utilize, for example, HF acid treatment. In addition, these cages can also include internal imaging markers that allow the user to properly align the device and generally facilitate insertion through visualization during navigation. The imaging marker shows up as a solid body amongst the mesh under x-ray, fluoroscopy or CT scan, for example.

Another benefit provided by the implantable devices of the present disclosure is that they are able to be specifically customized to the patient's needs. Customization of the implantable devices is relevant to providing a preferred modulus matching between the implant device and the various qualities and types of bone being treated, such as for example, cortical versus cancellous, apophyseal versus central, and sclerotic versus osteopenic bone, each of which has its own different compression to structural failure data. Likewise, similar data can also be generated for various implant designs, such as for example, porous versus solid, trabecular versus non-trabecular, etc. Such data may be cadaveric, or computer finite element generated. Clinical correlation with, for example, DEXA data can also allow implantable devices to be designed specifically for use with sclerotic, normal, or osteopenic bone. Thus, the ability to provide customized implantable devices such as the ones provided herein allow the matching of the Elastic Modulus of Complex Structures (EMOCS), which enable implantable devices to be engineered to minimize mismatch, mitigate subsidence and optimize healing, thereby providing better clinical outcomes.

In one exemplary embodiment, an expandable spinal implant is provided. The expandable spinal implant may comprise an upper plate component configured for placement against an endplate of a first vertebral body, and a lower plate component configured for placement against an endplate of a second, adjacent vertebral body, the upper and lower plate components being connected at an articulating joint, and a blocking pin comprising a shaft and an enlarged head portion, the blocking pin being configured to effect angular adjustment of the expandable spinal implant as the pin is advanced toward an anterior end of the implant. The articulating joint may be configured to allow pivoting movement of the upper and lower plate components relative to one another.

The spinal implant including the blocking pin may be manufactured by an additive production technique, with the blocking pin being manufactured as a separate component to reside inside but still be moveable within the cage. In some embodiments, the expandable spinal implant may be a PLIF (posterior lumbar interbody fusion) cage. The expandable spinal implant may have a first configuration wherein the plate components are angled toward one another at an anterior portion, then parallel to one another in an intermediate configuration, and a second configuration wherein the plate components are locked together and are angled relative to one another at a posterior portion. In the second configuration, the implant adjusts the angle of lordosis, and restores the sagittal balance and alignment of the spine. Although the following discussion focuses on spinal implants, it will be appreciated that many of the principles may equally be applied to other structural body parts requiring bone repair or bone fusion within a human or animal body, including other joints such as knee, shoulder, ankle or finger joints. It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the disclosure. Additional features of the disclosure will be set forth in part in the description which follows or may be learned by practice of the disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate several embodiments of the disclosure and together with the description, serve to explain the principles of the disclosure.

FIG. 1 illustrates a perspective view of an exemplary embodiment of an intervertebral cage in accordance with the present disclosure.

FIG. 2A illustrates an anterior view of the intervertebral cage of FIG. 1.

FIG. 2B illustrates a lateral view of the intervertebral cage of FIG. 1.

FIG. 2C illustrates a posterior view of the intervertebral cage of FIG. 1.

FIG. 2D illustrates a cranial-caudal view of the intervertebral cage of FIG. 1. FIG. 2E illustrates an isometric view of the intervertebral cage of FIG. 1.

FIG. 3 illustrates an exploded view of the intervertebral cage of FIG. 1 and associated blocking pin.

FIG. 4A illustrates a side view of the intervertebral cage of FIG. 1 and associated blocking pin in its manufactured position. FIG. 4B illustrates a cross-sectional view of the intervertebral cage and blocking pin of FIG. 4A.

FIGS. 5 A— 5C illustrate various views of the upper plate component of the intervertebral cage of FIG. 1, in which FIG. 5 A illustrates a side view, FIG. 5B illustrates a partial cutaway view, and FIG. 5C illustrates a perspective view.

FIGS. 6A— 6C illustrate various views of the lower plate component of the intervertebral cage of FIG. 1, in which FIG. 6A illustrates a side view, FIG. 6B illustrates a perspective view, and FIG. 6C illustrates an enlarged posterior view.

FIGS. 7A and 7B illustrate various views of the blocking pin of FIG. 3, in which FIG. 7A illustrates a top-down view and FIG. 7B illustrates a perspective view.

FIGS. 8 A— 8 J illustrate a method of expanding the intervertebral cage of FIG. 1 , in which FIGS. 8A, 8C, 8E, 8G, and 81 illustrate lateral views of the cage over the course of expansion, while FIGS. 8B, 8D, 8F, 8H, and 8J illustrate cross-sectional views of the cage over the course of expansion.

DETAILED DESCRIPTION

The present disclosure provides various spinal implant devices, such as interbody fusion spacers, or cages, for insertion between adjacent vertebrae. The devices can be configured for use in either the cervical or lumbar region of the spine. In some embodiments, these devices are configured as PLIF cages, or posterior lumbar interbody fusion cages. These cages can restore and maintain intervertebral height of the spinal segment to be treated, and stabilize the spine by restoring sagittal balance and alignment. In some embodiments, the cages may contain an articulating joint to allow expansion and angular adjustment. This articulating joint allows upper and lower plate components to move relative to one another. The cages may have a first, insertion configuration characterized by a reduced size at each of their insertion ends to facilitate insertion through a narrow access passage and into the intervertebral space. The cages may be inserted in a first, reduced size and then expanded to a second, expanded size once implanted. In their second configuration, the cages are able to maintain the proper disc height and stabilize the spine by restoring sagittal balance and alignment. It is contemplated that, in some embodiments, the intervertebral cages may also be designed to allow the cages to expand in a freely selectable (or stepless) manner to reach its second, expanded configuration. The intervertebral cages are configured to be able to adjust the angle of lordosis, and can accommodate larger lodortic angles in their second, expanded configuration. Further, these cages may promote fusion to further enhance spine stability by immobilizing the adjacent vertebral bodies.

Additionally, the implantable devices may be manufactured using selective laser melting (SLM) techniques, a form of additive manufacturing. The devices may also be manufactured by other comparable techniques, such as for example, 3D printing, electron beam melting (EBM), layer deposition, and rapid manufacturing. With these production techniques, it is possible to create an all-in-one, multi-component device which may have interconnected and movable parts without further need for external fixation or attachment elements to keep the components together. Accordingly, the intervertebral cages of the present disclosure are formed of multiple, interconnected parts that do not require additional external fixation elements to keep together.

Even more relevant, devices manufactured in this manner would not have connection seams whereas devices traditionally manufactured would have joined seams to connect one component to another. These connection seams can often represent weakened areas of the implantable device, particularly when the bonds of these seams wear or break over time with repeated use or under stress. By manufacturing the disclosed implantable devices using additive manufacturing, connection seams are avoided entirely and therefore the problem is avoided. In some embodiments, the cages can be made with an engineered cellular structure that includes a network of pores, microstructures and nanostructures to facilitate osteosynthesis. For example, the engineered cellular can comprise an interconnected network of pores and other micro and nano sized structures that take on a mesh-like appearance. These engineered cellular structures can be provided by etching or blasting to change the surface of the device on the nano level. One type of etching process may utilize, for example, HF acid treatment. In addition, these cages can also include internal imaging markers that allow the user to properly align the cage and generally facilitate insertion through visualization during navigation. The imaging marker shows up as a solid body amongst the mesh under x-ray, fluoroscopy or CT scan, for example.

Another benefit provided by the implantable devices of the present disclosure is that they are able to be specifically customized to the patient's needs. Customization of the implantable devices is relevant to providing a preferred modulus matching between the implant device and the various qualities and types of bone being treated, such as for example, cortical versus cancellous, apophyseal versus central, and sclerotic versus osteopenic bone, each of which has its own different compression to structural failure data. Likewise, similar data can also be generated for various implant designs, such as for example, porous versus solid, trabecular versus non-trabecular, etc. Such data may be cadaveric, or computer finite element generated. Clinical correlation with, for example, DEXA data can also allow implantable devices to be designed specifically for use with sclerotic, normal, or osteopenic bone. Thus, the ability to provide customized implantable devices such as the ones provided herein allow the matching of the Elastic Modulus of Complex Structures (EMOCS), which enable implantable devices to be engineered to minimize mismatch, mitigate subsidence and optimize healing, thereby providing better clinical outcomes.

Turning now to the drawings, FIG. 1 shows an exemplary embodiment of an expandable and angularly adjustable intervertebral cage 10 of the present disclosure. The cage 10 may comprise a pair of articulating shells or plate components 20, 40 configured for placement against endplates of a pair of adjacent vertebral bodies. In one embodiment, the articulating plate components may include a fiat surface for placement against the endplates. As illustrated in greater detail in FIGS. 2 A to 2E, in which FIG. 2 A shows the anterior view of the cage 10, FIG. 2B shows the side or lateral view of the cage 10, FIG. 2C shows the posterior view of the cage 10, FIG. 2D shows the cranial-caudal view of the cage 10, and FIG. 2E shows the isometric view of the cage 10, the cage 10 may comprise an upper plate component 20 and a bottom plate component 40 configured to articulate relative to one another at an articulating joint. In the present embodiment, movement of the plate components 20, 40 can be realized by an articulating joint mechanism residing between these components 20, 40, allowing the internal surfaces of the components 20, 40 to slide relative to one another. In other words, the bottom plate component 40 serves as the base, while the upper plate component 20 rocks back and forth in a see-saw like motion relative to the base 40. FIG. 3 illustrates an exploded view of the assembly of the intervertebral cage 10 and blocking pin 60 of the present embodiment. The base or lower plate component 40 may comprise an internal housing 42 having a slot or cavity 48 for receiving the blocking pin 60. This slot or cavity 48 can communicate with a port or channel 44 at the rear of the housing 42, at the second trailing end 14 of the cage 10, to receive and move the pin 60 within the housing 42. At each side of the housing 42 are protrusions or knobs 52. As shown, the knobs 52 may have smooth surfaces to allow smooth articulating movement of the upper plate component 20 relative to the base 40. In some embodiments, these knobs 52 are rounded and configured with a complementary shape to the grooves 28 of the upper plate component 20. The upper plate component 20 may be configured to sit over and on top of the housing 42. The upper plate component 20 and lower plate component 40 may be tapered at their free ends at the first, leading end 12 of the cage 10, if so desired.

As further shown, the pin 60 may comprise an elongate shaft 64 attached to which is an enlarged pin head 68. As further shown, the enlarged head portion 68 may include a shoulder 72 or notched portion. In use, the pin 60 serves to help tilt, or pivot, the upper plate component 20 relative to the bottom plate component or base 40, and also blocks the movement of the components 20, 40 once the final configuration has been achieved, so that the position may be locked and no further movement occurs.

As mentioned above, the implantable devices of the present disclosure may be manufactured in such a way that the processing of all components into the final assembled device is achieved in one step by generative / additive production techniques (e.g., selective laser melting (SLM) or other similar techniques as mentioned above). FIGS. 4 A and 4B illustrate an exemplary manufacturing configuration showing how the cage 10 and the blocking pin 60 can be manufactured nested together under such a technique. It should be noted how the benefits of generative / additive production techniques may be utilized here to provide a multi-component assembly with interactive components that do not require any additional external fixation elements to maintain these subcomponents intact and interacting with one another. As can be seen, the entire assembly of cage 10 plus blocking pin 60 may be produced altogether as one unit having movable internal parts. As previously mentioned, devices manufactured in this manner would not have connection seams whereas devices traditionally manufactured would have joined seams to connect one component to another. These connection seams can often represent weakened areas of the implantable device, particularly when the bonds of these seams wear or break over time with repeated use or under stress. By manufacturing the disclosed implantable devices using additive manufacturing, one of the advantages with these devices is that connection seams are avoided entirely and therefore the problem is avoided.

Another advantage of the present devices is that, by manufacturing these devices using an additive manufacturing process, all of the components of the device (that is, both the intervertebral cage and the pins for expanding and blocking) remain a complete construct during both the insertion process as well as the expansion process. That is, multiple components are provided together as a collective single unit so that the collective single unit is inserted into the patient, actuated to allow expansion, and then allowed to remain as a collective single unit in situ. In contrast to other cages requiring external expansion screws or wedges for expansion, in the present embodiments the expansion and blocking components do not need to be inserted into the cage, nor removed from the cage, at any stage during the process. This is because these components are manufactured to be captured internal to the cages, and while freely movable within the cage, are already contained within the cage so that no additional insertion or removal is necessary. FIGS. 5A to 5C illustrate in greater detail the upper plate component 20 of the intervertebral cage 10 of the present disclosure. As shown, the upper plate component 20 may comprise a pair of extended arms or sidewalls 24 between which is a cavity or slot 26 that is configured to receive the pin 60 as well as cooperate with the housing 42 of the base 40. Each of the extended sidewalls 24 may include an undercut surface or groove 28. The groove 28 may be configured to receive and cooperate with the knobs 52 of the base 40, and may have a rounded shape in one embodiment as shown. As illustrated, the upper plate component 20 fits over and onto the lower base plate component 40, with the extended arms or sidewalls 24 fitting over the housing 42 such that the knobs 52 fit inside the grooves 28 of the sidewalls 24. The inner cavity 26 may further include a bevel surface 34 as well as a blocking surface 36, which features will be described in more detail below.

FIGS. 6 A to 6C illustrate in greater detail the lower plate component or base 40 of the intervertebral cage 10 of the present disclosure. As shown and as previously discussed, the lower plate component 40 may comprise a housing 42 and a cavity or slot 48 therein. This cavity 48 may be configured to receive the blocking pin 60 and may also include guiding surfaces 50. On the external surface of either side of the housing 42 are knobs or protrusions 52. These protrusions 52 may have a smooth, contoured surface that complement or match the grooves 28 of the upper plate component 20 to allow these components to fit together and move relative to one another, thereby creating an articulating joint between the upper and lower plate components 20, 40. The housing 42 may also include on its sides a stop ramp 56.

At the rear of the base 40 near the second, trailing end 14 of the cage 10 resides the port or channel 44 for receiving the pin shaft 64. Surrounding the channel 44 is the instrument interface 80, which can be seen in an enlarged detailed view in FIG. 6C. The instrument interface 80 may be configured to adapt to a bayonet-type connection to allow a delivery instrument, for example, to be attached to the device 10. The instrument interface 80 may include an outer contact surface 82, a bayonet fitting 84, recesses 86 surrounding the channel 44 for instrument insertion, and a cylindrical guiding surface 88 provided by the port or channel 44. Collectively, the instrument interface 80 provides the necessary structure for attachment to other instruments, including delivery instruments for inserting the implantable device 10 and/or tools for rotating the blocking pin 60.

FIGS. 7 A and 7B illustrate the details of the blocking pin 60 that may be used with the intervertebral cage 10 of the present disclosure. The blocking pin 60 may comprise an elongate shaft 64 attached to which is an enlarged pin head 68. The pin head 68 may have a guiding surface 70 and a shoulder portion 72. The shoulder portion 72 serves as the adjustment surface and may be adjacent to a ridge 74 that serves as a bumper or shoulder stop when pressed against the stop ramp 56 of the upper plate component 20.

FIGS. 8 A— 8 J illustrate the process of expanding and angularly adjusting the intervertebral cage 10 of the present disclosure. In its initial insertion stage or configuration, the expandable cage 10 may have a compressed, reduced size whereby the upper plate component 20 and lower plate component 40 are angled towards one another at the first, leading end 12 of the cage 10 or towards the anterior, as shown in FIGS. 8 A and 8B. This creates a tapered nose or leading tip, and the slimmest profile (i.e., the smallest anterior height) to facilitate insertion, which is particularly beneficial to traverse the narrow access path to the implant site. In some embodiments, the ends of the plate components 20, 40 can also include a bevel or taper, if desired. The plate components 20, 40 may each include flat external surfaces to contact and press against the endplates of the vertebral bodies.

The blocking pin 60, which may be additively manufactured to reside within the cage 10 itself in a first insertion configuration, does not interfere with the pivoting of the plate components 20, 40, and can be considered in a non-active state at this point. As shown, the blocking pin 60 rests within the cavity 48 of the housing 42 but does not in this configuration abut the bevel surface 34 or shoulder 52 of the plate components 20, 40. FIGS. 8C and 8D show the cage 10 in an intermediate position or configuration.

In this configuration, the upper and lower plate components 20, 40 are parallel to one another, and defines the smallest insertion height possible for the intervertebral cage 10. Note that the blocking pin 60 has advanced anteriorly or towards the first, leading end 12 in this intermediate configuration, and that the enlarged head 68 is urging against the upper plate component 20. Once the cage 10 has passed through the narrow access path and into the intervertebral / intradiscal space, the blocking pin 60 may continue to be advanced, as shown in FIGS. 8E and 8F. The advancement of the blocking pin 60 anteriorly or towards the first, leading end 12 results in the pivoting of the upper plate component 20 relative to the lower plate component 40. The plate components 20, 40 become angled or partially open, with the anterior height being greater than the posterior height, as shown. FIGS. 8G and 8H show the cage 10 continuing in its active adjustment phase and load transfer at the posterior of the cage 10. As the blocking pin 60 is advanced anteriorly, the plate components 20, 40 continue to be angled towards the posterior and increasingly open towards the anterior. As shown in FIGS. 81 and 8 J, the cage 10 may now have the greatest anterior height possible when fully adjusted, which is when the blocking pin 60 is at its anterior-most position within the housing 42 and cavities 26, 48 of the upper and lower plate components, 20, 40. In this configuration, the load transfer is at the posterior of the cage 10 and the cage 10 is fully expanded or adjusted, and in its blocked or locked position. The shoulder 72 and ridge 74 of the enlarged pin head 68 abuts against the beveled surface 34 and blocking surface 36 of the upper plate component 20.

In this final, expanded position, the cage 10 is effective in accommodating the lordosis angle of the vertebral segment, and can restore sagittal balance and alignment to the spine. The plate components 20, 40 are configured to press against the endplates of the vertebral bodies and can now immobilize and stabilize this region. As mentioned above, the intervertebral cages of the present disclosure are configured to be able to allow insertion through a narrow access path, but are able to be expanded and angularly adjusted so that the cages are capable of adjusting the angle of lordosis of the vertebral segments. By being able to smoothly pivot at the joint where the knobs 52 articulate inside the grooves 28, the upper plate component 20 may effectively see-saw relative to the base or lower plate component 40 to allow a very narrow anterior for insertion and a larger anterior after implantation to accommodate and adapt to larger angles of lordosis.

As mentioned above, the intervertebral cages of the present disclosure are configured to be able to allow insertion through a narrow access path, but are able to be expanded and angularly adjusted so that the cages are capable of adjusting the angle of lordosis of the vertebral segments. By being able to smoothly roll at the articulating joint, the upper plate component 20 may effectively see-saw relative to the base or lower plate component 40 to allow a very narrow anterior for insertion and a larger anterior after implantation to accommodate and adapt to larger angles of lordosis. Additionally, the cage can effectively restore sagittal balance and alignment of the spine, and can promote fusion to immobilize and stabilize the spinal segment. With respect to the ability of the expandable cages 10 to promote fusion, many in- vitro and in-vivo studies on bone healing and fusion have shown that porosity is necessary to allow vascularization, and that the desired infrastructure for promoting new bone growth should have a porous interconnected pore network with surface properties that are optimized for cell attachment, migration, proliferation and differentiation. At the same time, there are many who believe the implant's ability to provide adequate structural support or mechanical integrity for new cellular activity is the main factor to achieving clinical success, while others emphasize the role of porosity as the key feature. Regardless of the relative importance of one aspect in comparison to the other, what is clear is that both structural integrity to stabilize, as well as the porous structure to support cellular growth, are key components of proper and sustainable bone regrowth.

Accordingly, these cages 10 may take advantage of current additive manufacturing techniques that allow for greater customization of the devices by creating a unitary body that may have both solid and porous features in one. In some embodiments, the cages 10 can have a porous structure, and be made with an engineered cellular structure that includes a network of pores, microstructures and nanostructures to facilitate osteosynthesis. For example, the engineered cellular structure can comprise an interconnected network of pores and other micro and nano sized structures that take on a mesh-like appearance. These engineered cellular structures can be provided by etching or blasting to change the surface of the device on the nano level. One type of etching process may utilize, for example, HF acid treatment. These same manufacturing techniques may be employed to provide these cages with an internal imaging marker. For example, these cages can also include internal imaging markers that allow the user to properly align the cage and generally facilitate insertion through visualization during navigation. The imaging marker shows up as a solid body amongst the mesh under x-ray, fluoroscopy or CT scan, for example. A cage may comprise a single marker, or a plurality of markers. These internal imaging markers greatly facilitate the ease and precision of implanting the cages, since it is possible to manufacture the cages with one or more internally embedded markers for improved visualization during navigation and implantation. Another benefit provided by the implantable devices of the present disclosure is that they are able to be specifically customized to the patient's needs. Customization of the implantable devices is relevant to providing a preferred modulus matching between the implant device and the various qualities and types of bone being treated, such as for example, cortical versus cancellous, apophyseal versus central, and sclerotic versus osteopenic bone, each of which has its own different compression to structural failure data. Likewise, similar data can also be generated for various implant designs, such as for example, porous versus solid, trabecular versus non-trabecular, etc. Such data may be cadaveric, or computer finite element generated. Clinical correlation with, for example, DEXA data can also allow implantable devices to be designed specifically for use with sclerotic, normal, or osteopenic bone. Thus, the ability to provide customized implantable devices such as the ones provided herein allow the matching of the Elastic Modulus of Complex Structures (EMOCS), which enable implantable devices to be engineered to minimize mismatch, mitigate subsidence and optimize healing, thereby providing better clinical outcomes.

A variety of spinal implants may be provided by the present disclosure, including interbody fusion cages for use in either the cervical or lumbar region of the spine. Although only a posterior lumbar interbody fusion (PLIF) device is shown, it is contemplated that the same principles may be utilized in a cervical interbody fusion (CIF) device, a transforaminal lumbar interbody fusion (TLIF) device, anterior lumbar interbody fusion (ALIF) cages, lateral lumbar interbody fusion (LLIF) cages, and oblique lumbar interbody fusion (OLIF) cages.

Other embodiments of the disclosure will be apparent to those skilled in the art from consideration of the specification and practice of the disclosure provided herein. It is intended that the specification and examples be considered as exemplary only.