fig1 shows a dissembled view of the modular dynamic pedicle screw 1 . screw 1 includes a threaded shank portion 2 having a one end that tapers into a point 4 at one end and has an opposite end 6 that includes a coupling element 8 . coupling element 8 includes internal female threads 10 . the pedicle screw 1 has a channel 20 through the entire length of the pedicle screw , including the tulip head 12 , the intermediate component 14 , and the threaded shank portion 2 . this channel 20 allows the pedicle screw 1 to be maneuvered on a kirschner wire 22 , also know as a k - wire . in practice the k - wire is positioned within the patient using fluoroscopy , or other imaging techniques , so as to provide precise positioning of the pedicle screw 1 . once the components are securely positioned the k - wire can be easily removed through the channel 20 which is open at the end of the threaded shank portion and extends through the uppermost portion of the head portion or tulip 12 . the threaded shank 2 is externally threaded . the threads 3 can be fenestrated or partially fenestrated . fenestrated threads are particularly appropriate for osteoporotic patients or patients who require greater assurance of increased pedicle screw purchase based on bone quality . the threaded shank 2 of the pedicle 1 are appropriately sized in relation to the patient &# 39 ; s pathology and can be formed in different lengths and external threaded diameters . the head or tulip portion 12 of the pedicle screw 1 includes upwardly extending cylindrical wall 15 wherein grooves 17 are positioned in diametrically opposed relationship . these opposing grooves 18 allow for top loading of either a rigid or non rigid rod 30 into the tulip . the tulip may be fixed or multi axial . the inner portion of the cylindrical wall accepts a threaded lock screw 32 to secure the rod 30 to the pedicle screw 1 . the tulip design can accept tulip extension towers , attached to tulip portion 12 , which will facilitate the percutaneous passing of the rod 30 through multiple screws based upon the number of spinal segments involved in the overall dynamic spinal stabilization system . the tulip extensions allow for external control of the tulip head during the rod delivery process . the screw extensions that are attached to the tulip portions remain in place until the percutaneous delivery and placement of the rod 30 has been achieved and threaded lock screws 32 have been finally tightened . in addition , the pedicle screw 1 is also configured to receive a shank extension tower . the screw extension tower is a completely rigid device that extends dorsally through the skin incision . this feature enables three dimensional manipulation of the spine segment . once the rigid manipulation of the segment is complete the screw extension tower is removed and the dynamic member is fully functional . the tulip design allows for top loading of the rod 30 delivered under direct visualization as is possible when the surgery is performed under open conditions . a coupling element 21 having a cylindrical wall with external threads for engagement with the intermediate member 14 is attached to tulip portion 12 with a ball and socket arrangement 24 . the intermediate portion 14 of the dynamic pedicle screw includes an elastic portion 40 , an upper coupling member 16 and a lower coupling member 18 . as shown in fig3 a - 3c , portion 40 is generally cylindrical in shape and includes a passageway 42 concentric with the longitudinal axis of the cylindrical body . the portion 40 is formed from elastic motion preserving dynamic material which allows for the requisite degree of motion and is capable of standing the mechanical loads associated with the human spine . this provides intraoperative flexibility for the surgeon to choose or customize the construct to address the patient &# 39 ; s specific pathology . the portion 40 is available in varying levels , ranges and modes of dynamism , such as dynamic , motion preserving , non - fusion and rigid . dynamism can be adjusted based on the type of material used , for example nitinol or polycarbonate , the length of the cylinder , the diameter and or wall thickness of the cylinder or any combination of the above variables ( as shown in fig5 a and 5b ). embedded within the wall of cylindrical portion 40 is a jacket 44 made from a polyester material , or the like , which extends outwardly from each end of the cylinder 40 , as shown in fig3 a through 3c . a second embodiment , shown in fig4 a through 4c utilizes a polyester , or the like , jacket that surrounds the outer surfaces of cylindrical member 40 and extends outwardly from each end of the cylinder 40 . extending portions 48 of the jacket extend into tabs formed in the upper and lower coupling members , 16 and 18 respectively , to complete the assembly of the intermediate portion 14 . upper coupling member 16 includes a cylindrical wall having an externally threaded surface . upper coupling member 16 is threadably connected to tulip coupling member 22 . likewise , lower coupling member 18 includes a cylindrical wall having an externally threaded surface . lower coupling member 18 is screwed on to coupling member 8 positioned on the threaded shank portion 2 . as an alternative , cylindrical member 40 can be bonded , glued or molded directly on to the upper and lower coupling members , 16 and 18 respectively , without the utilization of a jacket . the intermediate portion can also be rigid allowing for rigid fixation . in order to assemble a rigid modular screw a non - elastic intermediate portion 14 is coupled to the threaded shank portion 2 and the tulip head portion 12 . in this instance , cylindrical member 40 can be made from the same material as the threaded shank 2 or the tulip head 12 or some other rigid compatible material . the non - elastic cylindrical member 40 can be threaded into upper and lower coupling members or otherwise suitably affixed thereto . fig6 a illustrates the lower coupling member 18 and the threaded shank 2 with its coupling member 8 . annular threads 10 on coupling 8 mate with external threads on lower coupling member 18 . fig6 b is a top view of lower coupling member 18 showing a socket 19 that includes a portion of channel 20 . socket 19 is designed to operatively engage an insertion or removal tool which can be inserted through the intermediate portion 14 via channel 20 . should it be necessary to change the dynamic characteristics of the spinal support system the surgeon would remove the rod 30 from the head 12 by first removing threaded lock screw 32 . following removal of the rod 30 the head portion 12 would be unthreaded from the intermediate portion 14 using an appropriate tool . thereafter , a tool would be inserted through the channel 20 in the intermediate member 14 to engage socket 19 formed in lower coupling member 18 . upon rotation of the tool the lower coupling 18 of the intermediate member will be unthreaded from the second coupling 8 formed on the threaded shank portion 2 . the intermediate portion can then be removed from the patient . a new intermediate portion 14 can then be positioned over the existing threaded shank portion 2 . thereafter a tool would be inserted through channel 20 of the intermediate member 14 and engage socket 19 formed in the lower coupling member 8 . upon rotation of the tool the lower coupling 18 of the intermediate member 14 will be threaded into the second coupling formed on the treaded shank 2 . the head portion 12 can then be threaded onto the intermediate portion 14 and the rod 30 can be affixed thereto by locking screw 32 . the ability to change the dynamism of the stabilization system without removing the threaded shank portion allows the surgeon to maintain the original bone purchase in the patient which facilitates the procedure , the healing process and improves the potential for long term success . fig6 c is a top view of the threaded shank 2 with channel 20 and coupling threads 10 . fig7 a is a side view showing tulip head member 12 with cylindrical side walls 15 and groove 17 . a coupling element 21 having a cylindrical wall with external threads for engagement with the intermediate member 14 is attached to tulip portion 12 with a ball and socket arrangement 24 . fig7 b is a side view of tulip head member 12 . fig7 c is a top view of the upper coupling member 16 . the rod 30 connects multiple screws based upon the number of segments involved in the overall construct . the rod can be of any compatible material ( peek , titanium , nitinol , etc ). this also increases the versatility of the system allowing for more control in defining the rigidity or dynamism of the overall construct . the rod 30 used in conjunction with the dynamic pedicle screw system can be either rigid or non rigid . all patents and publications mentioned in this specification are indicative of the levels of those skilled in the art to which the invention pertains . all patents and publications are herein incorporated by reference to the same extent as if each individual publication was specifically and individually indicated to be incorporated by reference . it is to be understood that while a certain form of the invention is illustrated , it is not to be limited to the specific form or arrangement herein described and shown . it will be apparent to those skilled in the art that various changes may be made without departing from the scope of the invention and the invention is not to be considered limited to what is shown and described in the specification and any drawings / figures included herein . one skilled in the art will readily appreciate that the present invention is well adapted to carry out the objectives and obtain the ends and advantages mentioned , as well as those inherent therein . the embodiments , methods , procedures and techniques described herein are presently representative of the preferred embodiments , are intended to be exemplary and are not intended as limitations on the scope . changes therein and other uses will occur to those skilled in the art which are encompassed within the spirit of the invention and are defined by the scope of the appended claims . although the invention has been described in connection with specific preferred embodiments , it should be understood that the invention as claimed should not be unduly limited to such specific embodiments . indeed , various modifications of the described modes for carrying out the invention which are obvious to those skilled in the art are intended to be within the scope of the following claims .
a modular anchoring device including a threaded shank for anchoring within a vertebra , an intermediate element and a head portion configured to receive and secure a rigid or non - rigid stabilization rod . the threaded shank , the intermediate element and the head portion of the anchoring device are cannulated to permit percutaneous implantation of the device . the intermediate portion is designed to be removable from the threaded shank portion subsequent to implantation of the anchoring device to enable substitution of another intermediate element having different dynamic characteristics .