Apparatus for correcting spinal deformities and method for using

Claim 1

A method for correcting scoliosis and rotational deformities of the spine by posterior surgical procedures, which method comprises: surgically exposing the spine posteriorly; hooking onto the cephalad side of a lamina of a first vertebra (170f) on one side of the spinous processes of said spine with a first hook (90f); hooking onto the caudad side of a lamina of a second vertebra (170e) on said one side of the spinous processes of said spine with a second hook (90e); hooking onto a first transverse process (184b) on said one side of said spinous processes of said spine of a third vertebra that is intermediate of said first and second vertebrae with a third hook (90h); applying a first force to said first (170f) and second (170e) vertebrae by changing the distance between said first (90f) and second (90e) hooks; applying a second force to said third vertebra that moves said first transverse process (184b) towards one (170f or 170e) of the other two said vertebrae, and that moves said first transverse process (184b) posteriorly thereby rotating said third vertebra; hooking onto a second transverse process (184a) on said one side of said spinous processes of said spine of a fourth vertebra that is intermediate of said second and third vertebrae; and applying a third force to said fourth vertebra that comprises moving said fourth vertebra away from said third vertebra and that moves said second transverse process (184a) posteriorly thereby rotating said fourth vertebra in the same direction as said third vertebra is rotated.

Claim 2

A method for correcting scoliosis and rotational deformities of the spine by posterior surgical procedures, which method comprises: surgically exposing the spine posteriorly; hooking onto the cephalad side of a lamina of a first vertebra (170f) on one side of the spinous processes of said spine with a first hook (90f); hooking onto the caudad side of a lamina of a second vertebra (170e) on said one side of the spinous processes of said spine with a second hook (90e); hooking onto a first transverse process (184b) on said one side of said spinous processes of said spine of a third vertebra that is intermediate of said first and second vertebrae with a third hook (90h); applying a first force to said first (170f) and second (170e) vertebrae by changing the distance between said first (90f) and second (90e) hooks; applying a second force to said third vertebra that moves said first transverse process (184b) towards one (170f or 170e) of the other two said vertebrae, and that moves said first transverse process (184b) posteriorly thereby rotating said third vertebra; hooking onto a second transverse process (184a) on said one side of said spinous processes of said spine of a fourth vertebra that is intermediate of said second and third vertebrae; and applying a third force to said fourth vertebra that comprises moving said fourth vertebra away from said third vertebra and that moves said second transverse process (184a) posteriorly thereby rotating said fourth vertebra in the same direction as said third vertebra is rotated.

Claim 5

An apparatus (166a or 166b of FIG. 26) of the type used in the correction of spinal deformities by posterior surgical procedures, having an elongated member (72a or 72b of FIG. 26, or 72 of FIG. 9) with first (174a or 174b) and second (178a or 178b) ends and with a longitudinal axis (80 of FIG. 9), having a first hook (90a or 90e of FIG. 26, or 90 of FIGS. 15 and 16) that includes both a first attaching portion (100) and a first hooking portion (104) that is disposed around a first hook axis (106), having a second hook (90b or 90f of FIG. 26, or 90 of FIGS. 15 and 16) that includes both a second attaching portion (100) and a second hooking portion (104) that is disposed around a second hook axis (106), and having means for operatively attaching said first and second hooks (90) to said elongated member with said hooking portions (104) opening substantially toward opposite ones (174a and 178a, or 174b and 178b) of said ends of said elongated member (72a or 72b), and for longitudinally positioning one of said hooks (90) with respect to the other of said hooks (90), the improvement which comprises:

Claim 6

An apparatus (166a or 166b of FIG. 26) of the type used in the correction of spinal deformities by posterior surgical procedures, having an elongated member (72a or 72b of FIG. 26, or 72 of FIG. 9) with first (174a or 174b) and second (178a or 178b) ends and with a longitudinal axis (80 of FIG. 9), having a first hook (90a or 90e of FIG. 26, or 90 of FIGS. 15 and 16) that includes both a first attaching portion (100) and a first hooking portion (104) that is disposed around a first hook axis (106), having a second hook (90b or 90f of FIG. 26, or 90 of FIGS. 15 and 16) that includes both a second attaching portion (100) and a second hooking portion (104) that is disposed around a second hook axis (106), and having means for operatively attaching said first and second hooks (90) to said elongated member with said hooking portions (104) opening substantially toward opposite ones (174a and 178a, or 174b and 178b) of said ends of said elongated member (72a or 72b), and for longitudinally positioning one of said hooks (90) with respect to the other of said hooks (90), the improvement which comprises:

Claim 9

An apparatus (166a or 166b of FIG. 26) of the type used in the correction of spinal deformities by posterior surgical procedures, having an elongated member (72a or 72b of FIG. 26, or 72 of FIG. 9) with first (174a or 174b) and second 178a or 178b) ends and with a longitudinal axis (80 of FIG. 9), having a first hook (90a or 90e of FIG. 26, or 90 of FIGS. 15 and 16) that includes a first attaching portion (100), and that includes a first hooking portion (104) disposed around a first hook axis (106), having a second hook (90b or 90f of FIG. 26, or 90 of FIGS. 15 and 16) that includes a second attaching portion (100), and that includes a second hooking portion (104) disposed around a second hook axis (106), and having means for operatively attaching said first and second hooks (90) to said elongated member with said hooking portions (104) opening substantially toward opposite ones (174a and 178a, or 174b and 178b) of said ends of said elongated member (72a or 72b), and for longitudinally positioning one of said hooks (90) with respect to the other of said hooks (90), the improvement which comprises: said means for operatively attaching said first hook (90) to said elongated member (72) comprises said first attaching portion (100) of said first hook (90), and a first carrier (88 of FIGS. 9-14); said means for operatively attaching said first hook (90) to said elongated member (72) comprises said first attaching portion (100) of said first hook (90), and a first carrier (88 of FIGS. 9-14); said first carrier (88 of FIGS. 9-14) includes a rod-receiving opening (92) being rotatably (120 of FIG. 10) disposed onto said elongated member (72 of FIGS. 9 and 10), and a socket (94) that is radially displaced from said rod-receiving opening (92) at a given distance; and said means for operatively attaching said first hook (90) to said elongated member (72) comprises means (102 of FIGS. 15 and 16) for attaching said attaching portion in said socket and for permitting said first attaching portion (100) to move rotationally (118 of FIG. 10) in said socket (94) about a pivot axis (116 of FIGS. 9-11) that is substantially parallel to said longitudinal axis (80).

Claim 10

An apparatus (166a or 166b of FIG. 26) of the type used in the correction of spinal deformities by posterior surgical procedures, having an elongated member (72a or 72b of FIG. 26, or 72 of FIG. 9) with first (174a or 174b) and second 178a or 178b) ends and with a longitudinal axis (80 of FIG. 9), having a first hook (90a or 90e of FIG. 26, or 90 of FIGS. 15 and 16) that includes a first attaching portion (100), and that includes a first hooking portion (104) disposed around a first hook axis (106), having a second hook (90b or 90f of FIG. 26, or 90 of FIGS. 15 and 16) that includes a second attaching portion (100), and that includes a second hooking portion (104) disposed around a second hook axis (106), and having means for operatively attaching said first and second hooks (90) to said elongated member with said hooking portions (104) opening substantially toward opposite ones (174a and 178a, or 174b and 178b) of said ends of said elongated member (72a or 72b), and for longitudinally positioning one of said hooks (90) with respect to the other of said hooks (90), the improvement which comprises: said means for operatively attaching said first hook (90) to said elongated member (72) comprises said first attaching portion (100) of said first hook (90), and a first carrier (88 of FIGS. 9-14); said means for operatively attaching said first hook (90) to said elongated member (72) comprises said first attaching portion (100) of said first hook (90), and a first carrier (88 of FIGS. 9-14); said first carrier (88 of FIGS. 9-14) includes a rod-receiving opening (92) being rotatably (120 of FIG. 10) disposed onto said elongated member (72 of FIGS. 9 and 10), and a socket (94) that is radially displaced from said rod-receiving opening (92) at a given distance; and said means for operatively attaching said first hook (90) to said elongated member (72) comprises means (102 of FIGS. 15 and 16) for attaching said attaching portion in said socket and for permitting said first attaching portion (100) to move rotationally (118 of FIG. 10) in said socket (94) about a pivot axis (116 of FIGS. 9-11) that is substantially parallel to said longitudinal axis (80).

Claim 11

An apparatus as claimed in claims 4 or 5 in which said attaching means (88) for said first hook (90) includes means (102+110+99) for permitting said first hooking portion (104) of said first hook (90) to pivot away from said elongated member (72) about an axis (122 of FIGS. 9-11) that is parallel to said first hook axis (106) and that intercepts said first attaching portion (100) of said first hook (90).

Claim 12

An apparatus as claimed in claims 4 or 5 in which said attaching means (88) for said first hook (90) includes means (102+110+99) for permitting said first hooking portion (104) to pivot at least 3 degrees each way from said longitudinal axis (80) about an axis (128 of FIGS. 9-11) that is orthogonal to said longitudinal axis (80) and that intersects both said longitudinal axis (80) and said pivot axis (116).

Claim 13

An apparatus as claimed in claims 4 or 5 in which said attaching means (88) for said first hook (90) includes means (102+110+99) for permitting said first hooking portion (104) of said first hook (90) to pivot away from said elongated member (72) about an axis (122 of FIGS. 9-11) that is parallel to said first hook axis (106) and that intercepts said attaching portion (100) of said first hook (90), and for permitting said first hooking portion (104) to pivot at least 3 degrees each way from said longitudinal axis (80) about an axis (128 of FIGS. 9-11) that is orthogonal to said longitudinal axis (80) and that intercepts both said longitudinal axis (80) and said pivot axis (116).

Claim 14

An apparatus as claimed in claims 4 or 5 in which said attaching means for said one hook (90) includes means, comprising a convex spherical surface (102) on said first attaching portion (100), for permitting said first hook to pivot about an axis (122 or 128 of FIGS. 9-11) that is orthogonal to said longitudinal axis (80) and that intercepts said socket axis (95).

Claim 15

An apparatus (166a or 166b of FIG. 26) of the type used in the correction of spinal deformities by posterior surgical procedures, having an elongated member (72a or 72b of FIG. 26, or 72 of FIG. 9) with first (174a or 174b) and second (178a or 178b) ends and with a longitudinal axis (80 of FIG. 9), having a first hook (90a or 90e of FIG. 26, or 90 of FIGS. 15 and 16) that includes a first attaching portion (100), and a first hooking portion (104) that is disposed around a first hook axis (106) and that opens toward said first attaching portion (100), having a second hook (90b or 90f of FIG. 26, or 90 of FIGS. 15 and 16) that includes a second attaching portion (100), and a second hooking portion (104) that is disposed around a second hook axis (106) and that opens toward said second attaching portion (100), and having means for operatively attaching said first and second hooks (90) to said elongated member with said hooking portions (104) opening substantially toward opposite ones (174a and 178a, or 174b and 178b) of said ends of said elongated member (72a or 72b), and for longitudinally positioning one of said hooks (90) with respect to the other of said hooks (90), the improvement which comprises: said means for operatively attaching said first hook (90) to said elongated member (72) comprises said first attaching portion (100) of said first hook (90), and a first carrier (88 of FIGS. 9-14); said first carrier (88 of FIGS. 9-14) comprises a body (89) having first (91) and second (93) end surfaces, having a rod-receiving opening (92) that is disposed along a second longitudinal axis (98), that opens through said end surfaces (92 and 93), and that is rotatably disposed onto said elongated member (72), having a socket (94) that is disposed along a socket axis (95) substantially parallel to and radially displaced from said second longitudinal axis (98), that opens through said first end surface (91), that extends longitudinally into said body (89), and that terminates in a socket surface (96), having a side surface (97) that interconnects said end surfaces (91 and 93) remote from said rod-receiving opening (92) and adjacent to said socket (94), and having a shank-receiving slot (99) that is disposed in a plane (123) that substantially includes both said second longitudinal axis (98) and said socket axis (95), and that opens into said socket (94) through said side surface (97) and through said end surfaces (91 and 93); said first hook (90) includes a hook shank (110) that is disposed intermediate of said first attaching portion (100) and said first hooking portion (104) and that is freely disposed into said shank-receiving slot (99); and said first attaching portion (100) includes a convex spherical surface (102) that is juxtaposed against said first attaching portion (100) and that seats against said socket surface (96); whereby said convex spherical surface (102) of said first attaching portion (100) permits rotational movement of said first hook (90) about said socket axis (95); and whereby said convex spherical surface (102) of said first attaching portion (100) and said shank-receiving slot (99) of said first carrier (88) cooperate to permit pivotal movement of said first hook (90) about an axis (122 of FIGS. 9-11) that is substantially orthogonal to a plane that includes said second longitudinal axis (98) and said socket axis (95) and that substantially intercepts said socket axis (95).

Claim 16

An apparatus (166a or 166b of FIG. 26) of the type used in the correction of spinal deformities by posterior surgical procedures, having an elongated member (72a or 72b of FIG. 26, or 72 of FIG. 9) with first (174a or 174b) and second (178a or 178b) ends and with a longitudinal axis (80 of FIG. 9), having a first hook (90a or 90e of FIG. 26, or 90 of FIGS. 15 and 16) that includes a first attaching portion (100), and a first hooking portion (104) that is disposed around a first hook axis (106) and that opens toward said first attaching portion (100), having a second hook (90b or 90f of FIG. 26, or 90 of FIGS. 15 and 16) that includes a second attaching portion (100), and a second hooking portion (104) that is disposed around a second hook axis (106) and that opens toward said second attaching portion (100), and having means for operatively attaching said first and second hooks (90) to said elongated member with said hooking portions (104) opening substantially toward opposite ones (174a and 178a, or 174b and 178b) of said ends of said elongated member (72a or 72b), and for longitudinally positioning one of said hooks (90) with respect to the other of said hooks (90), the improvement which comprises: said means for operatively attaching said first hook (90) to said elongated member (72) comprises said first attaching portion (100) of said first hook (90), and a first carrier (88 of FIGS. 9-14); said first carrier (88 of FIGS. 9-14) comprises a body (89) having first (91) and second (93) end surfaces, having a rod-receiving opening (92) that is disposed along a second longitudinal axis (98), that opens through said end surfaces (92 and 93), and that is rotatably disposed onto said elongated member (72), having a socket (94) that is disposed along a socket axis (95) substantially parallel to and radially displaced from said second longitudinal axis (98), that opens through said first end surface (91), that extends longitudinally into said body (89), and that terminates in a socket surface (96), having a side surface (97) that interconnects said end surfaces (91 and 93) remote from said rod-receiving opening (92) and adjacent to said socket (94), and having a shank-receiving slot (99) that is disposed in a plane (123) that substantially includes both said second longitudinal axis (98) and said socket axis (95), and that opens into said socket (94) through said side surface (97) and through said end surfaces (91 and 93); said first hook (90) includes a hook shank (110) that is disposed intermediate of said first attaching portion (100) and said first hooking portion (104) and that is freely disposed into said shank-receiving slot (99); and said first attaching portion (100) includes a convex spherical surface (102) that is juxtaposed against said first attaching portion (100) and that seats against said socket surface (96); whereby said convex spherical surface (102) of said first attaching portion (100) permits rotational movement of said first hook (90) about said socket axis (95); and whereby said convex spherical surface (102) of said first attaching portion (100) and said shank-receiving slot (99) of said first carrier (88) cooperate to permit pivotal movement of said first hook (90) about an axis (122 of FIGS. 9-11) that is substantially orthogonal to a plane that includes said second longitudinal axis (98) and said socket axis (95) and that substantially intercepts said socket axis (95).

Claim 18

An apparatus as claimed in claims 4, 5, or 10 in which said elongated member (72) includes an externally threaded portion (73); and said means for longitudinally positioning said one hook (90) includes said threaded portion (73) and a threaded nut (76).

Claim 19

An apparatus (166a or 166b of FIG. 26) of the type used in the correction of spinal deformities by posterior surgical procedures, having an elongated member (72b of FIG. 26, or 72 of FIG. 9) with first (174a or 174b) and second (178a or 178b) ends and with a longitudinal axis (80 of FIG. 9), having a first hook (90a or 90e of FIG. 26, or 90 of FIGS. 15 and 16) that is operatively attached to said elongated member (72) at a first longitudinal position with respect to said longitudinal axis (80) and that opens substantially toward one of said ends, having a second hook (90b or 90f of FIG. 26 or 90 of FIGS. 9-11) that is operatively attached to said elongated member (72) and that opens substantially toward the other of said ends, and having means for longitudinally positioning one of said hooks (90) with respect to the other of said hooks (90), the improvement which comprises: a third hook (90c, 90d, 90f, or 90h of FIG. 26, or 90 of FIGS. 15 and 16) having an attaching portion (100) and having a hooking portion (104) that is disposed around a hook axis (106); and means (88c, 88d, 182, or 183 of FIG. 26, or 88 of FIGS. 9-14, or 182 of FIGS. 29-31) for operatively attaching said third hook (90) to said elongated member (72) intermediate of said first and second hooks with said attaching portion (100) radially displaced from said longitudinal axis (80) for longitudinally positioning said third hook (90c, 90d, 90g, or 90h of FIG. 26) with respect to one of the other of said hooks (90a, 90b, 90e, or 90f of FIG. 26), for permitting said attaching portion (100) of said third hook (90) to move circumferentially with respect to said longitudinal axis (80) and one of the other of said hooks, and for permitting rotational movement of said third hook (90) about a pivot axis (116 or 122 of FIGS. 9-11) that is spaced from said longitudinal axis (80) and that intercepts said attaching portion.

Claim 20

An apparatus (166a or 166b of FIG. 26) of the type used in the correction of spinal deformities by posterior surgical procedures, having an elongated member (72b of FIG. 26, or 72 of FIG. 9) with first (174a or 174b) and second (178a or 178b) ends and with a longitudinal axis (80 of FIG. 9), having a first hook (90a or 90e of FIG. 26, or 90 of FIGS. 15 and 16) that is operatively attached to said elongated member (72) at a first longitudinal position with respect to said longitudinal axis (80) and that opens substantially toward one of said ends, having a second hook (90b or 90f of FIG. 26 or 90 of FIGS. 9-11) that is operatively attached to said elongated member (72) and that opens substantially toward the other of said ends, and having means for longitudinally positioning one of said hooks (90) with respect to the other of said hooks (90), the improvement which comprises: a third hook (90c, 90d, 90f, or 90h of FIG. 26, or 90 of FIGS. 15 and 16) having an attaching portion (100) and having a hooking portion (104) that is disposed around a hook axis (106); and means (88c, 88d, 182, or 183 of FIG. 26, or 88 of FIGS. 9-14, or 182 of FIGS. 29-31) for operatively attaching said third hook (90) to said elongated member (72) intermediate of said first and second hooks with said attaching portion (100) radially displaced from said longitudinal axis (80) for longitudinally positioning said third hook (90c, 90d, 90g, or 90h of FIG. 26) with respect to one of the other of said hooks (90a, 90b, 90e, or 90f of FIG. 26), for permitting said attaching portion (100) of said third hook (90) to move circumferentially with respect to said longitudinal axis (80) and one of the other of said hooks, and for permitting rotational movement of said third hook (90) about a pivot axis (116 or 122 of FIGS. 9-11) that is spaced from said longitudinal axis (80) and that intercepts said attaching portion.

Claim 23

An apparatus (166a or 166b of FIG. 26) of the type used in the correction of spinal deformities by posterior surgical procedures, having an elongated member (72b of FIG. 26, or 72 of FIG. 9) with first (174b) and second (178b) ends and with a longitudinal axis (80 of FIG. 9), having a first hook (90e of FIG. 26, or 90 of FIGS. 15 and 16) that is operatively attached to said elongated member (72) at a first longitudinal position with respect to said longitudinal axis (80) and that opens substantially toward one of said ends, having a second hook (90f of FIG. 26 or 90 of FIGS. 9-11) that is operatively attached to said elongated member (72) and that opens substantially toward the other of said ends, and having means for longitudinally positioning one of said hooks (90) with respect to the other of said hooks (90), the improvement which comprises: a third hook (90g or 90h of FIG. 26, or 90 of FIGS. 15 and 16) having an attaching portion (100) and having a hooking portion (104) that is disposed around a hook axis (106); and means (182 or 183 of FIG. 26, or 182 of FIGS. 29-31) for operatively attaching said third hook (90) to said elongated member (72) intermediate of said first and second hooks with said attaching portion (100) radially displaced from said longitudinal axis (80), for longitudinally positioning said third hook (90g or 90h of FIG. 26) with respect to one of the other of said hooks (90e or 90f of FIG. 26), for permitting said attaching portion (100) of said third hook (90) to move circumferentially with respect to said longitudinal axis (80) and one of the other of said hooks, for permitting said third hook (90 of FIGS. 29-31) to be positioned in a hooking plane (193 of FIG. 29) that is at an angle of 15 to 45 degrees with respect to said longitudinal axis (80) as measured about a transverse axis (128 of FIGS. 29 and 30) that is orthogonal to said longitudinal axis (80) and that intercepts both said longitudinal axis (80) and said attaching portion (100) of said third hook (90), and for permitting said third hook (90) to pivot about a pivot axis (122 of FIG. 29) that is substantially parallel to said hook axis (106) and that intercepts said attaching portion.

Claim 24

An apparatus (166a or 166b of FIG. 26) of the type used in the correction of spinal deformities by posterior surgical procedures, having an elongated member (72b of FIG. 26, or 72 of FIG. 9) with first (174b) and second (178b) ends and with a longitudinal axis (80 of FIG. 9), having a first hook (90e of FIG. 26, or 90 of FIGS. 15 and 16) that is operatively attached to said elongated member (72) at a first longitudinal position with respect to said longitudinal axis (80) and that opens substantially toward one of said ends, having a second hook (90f of FIG. 26 or 90 of FIGS. 9-11) that is operatively attached to said elongated member (72) and that opens substantially toward the other of said ends, and having means for longitudinally positioning one of said hooks (90) with respect to the other of said hooks (90), the improvement which comprises: a third hook (90g or 90h of FIG. 26, or 90 of FIGS. 15 and 16) having an attaching portion (100) and having a hooking portion (104) that is disposed around a hook axis (106); and means (182 or 183 of FIG. 26, or 182 of FIGS. 29-31) for operatively attaching said third hook (90) to said elongated member (72) intermediate of said first and second hooks with said attaching portion (100) radially displaced from said longitudinal axis (80), for longitudinally positioning said third hook (90g or 90h of FIG. 26) with respect to one of the other of said hooks (90e or 90f of FIG. 26), for permitting said attaching portion (100) of said third hook (90) to move circumferentially with respect to said longitudinal axis (80) and one of the other of said hooks, for permitting said third hook (90 of FIGS. 29-31) to be positioned in a hooking plane (193 of FIG. 29) that is at an angle of 15 to 45 degrees with respect to said longitudinal axis (80) as measured about a transverse axis (128 of FIGS. 29 and 30) that is orthogonal to said longitudinal axis (80) and that intercepts both said longitudinal axis (80) and said attaching portion (100) of said third hook (90), and for permitting said third hook (90) to pivot about a pivot axis (122 of FIG. 29) that is substantially parallel to said hook axis (106) and that intercepts said attaching portion.

Claim 25

An apparatus (166b of FIG. 26) of the type used in the correction of spinal deformities by posterior surgical procedures, having an elongated member (72b of FIG. 26, or 72 of FIG. 9) with first (174b) and second (178b) ends and with a longitudinal axis (80 of FIG. 9), having a first hook (90e of FIG. 26, or 90 of FIGS. 15 and 16) that is operatively attached to said elongated member (72) at a first longitudinal position with respect to said longitudinal axis (80) and that opens substantially toward one of said ends, having a second hook (90f of FIG. 26 or 90 of FIGS. 9-11) that is operatively attached to said elongated member (72) and that opens substantially toward the other of said ends, and having means for longitudinally positioning one (90e or 90f) of said hooks with respect to the other of said hooks, the improvement which comprises: a third hook (90g or 90h of FIG. 26, or 90 of FIGS. 15 and 16) having an attaching portion (100), and having a hooking portion (104) that is disposed around a hook axis (106); and means (182 or 183 of FIG. 26, or 182 of FIGS. 29-31) for operatively attaching said third hook (90g or 90h of FIG. 26, or 90 of FIGS. 29-31) to said elongated member (72b of FIG. 26, or 72 of FIGS. 29-31) intermediate of said first (90e) and second (90f) hooks with said attaching portion radially displaced from said longitudinal axis (80), for longitudinally positioning said third hook with respect to one or the other (90e or 90f) of said hooks, for permitting said third hook (90 of FIGS. 29-31) to be positioned in a hooking plane (193 of FIG. 29) that is at an angle of 15 to 45 degrees with respect to said longitudinal axis (80) as measured about a transverse axis (80) and that intercepts both said longitudinal axis (80) and said attaching portion (100) of said third hook (90), for permitting said attaching portion (100) of said third hook (90) to move circumferentially with respect to said longitudinal axis (80) and one of the other of said hooks, and for permitting rotational movement of said third hook (90) about a pivot axis (116 of FIGS. 9-11) that lies in said hooking plane (193) and that intercepts said attaching portion (100).

Claim 26

An apparatus (166b of FIG. 26) of the type used in the correction of spinal deformities by posterior surgical procedures, having an elongated member (72b of FIG. 26, or 72 of FIG. 9) with first (174b) and second (178b) ends and with a longitudinal axis (80 of FIG. 9), having a first hook (90e of FIG. 26, or 90 of FIGS. 15 and 16) that is operatively attached to said elongated member (72) at a first longitudinal position with respect to said longitudinal axis (80) and that opens substantially toward one of said ends, having a second hook (90f of FIG. 26 or 90 of FIGS. 9-11) that is operatively attached to said elongated member (72) and that opens substantially toward the other of said ends, and having means for longitudinally positioning one (90e or 90f) of said hooks with respect to the other of said hooks, the improvement which comprises: a third hook (90g or 90h of FIG. 26, or 90 of FIGS. 15 and 16) having an attaching portion (100), and having a hooking portion (104) that is disposed around a hook axis (106); and means (182 or 183 of FIG. 26, or 182 of FIGS. 29-31) for operatively attaching said third hook (90g or 90h of FIG. 26, or 90 of FIGS. 29-31) to said elongated member (72b of FIG. 26, or 72 of FIGS. 29-31) intermediate of said first (90e) and second (90f) hooks with said attaching portion radially displaced from said longitudinal axis (80), for longitudinally positioning said third hook with respect to one or the other (90e or 90f) of said hooks, for permitting said third hook (90 of FIGS. 29-31) to be positioned in a hooking plane (193 of FIG. 29) that is at an angle of 15 to 45 degrees with respect to said longitudinal axis (80) as measured about a transverse axis (80) and that intercepts both said longitudinal axis (80) and said attaching portion (100) of said third hook (90), for permitting said attaching portion (100) of said third hook (90) to move circumferentially with respect to said longitudinal axis (80) and one of the other of said hooks, and for permitting rotational movement of said third hook (90) about a pivot axis (116 of FIGS. 9-11) that lies in said hooking plane (193) and that intercepts said attaching portion (100).

Claim 27

An apparatus as claimed in claims 13, 16, or 17 in which said attaching means for said third hook (90) includes means, comprising a spherical surface (102) on said attaching portion (100) for permitting said third hook (90) to pivot about a second axis that intercepts said attaching portion (100).

Claim 28

An apparatus (116b of FIG. 26) of the type used in the correction of spinal deformities by posterior surgical procedures, having an elongated member (72b of FIG. 26, or 72 of FIG. 9) with first (174b) and second (178b) ends and with a longitudinal axis (80 of FIG. 9), having a first hook (90e of FIG. 26, or 90 of FIGS. 9-11) that is operatively attached to said elongated member (72) at a first longitudinal position with respect to said longitudinal axis (80) and that opens substantially toward one of said ends, having a second hook (90f of FIG. 26 or 90 of FIGS. 9-11) that is operatively attached to said elongated member (72) and that opens substantially toward the other of said ends, and having means for longitudinally positioning one (90e or 90f) of said hooks with respect to the other of said hooks, the improvement which comprises: a third hook (90g or 90h of FIG. 26, or 90 of FIGS. 15 and 16) having an attaching portion (100), having a hooking portion (104) that is disposed around a hook axis (106) and that opens toward said attaching portion (100), and having a hook shank (110) that interconnects said attaching portion (100) and said hooking portion (104); and a carrier (182 or 183 of FIG. 26, or 182 of FIGS. 29-31) having a body that includes first and second end surfaces, having a rod-receiving opening (92 of FIG. 12) that is disposed along a longitudinal axis, that opens through said end surfaces, and that is rotatably disposed onto said elongated member (72), having a socket (94) radially disposed along a socket axis that is rotated from 15 to 45 degrees from said longitudinal axis (80) as measured about a transverse axis (128) that is orthogonal to said longitudinal axis (80) and that intercepts both said longitudinal axis (80) and said attaching portion (100), that opens through said first end surface, and that includes a socket surface (96) that is disposed intermediate of said end surfaces, and having means, comprising a slot in said carrier (182 or 183), for permitting said third hook (90) to pivot about a pivot axis (122) in a hooking plane (193) that includes said socket axis and said transverse axis (128).

Claim 29

An apparatus (116b of FIG. 26) of the type used in the correction of spinal deformities by posterior surgical procedures, having an elongated member (72b of FIG. 26, or 72 of FIG. 9) with first (174b) and second (178b) ends and with a longitudinal axis (80 of FIG. 9), having a first hook (90e of FIG. 26, or 90 of FIGS. 9-11) that is operatively attached to said elongated member (72) at a first longitudinal position with respect to said longitudinal axis (80) and that opens substantially toward one of said ends, having a second hook (90f of FIG. 26 or 90 of FIGS. 9-11) that is operatively attached to said elongated member (72) and that opens substantially toward the other of said ends, and having means for longitudinally positioning one (90e or 90f) of said hooks with respect to the other of said hooks, the improvement which comprises: a third hook (90g or 90h of FIG. 26, or 90 of FIGS. 15 and 16) having an attaching portion (100), having a hooking portion (104) that is disposed around a hook axis (106) and that opens toward said attaching portion (100), and having a hook shank (110) that interconnects said attaching portion (100) and said hooking portion (104); and a carrier (182 or 183 of FIG. 26, or 182 of FIGS. 29-31) having a body that includes first and second end surfaces, having a rod-receiving opening (92 of FIG. 12) that is disposed along a longitudinal axis, that opens through said end surfaces, and that is rotatably disposed onto said elongated member (72), having a socket (94) radially disposed along a socket axis that is rotated from 15 to 45 degrees from said longitudinal axis (80) as measured about a transverse axis (128) that is orthogonal to said longitudinal axis (80) and that intercepts both said longitudinal axis (80) and said attaching portion (100), that opens through said first end surface, and that includes a socket surface (96) that is disposed intermediate of said end surfaces, and having means, comprising a slot in said carrier (182 or 183), for permitting said third hook (90) to pivot about a pivot axis (122) in a hooking plane (193) that includes said socket axis and said transverse axis (128).

Claim 31

An apparatus as claimed in claims 13, 16, 17, or 19 in which said attaching means for said third hook (90) includes means (102+110+99) for permitting said hooking portion (104) to pivot a total of at least 6 degrees about an axis (128 of FIGS. 9-11, or 128 of FIGS. 29 and 30) that is orthogonal to said longitudinal axis (80) and that intersects both said longitudinal axis (80) and said attaching portion (100).

Claim 32

An apparatus as claimed in claims 13, 16, 17, or 19 in which said elongated member (72) includes an externally threaded portion (73); and said means for longitudinally positioning said third hook (90) includes said threaded portion (73) and a threaded nut (76).

Claim 33

A method for use in correcting spinal deformities by posterior surgical procedures, which method comprises: surgically exposing the spine posteriorly; hooking first (90a or 90e) and second (90b or 90f) hooks onto respective ones of first and second vertebrae on one side of the spinous processes of said spine subsequent to said exposing step; placing an elongated member (72a or 72b) having a longitudinal axis (80a or 80b) adjacent to said spine on said one side of said spinous processes subsequent to said exposing step; pivotally attaching said first hook to said elongated member at a first longitudinal position thereof, at a radial distance therefrom, and at a first circumferential position in relation thereto; operatively attaching said second hook to said elongated member at a second longitudinal position thereof; longitudinally positioning one of said hooks with respect to the other of said hooks in the direction that applies a longitudinal force to said hooks; and pivoting said first hook about a pivot axis (116) that intercepts said pivotal attaching of said first hook and that is within 45 degrees of being parallel to said longitudinal axis.

Claim 34

A method for use in correcting spinal deformities by posterior surgical procedures, which method comprises: surgically exposing the spine posteriorly; hooking first (90a or 90e) and second (90b or 90f) hooks onto respective ones of first and second vertebrae on one side of the spinous processes of said spine subsequent to said exposing step; placing an elongated member (72a or 72b) having a longitudinal axis (80a or 80b) adjacent to said spine on said one side of said spinous processes subsequent to said exposing step; pivotally attaching said first hook to said elongated member at a first longitudinal position thereof, at a radial distance therefrom, and at a first circumferential position in relation thereto; operatively attaching said second hook to said elongated member at a second longitudinal position thereof; longitudinally positioning one of said hooks with respect to the other of said hooks in the direction that applies a longitudinal force to said hooks; and pivoting said first hook about a pivot axis (116) that intercepts said pivotal attaching of said first hook and that is within 45 degrees of being parallel to said longitudinal axis.

Claim 35

A method for use in correcting spinal deformities by posterior surgical procedures, which method comprises: surgically exposing the spine posteriorly; hooking first (90a or 90e) and second (90b or 90f) hooks onto respective ones of first and second vertebrae on one side of the spinous processes of said spine subsequent to said exposing step; assembling first (88a or 88e) and second (88b or 88f) carriers onto an elongated member (72a or 72b) that includes a longitudinal axis (80a or 80b); placing said elongated member (72a or 72b) adjacent to said spine on said one side of said spinous processes; pivotally attaching one of said hooks to one of said carriers at a radial distance from said elongated member and at a first circumferential position with relation thereto; attaching the other one of said hooks to the other one of said carriers; longitudinally positioning one of said carriers with respect to the other of said carriers in the direction that applies a longitudinal force to said hooks; circumferentially positioning said pivotal attachment of said one hook about said longitudinal axis at said radial distance by rotationally positioning said one carrier; and pivoting said one hook about a pivot axis (116) that intercepts said pivotal attaching of said one hook and that is within 45 degrees of being parallel to said longitudinal axis.

Claim 36

A method for use in correcting spinal deformities by posterior surgical procedures, which method comprises: surgically exposing the spine posteriorly; hooking first (90a or 90e) and second (90b or 90f) hooks onto respective ones of first and second vertebrae on one side of the spinous processes of said spine subsequent to said exposing step; assembling first (88a or 88e) and second (88b or 88f) carriers onto an elongated member (72a or 72b) that includes a longitudinal axis (80a or 80b); placing said elongated member (72a or 72b) adjacent to said spine on said one side of said spinous processes; pivotally attaching one of said hooks to one of said carriers at a radial distance from said elongated member and at a first circumferential position with relation thereto; attaching the other one of said hooks to the other one of said carriers; longitudinally positioning one of said carriers with respect to the other of said carriers in the direction that applies a longitudinal force to said hooks; circumferentially positioning said pivotal attachment of said one hook about said longitudinal axis at said radial distance by rotationally positioning said one carrier; and pivoting said one hook about a pivot axis (116) that intercepts said pivotal attaching of said one hook and that is within 45 degrees of being parallel to said longitudinal axis.

Claim 37

A method for use in correcting signal deformities by posterior surgical procedures, which method comprises: surgically exposing the spine posteriorly; hooking first (90a or 90e) and second (90b or 90f) hooks onto respective ones of first and second vertebrae on one side of the spinous processes thereof subsequent to said exposing step; placing an elongated member (72a or 72b) having a longitudinal axis (80a or 80b) adjacent to said spine on said one side of said spinous processes thereof; operatively attaching said first hook to said elongated member at a first longitudinal position thereof and at a radial distance therefrom; operatively attaching said second hook to said elongated member at a second longitudinal position thereof and at a radial distance therefrom; longitudinally positioning one of said hooks with respect to the other of said hooks in the direction that applies a longitudinal force to one of said hooks; circumferentially positioning said attaching of one of said hooks with respect to the other of said hooks about said longitudinal axis as a function of said longitudinal positioning, said hooking force, and resultant correction of said spinal deformities; and pivotally positioning said one hook about an axis (116, 122, or 128 of FIG. 9) that is diverse from said longitudinal axis (80) as a function of said positioning step and said longitudinal force.

Claim 38

A method for use in correcting signal deformities by posterior surgical procedures, which method comprises: surgically exposing the spine posteriorly; hooking first (90a or 90e) and second (90b or 90f) hooks onto respective ones of first and second vertebrae on one side of the spinous processes thereof subsequent to said exposing step; placing an elongated member (72a or 72b) having a longitudinal axis (80a or 80b) adjacent to said spine on said one side of said spinous processes thereof; operatively attaching said first hook to said elongated member at a first longitudinal position thereof and at a radial distance therefrom; operatively attaching said second hook to said elongated member at a second longitudinal position thereof and at a radial distance therefrom; longitudinally positioning one of said hooks with respect to the other of said hooks in the direction that applies a longitudinal force to one of said hooks; circumferentially positioning said attaching of one of said hooks with respect to the other of said hooks about said longitudinal axis as a function of said longitudinal positioning, said hooking force, and resultant correction of said spinal deformities; and pivotally positioning said one hook about an axis (116, 122, or 128 of FIG. 9) that is diverse from said longitudinal axis (80) as a function of said positioning step and said longitudinal force.

Claim 42

A method for use in correcting spinal deformities by posterior surgical procedures, which method comprises: surgically exposing the spine posteriorly; hooking a first hook (90e) onto a lamina of a first vertebra, on the caudad side, and on one side of the spinous processes, subsequent to said exposing step; hooking a second hook (90f) onto a lamina of a second vertebra, on the cephalad side, and on said one side of said spinous processes, subsequent to said exposing step; attaching said first and second hooks to an elongated member (72b) having a longitudinal axis; hooking a third hook (90g or 90h) onto a transverse process (184a or 184b) that is intermediate of said first and second vertebrae and that is on said one side of said spinous processes; pivotally attaching said third hook to said elongated member, at a radially spaced distance from said longitudinal axis, and with said third hook being in a hooking plane (193 of FIG. 29) that is at an angle (195) of 15 to 45 degrees with respect to said longitudinal axis; longitudinally positioning one of said hooks with respect to another one of said hooks in the direction that provides a hooking force on said third hook; circumferentially positioning (FIG. 38) said pivotal attaching of said third hook as a function of said hooking force (194 of FIGS. 33 and 37) on said third hook and said angle (195) of said hooking plane (193); and pivotally positioning said third hook about an axis (116, 122, or 128 of FIG. 9) that is diverse from said longitudinal axis (80), and that intercepts said pivotal attaching of said third hook, as a function of said longitudinal positioning step and said hooking force.

Claim 43

A method for use in correcting spinal deformities by posterior surgical procedures, which method comprises: surgically exposing the spine posteriorly; hooking a first hook (90e) onto a lamina of a first vertebra, on the caudad side, and on one side of the spinous processes, subsequent to said exposing step; hooking a second hook (90f) onto a lamina of a second vertebra, on the cephalad side, and on said one side of said spinous processes, subsequent to said exposing step; attaching said first and second hooks to an elongated member (72b) having a longitudinal axis; hooking a third hook (90g or 90h) onto a transverse process (184a or 184b) that is intermediate of said first and second vertebrae and that is on said one side of said spinous processes; pivotally attaching said third hook to said elongated member, at a radially spaced distance from said longitudinal axis, and with said third hook being in a hooking plane (193 of FIG. 29) that is at an angle (195) of 15 to 45 degrees with respect to said longitudinal axis; longitudinally positioning one of said hooks with respect to another one of said hooks in the direction that provides a hooking force on said third hook; circumferentially positioning (FIG. 38) said pivotal attaching of said third hook as a function of said hooking force (194 of FIGS. 33 and 37) on said third hook and said angle (195) of said hooking plane (193); and pivotally positioning said third hook about an axis (116, 122, or 128 of FIG. 9) that is diverse from said longitudinal axis (80), and that intercepts said pivotal attaching of said third hook, as a function of said longitudinal positioning step and said hooking force.

Claim 44

A method for use in correcting spinal deformities by posterior surgical procedures, which method comprises: surgically exposing the spine posteriorly; hooking a first hook (90e) onto a lamina of a first vertebra on the caudad side, and on one side of the spinous processes, subsequent to said exposing step; hooking a second hook (90f) onto a lamina of a second vertebra, on the cephalad side, and on said one side of said spinous processes, subsequent to said exposing step; hooking a third hook (90g or 90h) onto a transverse process (184a or 184b) that is intermediate of said first and second vertebrae and that is on said one side of said spinous processes; assembling first (88e), second (88f), and third (182 or 183) carriers onto an elongated member (72b) that includes a longitudinal axis (80b); attaching said first and second hooks to said first and second carriers respectively; pivotally attaching said third hook to said third carrier, at a radial distance from said elongated member, and with said third hook in a hooking plane (193 of FIG. 29) that is at an angle (195) of 15 to 45 degrees with respect to said longitudinal axis; longitudinally positioning one of said hooks with respect to another of said hooks in a direction that puts a hooking force onto said third hook; circumferentially positioning (FIG. 38) said third carrier (182), and said pivotal attachment of said third hook, as a function of said hooking force (194 of FIGS. 33 and 37) on said third hook and said angle (195) of said hooking plane (193); and pivoting said third hook posteriorly as a function of said hooking force.

Claim 45

A method for use in correcting spinal deformities by posterior surgical procedures, which method comprises: surgically exposing the spine posteriorly; hooking a first hook (90e) onto a lamina of a first vertebra on the caudad side, and on one side of the spinous processes, subsequent to said exposing step; hooking a second hook (90f) onto a lamina of a second vertebra, on the cephalad side, and on said one side of said spinous processes, subsequent to said exposing step; hooking a third hook (90g or 90h) onto a transverse process (184a or 184b) that is intermediate of said first and second vertebrae and that is on said one side of said spinous processes; assembling first (88e), second (88f), and third (182 or 183) carriers onto an elongated member (72b) that includes a longitudinal axis (80b); attaching said first and second hooks to said first and second carriers respectively; pivotally attaching said third hook to said third carrier, at a radial distance from said elongated member, and with said third hook in a hooking plane (193 of FIG. 29) that is at an angle (195) of 15 to 45 degrees with respect to said longitudinal axis; longitudinally positioning one of said hooks with respect to another of said hooks in a direction that puts a hooking force onto said third hook; circumferentially positioning (FIG. 38) said third carrier (182), and said pivotal attachment of said third hook, as a function of said hooking force (194 of FIGS. 33 and 37) on said third hook and said angle (195) of said hooking plane (193); and pivoting said third hook posteriorly as a function of said hooking force.

Claim 46

A method as claimed in claims 29 or 30 in which said method further comprises pivoting said third hook about an axis that lies in said hooking plane (193), as a function of said longitudinal positioning, said hooking force, and resultant correction of said spinal deformities.

Claim 47

A method as claimed in claims 23, 25, or 30 in which said elongated member (72) includes an externally threaded portion (73) and said longitudinal positioning includes helical positioning of threaded nuts (76).

Claim 48

A method for use in correcting spinal deformities by posterior surgical procedures, which method comprises: surgically exposing the spine posteriorly; hooking a first hook (90e) onto a lamina of the first vertebra, on the caudad side, and on one side of the spinous processes, subsequent to said exposing step; hooking a second hook (90f) onto a lamina of a second vertebra, on the cephalad side, and on said one side of said spinous processes, subsequent to said exposing step; attaching said first and second hooks to an elongated member (72b) having a longitudinal axis; hooking a third hook (90e or 90h), that includes an attaching portion (100), onto a transverse process (184a or 184b) that in intermediate of said first and second vertebrae and that is on said one side of said spinous processes; pivotally attaching said attaching portion to said elongated member, at a radially spaced distance from said longitudinal axis, and with said third hook being in a hooking plane (193 of FIG. 29) that is at an angle (195) of 15 to 45 degrees with respect to said longitudinal axis; longitudinally positioning one of said hooks with respect to another one of said hooks in the direction that provides a hooking force on said third hook; circumferentially positioning (FIG. 38) said pivotal attachment of said third hook as a function of said hooking force (194 of FIGS. 33 and 37) on said third hook and said angle (195) of said hooking plane (193); and pivoting said third hook (80), about an axis (128 of FIGS. 29 and 30) that orthogonally intercepts said longitudinal axis (80) and that intercepts said attaching portion (100), as a function of said longitudinal positioning, said hooking force, and resultant correction of said spinal deformities.

Claim 49

A method for use in correcting spinal deformities by posterior surgical procedures, which method comprises: surgically exposing the spine posteriorly; hooking a first hook (90e) onto a lamina of the first vertebra, on the caudad side, and on one side of the spinous processes, subsequent to said exposing step; hooking a second hook (90f) onto a lamina of a second vertebra, on the cephalad side, and on said one side of said spinous processes, subsequent to said exposing step; attaching said first and second hooks to an elongated member (72b) having a longitudinal axis; hooking a third hook (90e or 90h), that includes an attaching portion (100), onto a transverse process (184a or 184b) that in intermediate of said first and second vertebrae and that is on said one side of said spinous processes; pivotally attaching said attaching portion to said elongated member, at a radially spaced distance from said longitudinal axis, and with said third hook being in a hooking plane (193 of FIG. 29) that is at an angle (195) of 15 to 45 degrees with respect to said longitudinal axis; longitudinally positioning one of said hooks with respect to another one of said hooks in the direction that provides a hooking force on said third hook; circumferentially positioning (FIG. 38) said pivotal attachment of said third hook as a function of said hooking force (194 of FIGS. 33 and 37) on said third hook and said angle (195) of said hooking plane (193); and pivoting said third hook (80), about an axis (128 of FIGS. 29 and 30) that orthogonally intercepts said longitudinal axis (80) and that intercepts said attaching portion (100), as a function of said longitudinal positioning, said hooking force, and resultant correction of said spinal deformities.

Claim 50

A method for use in correcting spinal deformities by posterior surgical procedures, which method comprises: surgically exposing the spine posteriorly; hooking a first hook (90e) onto a lamina of a first vertebra, on the caudad side, and one side of the spinous processes, subsequent to said exposing step; hooking a second hook (90f) onto a lamina of a second vertebra, on the cephalad side, and on said one side of said spinous processes, subsequent to said exposing step; hooking a third hook (90g or 90h), that includes an attaching portion (100), onto a transverse process (184a or 184b) that is intermediate of said first and second vertebrae and that is on said one side of said spinous processes; assembling first (88e), second (88f), and third (182 or 183) carriers onto an elongated member (72b) that includes a longitudinal axis (80b); attaching said first and second hooks to said first and second carriers respectively; pivotally attaching said attaching portion of said third hook to said third carrier, at a radial distance from said elongated member, and with said third hook in a hooking plane (193 of FIG. 29) that is at an angle (195) of 15 to 45 degrees with respect to said longitudinal axis; longitudinally positioning one of said hooks with respect to another of said hooks in a direction that puts a hooking force onto said third hook; circumferentially positioning (FIG. 38) said third carrier (182), and said attaching portion, as a function of said hooking force (194 of FIGS. 33 and 37) on said third hook and said angle (195) of said hooking plane (193); pivoting said third hook posteriorly, about an axis (122) that intercepts said attaching portion, as a function of said hooking force; and pivoting said third hook (90), about an axis (128 of FIGS. 29 and 30) that orthogonally intercepts said longitudinal axis (80) and that intercepts said attaching portion (100), as a function of said longitudinal positioning, said hooking force, and resultant correction of said spinal deformities.

Claim 51

A method for use in correcting spinal deformities by posterior surgical procedures, which method comprises: surgically exposing the spine posteriorly; hooking a first hook (90e) onto a lamina of a first vertebra, on the caudad side, and one side of the spinous processes, subsequent to said exposing step; hooking a second hook (90f) onto a lamina of a second vertebra, on the cephalad side, and on said one side of said spinous processes, subsequent to said exposing step; hooking a third hook (90g or 90h), that includes an attaching portion (100), onto a transverse process (184a or 184b) that is intermediate of said first and second vertebrae and that is on said one side of said spinous processes; assembling first (88e), second (88f), and third (182 or 183) carriers onto an elongated member (72b) that includes a longitudinal axis (80b); attaching said first and second hooks to said first and second carriers respectively; pivotally attaching said attaching portion of said third hook to said third carrier, at a radial distance from said elongated member, and with said third hook in a hooking plane (193 of FIG. 29) that is at an angle (195) of 15 to 45 degrees with respect to said longitudinal axis; longitudinally positioning one of said hooks with respect to another of said hooks in a direction that puts a hooking force onto said third hook; circumferentially positioning (FIG. 38) said third carrier (182), and said attaching portion, as a function of said hooking force (194 of FIGS. 33 and 37) on said third hook and said angle (195) of said hooking plane (193); pivoting said third hook posteriorly, about an axis (122) that intercepts said attaching portion, as a function of said hooking force; and pivoting said third hook (90), about an axis (128 of FIGS. 29 and 30) that orthogonally intercepts said longitudinal axis (80) and that intercepts said attaching portion (100), as a function of said longitudinal positioning, said hooking force, and resultant correction of said spinal deformities.