(19) United States
`(12) Patent Application Publication (10) Pub. No.: US 2013/0023994 A1
`Glerum
`(43) Pub. Date:
`Jan. 24, 2013
`
`US 2013 0023994A1
`
`(54) EXPANDABLE FUSION DEVICE AND
`METHOD OF INSTALLATION THEREOF
`
`(76) Inventor: Chad Glerum, Pennsburg, PA (US)
`(21) Appl. No.: 13/557,902
`(22) Filed:
`Jul. 25, 2012
`
`O
`O
`Related U.S. Application Data
`(63) Continuation-in-part of application No. 13/451,230,
`filed on Apr. 19, 2012, which is a continuation of
`application No. 13/440,158, filed on Apr. 5, 2012,
`which is a continuation-in-part of application No.
`127823,736, filed on Jun. 25, 2010, which is a continu
`ation-in-part of application No. 13/273,994, filed on
`Oct. 14, 2011, which is a continuation of application
`No. 12/579,833, filed on Oct. 15, 2009, now Pat. No.
`8,062,375.
`
`Publication Classification
`
`(51) Int. Cl.
`(2006.01)
`A6IF 2/44
`(52) U.S. Cl. .................................................... 623/1716
`
`ABSTRACT
`(57)
`The present invention provides an expandable fusion device
`capable of being installed inside an intervertebral disc space
`to maintain normal disc spacing and restore spinal stability,
`thereby facilitating an intervertebral fusion. In one embodi
`ment, the fusion device includes a body portion, a first end
`plate, and a second endplate, the first and second endplates
`capable of being moved in a direction away from the body
`portion into an expanded configuration or capable of being
`moved towards the body portion into an unexpanded configu
`ration. The fusion device is capable of being deployed and
`installed in both configurations.
`
`
`
`Exhibit 1018
`LIFE SPINE, INC.
`IPR2022-01602
`
`000001
`
`

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`Patent Application Publication
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`Jan. 24, 2013 Sheet 1 of 38
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`US 2013/0023994 A1
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`US 2013/0023994 A1
`
`Jan. 24, 2013
`
`EXPANDABLE FUSION DEVICE AND
`METHOD OF INSTALLATION THEREOF
`
`CROSS-REFERENCE TO RELATED
`APPLICATIONS
`0001. This patent application is a continuation-in-part
`application claiming priority to U.S. patent application Ser.
`No. 13/451,230, filed Apr. 19, 2012, which is a continuation
`of U.S. patent application Ser. No. 13/440,158, filed Apr. 5,
`2012, which is a continuation-in-part application of U.S.
`patent application Ser. No. 12/823,736, filed Jun. 25, 2010,
`and a continuation-in-part application claiming priority to
`U.S. patent application Ser. No. 13/273,994, filed Oct. 14,
`2011, which is a continuation of U.S. patent application Ser.
`No. 12/579,833, filed Oct. 15, 2009, now issued as U.S. Pat.
`No. 8,062.375, the entire contents of which are incorporated
`by reference.
`
`FIELD OF THE INVENTION
`0002 The present invention relates to the apparatus and
`method for promoting an intervertebral fusion, and more
`particularly relates to an expandable fusion device capable of
`being inserted between adjacent vertebrae to facilitate the
`fusion process.
`
`BACKGROUND OF THE INVENTION
`0003. A common procedure for handling pain associated
`with intervertebral discs that have become degenerated due to
`various factors such as trauma or aging is the use of interver
`tebral fusion devices for fusing one or more adjacent vertebral
`bodies. Generally, to fuse the adjacent vertebral bodies, the
`intervertebral disc is first partially or fully removed. An inter
`vertebral fusion device is then typically inserted between
`neighboring vertebrae to maintain normal disc spacing and
`restore spinal stability, thereby facilitating an intervertebral
`fusion.
`0004. There are a number of known conventional fusion
`devices and methodologies in the art for accomplishing the
`intervertebral fusion. These include screw and rod arrange
`ments, Solid bone implants, and fusion devices which include
`a cage or other implant mechanism which, typically, is packed
`with bone and/or bone growth inducing Substances. These
`devices are implanted between adjacent vertebral bodies in
`order to fuse the vertebral bodies together, alleviating the
`associated pain.
`0005. However, there are drawbacks associated with the
`known conventional fusion devices and methodologies. For
`example, present methods for installing a conventional fusion
`device often require that the adjacent vertebral bodies be
`distracted to restore a diseased disc space to its normal or
`healthy height prior to implantation of the fusion device. In
`order to maintain this height once the fusion device is
`inserted, the fusion device is usually dimensioned larger in
`height than the initial distraction height. This difference in
`height can make it difficult for a Surgeon to install the fusion
`device in the distracted intervertebral space.
`0006. As such, there exists a need for a fusion device
`capable of being installed inside an intervertebral disc space
`at a minimum to no distraction height and for a fusion device
`that can maintain a normal distance between adjacent verte
`bral bodies when implanted.
`
`SUMMARY OF THE INVENTION
`0007. In an exemplary embodiment, the present invention
`provides an expandable fusion device capable of being
`installed inside an intervertebral disc space to maintain nor
`mal disc spacing and restore spinal Stability, thereby facili
`tating an intervertebral fusion. In one embodiment, the fusion
`device includes a body portion, a first endplate, and a second
`endplate. The first and second endplates are capable of being
`moved in a direction away from the body portion into an
`expanded configuration or capable of being moved towards
`the body portion into an unexpanded configuration. The
`expandable fusion device is capable of being deployed and
`installed in the unexpanded configuration or the expanded
`configuration.
`0008 Further areas of applicability of the present inven
`tion will become apparent from the detailed description pro
`vided hereinafter. It should be understood that the detailed
`description and specific examples, while indicating the pre
`ferred or exemplary embodiments of the invention, are
`intended for purposes of illustration only and are not intended
`to limit the scope of the invention.
`
`BRIEF DESCRIPTION OF THE DRAWINGS
`0009. The present invention will become more fully
`understood from the detailed description and the accompa
`nying drawings, wherein:
`0010 FIG. 1 is a side view of an embodiment of an
`expandable fusion device shown between adjacent vertebrae
`according to the present invention;
`0011
`FIG. 2 is an exploded view of the expandable fusion
`device of FIG. 1;
`0012 FIG. 3 is a front perspective view of the expandable
`fusion device of FIG. 1 shown in an unexpanded position
`0013 FIG. 4 is a front perspective view of the expandable
`fusion device of FIG. 1 shown in an expanded position;
`0014 FIG. 5 is a rear perspective view of the expandable
`fusion device of FIG. 1 shown in an unexpanded position;
`0015 FIG. 6 is a rear perspective view of the expandable
`fusion device of FIG. 1 shown in an expanded position;
`0016 FIG. 7 is a side view of the expandable fusion device
`of FIG. 1 shown in an unexpanded position;
`(0017 FIG. 8 is a side view of the expandable fusion device
`of FIG. 1 shown in an expanded position;
`(0018 FIG.9 is a top view of the expandable fusion device
`of FIG. 1;
`0019 FIG. 10. is a side partial cross-sectional view of the
`expandable fusion device of FIG. 1 shown in an unexpanded
`position;
`0020 FIG. 11 is a side partial cross-sectional view of the
`expandable fusion device of FIG. 1 shown in an expanded
`position;
`0021
`FIG. 12 is a side schematic view of the expandable
`fusion device of FIG. 1 having different endplates:
`0022 FIG. 13 is a partial side schematic view of the
`expandable fusion device of FIG. 1 showing different modes
`of endplate expansion; and
`0023 FIG. 14 is a side schematic view of the expandable
`fusion device of FIG. 1 with artificial endplates shown
`between adjacent vertebrae.
`0024 FIG. 15 is a side view of an embodiment of an
`expandable fusion device shown between adjacent vertebrae
`according to the present invention;
`
`000040
`
`

`

`US 2013/0023994 A1
`
`Jan. 24, 2013
`
`0025 FIG. 16 is an exploded view of the expandable
`fusion device of FIG. 15:
`0026 FIG. 17 is a rear perspective view of the expandable
`fusion device of FIG. 15 shown in an unexpanded position;
`0027 FIG. 18 is a side cross-sectional view of the expand
`able fusion device of FIG. 15 shown with one of the endplates
`removed;
`0028 FIG. 19 is a side partial cross-sectional view of the
`expandable fusion device of FIG. 15 shown in an unexpanded
`position;
`0029 FIG. 20 is a side partial cross-sectional view of the
`expandable fusion device of FIG. 15 shown in an expanded
`position;
`0030 FIG. 21 is a side schematic view of the expandable
`fusion device of FIG. 15 having different endplates:
`0031
`FIG. 22 is a partial side schematic view of the
`expandable fusion device of FIG. 15 showing different modes
`of endplate expansion;
`0032 FIG. 23 is a side schematic view of the expandable
`fusion device of FIG. 15 with artificial endplates shown
`between adjacent vertebrae;
`0033 FIG. 24 is a side view cross-sectional view of
`another embodiment of an expandable fusion device shown in
`an unexpanded position;
`0034 FIG. 25 is a side view cross-sectional view of the
`expandable fusion device of FIG. 24 shown in an expanded
`position;
`0035 FIG. 26 is a side view of the expandable fusion
`device of FIG. 24 showing the translation member and the
`ramped insert:
`0036 FIG.27 is a front perspective view of the expandable
`fusion device of FIG. 24 showing the translation member and
`the ramped insert;
`0037 FIG. 28 is a rear perspective of another embodiment
`of an expandable fusion device with the endplates having a
`threaded hole;
`0038 FIG. 29 is a top view of another embodiment of an
`expandable fusion device shown in an unexpanded position;
`0039 FIG. 30 is a bottom view of the expandable fusion
`device of FIG. 29:
`0040 FIG.31 is top view of the expandable fusion device
`of FIG. 29 shown in an expanded position:
`0041
`FIG. 32 is an exploded perspective view of another
`embodiment of an expandable fusion device:
`0042 FIG. 33 is an end view of the expandable fusion
`device of FIG. 32 in an unexpanded position;
`0043 FIG. 34 is an end view of the expandable fusion
`device of FIG. 32 in an expanded position:
`0044 FIG. 35 is a perspective view of another embodi
`ment of an expandable fusion device;
`004.5
`FIG. 36 is a top view of the expandable fusion
`device of FIG.35:
`0046 FIG. 37 is a perspective view of the expandable
`fusion device of FIG. 35 with a closed end.
`0047 FIG. 38 is a front view of the expandable fusion
`device of FIG. 37 shown between adjacent vertebrae in an
`unexpanded position; and
`0048 FIG. 39 is a front view of the expandable fusion
`device of FIG. 37 shown between adjacent vertebrae in an
`expanded position.
`0049 FIG. 40 is an exploded view of an alternative fusion
`device.
`0050 FIG. 41 is a top view of the device in FIG. 40 with a
`first endplate removed.
`
`FIG. 42 is a top view of the alternative fusion device
`0051
`having side stabilization members.
`0052 FIG. 43 is a perspective view of the device in FIG.
`42.
`0053 FIG. 44 is a side cross-sectional view of the device
`in FIG. 42.
`0054 FIG. 45 is a perspective view of a trial member in a
`non-expanded configuration.
`0055 FIG. 46 is a side cross-sectional view of the trial
`member of FIG. 45 in an expanded configuration.
`0056 FIG. 47 is a top view of the trial member.
`0057 FIG. 48 is an exploded view of the trial member.
`0.058
`FIG. 49 is a side cross-sectional view of a portion of
`an alternative fusion device incorporating a ring member
`therein.
`0059 FIG. 50 is a perspective view of a portion of the
`alternative fusion device of FIG. 49.
`0060 FIG. 51 is a side cross-sectional view of a proximal
`portion of a trial member in an unlocked configuration.
`0061
`FIG. 52 is a side cross-sectional view of a proximal
`portion of a trial member in a locked configuration.
`0062 FIG. 53 is an alternate side cross-sectional view of a
`proximal portion of a trial member in a locked configuration.
`0063 FIG. 54 is a perspective cross-sectional view of a
`proximal portion of a trial member in a locked configuration.
`0064 FIG.55 is a front cross-sectional view of a proximal
`portion of a trial member.
`0065 FIG. 56 is a side view of an instrument for engaging
`a fusion device.
`0066 FIGS. 57A-57C illustrate a distal portion of an
`instrument in the process of engaging a fusion device for
`delivery and actuation.
`0067 FIGS. 58A and 58B illustrate a proximal portion of
`an instrument including a handle for delivering and actuating
`a fusion device.
`0068 FIG. 59 is a side cross-sectional view of a proximal
`portion of an instrument including a handle.
`0069 FIGS. 60A-60C illustrate an alternative embodi
`ment of an inserter tube of an instrument.
`
`DETAILED DESCRIPTION OF THE
`EMBODIMENTS
`0070 The following description of the preferred embodi
`ment(s) is merely exemplary in nature and is in no way
`intended to limit the invention, its application, or uses.
`0071. A spinal fusion is typically employed to eliminate
`pain caused by the motion of degenerated disk material. Upon
`Successful fusion, a fusion device becomes permanently fixed
`within the intervertebral disc space. Looking at FIG. 1, an
`exemplary embodiment of an expandable fusion device 10 is
`shown between adjacent vertebral bodies 2 and 3. The fusion
`device 10 engages the endplates 4 and 5 of the adjacent
`vertebral bodies 2 and 3 and, in the installed position, main
`tains normal intervertebral disc spacing and restores spinal
`stability, thereby facilitating an intervertebral fusion. The
`expandable fusion device 10 can be manufactured from a
`number of materials including titanium, stainless Steel, tita
`nium alloys, non-titanium metallic alloys, polymeric materi
`als, plastics, plastic composites, PEEK, ceramic, and elastic
`materials.
`0072. In an exemplary embodiment, bone graft or similar
`bone growth inducing material can be introduced around and
`within the fusion device 10 to further promote and facilitate
`the intervertebral fusion. The fusion device 10, in one
`
`000041
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`
`Jan. 24, 2013
`
`embodiment, is preferably packed with bone graft or similar
`bone growth inducing material to promote the growth of bone
`through and around the fusion device. Such bone graft may be
`packed between the endplates of the adjacent vertebral bodies
`prior to, Subsequent to, or during implantation of the fusion
`device.
`0073. With reference to FIG. 2, an exploded perspective
`view of one embodiment of the fusion device 10 is shown. In
`an exemplary embodiment, the fusion device 10 includes a
`body portion 12, a first endplate 14, a second endplate 16, a
`translation member 18, a plurality of pins 20, an actuation
`member 22, and a locking mechanism 24.
`0074. With additional reference to FIGS. 3-8, in an exem
`plary embodiment, the body portion 12 has a first end 26, a
`second end 28, a first side portion 30 connecting the first end
`26 and the second end 28, and a second side portion 32
`connecting the first end 26 and the second end 28. The body
`portion 12 further includes an upper end 34, which is sized to
`receive at least a portion of the first endplate 14, and a lower
`end 36, which is sized to receive at least a portion of the
`second endplate 16.
`0075. The first end 26 of the fusion device 10, in an exem
`plary embodiment, includes at least one angled Surface 38.
`but can include multiple angled Surfaces. The angled Surface
`can serve to distract the adjacent vertebral bodies when the
`fusion device 10 is inserted into an intervertebral space. In
`another preferred embodiment, it is contemplated that there
`are at least two opposing angled Surfaces forming a generally
`wedge shaped to distract the adjacent vertebral bodies when
`the fusion device 10 is inserted into an intervertebral space.
`0076. The second end 28 of the body portion 12, in an
`exemplary embodiment, includes an opening 40 which may
`include threading. In another exemplary embodiment, the
`opening 40 may include ratchet teeth instead of threading.
`The opening 40 extends from the second end 28 of the body
`portion 12 into a central opening 42 in the body portion 12. In
`one embodiment, the central opening 42 is sized to receive the
`translation member 18 and the opening 40 is sized to thread
`ingly receive the actuation member 22. In another exemplary
`embodiment, the opening 40 is sized to receive the actuation
`member 22 in a ratcheting fashion. In yet another exemplary
`embodiment, first side portion 30 and second side portion 32
`each include a recess 44 located towards the second end 28 of
`the body portion 12. The recess 44 is configured and dimen
`Sioned to receive an insertion instrument (not shown) that
`assists in the insertion of the fusion device 10 into an inter
`vertebral space.
`0077 Although the following discussion relates to the first
`endplate 14, it should be understood that it also equally
`applies to the second endplate 16 as the second endplate 16 is
`substantially identical to the first endplate 14. Turning now to
`FIGS. 2-11, in an exemplary embodiment, the first endplate
`14 has an upper Surface 46, a lower Surface 48, and a through
`opening 49. The through opening 49, in an exemplary
`embodiment, is sized to receive bone graft or similar bone
`growth inducing material and further allow the bone graft or
`similar bone growth inducing material to be packed in the
`central opening 42 in the body portion 12.
`0078. In one embodiment, the lower surface 48 includes at
`least one extension 50 extending along at least a portion of the
`lower surface 48. As best seen in FIGS. 2 and 4, in an exem
`plary embodiment, the extension 50 can extend along a Sub
`stantial portion of the lower Surface 48, including, along each
`side of the endplate 14 and along the front end of the endplate
`
`14. In another exemplary embodiment, the extension 50
`includes at least one slot 52, but can include any number of
`slots 52, including two sets of slots 52 opposing each other, as
`best seen in FIG. 2. The slots 52 are configured and dimen
`Sioned to receive pins 20 and are oriented in an oblique
`fashion. In another embodiment, the slots 52 may be oriented
`in a generally vertical orientation.
`0079. In an exemplary embodiment, the extension 50 is
`sized to be received within the central opening 42 of the body
`portion 12. As best seen in FIGS. 11-12, the lower surface 48
`of the first endplate 14 further includes, in an exemplary
`embodiment, at least one ramped surface 54. In another
`exemplary embodiment, there are two spaced ramped Sur
`faces 54, 56. It is contemplated that the slope of the ramped
`surfaces 54.56 can be equal or can differ from each other. The
`effect of varying the slopes of the ramped surfaces 54, 56 is
`discussed below.
`0080 Referring now to FIGS. 2-9, in one embodiment, the
`upper surface 46 of the first endplate 14 is flat and generally
`planar to allow the upper surface 46 of the endplate 14 to
`engage with the adjacent vertebral body 2. Alternatively, as
`shown in FIG. 12, the upper surface 46 can be curved con
`vexly or concavely to allow for a greater or lesser degree of
`engagement with the adjacent vertebral body 2. It is also
`contemplated that the upper Surface 46 can be generally pla
`nar but includes a generally straight ramped Surface or a
`curved ramped surface. The ramped surface allows for
`engagement with the adjacent vertebral body 2 in a lordotic
`fashion. Turning back to FIGS. 2-9, in an exemplary embodi
`ment, the upper surface 46 includes texturing 58 to aid in
`gripping the adjacent vertebral bodies. Although not limited
`to the following, the texturing can include teeth, ridges, fric
`tion increasing elements, keels, or gripping or purchasing
`projections.
`0081. With reference to FIGS. 2 and 10-11, in an exem
`plary embodiment, the translation member 18 is sized to be
`received within the central opening 42 of the body portion 12
`and includes at least a first expansion portion 60. In another
`embodiment, the translation member 18 includes a first
`expansion portion 60 and a second expansion portion 62, the
`expansion portions 60, 62 being connected together via a
`bridge portion 68. It is also contemplated that there may be
`more than two expansion portions where each of the expan
`sion portions is connected by a bridgeportion. The expansion
`portions 60, 62 each have angled surfaces 64, 66 configured
`and dimensioned to engage the ramp surfaces 54, 56 of the
`first and second endplates 14, 16. In an exemplary embodi
`ment, the translation member 18 also includes recesses 70,
`72, the recesses 70, 72 are sized to receive and retain pins 20.
`In one embodiment, the expansion portion 60 includes an
`opening 74, which is sized to receive a portion of the actuation
`member 22, and the expansion portion 62 includes a nose 76,
`which is received within an opening 78 in the first end 26 to
`stabilize the translation member 18 in the central opening 42
`of the body member 12.
`I0082 In an exemplary embodiment, the actuation member
`22 has a first end 80, a second end 82 and threading 84
`extending along at least a portion thereoffrom the first end 80
`to the second end 82. The threading 84 threadingly engages
`the threading extending along a portion of opening 40 in the
`body portion 12. In another exemplary embodiment, the
`actuation member 22 includes ratchetteeth instead of thread
`ing. The ratchet teeth engage corresponding ratchet teeth in
`the opening 40 in the body portion 12. The first end 80
`
`000042
`
`

`

`US 2013/0023994 A1
`
`Jan. 24, 2013
`
`includes a recess 86 dimensioned to receive an instrument
`(not shown) that is capable of advancing the actuation mem
`ber 22 with respect to the body portion 12 of the fusion device
`10. The second end 82 of the actuation member 22 includes an
`extension 88 that is received within the opening 74 of the
`expansion portion 60. In one embodiment, the extension 88
`may include a plurality of slits and a lip portion. The plurality
`of slits allows the extension portion 88 to flex inwardly reduc
`ing its diameter when received in the opening 74. Once the lip
`portion of the extension portion 88 is advanced beyond the
`end of the opening 74, the extension portion 88 will return
`back to its original diameter and the lip portion will engage
`the expansion portion 60. It is further contemplated that a pin
`member 90 can be included to prevent the extension portion
`from flexing inwardly thereby preventing the actuation mem
`ber 22 from disengaging from the translation member 18.
`0083. In an exemplary embodiment, the fusion device 10
`can further include a locking mechanism 24. The mechanism
`24 is designed to resist rotation of the actuation member 22
`rather than prevent rotation of the actuation member 22. In an
`exemplary embodiment, either deformable threading can be
`included on actuation member 22 or a disruption of the
`threading may be included where a deformable material is
`included in the threading disruption. It is contemplated that
`the deformable member or deformable threading can be made
`from a deformable or elastic, biocompatible material such as
`initinol or PEEK.
`I0084 Turning now to FIGS. 1-8 and 10-11, a method of
`installing the expandable fusion device 10 is now discussed.
`Prior to insertion of the fusion device 10, the intervertebral
`space is prepared. In one method of installation, a diskectomy
`is performed where the intervertebral disc, in its entirety, is
`removed. Alternatively, only a portion of the intervertebral
`disc can be removed. The endplates of the adjacent vertebral
`bodies 2, 3 are then scraped to create an exposed end Surface
`for facilitating bone growth across the invertebral space. The
`expandable fusion device 10 is then introduced into the inter
`vertebral space, with the first end 26 being inserted first into
`the disc space followed by the second end 28. In an exemplary
`method, the fusion device 10 is in the unexpanded position
`when introduced into the intervertebral space. The wedged
`shaped first end 26 will assist in distracting the adjacent
`vertebral bodies 2, 3 if necessary. This allows for the option of
`having little to no distraction of the intervertebral space prior
`to the insertion of the fusion device 10. In another exemplary
`method, the intervertebral space may be distracted prior to
`insertion of the fusion device 10. The distraction provide
`Some benefits by providing greater access to the Surgical site
`making removal of the intervertebral disc easier and making
`scraping of the endplates of the vertebral bodies 2, 3 easier.
`0085. With the fusion device 10 inserted into and seated in
`the appropriate position in the intervertebral disc space, the
`fusion device can then expanded into the expanded position,
`as best seen in FIGS. 1, 4, 6, 8, and 11. To expand the fusion
`device 10, an instrument is engaged with recess 86 in the
`actuation member 22. The instrument is used to rotate actua
`tion member 22. As discussed above, actuation member 22 is
`threadingly engaged body portion 12 and is engaged with
`translation member 18; thus, as the actuation member 22 is
`rotated in a first direction, the actuation member 22 and the
`translation member 18 move with respect to the body portion
`12 toward the first end 26 of the body portion 12. In another
`exemplary embodiment, the actuation member 22 is moved in
`a linear direction with the ratchet teeth engaging as means for
`
`controlling the movement of the actuation member 22 and the
`translation member 18. As the translation member 18 moves,
`the ramped surface 64, 66 of the expansion portions 60, 62
`push against the ramped surfaces 54, 56 of the endplates 14,
`16 pushing endplates 14, 16 outwardly into the expanded
`position. This can best be seen in FIGS. 10 and 11. Since the
`expansion of the fusion device 10 is actuated by a rotational
`input, the expansion of the fusion device 10 is infinite. In other
`words, the endplates 14, 16 can be expanded to an infinite
`number of heights dependent on the rotational advancement
`of the actuation member 22. As discussed above, the fusion
`device 10 includes a locking mechanism 24 which assists in
`retaining the endplates 14, 16 at the desired height.
`I0086. It should also be noted that the expansion of the
`endplates 14, 16 can be varied based on the differences in the
`dimensions of the ramped surfaces 54,56, 64, 66. As best seen
`in FIG. 13, the endplates 14, 16 can be expanded in any of the
`following ways: Straight rise expansion, straight rise expan
`sion followed by a toggle into a lordotic expanded configu
`ration, or a phase off straight rise into a lordotic expanded
`configuration.
`I0087 Turning back to FIGS. 1-8 and 10-11, in the event
`the fusion device 10 needs to be repositioned or revised after
`being installed and expanded, the fusion device 10 can be
`contracted back to the unexpanded configuration, reposi
`tioned, and expanded again once the desired positioning is
`achieved. To contract the fusion device 10, the instrument is
`engaged with recess 86 in the actuation member 22. The
`instrument is used to rotate actuation member 22. As dis
`cussed above, actuation member 22 is threadingly engaged
`body portion 12 and is engaged with translation member 18;
`thus, as the actuation member 22 is rotated in a second direc
`tion, opposite