Single-lock anterior cervical plate

• US 6,428,542 B1
• Filed: 07/17/2000
• Issued: 08/06/2002
• Est. Priority Date: 02/11/1997
• Status: Expired due to Term

• Current Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Original Assignee: Gary K. Michelson
• Inventors: Michelson, Gary K.
• Primary Examiner(s): REIP, DAVID OWEN
• Application Number:
  US09/618,037
• Time in Patent Office: 750 Days
• Field of Search: 606/61, 606/64, 606/70, 606/71, 606/72, 606/73, 606/76, 606/77
• US Class Current: 606/70
• CPC Class Codes: A61B 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/1728 for holes for bone plates or plate screws
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/7058 Plates mounted on top of bone anchor heads or shoulders
• CPC Class Codes: A61B 17/7059 Cortical plates A61B17/7007, A61B17/7058 take precedence
• CPC Class Codes: A61B 17/80 Cortical plates , i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
• CPC Class Codes: A61B 17/8019 where the means are a separate tool rather than being part of the plate
• CPC Class Codes: A61B 17/8033 having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
• CPC Class Codes: A61B 17/8042 the additional component being a cover over the screw head
• CPC Class Codes: A61B 17/8085 with pliable or malleable elements or having a mesh-like structure, e.g. small strips A61B17/8071, A61B17/8076 take precedence
• CPC Class Codes: A61B 17/861 specially shaped for gripping driver
• CPC Class Codes: A61B 17/8625 Shanks, i.e. parts contacting bone tissue
• CPC Class Codes: A61B 17/863 with thread interrupted or changing its form along shank, other than constant taper
• CPC Class Codes: A61B 17/8695 Washers surrounding screw head in plate hole A61B17/8047, between bone plate and bone A61B17/8028
• CPC Class Codes: A61B 17/8875 Screwdrivers, spanners or wrenches
• CPC Class Codes: A61B 2017/0046 with a releasable handle; with handle and operating part separable for prosthetic joint-implanting tools A61F2/4603
• CPC Class Codes: A61B 2017/8655 with special features for locking in the bone
• CPC Class Codes: A61F 2/0077 Special surfaces of prostheses, e.g. for improving ingrowth A61F2/30767 takes precedence
• CPC Class Codes: Y10S 606/902 Cortical plate specifically adapted for a particular bone
• CPC Class Codes: Y10S 606/907 : Composed of particular material or coated
• CPC Class Codes: Y10S 606/908 : Bioabsorbable material
• CPC Class Codes: Y10S 606/91 : Polymer

Abstract

Anatomically contoured anterior cervical plates with bone ingrowth surfaces, providing for intersegmental compressive preloading, and a rigid and locked interface to all of the bone screws, with those engaging the vertebrae deployed in highly convergent pairs. The bone screws have a tapered self-tapping leading end, an increasing root diameter with a generally constant outer diameter with a thread that is narrow and sharp throughout and an enlarged head portion capable of an interference fit to the receiving holes of the plate. Instrumentation consists of plate holders, a compression apparatus and a pilot hole forming device that interlocks with the plate. Methods for spinal compression and bone hole preparation are provided.

Claims

1. A plate system adapted for use in the anterior human cervical spine for contacting the anterior aspect of at least two cervical vertebral bodies, said plate system comprising:

a plate having a longitudinal axis and a length sufficient to span a disc space and overlap portions of at least two adjacent cervical vertebral bodies, a lower surface for placement against the cervical vertebral bodies and an upper surface opposite said lower surface, said lower surface being concave along a substantial portion of the longitudinal axis of said plate;

at least two bone screws each having a central longitudinal axis and being adapted to engage each of the at least two cervical vertebral bodies, respectively, each of said bone screws having a leading end for insertion into the bone of the cervical vertebral bodies and a trailing end opposite said leading end, said trailing end having a top surface oriented toward said trailing end of said bone screw and a bottom surface opposite said top surface oriented toward said leading end of said bone screw;

at least two bone screw receiving holes extending through said plate from said upper surface through said lower surface, at least a first of said bone screw receiving holes associated with a first of the cervical vertebral bodies and at least a second of said bone screw receiving holes associated with a second of the cervical vertebral bodies; and

at least one locking element, each of said at least one locking element adapted to lock to said plate only a single one of said bone screws inserted in a single one of said at least two bone screw receiving holes, said locking element adapted to be coupled to said plate prior to the insertion of said bone screw to be locked by said locking element into said one of said bone screw receiving holes, said locking element being moveable from an initial position that permits the insertion of said bone screw into said one of said bone screw receiving holes to a final position that is adapted to extend over at least a portion of said top surface of said bone screw inserted in said one of said bone screw receiving holes.

2. The plate system of claim 1, wherein said top surface of said trailing end of said bone screw is generally transverse to the longitudinal axis of said bone screw, said locking element contacting said top surface of said bone screw when in said final position.

3. The plate system of claim 2, wherein said locking element is adapted to be removably coupled to said plate.

4. The plate system of claim 2, wherein said locking element in the final position covers at least a portion only one of said bone screw receiving holes.

5. The plate system of claim 1, wherein said locking element is adapted to be rotated from the initial position to the final position.

6. The plate system of claim 5, wherein less than a full rotation of said locking element rotates said locking element from the initial position to the final position.

7. The plate system of claim 1, wherein at least a portion of said locking element slides from the initial position to the final position.

8. The plate system of claim 7, wherein said locking element slides over at least a portion of only one of said bone screw receiving holes.

9. The plate system of claim 7, wherein said locking element slides over at least a portion of one of said bone screws when in said one of said bone screw receiving holes.

10. The plate system of claim 1, wherein said locking element comprises at least one of a screw, a rivet, and a cap.

11. The plate system of claim 1, wherein said locking element includes a generally circular head having at least one cut-out segment.

12. The plate system of claim 1, wherein said locking element comprises at least one of a camming surface, a ramped surface, and a threaded portion.

13. The plate system of claim 1, wherein said locking element has a low profile so as to not interfere with overlying tissues and adjacent vessels and neurological structures when said locking element is in the final position.

14. The plate system of claim 1, wherein at least one end of said plate is configured to cooperatively engage a compression tool for movement of at least one vertebral body toward another vertebral body during installation of said plate.

15. The plate system of claim 1, further comprising an access opening in said plate for accessing at least one vertebral body with a compression tool for movement of at least one vertebral body toward another vertebral body during installation of said plate.

16. The plate system of claim 1, wherein at least a portion of said lower surface is roughened to promote the growth of bone along said lower surface.

17. The plate system of claim 1, wherein at least one of said bone screw receiving holes is configured to form an interference fit with one of said bone screws.

18. The plate system of claim 1, wherein at least a first pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of the first cervical vertebral body and at least a second pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of the second cervical vertebral body.

19. The plate system of claim 18, wherein said bone screw receiving holes of at least one of said first and second pairs of bone screw receiving holes are generally arranged in side-by-side pairs.

20. The plate system of claim 1, wherein at least two of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of a single cervical vertebral body adjacent a disc space to be fused.

21. The plate system of claim 1, in combination with a fusion promoting substance.

22. The plate system of claim 21, wherein said fusion promoting substance is at least in part bone.

23. The plate system of claim 21, wherein said fusion promoting substance includes at least one of bone morphogenetic protein, hydroxyapatite, and hydroxyapatite tricalcium phosphate.

24. The plate system of claim 21, wherein said fusion promoting substance includes at least one of bone morphogenetic protein, hydroxyapatite, and hydroxyapatite tricalcium phosphate.

25. The plate system of claim, 1, wherein at least a portion of one of said plate, said locking element, and said bone screws is a bioresorbable material.

26. The plate system of claim 25, wherein said bioresorbable material is at least in part bone.

27. The plate system of claim 1, in combination with an interbody implant.

28. The plate system of claim 1, in combination with a bone graft.

29. The plate of claim 1, wherein at least a portion of said lower surface comprises a bone ingrowth material.

30. The plate of claim 1, wherein at least a portion of said lower surface of said plate includes a bone ingrowth surface.

31. The plate of claim 1, in combination with a bioresorbable material.

32. A plate adapted for use in the anterior human cervical spine for contacting the anterior aspect of at least two cervical vertebral bodies, said plate comprising:

a longitudinal axis and a length sufficient to span a disc space and overlap portions of at least two adjacent cervical vertebral bodies, a lower surface for placement against the cervical vertebral bodies and an upper surface opposite said lower surface, said lower surface being concave along a substantial portion of the longitudinal axis of said plate;

at least two bone screw receiving holes extending through said plate from said upper surface through said lower surface, at least a first of said bone screw receiving holes associated with a first of the cervical vertebral bodies and at least a second of said bone screw receiving holes associated with a second of the cervical vertebral bodies, each of said bone screw receiving holes being adapted to receive a single bone screw to attach said plate to the cervical spine; and

at least one locking element, each of said at least one locking element adapted to lock to said plate only a single bone screw inserted in one of said at least two bone screw receiving holes, said locking element adapted to be coupled to said plate prior to the insertion of the bone screw to be locked by said locking element into said bone screw receiving hole, said locking element being moveable from an initial position that permits the insertion of said bone screw into said one of said bone screw receiving holes to a final position that is adapted to extend over at least a portion of said one of said bone screw receiving holes into which the single bone screw is to be inserted.

33. The plate of claim 32, further comprising at least one bone screw having a leading end for insertion into the cervical spine and a trailing end opposite said leading end, said trailing end including a surface generally transverse to a longitudinal axis of said screw, said locking element contacting said generally transverse surface of said bone screw.

34. The plate of claim 32, wherein said locking element is coupled to said plate.

35. The plate of claim 34, wherein said locking element is removably coupled to said plate.

36. The plate of claim 32, wherein said locking element in the final position covers at least a portion of only one of said bone screw receiving holes.

37. The plate of claim 32, wherein said locking element is adapted to be rotated from the inital position to the final position.

38. The plate of claim 37, wherein less than a full rotation of said locking element rotates said locking element from the inital position to the final position.

39. The plate of claim 32, wherein at least a portion of said locking element slides from the inital position to the final position.

40. The plate of claim 39, wherein said locking element slides over at least a portion of only one of said bone screw receiving holes.

41. The plate of claim 39, wherein said locking element slides over at least a portion of one of the bone screws when in one of said bone screw receiving holes.

42. The plate of claim 32, wherein said locking element comprises at least one of a screw, a rivet, and a cap.

43. The plate of claim 32, wherein said locking element includes a generally circular head having at least one cut-out segment.

44. The plate of claim 32, wherein said locking element comprises at least one of a camming surface, a ramped surface, and a threaded portion.

45. The plate of claim 32, wherein said locking element has a low profile so as to not interfere with overlying tissues and adjacent vessels and neurological structures when said locking element is in the final position.

46. The plate of claim 32, wherein at least one end of said plate is configured to cooperatively engage a compression tool for movement of at least one vertebral body toward another vertebral body during installation of said plate.

47. The plate of claim 32, further comprising an access opening in said plate for accessing at least one vertebral body with a compression tool for movement of at least one vertebral body toward another vertebral body during installation of said plate.

48. The plate of claim 32, wherein at least a portion of said lower surface is roughened to promote the growth of bone along said lower surface.

49. The plate of claim 32, wherein at least one of said bone screw receiving holes is configured to form an interface fir with a properly dimensioned bone screw to be received therein.

50. The plate of claim 32, wherein at least a first pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of the first cervical vertebral body and at least a second pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of the first cervical vertebral body and at least a second pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of the second cervical vertebral body.

51. The plate of claim 50, wherein said bone screw receiving holes of at least one of said first and second pairs of bone screw receiving holes are generally arranged in side-by-side pairs.

52. A plate of claim 32, wherein at least two of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of a single cervical vertebral body adjacent a disc space to be fused.

53. The plate of claim 32, in combination with a fusion promoting substance.

54. The plate system of claim 33, wherein said fusion promoting substance is at least in part bone.

55. The plate of claim 52, wherein said locking portion has a low profile so as to not interfere with overlying tissues and adjacent vessels and neurological structures when said locking portion is in the final position.

56. The plate of claim 52, wherein said fusion promoting substance includes at least one of bone morphogentic protein, hydroxyapatite, and hydroxyapatite tricalcium phosphate.

57. The plate of claim 52, further comprising an access opening in said plate for accessing at least one vertebral body with a compression tool for movement of at least one vertebral body toward another vertebral body during installation of said plate.

58. The plate of claim 52, wherein said lower surface of said plate has a concave curvature configured to conform to the anterior aspect of at least a portion of two cervical vertebral bodies.

59. The plate system of claim 52, in combination with an interbody implant.

60. The plate system of claim 32, in combination with a bone graft.

61. The plate system of claim 32, wherein at least a portion of said lower surface comprises a bone ingrowth material.

62. The plate system of claim 32, wherein at least a portion of said lower surface of said plate includes a bone ingrowth surface.

63. The plate system of claim 32, in combination with a bioresorbable material.

67. The plate of claim 52, further comprising bone screws for engaging said plate to the cervical spine, wherein at least a portion of one of said plate, said locking portion, and said bone screws is a bioresorbable material.

68. The plate of claim 67, wherein said bioresorbable material is at least in part bone.

97. The plate system of claim 67, in combination with a bone graft.

64. A plate adapted for use in the anterior human cervical spine for contacting the anterior aspect of at least two cervical vertebral bodies, said plate comprising:

a longitudinal axis and a length sufficient to span a disc space and overlap portions of at least two adjacent cervical vertebral bodies, a lower surface for placement against the cervical vertebral bodies and an upper surface opposite said lower surface, said lower surface being concave along a substantial portion of the longitudinal axis of said plate;

at least two bone screw receiving holes extending through said plate from said upper surface through said lower surface, at least a first of said bone screw receiving holes associated with a first of the cervical vertebral bodies and at least a second of said bone screw receiving holes associated with a second of the cervical vertebral bodies, each of said bone screw receiving holes being adapted to receive a single bone screw to attach said plate to the cervical spine; and

said plate having at least one non-detachable locking portion, each of said at least one locking portion adapted to lock to said plate only a single bone screw insereted in one of said at least two bone screw receiving holes, said locking portion being moveable from an inital position that permits the insertion of the bone screw to be locked by said locking portion into said one of said bone screw receiving holes to a final position that is adapted to extend over at least a portion of said one of said bone screw receiving holes to retain the bone screw to said plate.

65. The plate of claim 64, wherein said fusion promoting substance is at least in part other than bone.

66. The plate of claim 64, wherein said fusion promoting substance includes at least one of bone morphogenetic protein, hydroxyapatite, and hydroxyapatite tricalcium phosphate.

69. The plate of claim 64, further comprising an access opening in said plate for accessing at least one vertebrel body with a compression tool for movement of at least one vertebrel body toward another vertebrel body during installation of said plate.

70. The plate system of claim 69, wherein said locking element is configured to threadably engage one of said bone screw receiving holes.

71. The plate system of claim 69, wherein at least a first pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of the first cervical vertebral body and at least a second pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of the second cervical vertebral body.

72. The plate system of claim 69, wherein at least two of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of a single cervical vertebral body adjacent a disc space to be fused.

73. The plate system of claim 64, wherein at least a first pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of the first cervical vertebral body and at least a second pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of the second cervical vertebral body.

74. The plate system of claim 73, wherein said bone screw receiving holes of at least one of said first and second pairs of bone screw receiving holes are generally arranged in side-by-side pairs.

75. The plate system of claim 73, wherein said fusion promoting substance comprises bone morphogenetic protein.

76. The plate system of claim 69, in combination with a bioresorbable material.

77. The plate system of claim 76, wherein said fusion promoting substance is at least in part bone.

78. The plate system of claim 77, wherein at least a first pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of the first cervical vertebral body and at least a second pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of the second cervical vertebral body.

79. The plate system of claim 77, wherein at least two of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of a single cervical vertebral body adjacent a disc space to be fused.

80. The plate system of claim 77, in combination with a fusion promoting substance.

81. The plate system of claim 80, wherein said fusion promoting substance is at least in part other than bone.

82. The plate system of claim 64, in combination with an interbody implant.

83. The plate system of claim 64, in combination with a bone graft.

84. The plate system of claim 64, wherein at least a portion of said lower surface comprises a bone ingrowth material.

85. The plate system of claim 64, wherein at least a portion of said lower surface of said plate includes a bone ingtowth surface.

86. The plate system of claim 64, in combination with a bioresorable material.

87. A plate system adapted for use in the anterior human cervical spine for contacting the anterior aspect of at least two cervical vertebral bodies, said plate system comprising:

a plate having a longitudinal axis and a length sufficient to span a disc space and overlap portions of at least two adjacent cervical vertebral bodies, a lower surface for placement against the cervical vertebral bodies and an upper surface opposite said lower surface, said lower surface being concave along a substantial portion of the longitudinal axis of said plate;

at least two bone screws each having a central longitudinal axis and being adapted to engage each of the at least two cervical vertebral bodies, respectively, each of said bone screws having a leading end for insertion into the bone of the cervical vertebral bodies and a trailing end opposite said leading end, said trailing end having a top surface oriented toward said trailing end of said bone screw and a bottom surface opposite said top surface oriented toward said leading end of said bone screw;

at least two bone screw receiving holes extending through said plate from said upper surface through said lower surface, at least a first of said bone screw receiving holes associated with a first of the cervical vertebral bodies and at least a second of said bone screw receiving holes associated with a second of the cervical vertebral bodies; and

at least one locking element, each of said at least one locking element adapted to lock to said plate only a single one of said bone screws inserted in a single one of said at least two bone screw receiving holes, said locking element adapted to be coupled to said plate prior to the insertion of said bone screw to be locked by said locking element into said one of said bone screw receiving holes, said locking element being moveable from an initial position that permits the insertion of said bone screw into said one of said bone screw receiving holes to a final position that is adapted to extend over at least a portion of said top surface of said bone screw inserted in said one of said bone screw receiving holes.

88. The plate system of claim 87, wherein said locking element is configured to threadably engage one of said bone screw receiving holes.

89. The plate system of claim 87, wherein at least a first pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of the first cervical vertebral body and at least a second pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of the second cervical vertebral plate.

90. The plate system of claim 87, wherein at least two of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of a single cervical vertebral body adjacent a disc space to be fused.

91. A plate system of claim 87, in combination with a fusion promoting substance.

92. The plate system of claim 91, wherein said fusion pormoting substance is at least part bone.

93. The plate system of claim 91, wherein said fusion promoting substance is at least in part other than bone.

94. The plate system of claim 91, wherein said fusion promoting substance includes at least one of bone morphofenetic protein, hydroxyapatite, and hydroxyapatite tricalcium phosphate.

95. The plate system of claim 87, in combination with a bioresorbable material.

96. The plate system of claim 87, in combination with an interbody implant.

98. The plate system of claim 87, wherein at least a portion of said lower surface comprises a bone ingrowth material.

99. The plate system of claim 87, wherein at least a portion of said lower surface of said plate includes a bone ingrowth surface.

100. A plate system adapted for use in the anterior human cervical spine for contacting the anterior aspect of at least two cervical vertebral bodies, said plate system comprising:

a plate having a longitudinal axis and a length sufficient to span a disc space and overlap portions of at least two adjacent cervical vertebral bodies, a lower surface for placement against the cervical vertebral bodies and an upper surface opposite said lower surface, said lower surface being concave along a substantial portion of the longitudinal axis of said plate;

at least two bone screws each having a central longitudinal axis and being adapted to engage each of the at least two cervical vertebral bodies, respectively, each of said bone screws having a leading end for insertion into the cervical spine and a trailing end opposite said leading end, at least one of said bone screws including proximate said trailing end a maximum cross section dimension transverse to the central longitudinal axis of said bone screw, said bone screw having a contact surface area having a generally flat portion;

at least two bone screw receiving holes extending through said plate from said upper surface through said lower surface, at least a first of said bone screw receiving holes associated with a first of the cervical vertebral bodies and at least a second of said bone screw receiving holes associated with a second of the cervical longitudinal axis and being adapted to receive one of said bone screws to attach said plate to the cervical spine; and

at least one locking element, each of said at least one locking element adapted to lock to said plate only one of said bone screws inserted in one of said bone screw receiving holes, each of said at least one locking element adapted to contact said generally flat portion of said contact surface area of a respective one of said bone screws so as to retain one of said bone screws to said plate.

101. The plate system of claim 100, wherein at least a first pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of the first cervical vertebral body and at least a second pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of the second cervical vertebral body.

102. The plate system of claim 100, wherein at least two of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of a single cervical vertebral body adjacent a disc spaced to be fused.

103. The plate system of claim 100, in combination with a fusion promoting substance.

104. The plate system of claim 103, wherein said fusion promoting substance is at least in part bone.

105. The plate system of claim 103, wherein said fusion promoting substance is at least in part other than bone.

106. The plate system of claim 103, wherein said fusion promoting substance includes at least one of bone morphogenetic protein, hydroxyapatite, and hydroxyapatite tricalcium phosphate.

107. The plate system of claim 100, in combination with a bioresorbable material.

108. The plate system of claim 100, in combination with an interbody implant.

109. The plate system of claim 100, in combination with a bone graft.

110. The plate system of claim 100, wherein a portion of said lower surface comprises a bone ingrowth material.

111. The plate system of claim 100, wherein at least a portion of said lower surface of said plate includes a bone ingrowth surface.

112. A plate system adapted for use in the anterior human cervical spine for contacting the anterior aspect of at least two cervical vertebral bodies, said plate system comprising:

a plate having a longitudinal axis and a length sufficient to span a disc space and overlap portions of at least two adjacent cervical vertebral bodies, a lower surface for placement against the cervical vertebral bodies and an upper surface oppisite said lower surface, said lower surface being concave along a substantial portion of the longitudinal axis of said plate;

at least two bone screws each having a central longitudinal axis and being adapted to engage each of the at least two cervical vertebral bodies, respectively, each of said bone screws having a leading end for insertion into the cervical spine and a trailing end opposite said leading end, said trailing end including a lower surface generally transverse to the central longitudinal axis of said screw;

at least two bone screw receiving holes extending through said plate from said upper surface through said lower surface, at least a first of said bone screw receiving holes associated with a first of the cervical vertebral bodies and at least a second of said bone screw receiving holes associated with a second of the cervical vertebral bodies, each of said bone screw receiving holes has a seat, said seat having a surface being at least in part flat and adapted to contact said lower surface of one of said bone screws; and

at least one locking element, each of said at least one locking element adapted to lock to said plate only one of said bone screws inserted in one of said at least two bone screw receiving holes, each of said at least one locking element contacting at least a portion of a respective one of said bone screws so as to retain one of said bone screws to said plate.

113. The plate system of claim 112, wherein at least a first pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of the first cervical vertebral body and at least a second pair of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect og the second cervical vertebral body.

114. The plate system of claim 112, wherein at least two of said bone screw receiving holes are oriented in said plate to overlie the anterior aspect of a single cervical vertebral body adjacent a disc space to be fused.

115. The plate system of claim 112, in combination with a fusion promoting substance.

116. The plate system of claim 115, wherein said fusion promoting substance is at least in part bone.

117. The plate system of claim 115, wherein said fusion promoting substance is at least in part other than bone.

118. The plate system of claim 115, wherein said fusion promoting substance includes at least one of bone morphogenetic protein, hydroxyapatite, and hydroxyapatite tricalcium phosphate.

119. The plate system of claim 112, in combination with a bioresorbable material.

120. The plate system of claim 112, in combination with an interbody implant.

121. The plate system of claim 112, in combination with a bone graft.

122. The plate system of claim 112, wherein at least a portion of said lower surface comprises a bone ingrowth material.

123. The plate system of claim 122, wherein at least a portion of said lower surface of said plate includes a bone ingrowth surface.