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WO2008152499A2 - Dispositif de corporéctomie implantable - Google Patents

Dispositif de corporéctomie implantable Download PDF

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Publication number
WO2008152499A2
WO2008152499A2 PCT/IB2008/001549 IB2008001549W WO2008152499A2 WO 2008152499 A2 WO2008152499 A2 WO 2008152499A2 IB 2008001549 W IB2008001549 W IB 2008001549W WO 2008152499 A2 WO2008152499 A2 WO 2008152499A2
Authority
WO
WIPO (PCT)
Prior art keywords
vertebra
adjacent
flexible joint
partially resected
vertebral
Prior art date
Application number
PCT/IB2008/001549
Other languages
English (en)
Other versions
WO2008152499A3 (fr
Inventor
Kirsten Schmieder
Armin Studer
Original Assignee
Pechlivanis, Ioannis
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Pechlivanis, Ioannis filed Critical Pechlivanis, Ioannis
Publication of WO2008152499A2 publication Critical patent/WO2008152499A2/fr
Publication of WO2008152499A3 publication Critical patent/WO2008152499A3/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442—Intervertebral or spinal discs, e.g. resilient
    • A61F2/4425—Intervertebral or spinal discs, e.g. resilient made of articulated components
    • A—HUMAN NECESSITIES
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    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/28—Bones
    • A61F2002/2835—Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30383—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
    • A61F2002/30387—Dovetail connection
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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
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    • A61F2002/30398—Sliding
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30476—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
    • A61F2002/30507—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism using a threaded locking member, e.g. a locking screw or a set screw
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30537—Special structural features of bone or joint prostheses not otherwise provided for adjustable
    • A61F2002/30538—Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting angular orientation
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30537—Special structural features of bone or joint prostheses not otherwise provided for adjustable
    • A61F2002/3055—Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting length
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30563—Special structural features of bone or joint prostheses not otherwise provided for having elastic means or damping means, different from springs, e.g. including an elastomeric core or shock absorbers
    • A—HUMAN NECESSITIES
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    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30576—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs
    • A61F2002/30578—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs having apertures, e.g. for receiving fixation screws
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30601—Special structural features of bone or joint prostheses not otherwise provided for telescopic
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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Definitions

  • the present disclosure relates to the field of surgical partial replacement of vertebrae, and especially to devices and methods which do not involve spinal fusion, thus maintaining spinal mobility.
  • Corpectomy is performed to compensate for degenerative or deteriorated disorders in bone. Following a partial corpectomy in patients with degenerative osteochondrosis and retrospondylosis or following traumatic vertebral fractures or in patients with tumorous lesions of the vertebral bodies, the surgeon needs to mechanically reconstruct the defect created and to provide long-term stability of the spine. This has been generally performed using spinal fusion.
  • a strut graft often obtained from the patient's iliac crest, is typically inserted into the cavity created by the corpectomy, and this supports the anterior vertebral column.
  • a titanium or PEEK cage implant is used. Fusion is achieved with a plate fixation involving both adjacent vertebral bodies. Both disc spaces are removed and fused.
  • the present disclosure describes new prosthetic implants for use after performance of partial corpectomy, which provide firm spinal support yet are adjustable in height, and which preserve mobility for the treated vertebral region, both in tilt and in rotation.
  • Examples of the device involve use of a generally rigid, cage-like implant, adjustable in height, with elements for fixation of the device to the remaining intact parts of the treated vertebra, and to the adjacent vertebrae.
  • the device thus provides safe bridging of the removed vertebral body, stabilization of the vertebral levels adjacent to the operated vertebra, yet still maintaining the mobility function of the two adjacent disc spaces, both in tilt and rotation, following the associated discectomy procedure.
  • the corpectomy implant described in this disclosure generally has a central structural element, generally in the form of a caged structure, whose height can be adjusted to suit the individual vertebral dimensions of the subject being treated. This structure is firmly fixed into the partial corpectomy cavity produced in the vertebral body treated. Flexible joint elements are attached to the extremities of the cage structure, and these flexible joints are fixed to the surfaces of the adjacent vertebral bodies. The flexible joints thus provide motion with disc-like properties, variable in both tilt angle and rotation, to the vertebral assembly treated using the device.
  • the device is thus an implantable, prosthetic device for repair of diseased vertebra after partial corpectomy, combining a rigid adjustable element with mobility generating extremity sections.
  • the flexible joint may be an elastomer material, which can be chosen to imitate the disc properties.
  • the properties of the elastomer material should be chosen to provide ease of turning and bending for the subject, and to prevent excessive straining of the material and the entire device.
  • the elastomer material may be bonded to the end surfaces of the implant, or a mechanical device, such as a ball and socket or a curved slide type of joint.
  • the outer ends of the flexible joints can be fixed to the adjacent vertebral bodies with flaps having a hole enabling a bone screw to be inserted, or a toothed or spiked surface used to bite into the bone surface and ensure firm fixation.
  • the central structure can also be affixed to the sound remaining vertebral bone by means of flaps and bone screws, of by means of toothed or spiked surfaces for biting into the bone surface after being wedged into the cavity.
  • Bone growth enhancing media can be used to encourage bone growth through holes in the end plates or in the walls associated with the central cage, thereby increasing the strength of the devoice fixation.
  • a flexible joint can be provided only at one end of the device.
  • the other end may then be made angularly adjustable to provide a predetermined angular orientation.
  • the device can also be constructed of sufficient length that its generally rigid, cage-like implant can be inserted into the cavities of two, or even more, partially resected adjacent vertebral bodies, so that it bridges more than one vertebral level.
  • the central section of the devices are described in this disclosure as being generally rigid, cage-like implants, it is to be understood that this implementation is only a commonly used practical example of the structure proposed, providing strength with lightness and the ability to incorporate bone growth elements within the cage.
  • the invention is not intended to be limited by this described structure, and for instance, without departing from the intended invention, the implant could be in the form of a solid element rather than a cage.
  • an orthopedic device comprising:
  • At least one flexible joint element having a first end part attached to an extremity region of the body, and disposed to face the surface of a vertebral body adjacent to one of the at least one partially resected vertebra, the at least one flexible element further having at least one fixation element for attaching its second end part to the adjacent vertebral body.
  • suitable joints for the at least one flexible joint element may be either an elastomer material insert, a ball and socket joint, a sliding ball joint or a curved slide joint, or any other suitable joint mechanism.
  • the at least one flexible joint should enable at least one of angular tilt motion and rotational motion.
  • each of the opposite ends of the external and internal sections may be ultimately attached to one of the two vertebra adjacent to the at least one partially resected vertebra, such that the adjacent vertebrae can be distracted by adjustment of the relative position of the internal and external portions.
  • the body may be a cage structure.
  • the at least one attachment element may comprise at least one side flap, such that the body may be fixed into the at least one cavity by use of at least one screw inserted though the at least one side flap into a lateral part of the at least one partially resected vertebra.
  • the at least one attachment element may comprise side walls associated with the body, the side walls having at least one of toothed and spiked protrusions which interact with the bone wall of the at least one cavity such that the body may be thus fixed within the at least one cavity.
  • any of the above-described devices may involve a device wherein the at least one flexible joint has at least one flap, such that it may be fixed to a vertebra adjacent to the at least one partially resected vertebra cavity by use of at least one screw.
  • the at least one flexible joint may have at least one of toothed and spiked protrusions on a surface remote from its attachment to the body of the device, such that the protrusions may interact with the surface of a vertebral body adjacent to the at least one partially resected vertebra, such that the at least one flexible joint element may thus be fixed to the surface of the vertebral body.
  • any of the body and the surfaces of the device may have holes through which bone growth can be achieved.
  • the at least one flexible joint element attached to an extremity region of the body may be two flexible joint elements, each attached to opposite extremity regions of the body, and each being disposed to face the surface of one of the vertebral bodies adjacent to the at least one partially resected vertebra, and that part of each of the two flexible joint elements remote from its attachment to the body may then be attached to one of the vertebral bodies adjacent to the at least one partially resected vertebra.
  • At least one of the flexible joint elements may comprise a plate with a base which can slide within a curved slide assembly, the curved slide assembly being disposed on the body.
  • both of the flexible joint elements may comprise a plate with a base which can slide within a curved slide assembly, and the sliding surfaces of the curved slide assemblies may then be oriented at an angle to each other such that the plates can be mutually inclined in more than one plane.
  • the curved sliding surfaces of the curved slide assemblies may advantageously be oriented at right angles to each other.
  • any of the plates may have an essentially circular base, such that the plate can rotate about its axis.
  • any of said plates may have at least one of toothed and spiked protrusions on a surface remote from the base, such that the protrusions interact with the surface of at least one vertebra body adjacent to the at least one partially resected vertebra, such that the plate is fixed to the surface of the vertebral body.
  • an orthopedic device comprising:
  • Such an orthopedic device may comprise: (i) a body with at least one attachment element for fixation of the body into cavities formed in two adjacent partially resected vertebra,
  • At least one fixation element for also attaching the at least one flexible joint element to at least one of the two adjacent partially resected vertebra.
  • Fig.1 shows schematically a cross section of a vertebral body, showing a partial corpectomy cavity prepared by the surgeon
  • Fig. 2 illustrates schematically an anterior view of a prior art method by which a partial corpectomy procedure may be performed for a single vertebral level
  • Fig. 3 illustrates schematically an exemplary vertebral implant system for use in a partial corpectomy procedure, providing stability, rigidity and adjustability, yet allows mobility of the spine in the region of the procedure;
  • Fig. 4A is a schematic rendering of the manner by which the device of Fig. 3 may be mounted in the patient's spine to bridge one vertebral level, while Fig. 4B shows a similar device to that of Fig. 4A but bridging two vertebral levels;
  • Fig. 5 is an exploded illustration of one example of a device for use in partial cervical corpectomy, showing the component parts of the device;
  • Figs. 6A to 6B show the device of Fig. 5 assembled, Fig. 6C shows the device extended;
  • Figs. 7A to 7D illustrate the way in which the angular bending motion of the device shown in the previous drawings, is executed.
  • Figs. 8A to 8C are schematic illustrations showing an alternative method of mounting the end plates onto the caged structure of the present device.
  • FIG. 1 illustrates schematically a cross section of a vertebral body 10, showing the partial corpectomy cavity 14 prepared by the surgeon after removal of the diseased bone.
  • the spinal column channel 12 is shown at the end of the opening.
  • Fig. 2 illustrates schematically an anterior view of a prior art method by which such a partial corpectomy procedure is performed for a single vertebral level.
  • the healthy vertebrae 20 are shown on either side of the diseased vertebra 22, whose central region has been removed to prepare for receipt of the implant 26.
  • the discs at either side of the diseased vertebrae have also been resected.
  • the implant used extends the whole height of the operated vertebra 22, and is generally adjusted so that the end faces of the adjacent vertebrae abut thereon. Once the implant is firmly wedged in place, a fusion plate 24 is screwed into it and into the adjacent healthy vertebrae, such that a firm structure is generated. Implanted bone growth can be used to assist the achievement of a rigid structure, fusing together the three vertebrae shown.
  • Fig. 3 illustrates schematically an anterior view of an exemplary novel vertebral implant device for use in a partial corpectomy procedure.
  • the device provides stability, rigidity and is adjustable for distraction purposes, and yet allows mobility of the spine in the region of the procedure.
  • the system may have a rigid, cage-like implant 30 dimensioned for insertion into the resected vertebral body.
  • the inner part of the cage-like implant 30 may be in the form of a chamber 32, which can be filled with bone or bone substitutes. Attachments may be provided for the fixation of the implant to the remaining bony parts of the partially resected vertebral body. In the exemplary device of Fig. 3, these attachments are shown in the form of flaps 31 on either side, with fixing screw holes.
  • the cage can be wedged into the resected vertebral cavity by pressure, or using side walls having teeth or spikes which firmly grip the adjacent bone wall.
  • the side walls can have holes through which bone growth can take place into the chamber 32, to ensure firm attachment.
  • Various combinations of wedging, side walls, and a flap or flaps may also be used, as appropriate.
  • the rigid, cage-like implant 30 is attached flexibly to one or both of the adjacent vertebrae.
  • a flexible segment is added which can vary its orientation angle and can rotation.
  • the flexible segment contains two plates 33, 34, with a joint 35 between them.
  • One of the plates 33 is attached to the rigid implant 30, and the other is attached to the adjacent vertebral end face.
  • the flexible joint 35 can be of any biocompatible type known in the art.
  • Some such possible flexible joints are those based on elastomer inserts, which provide characteristics close to those of the removed disc, or on sliding ball joints, or on sliding curved surfaces.
  • the flexible joint 35 may alternatively be attached directly to the extremity of the cage- like implant 30, without an intermediate plate, as shown at the lower end of the device. Attachment to the adjacent vertebral body may be achieved using any suitable method, such as flaps 36 with screw holes, or walls having teeth or spikes which firmly grip the adjacent vertebral end surfaces.
  • the plates can have holes through which bone growth can take place to ensure firm attachment.
  • the devices described in this disclosure can therefore be summarized as generally being composed of two or three sections, a rigid implant section, labeled 37 on the right hand arrowed scale of Fig. 3, for attaching to the partially resected vertebral body, and at least one flexible joint section, labeled 38 on the right hand scale of Fig. 3, for attaching to the adjacent healthy vertebral body or bodies.
  • a rigid implant section labeled 37 on the right hand arrowed scale of Fig. 3
  • at least one flexible joint section labeled 38 on the right hand scale of Fig. 3
  • it can be attached flexibly on both ends, and according to other implementations, flexibly only on one end, and rigidly on the other. Therefore, either one or two flexible joints may be used. Where only one mobile joint element is used, the end plate on the opposite end of the device should have some means of angular adjustment for orientating purposes.
  • the adjustability and specific modes of flexibility of the device will be shown hereinbelow in the specific implementations shown in Figs
  • FIG. 4A is a schematic anterior view of the manner by which the device of Fig. 3 may be mounted in the patient's spine. Like features are labeled with the same reference numbers as in Fig. 3.
  • Three vertebral bodies are shown - a central one 41 , having been partially resected to remove the diseased bone material, and two adjacent vertebral bodies 42, 43.
  • the device is shown attached to the remaining bone material of the central vertebra 41 by means of flaps 31 and screws 46 inserted therethrough.
  • the central vertebral body and its implanted device are shown attached to the adjacent vertebral bodies 42 43, by means of the flaps 36 and screws 45 inserted therethrough.
  • the end plates 34 have a sufficiently large contact area with the end surfaces plates of the adjacent vertebral bodies, that it is possible to equip the endplates with spikes or teeth which enter the end surfaces of the vertebral bodies, thereby ensuring improved fixation of the entire device. This can be provided in addition to, or in lieu of the flap and screw fixing.
  • the frontal part and/or the lateral part of the rigid cage-like implant 30 can be equipped with holes or slits, allowing bone growth through and towards the remaining adjacent vertebral body.
  • the posterior wall of the rigid cage-like implant 30 should generally be a closed wall structure, to ensure the safety of the neural structures lying posterior in those implementations where bone substitutes (granula) or spongious bone chips are used to fill the cage, to encourage bone growth.
  • the implant can be constructed to be adjustable in order to fit different heights of vertebra by distraction.
  • Fig. 4B shows an exemplary device, similar to that of Fig. 4A, but with a longer central insert section 40, such that that section will fit into the cavities formed by partial corpectomy performed in two adjacent vertebrae 47, 48.
  • the central rigid insert 40 is attached using bone screws 46 and flaps 31 to the two resected vertebral bodies 47, 48, effectively fusing them together.
  • the device then bridges between two non-adjacent vertebrae 42, 43, to which are attached the flexible joints 35 of the device with their associated fixing plates 34 and flaps 36.
  • the long body 40 may be constructed in the form of a cage, with one or more openings 32 for filling with bone grafts if desired. Additionally, it may be adjustable, as in the example of Fig. 4A, to fit the vertebral spacing required.
  • the other features of the implementation of Fig. 4B are marked with the same signs as those of Fig. 4A.
  • Figs. 5 to 8C now show a number of drawings, illustrating engineered solutions to the ideas illustrated hereinabove for the example of a single level device. It is to be understood however, that these drawings are only some examples of implementing the present invention, which is not intended to be limited by any specific one of these implementations, or by any of these implementations.
  • the rigid, cage-like implant may be made up of two parts, an inner sliding section 51 , which has a sliding fit into an outer fixed section 52.
  • the implant to be adjustable in height.
  • the outer fixed section 52 sits within the partial corpectomy cavity of the vertebral body, and the inner sliding section 52 is adjusted in order to distract the vertebrae to the desired height to relieve pressure on the spinal cord and/or any nerve roots affected.
  • a fixing screw 53 clamps the two sections into one rigid cage.
  • the entire cage assembly may be affixed into the partial corpectomy cavity by means of two angled side walls 54, optionally having teeth or spikes which firmly grip the adjacent vertebral cavity bone surfaces.
  • the side walls may have flaps with screw holes for bolting to the healthy remaining bone of the vertebral body, by means of screws 55.
  • the two ends of the rigid cage structure have curved slide surfaces 56, 57, which may be advantageously arranged at right angles to each other.
  • the slide surfaces have internal channels 60 with shoulders.
  • Onto each of these slide surfaces a curved end plate 58 may be fitted, by sliding the enlarged base 50 of the end plate into the channel 61 , where it is held in place by the shoulder.
  • the base 50 illustrated is that of the bottom end plate, since that of the top end plate is hidden from view in the perspective of Fig. 5.
  • a motion limiting screw 59 is inserted into each end plate once the end plates are slid into position in their respective curved channels.
  • the end plates can provide limited angular motion relative to the rigid cage structure of the device in two orthogonal directions, and also to rotate relative to the rigid cage structure.
  • the outer surfaces of the end plates 58 are teethed or spiked to enable them to be firmly affixed to the adjacent vertebral body end faces. Since the rigid caged structure is firmly affixed into the partially resected central vertebral body, this arrangement thus enables the adjacent vertebrae to have angular mobility for bending of the spine in essentially any direction, and for rotation of the spine at the regions fitted with this device.
  • FIG. 6A and 6B which show the device of Fig. 5 assembled.
  • Fig. 6A is an overall outer view
  • Fig. 6B is a cut away view to show the internal structure. From 6A, it is clearly seen how the two curved slide surfaces 56, 57, are arranged angularly to each other, most conveniently at right angles to each other, so that the mutual bending motion of the end plates, and thus of their attached vertebrae, can take place through essentially any angular sector.
  • the inner shoulders 61 of the curved slide surface is shown to illustrate how the end plates are held within the slide surfaces as they move.
  • Fig. 6B the inner shoulders 61 of the curved slide surface is shown to illustrate how the end plates are held within the slide surfaces as they move.
  • the top slide surface has its internal channel arranged such that the top end plate 62 can move in a direction into and out of the plane of the drawing, while the bottom slide surface has its internal channel arranged such that bottom end plate 63 can slide right and left in the sense of the drawing plane.
  • the inner base shoulder 64 of the end plates are segments of a sphere, and the opposing shoulder surfaces of the inner channels of the curved slide are matching spherically curved, the end plates can also rotate freely about their axis. This construction is more clearly shown on the endplates 58 illustrated in the disassembled device of Fig. 5.
  • a motion limiting shoulder 65 is also provided, against which the motion limiting screw 59 abuts in order to limit the angular bending of the device.
  • Fig. 6C illustrates the assembled device of Fig. 6B, but with the inner sliding section 51 extended and clamped with the fixing screw 53, to illustrate how the device is adjusted to suit different vertebral spacings, according to the subject and the distraction used.
  • FIGs. 7A to 7D are side views of the device, to illustrate how forward and backward tilting can be achieved.
  • Fig. 7A which is a cut away view
  • the bottom end plate 63 is shown in its furthest rearward inclined position, as limited by the contact of the motion limiting screw 59 with the motion limiting shoulder 65.
  • the top end plate 62 is constrained by its slide channel to move in the plane perpendicular to that of the drawing plane.
  • FIG. 7B is an external view of the device, also taken from the side, showing the extent of the forward tilting motion of the bottom end plate 63.
  • Figs. 7C and 7D are anterior cut away views of the device, to illustrate the right-left tilting motion afforded to the device, in this example by the top end plate 62 slide.
  • Fig. 7C shows the end plate62 tilted maximally right
  • Fig. 7D shows the end plate 62 tilted maximally left.
  • the bottom end plate 63 can tilt in the plane into and out of the plane of the drawing.
  • Figs. 8A to 8C are schematic illustrations showing an alternative method of mounting the end plates onto the caged structure.
  • the widened base 80 of the end plate 81 does not extend over 360 degrees, but only over two opposing sectors of the base.
  • the other opposing sectors of the base 82 are thus narrower.
  • the rear channel of the curved slide is constructing having a slot width 83 such that only the narrow sector of the base of the end plate will enter it.
  • Figs. 8A and 8B are cut away drawings showing how this mounting and tilting motion is effected.
  • Fig. 8A the top end plate 85 is shown, after being inserted and rotated so that its broad base dimension is held within the channel slot 86 by the shoulder 87, enabling it to tilt into and out of the plane of the drawing.

Landscapes

  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Neurology (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)

Abstract

L'invention porte sur un implant prothétique pour des corporéctomies partielles, notamment pour la conservation de la mobilité après une chirurgie, impliquant une corporéctomie partielle chez des patients ayant des maladies dégénératives, traumatiques ou tumorales. L'implant comprend un implant de type rigide, cage ou plaque, avec des rabats pour une fixation dans le défaut de corporéctomie. Sur l'une ou l'autre ou les deux extrémités de l'implant, opposé aux corps vertébraux adjacents, se trouve un élément de type articulation mobile. Cet élément a des aptitudes de type disque fournissant une mobilité à la fois selon un angle de courbure et en rotation. Cet élément d'articulation mobile fournit également des moyens de fixation au corps ou aux corps vertébraux adjacents. Des exemples de tels éléments d'articulation mobiles peuvent être des éléments de matière élastomère, des articulations à rotule, des articulations à rotule coulissantes ou des articulations coulissantes incurvées. Le dispositif peut être construit en ayant une longueur conçue pour des corporéctomies partielles dans une ou plusieurs vertèbres adjacents.
PCT/IB2008/001549 2007-06-11 2008-06-11 Dispositif de corporéctomie implantable WO2008152499A2 (fr)

Applications Claiming Priority (6)

Application Number Priority Date Filing Date Title
DE102007026851 2007-06-11
DE102007026851.5 2007-06-11
DE102007042946.2A DE102007042946B4 (de) 2007-06-11 2007-09-10 Implantierbarer, prothetischer Wirbelkörperersatz
DE102007042946.2 2007-09-10
US96011007P 2007-09-17 2007-09-17
US60/960,110 2007-09-17

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WO2008152499A2 true WO2008152499A2 (fr) 2008-12-18
WO2008152499A3 WO2008152499A3 (fr) 2009-02-05

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WO (1) WO2008152499A2 (fr)

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US9211193B2 (en) 2013-08-30 2015-12-15 Aesculap Implant Systems, Llc Prosthesis, system and method
US9216096B2 (en) 2010-03-16 2015-12-22 Pinnacle Spine Group, Llc Intervertebral implants and related tools
US9380932B1 (en) 2011-11-02 2016-07-05 Pinnacle Spine Group, Llc Retractor devices for minimally invasive access to the spine
US9700425B1 (en) 2011-03-20 2017-07-11 Nuvasive, Inc. Vertebral body replacement and insertion methods
CN107049562A (zh) * 2017-04-19 2017-08-18 中国人民解放军第四军医大学 一种双动关节颈椎假体
US10070970B2 (en) 2013-03-14 2018-09-11 Pinnacle Spine Group, Llc Interbody implants and graft delivery systems

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DE4208116C2 (de) * 1992-03-13 1995-08-03 Link Waldemar Gmbh Co Bandscheibenendoprothese
DE4423257C2 (de) * 1994-07-02 2001-07-12 Ulrich Heinrich Implantat zum Einsetzen zwischen Wirbelkörper der Wirbelsäule als Platzhalter
DE19519101B4 (de) * 1995-05-24 2009-04-23 Harms, Jürgen, Prof. Dr. Höhenverstellbarer Wirbelkörperersatz
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US9216096B2 (en) 2010-03-16 2015-12-22 Pinnacle Spine Group, Llc Intervertebral implants and related tools
US9649203B2 (en) 2010-03-16 2017-05-16 Pinnacle Spine Group, Llc Methods of post-filling an intervertebral implant
US9788973B2 (en) 2010-03-16 2017-10-17 Pinnacle Spine Group, Llc Spinal implant
US9700425B1 (en) 2011-03-20 2017-07-11 Nuvasive, Inc. Vertebral body replacement and insertion methods
US10485672B2 (en) 2011-03-20 2019-11-26 Nuvasive, Inc. Vertebral body replacement and insertion methods
US11389301B2 (en) 2011-03-20 2022-07-19 Nuvasive, Inc. Vertebral body replacement and insertion methods
US12186198B2 (en) 2011-03-20 2025-01-07 Nuvasive, Inc. Vertebral body replacement and insertion methods
US9380932B1 (en) 2011-11-02 2016-07-05 Pinnacle Spine Group, Llc Retractor devices for minimally invasive access to the spine
US10070970B2 (en) 2013-03-14 2018-09-11 Pinnacle Spine Group, Llc Interbody implants and graft delivery systems
US9211193B2 (en) 2013-08-30 2015-12-15 Aesculap Implant Systems, Llc Prosthesis, system and method
CN107049562A (zh) * 2017-04-19 2017-08-18 中国人民解放军第四军医大学 一种双动关节颈椎假体

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DE102007042946A1 (de) 2008-12-18
DE102007042946B4 (de) 2014-06-05

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