one or more detailed embodiments of the present invention are disclosed herein ; however , it is to be understood that the disclosed embodiments are merely exemplary of the invention , which may be embodied in various forms . therefore , specific structural and functional details disclosed herein are not to be interpreted as limiting , but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the present invention in virtually any appropriately detailed structure . fig1 shows one embodiment of an anterior locking interbody cage for use as an anterior interbody fusion device 100 in the lumbar spine 105 . the disc interspace is shaped like a “ d ” 110 . the device 100 has a generally oval or circular shaped body or cage , when viewed from above , having an annular wall enclosing a hollow interior or area 115 that would permit bony growth into spinal bones above and below the device when implanted . the hollow area 115 would be filled with bone autograft , allograft or a bone graft substitute . fig2 shows a “ d ” shaped body 200 body or cage , when viewed from above , having an annular wall enclosing a hollow interior or area 215 that would permit bony growth into spinal bones above and below the device when implanted . the hollow area 215 would be filled with bone autograft , allograft or a bone graft substitute . there are some advantages using the oval or circular shape shown in fig1 over “ d ” shape 200 shown in fig2 . for example , the “ d ” shaped device can only be placed in the disc space in one orientation . the “ d ” shape has posterior corners that can impinge on the aortic / venous iliac vessels . the “ d ” design is not suitable for a lateral approach 120 . in contrast , an oval shaped device permits more implant options , so that the device could be placed in different rotational orientations within the spine , and would have the advantage of sliding safely past aortic / venous iliac vessels . the oval shaped device 100 also allows variability to approach the disc space from multiple angles 120 , again permitting variability to better accommodate the vascular anatomy , such as . for example , oval shaped device may also be placed into patients through a lateral approach 120 , which a “ d ” design does not afford , the lateral approach being favored by many surgeons in an anterior approach to l4 / 5 . fig3 a shows a l5 / s1 anterior view of one embodiment of a modular anterior locking interbody cage ( malic ) system 300 configured to be placed between vertebra . the system 300 includes an interbody fusion device or implant 305 and an attachment plate 310 . the implant 305 may be made of a metal , a non metal synthetic material , or a nmsm / metal amalgam , discussed below . the attachment plates 310 are coupled to the implant with a screw , and would allow a variation of attachment plates 310 to be attached onto the implant 305 , making the system 300 modular . the attachment plates are designed to accommodate the vascular 325 anatomy . using a screw or other fixation means such as a rivet or snap locking mechanism for attachment with the implant allows the attachment plate to rotate to various orientations to avoid the vascular anatomy . the attachment plate may be coupled to the implant either before , during , or after implantation . the screw attachment also allows the attachment plate to be removable from the body in case it needs to be replaced or repositioned . the attachment plate 310 has a superior portion ( anatomically cranial ) and an inferior portion ( anatomically caudal ). the superior portion is narrower than the inferior portion . the attachment plate 310 in turn would have holes that would allow the placement of bone screws 320 into the vertebra above and / or below , locking the implant 305 in place . the attachment plate 310 may be made from metal , such as titanium , stainless steel or cobalt - chromium . the attachment plate 310 may also be made from high strength composites or plastics such as peek . in addition , the attachment plate 310 adjacent to the device 305 may have a contouring that would allow a male / female counterpart contouring on a front surface of the device . this would allow a surface interlock that would resist rotational forces between the attachment plate 310 and the device 305 . the primary reason for the attachment plate 310 shape is the complexity of the vascular anatomy , especially at the spinal levels superior to l5 - s1 , that can make access in one area of the spine easier than another . this would allow the surgeon a variety of attachment plates 310 to choose from , selecting the best shape to accommodate the complex vascular anatomy . by creating this modularity in attachable plates this device would have a variety of attachable plates that would accommodate different vascular anatomic challenges , allowing surgery to be performed in a safer manner . this would be done without sacrificing biomechanical strength and the plate would in turn lock onto the malic . fig3 b is a side view showing one embodiment of attaching the attachment plate 310 to the implant 305 . screw 335 attaches the attachment plate 310 to the implant 305 , in particular , attaching to the embedded metal plate 340 within the implant 305 . bone screws 325 are then used to attach the attachment plate to the vertebra above and / or below implant 305 . fig4 a shows one example of an anterior view of the spine in which a vascular portion requires retraction for implantation and attachment of an attachment plate 310 to a body 305 and adjacent vertebrae . in this example of the vertebral levels above l5 - s1 area , the vascular portion 325 is draped over the left side of the vertebrae . the vascular 325 a and / or 325 b is retracted 330 , such as shown in fig4 b , to make room for the attachment plate 310 to attach to the implant 305 and vertebrae . fig4 c - 4e show different sizes and shapes of attachment plates 310 that may be used to avoid the vascular , having superior portions narrower than inferior portions . in fig4 c , attachment plate 310 a may include provisions for one screw attaching to a vertebra above the implant 305 and two screws attaching to a vertebra below the implant 305 . in fig4 d , attachment plate 310 b attaches to a vertebra below the implant 305 . in fig4 e , attachment plate 310 c may include provisions for one screw attaching a vertebra above the implant 305 and two screws attaching to a vertebra below the implant 305 . in some cases , it may be desirable to have surface treatment of the attachment plate 310 and implant 305 where they join . for example , fig5 shows two examples a and b . the mating surfaces in a have adjacent irregular contouring and b have regular pyramidal male / female interlocking features to provide additional stability of the assemble components that may include rotational stability . fig6 a shows one embodiment an implant 400 , having a generally oval or circular shape similar to device 100 , with an amalgam body of non metal synthetic material ( nmsm ) and metal material . in some embodiments , implant 400 may be used in place of implant 300 in the systems describe above . the device 400 includes an oval body 405 or cage with an annular wall 415 having upper and lower surfaces enclosing a central opening 410 or hollow interior . the upper and lower surfaces are configured to contact adjacent spine member and may have raised ridges projecting outwardly from each of the surfaces for engaging the spinal column . the annular wall 415 of the implant 405 includes an anterior portion 415 a , a posterior portion 415 b and lateral portions 415 c . the implant 405 is made from a non - metal synthetic material with a metal plate 420 integrally formed within the anterior side of the non metal synthetic material implant 405 . the metal plate 420 does not fully extend around the implant 405 . the non - metal synthetic material may be made from carbon , peek ( polyethylketone ), graphite , woven carbon , kevlar , or other suitable synthetic material that has strength capable of withstanding compression and rotational forces . the metal material may be titanium , stainless steel or cobaltlchromium . the amalgam feature could also be applied to nmsm threaded cages placed in the anterior lumbar spine , as well as cages placed in the interbody space from a lateral approach . this amalgam feature may also apply to cages , cylindrical or rectangular placed in the cervical or thoracic spine . while the preferred shape of the implant is oval , other shapes may also be used , such as circular , kidney or “ d ” shaped . there are numerous advantages of a nmsm / metal amalgam for an implant . for example , one advantage is the metal within the device allows a surgeon to identify the position of the device in space to assist in implantation at the proper location and orientation with in the spine . another advantage is that the nmsm material allows a surgeon to assess fusion postoperatively after the implantation of the device . this is due to the fact that x - rays penetrate the nmsm to allow bony visualization through the device . the surgeon would be able to evaluate the fusion of the device to the spine by using the lateral x - rays taken only through lateral portions of the nmsm device alone . one weakness of using a nmsm device alone ( i . e ., without metal ) is the difficulty in holding the device with instruments or less durable antirotation feature . often the holding instruments ( typically made of peek ) overwhelm the nmsm device during implantation , resulting in deformation and damage . another advantage of the disclosed nmsm / metal amalgam is that the metal can allow a firmer “ grabbing ” of the device with implantation tools . holding or grabbing the proposed nmsm / metal amalgam device with an implantation tool , which would hold the metal plate ( s ), would avoid such damage to the implant and allow better control during implantation . advantage of more durable feature to prevent rotation between the implant and plate . the combination of metal in the form of a fixation element within the nmsm device is a novel concept . in some embodiments , a plurality of tool engaging openings ( not shown ) may be disposed in the annular wall 415 having the metal plate ( s ) 420 . the openings can be threaded or otherwise configured to receive a conventional insertion tool ( not shown ). fig6 b - 6e show other embodiments of a nmsm / metal amalgam implant . in fig6 b , the metal within the device may include one or more metal plates , for example , plates 420 a , 420 b . in fig6 c , the metal within the nmsm / metal amalgam device could take the form of multiple washers or threaded inserts 425 . in fig6 d , the metal within the nmsm / metal amalgam device could take the form of a plate 430 with threaded screw holes 435 . in fig6 e , the metal within the nmsm / metal amalgam device could include both anterior plate ( s ) 420 on the anterior side and posterior plate ( s ) 440 on the posterior side of the device . fig7 shows a view of a lateral x - ray showing the implant 400 positioned within between adjacent vertebrae 450 . by positioning the metal within the anterior portion 415 a , and optionally the posterior portion 415 b , the surgeon would be able to evaluate the fusion of the device to the spine by using the lateral x - rays taken only through lateral portions 415 c of the nmsm device alone . an anterior 415 a / posterior 415 b x - ray would not be as desirable as the metal components of the device would obscure the fusion . there are numerous advantages of a nmsm / metal amalgam for an implant . for example , one advantage is the metal within the device allows a surgeon to identify the position of the device in space to assist in implantation at the proper location and orientation with in the spine . another advantage is that the nmsm material allows a surgeon to assess fusion postoperatively after the implantation of the device . this is due to the fact that x - rays penetrate the nmsm to allow bony visualization through the device . surgeons typically do not assess fusion through an anterior / posterior x - ray , and this is the view of the fusion that the metal components of the device would obscure . example embodiments of the methods and components of the present invention have been described herein . as noted elsewhere , these example embodiments have been described for illustrative purposes only , and are not limiting . other embodiments are possible and are covered by the invention . such embodiments will be apparent to persons skilled in the relevant art ( s ) based on the teachings contained herein . thus , the breadth and scope of the present invention should not be limited by any of the above - described exemplary embodiments , but should be defined only in accordance with the following claims and their equivalents .
apparatus and method if using a modular spinal implant system for use between adjacent vertebrae near vascular anatomy . the system includes an implant configured the fit between adjacent vertebrae , the implant having annular side walls with upper and lower surfaces configured to enclose a hollow interior , and an attachment plate rotatably coupled to the implant and configured to rotate to variable orientations relative to the implant to avoid the vascular anatomy , the attachment plate having a superior portion that is narrower than an inferior portion , the attachment plate having at least one vertebra attachment hole configured for attaching to at least one adjacent vertebrae using one or more bone screws .