Instrumentation for inserting an expandable interbody spinal fusion implant

• US 7,118,579 B2
• Filed: 02/04/2002
• Issued: 10/10/2006
• Est. Priority Date: 02/04/2001
• Status: Expired due to Term

• Current Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Original Assignee: SDGI Holdings Incorporated (Medtronic Plc)
• Inventors: Michelson, Gary K.
• Primary Examiner(s): Isabella, David J.
• Application Number:
  US10/061,236
• Publication Number:
  US 20020177897A1
• Time in Patent Office: 1,709 Days
• Field of Search: 623 1711- 1716, 606/61, 606/66, 606/92, 606/99
• US Class Current: 606/99
• CPC Class Codes: A61F 2/44 for the spine, e.g. vertebrae, spinal discs
• CPC Class Codes: A61F 2/4601 for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
• CPC Class Codes: A61F 2/4603 for insertion or extraction of endoprosthetic joints or of accessories thereof
• CPC Class Codes: A61F 2/4611 of spinal prostheses
• CPC Class Codes: A61F 2/4637 for connecting or disconnecting two parts of a prosthesis
• CPC Class Codes: A61F 2002/30143 hexagonal
• CPC Class Codes: A61F 2002/30224 cylindrical
• CPC Class Codes: A61F 2002/30235 tubular, e.g. sleeves
• CPC Class Codes: A61F 2002/30428 made by inserting a protrusion into a slot
• CPC Class Codes: A61F 2002/30487 Circumferential cooperating grooves and beads on cooperating lateral surfaces of a mainly longitudinal connection
• CPC Class Codes: A61F 2002/30574 with an integral complete or partial collar or flange
• CPC Class Codes: A61F 2002/30579 with mechanically expandable devices, e.g. fixation devices
• CPC Class Codes: A61F 2002/30777 Oblong apertures
• CPC Class Codes: A61F 2002/30787 inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/30975 made of two halves
• CPC Class Codes: 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
• CPC Class Codes: A61F 2220/0025 Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2230/0017 Angular shapes
• CPC Class Codes: A61F 2230/0069 cylindrical

Abstract

Instruments and methods for inserting and expanding interbody spinal fusion implants having an expandable height.

Claims

1. An implant holder for inserting an interbody spinal implant into the spine of a human, said implant holder comprising:

an outer sleeve having a longitudinal axis, a passage along the longitudinal axis, and a distal end with an implant engagement area adapted to cooperatively engage the implant, said implant engagement area including extensions having an exterior surface adapted to engage the implant, said extensions being adapted to move between a disengaged position and an engaged position; and

a shaft having a passage, said shaft being adapted to move along at least a portion of said passage of said outer sleeve, said passage of said shaft being adapted to permit the passage of an instrument or fusion promoting substances therethrough.

2. The implant holder of claim 1, wherein said outer sleeve has a minimum thickness along at least a portion of at least one of said extensions.

3. The implant holder of claim 1, wherein at least two of said extensions are side extensions adapted to move across at least a portion of a width of the implant to engage said implant holder to the implant.

4. The implant holder of claim 1, wherein at least two of said extensions are upper and lower extensions adapted to engage said implant holder to the implant.

5. The implant holder of claim 1, wherein at least two of said extensions include a stop adapted to limit advancement of said implant holder into the implant.

6. The implant holder of claim 1, wherein said extensions have an interior surface oriented toward said passage of said outer sleeve, said extensions being adapted to move away from the longitudinal axis of said outer sleeve to the engaged position by an outward force applied to said interior surface.

7. The implant holder of claim 6, wherein said interior surface includes a ramp.

8. The implant holder of claim 7, wherein said shaft includes a nose portion, said nose portion being beveled to cooperatively engage said ramp.

9. The implant holder of claim 1, wherein said shaft is configured to move said extensions away from the longitudinal axis of said outer sleeve to the engaged position.

10. The implant holder of claim 1, wherein the implant has a trailing end and said implant engagement area includes at least one projection adapted to cooperatively engage at least a portion of the trailing end of the implant.

11. The implant holder of claim 10, wherein said at least one projection is adapted to cooperatively engage a recess in the trailing end of the implant.

12. The implant holder of claim 11, wherein said at least one projection includes a flange and said recess is a slot.

13. The implant holder of claim 1, wherein the implant is an expandable spinal implant having a trailing end, said implant engagement area including extensions having a projection adapted to cooperatively engage at least a portion of the trailing end of the expandable spinal implant.

14. The implant holder of claim 13, wherein said projection is adapted to remain engaged to the expandable spinal implant while the expandable spinal implant is expanded from an unexpanded position to an expanded position.

15. The implant holder of claim 1, wherein said shaft has a proximal end adapted to receive a handle.

16. The implant holder of claim 15, wherein said handle is detachable.

17. The implant holder of claim 1, further comprising a second shaft adapted to move along at least a portion of said passage of said shaft.

18. The implant holder of claim 17, wherein the implant is an expandable spinal implant and said second shaft is an expander driver adapted to expand the expandable implant.

19. The implant holder of claim 18, wherein the implant has an expander, the implant being adapted to increase in height with rotation of the expander, said expander driver having a distal end adapted to engage the expander of the expandable implant to permit rotation of the expander of the expandable implant.

20. The implant holder of claim 19, wherein said expander driver includes a handle to allow said expander driver to be rotated upon engagement with the expander of the expandable implant.

21. The implant holder of claim 19, wherein said distal end of said expander driver has a tip adapted to cooperatively engage an opening in the expander of the expandable implant.

22. The implant holder of claim 19, wherein said expandable implant has at least a second expander, said expander driver being adapted to engage at least two of the expanders.

23. The implant holder of claim 22, wherein said expander driver has an elongated tip adapted to cooperatively engage an opening in at least two of the expanders.

24. The implant holder of claim 18, wherein said expander driver has a shaft engagement portion configured for lockable engagement with an expander driver engagement portion of said shaft.

25. The implant holder of claim 24, wherein said expander driver is movable within said shaft between a first locked position not permiting rotation relative to said shaft and a second locked position permitting said expander driver to rotate relative to said shaft.

26. The implant holder of claim 25, wherein said expander driver engagement portion limits the rotation of said expander driver to one direction in the second locked position.

27. The implant holder of claim 26, wherein said expander driver engagement portion limits the amount of rotation of said expander driver in the second locked position.

28. The implant holder of claim 24, wherein said shaft engagement portion of said expander driver has at least one detent adapted for lockable engagement with a spring-biased ball in said expander driver engagement portion of said shaft of said implant holder.

29. The implant holder of claim 18, wherein said expander driver has an enlarged portion sized and shaped to fit into and rotate within said shaft of said implant holder.

30. The implant holder of claim 29, wherein said enlarged portion of said expander driver has a shoulder and a peg adapted to cooperate with said shaft of said implant holder, said shaft of said implant holder having a cutout and a slot adapted to cooperate with said shoulder and peg of said enlarged portion of said expander driver to limit the rotation of said expander driver while engaged with said shaft of said implant holder.

31. The implant holder of claim 1, in combination with a spinal implant having a trailing end adapted to be engaged to said implant holder.

32. The combination of claim 31, wherein said spinal implant is a spinal fusion implant for promoting fusion between adjacent vertebral bodies, said implant having upper and lower surfaces for placement between and in contact with the adjacent vertebral bodies, each of said upper and lower surfaces having at least one opening adapted to permit bone from the adjacent vertebral bodies to grow through said implant.

33. The combination of claim 32, wherein said spinal fusion implant has a hollow between said upper and lower surfaces for holding fusion promoting substances.

34. The combination of claim 32, wherein said spinal fusion implant is an expandable implant having an expander adapted to increase the height of said implant upon movement from an insertion position to a final deployed position.

35. The combination of claim 34, wherein said spinal fusion implant is separable into an upper member and a lower member to permit the placement of said expander between said upper and lower members.

36. The combination of claim 35, wherein said upper and lower members are at least in part arcuate.

37. The combination of claim 36, wherein said spinal fusion implant includes a thread along at least a portion of said upper and lower surfaces of said implant.

38. The combination of claim 35, wherein said upper and lower members are configured for at least in part linear insertion into a prepared implantation space between the adjacent vertebral bodies.

39. The combination of claim 38, wherein said spinal fusion implant includes surface projections configured to resist expulsion of said implant from an implantation space into which said spinal fusion implant is adapted to be inserted.

40. The combination of claim 35, wherein said upper and lower members are angled relative to one another to induce an angulation of the adjacent vertebral bodies relative to one another.

41. The combination of claim 31, wherein said implant comprises at least one of the following materials:

metal, titanium, plastic, and ceramic appropriate for implantation in the human body.

42. The combination of claim 31, wherein said implant is at least in part resorbable.

43. The combination of claim 31, wherein said implant is an inert spacer.

44. The combination of claim 31, wherein said implant is an artificial disc.

45. The combination of claim 31, wherein said implant is a bone graft.

46. The combination of claim 31, wherein said implant has a hollow between said upper and lower surfaces, said hollow having a composite material therein.

47. The combination of claim 32, wherein said spinal fusion implant is in combination with a fusion promoting substance.

48. The combination of claim 47, wherein said fusion promoting substance is selected from one of bone, bone derived products, demineralized bone matrix, ossifying proteins, bone morphogenetic protein, hydroxyapatite, and genes coding for the production of bone.

49. The combination of claim 32, wherein said implant is in combination with a chemical substance adapted to inhibit scar formation.

50. The combination of claim 32, wherein said implant is in combination with an antimicrobial material.

51. The implant holder of claim 1, wherein said implant engagement area of said outer sleeve is adapted to linearly engage the implant.

52. The implant holder of claim 1, wherein said implant engagement area of said outer sleeve is adapted to slideably engage the implant.

53. The implant holder of claim 1, wherein said implant engagement area of said outer sleeve is adapted to lock to said implant.

54. The implant holder of claim 1, wherein said outer sleeve includes at least one opening having a central axis generally perpendicular to the longitudinal axis of said outer sleeve.

55. The implant holder of claim 1, wherein said implant engagement area includes at least four extensions having an exterior surface adapted to engage the implant.

56. The implant holder of claim 1, wherein said shaft is configured to lock to said outer sleeve.

57. An implant holder for inserting an interbody spinal implant into the spine of a human, said implant holder comprising:

an outer sleeve having a longitudinal axis, a passage along the longitudinal axis, and a distal end with an implant engagement area adapted to cooperatively engage the implant, said implant engagement area including extensions having an exterior surface adapted to engage the implant, said extensions being adapted to move between a disengaged position with the extensions at a first distance from one another and an engaged position with the extensions at a second distance from one another, the second distance being larger than the first distance; and

a shaft having a passage, said shaft being adapted to move along at least a portion of said passage of said outer sleeve, said passage of said shaft being adapted to permit the passage of an instrument or fusion promoting substances therethrough.

58. The implant holder of claim 57, wherein said extensions have an interior surface oriented toward said passage of said outer sleeve, said extensions being adapted to move away from the longitudinal axis of said outer sleeve to the engaged position by an outward force applied to said interior surface.

59. The implant holder of claim 57, wherein said shaft is configured to move said extensions away from the longitudinal axis of said outer sleeve to the engaged position.

60. The implant holder of claim 57, wherein the implant has a trailing end and said implant engagement area includes at least one projection adapted to cooperatively engage at least a portion of the trailing end of the implant.

61. The implant holder of claim 60, wherein said at least one projection is adapted to cooperatively engage a recess in the trailing end of the implant.

62. The implant holder of claim 61, wherein said at least one projection includes a flange and said recess is a slot.

63. The implant holder of claim 57, wherein the implant is an expandable spinal implant having a trailing end, said implant engagement area including extensions having a projection adapted to cooperatively engage at least a portion of the trailing end of the expandable spinal implant.

64. The implant holder of claim 63, wherein said projection is adapted to remain engaged to the expandable spinal implant while the expandable spinal implant is expanded from an unexpanded position to an expanded position.

65. The implant holder of claim 57, wherein said shaft has a proximal end adapted to receive a handle.

66. The implant holder of claim 65, wherein said handle is detachable.

67. The implant holder of claim 57, further comprising a second shaft adapted to move along at least a portion of said passage of said shaft.

68. The implant holder of claim 67, wherein the implant is an expandable spinal implant and said second shaft is an expander driver adapted to expand the expandable implant.

69. The implant holder of claim 68, wherein the implant has an expander, the implant being adapted to increase in height with rotation of the expander, said expander driver having a distal end adapted to engage the expander of the expandable implant to permit rotation of the expander of the expandable implant.

70. The implant holder of claim 69, wherein said expander driver includes a handle to allow said expander driver to be rotated upon engagement with the expander of the expandable implant.

71. The implant holder of claim 69, wherein said distal end of said expander driver has a tip adapted to cooperatively engage an opening in the expander of the expandable implant.

72. The implant holder of claim 69, wherein said expandable implant has at least a second expander, said expander driver being adapted to engage at least two of the expanders.

73. The implant holder of claim 72, wherein said expander driver has an elongated tip adapted to cooperatively engage an opening in at least two of the expanders.

74. The implant holder of claim 68, wherein said expander driver has a shaft engagement portion configured for lockable engagement with an expander driver engagement portion of said shaft.

75. The implant holder of claim 74, wherein said expander driver is movable within said shaft between a first looked position not permitting rotation relative to said shaft and a second locked position permitling said expander driver to rotate relative to said shaft.

76. The implant holder of claim 75, wherein said expander driver engagement portion limits the rotation of said expander diver to one direction in the second locked position.

77. The implant holder of claim 76, wherein said expander driver engagement portion limits the amount of rotation of said expander driver in the second locked position.

78. The implant holder of claim 74, wherein said shaft engagement portion of said expander driver has at least one detent adapted for lockable engagement with a spring-biased ball in said expander driver engagement portion of said shaft of said implant holder.

79. The implant holder of claim 68, wherein said expander driver has an enlarged portion sized and shaped to fit into and rotate within said shaft of said implant holder.

80. The implant holder of claim 79, wherein said enlarged portion of said expander driver has a shoulder and a peg adapted to cooperate with said shaft of said implant holder, said shaft of said implant holder having a cutout and a slot adapted to cooperate with said shoulder and peg of said enlarged portion of said expander driver to limit the rotation of said expander driver while engaged with said shaft of said implant holder.

81. The implant holder of claim 57, in combination with a spinal implant having a trailing end adapted to be engaged to said implant holder.

82. The combination of claim 81, wherein said spinal implant is a spinal fusion implant for promoting fusion between adjacent vertebral bodies, said implant having upper and lower surfaces for placement between and in contact with the adjacent vertebral bodies, each of said upper and lower surfaces having at least one opening adapted to permit bone from the adjacent vertebral bodies to grow through said implant.

83. The combination of claim 82, wherein said spinal fusion implant has a hollow between said upper and lower surfaces for holding fusion promoting substances.

84. The combination of claim 82, wherein said spinal fusion implant is an expandable implant having an expander adapted to increase the height of said implant upon movement from an insertion position to a final deployed position.

85. The combination of claim 84, wherein said spinal fusion implant is separable into an upper member and a lower member to permit the placement of said expander between said upper and lower members.

86. The combination of claim 85, wherein said upper and lower members are at least in part arcuate.

87. The combination of claim 86, wherein said spinal fusion implant includes a thread along at least a portion of said upper and lower surfaces of said implant.

88. The combination of claim 85, wherein said upper and lower members are configured for at least in part linear insertion into a prepared implantation space between the adjacent vertebral bodies.

89. The combination of claim 88, wherein said spinal fusion implant includes surface projections configured to resist expulsion of said implant from an implantation space into which said spinal fusion implant is adapted to be inserted.

90. The combination of claim 85, wherein said upper and lower members are angled relative to one another to induce an angulation of the adjacent vertebral bodies relative to one another.

91. The combination of claim 81, wherein said implant comprises at least in part of one of bone and bone growth promoting material.

92. The combination of claim 81, wherein said implant comprises at least one of the following materials:

metal, titanium, plastic, and ceramic appropriate for implantation in the human body.

93. The combination of claim 81, wherein said implant is at least in part resorbable.

94. The combination of claim 81, wherein said implant is formed of a porous material.

95. The combination of claim 81, wherein said implant is an inert spacer.

96. The combination of claim 81, wherein said implant is an artificial disc.

97. The combination of claim 81, wherein said implant is a bone graft.

98. The combination of claim 81, wherein said implant has a hollow between said upper and lower surfaces, said hollow having a composite material therein.

99. The combination of claim 98, wherein said composite material is other than bone.

100. The combination of claim 82, wherein said spinal fusion implant is in combination with a fusion promoting substance.

101. The combination of claim 100, wherein said fusion promoting substance is selected from one of bone, bone derived products, demineralized bone matrix, ossifying proteins, bone morphogenetic protein, hydroxyapatite, and genes coding for the production of bone.

102. The combination of claim 82, wherein said implant is treated with a fusion promoting substance.

103. The combination of claim 82, wherein said implant is in combination with a chemical substance adapted to inhibit scar formation.

104. The combination of claim 82, wherein said implant is in combination with an antimicrobial material.

105. The implant holder of claim 57, wherein said implant engagement area of said outer sleeve is adapted to linearly engage the implant.

106. The implant holder of claim 57, wherein said implant engagement area of said outer sleeve is adapted to slideably engage the implant.

107. The implant holder of claim 57, wherein said implant engagement area of said outer sleeve is adapted to lock to said implant.

108. The implant holder of claim 58, wherein said interior surface includes a ramp.

109. The implant holder of claim 108, wherein said shaft includes a nose portion, said nose portion being beveled to cooperatively engage said ramp.

110. The implant holder of claim 57, wherein said outer sleeve includes at least one opening having a central axis generally perpendicular to the longitudinal axis of said outer sleeve.

111. The implant holder of claim 57, wherein said outer sleeve has a minimum thickness along at least a portion of at least one of said extensions.

112. The implant holder of claim 57, wherein at least two of said extensions are side extensions adapted to move across at least a portion of a width of the implant to engage said implant holder to the implant.

113. The implant holder of claim 57, wherein at least two of said extensions are upper and lower extensions adapted to engage said implant holder to the implant.

114. The implant holder of claim 57, wherein at least two of said extensions include a stop adapted to limit advancement of said implant holder into the implant.

115. The implant holder of claim 57, wherein said implant engagement area includes at least four extensions having an exterior surface adapted to engage the implant.

116. The implant holder of claim 57, wherein said shaft is configured to lock to said outer sleeve.

121. The implant holder of claim 57, wherein the implant has a width, said implant engagement area having a width adapted to engage the width of the implant.

117. An implant holder for inserting an interbody spinal implant into the spine of a human, said implant holder comprising:

an outer sleeve having a longitudinal axis, a passage along the longitudinal axis, and a distal end with an implant engagement area adapted to cooperatively engage the implant; and

a shaft having a passage, said shaft being adapted to move along at least a portion of said passage of said outer sleeve, said passage of said shaft being adapted to permit the passage of an instrument or fusion promoting substances therethrough, said shaft having a first portion with a reduced external dimension configured to move within said passage of said outer sleeve, a second portion having an enlarged external dimension, said a junction between said first and second portions, said junction forming a shoulder adapted to limit the depth of insertion of said shaft into said outer sleeve.

118. The implant holder of claim 117, wherein said first portion of said shaft has a peg adapted to cooperate with said outer sleeve, said outer sleeve having a cutout adapted to cooperate with said shoulder and said peg of said first portion of said shaft to lock said shaft to said outer sleeve of said implant holder.

119. An implant holder for inserting an interbody spinal implant into the spine of a human, said implant holder comprising:

an outer sleeve having a longitudinal axis, a passage along the longitudinal axis, and a distal end with an implant engagement area adapted to cooperatively engage the implant; and

a shaft having a passage, said shaft being adapted to move along at least a portion of said passage of said outer sleeve, said passage of said shaft being adapted to permit the passage of an instrument or fusion promoting substances therethrough, said passage of said outer sleeve having a reduced cross-sectional dimension transverse to the longitudinal axis proximate said distal end of said outer sleeve.

120. The implant holder of claim 119, wherein said implant engagement area has a width adapted to engage the width of the implant, the reduced cross-sectional dimension being along the width of said implant engagement area.

122. The implant holder of claim 119, wherein said implant engagement area includes extensions having an exterior surface adapted to engage the implant, said extensions being adapted to move between a disengaged position with the extensions at a first distance from one another and an engaged position with the extensions at a second distance from one another, the second distance being larger than the first distance.

123. The implant holder of claim 122, wherein said outer sleeve has a minimum thickness along at least a portion of at least one of said extensions.

124. The implant holder of claim 122, wherein at least two of said extensions are side extensions adapted to move across at least a portion of a width of the implant to engage said implant holder to the implant.

125. The implant holder of claim 122, wherein at least two of said extensions are upper and lower extensions adapted to engage said implant holder to the implant.

126. The implant holder of claim 122, wherein at least two of said extensions include a stop adapted to limit advancement of said implant holder into the implant.

127. The implant holder of claim 122, wherein said extensions have an interior surface oriented toward said passage of said outer sleeve, said extensions being adapted to move away from the longitudinal axis of said outer sleeve to the engaged position by an outward force applied to said interior surface.

128. The implant holder of claim 127, wherein said interior surface includes a ramp.

129. The implant holder of claim 128, wherein said shaft includes a nose portion, said nose portion being beveled to cooperatively engage said ramp.

130. The implant holder of claim 122, wherein said shaft is configured to move said extensions away from the longitudinal axis of said outer sleeve to the engaged position.

131. The implant holder of claim 119, wherein the implant has a trailing end and said implant engagement area includes at least one projection adapted to cooperatively engage at least a portion of the trailing end of the implant.

132. The implant holder of claim 131, wherein said at least one projection is adapted to cooperatively engage a recess in the trailing end of the implant.

133. The implant holder of claim 132, wherein said at least one projection includes a flange and said recess is a slot.

134. The implant holder of claim 119, wherein the implant is an expandable spinal implant having a trailing end, said implant engagement area including extensions having a projection adapted to cooperatively engage at least a portion of the trailing end of the expandable spinal implant.

135. The implant holder of claim 134, wherein said projection is adapted to remain engaged to the expandable spinal implant while the expandable spinal implant is expanded from an unexpanded position to an expanded position.

136. The implant holder of claim 119, wherein said shaft has a proximal end adapted to receive a handle.

137. The implant holder of claim 136, wherein said handle is detachable.

138. The implant holder of claim 119, further comprising a second shaft adapted to move along at least a portion of said passage of said shaft.

139. The implant holder of claim 138, wherein the implant is an expandable spinal implant and said second shaft is an expander driver adapted to expand the expandable implant.

140. The implant holder of claim 139, wherein the implant has an expander, the implant being adapted to increase in height with rotation of the expander, said expander driver having a distal end adapted to engage the expander of the expandable implant to permit rotation of the expander of the expandable implant.

141. The implant holder of claim 140, wherein said expander driver includes a handle to allow said expander driver to be rotated upon engagement with the expander of the expandable implant.

142. The implant holder of claim 140, wherein said distal end of said expander driver has a tip adapted to cooperatively engage an opening in the expander of the expandable implant.

143. The implant holder of claim 140, wherein said expandable implant has at least a second expander, said expander driver being adapted to engage at least two of the expanders.

144. The implant holder of claim 143, wherein said expander driver has an elongated tip adapted to cooperatively engage an opening in at least two of the expanders.

145. The implant holder of claim 139, wherein said expander driver has a shaft engagement portion configured for lockable engagement with an expander driver engagement portion of said shaft.

146. The implant holder of claim 145, wherein said expander driver is movable within said shaft between a first locked position not permiting rotation relative to said shaft and a second locked position permitting said expander driver to rotate relative to said shaft.

147. The implant holder of claim 146, wherein said expander driver engagement portion limits the rotation of said expander driver to one direction in the second locked position.

148. The implant holder of claim 147, wherein said expander driver engagement portion limits the amount of rotation of said expander driver in the second locked position.

149. The implant holder of claim 145, wherein said shaft engagement portion of said expander driver has at least one detent adapted for lockable engagement with a spring-biased ball in said expander driver engagement portion of said shaft of said implant holder.

150. The implant holder of claim 139, wherein said expander driver has an enlarged portion sized and shaped to fit into and rotate within said shaft of said implant holder.

151. The implant holder of claim 150, wherein said enlarged portion of said expander driver has a shoulder and a peg adapted to cooperate with said shaft of said implant holder, said shaft of said implant holder having a cutout and a slot adapted to cooperate with said shoulder and peg of said enlarged portion of said expander driver to limit the rotation of said expander driver while engaged with said shaft of said implant holder.

152. The implant holder of claim 119, in combination with a spinal implant having a trailing end adapted to be engaged to said implant holder.

153. The combination of claim 152, wherein said spinal implant is a spinal fusion implant for promoting fusion between adjacent vertebral bodies, said implant having upper and lower surfaces for placement between and in contact with the adjacent vertebral bodies, each of said upper and lower surfaces having at least one opening adapted to permit bone from the adjacent vertebral bodies to grow through said implant.

154. The combination of claim 153, wherein said spinal fusion implant has a hollow between said upper and lower surfaces for holding fusion promoting substances.

155. The combination of claim 153, wherein said spinal fusion implant is an expandable implant having an expander adapted to increase the height of said implant upon movement from an insertion position to a final deployed position.

156. The combination of claim 155, wherein said spinal fusion implant is separable into an upper member and a lower member to permit the placement of said expander between said upper and lower members.

157. The combination of claim 156, wherein said upper and lower members are at least in part arcuate.

158. The combination of claim 157, wherein said spinal fusion implant includes a thread along at least a portion of said upper and lower surfaces of said implant.

159. The combination of claim 156, wherein said upper and lower members are configured for at least in part linear insertion into a prepared implantation space between the adjacent vertebral bodies.

160. The combination of claim 159, wherein said spinal fusion implant includes surface projections configured to resist expulsion of said implant from an implantation space into which said spinal fusion implant is adapted to be inserted.

161. The combination of claim 156, wherein said upper and lower members are angled relative to one another to induce an angulation of the adjacent vertebral bodies relative to one another.

162. The combination of claim 152, wherein said implant comprises at least in part of one of bone and bone growth promoting material.

163. The combination of claim 152, wherein said implant comprises at least one of the following materials:

metal, titanium, plastic, and ceramic appropriate for implantation in the human body.

164. The combination of claim 152, wherein said implant is at least in part resorbable.

165. The combination of claim 152, wherein said implant is formed of a porous material.

166. The combination of claim 152, wherein said implant is an inert spacer.

167. The combination of claim 152, wherein said implant is an artificial disc.

168. The combination of claim 152, wherein said implant is a bone graft.

169. The combination of claim 152, wherein said implant has a hollow between said upper and lower surfaces, said hollow having a composite material therein.

170. The combination of claim 169, wherein said composite material is other than bone.

171. The combination of claim 153, wherein said spinal fusion implant is in combination with a fusion promoting substance.

172. The combination of claim 171, wherein said fusion promoting substance is selected from one of bone, bone derived products, demineralized bone matrix, ossifying proteins, bone morphogenetic protein, hydroxyapatite, and genes coding for the production of bone.

173. The combination of claim 153, wherein said implant is treated with a fusion promoting substance.

174. The combination of claim 153, wherein said implant is in combination with a chemical substance adapted to inhibit scar formation.

175. The combination of claim 153, wherein said implant is in combination with an antimicrobial material.

176. The implant holder of claim 119, wherein said implant engagement area of said outer sleeve is adapted to linearly engage the implant.

177. The implant holder of claim 119, wherein said implant engagement area of said outer sleeve is adapted to slideably engage the implant.

178. The implant holder of claim 119, wherein said implant engagement area of said outer sleeve is adapted to lock to said implant.

179. The implant holder of claim 119, wherein said outer sleeve includes at least one opening having a central axis generally perpendicular to the longitudinal axis of said outer sleeve.

180. The implant holder of claim 119, wherein said implant engagement area includes at least four extensions having an exterior surface adapted to engage the implant.

181. The implant holder of claim 119, wherein said shaft is configured to lock to said outer sleeve.