FR2727003A1 - Lumbar-sacral vertebrae anterior stabiliser - Google Patents

Lumbar-sacral vertebrae anterior stabiliser Download PDF

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Publication number
FR2727003A1
FR2727003A1 FR9414067A FR9414067A FR2727003A1 FR 2727003 A1 FR2727003 A1 FR 2727003A1 FR 9414067 A FR9414067 A FR 9414067A FR 9414067 A FR9414067 A FR 9414067A FR 2727003 A1 FR2727003 A1 FR 2727003A1
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France
Prior art keywords
anterior
vertebral bodies
grafts
posterior
spongy
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Granted
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FR9414067A
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French (fr)
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FR2727003B1 (en
Inventor
Philippe Tisserand
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Euros SAS
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Euros SAS
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    • 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
    • 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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    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
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    • A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni alloys

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Neurology (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Heart & Thoracic Surgery (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

The stabiliser consists of an insert designed to fit between two vertebrae (L1,L2) to maintain the spacing between them and receive spongy grafts, permitting their intersomatic fusion. The insert has holes (1g,1h) for fixings (2,3) which engage with the adjacent vertebrae and are angled at 90 deg to one another. The inset is three-dimensional and hollow, generally rectangular and shaped to conform to the anatomy of the adjacent vertebrae. It has a concave posterior surface (1c) and a rounded anterior surface (1d), with the anterior surface having a greater height than the posterior one to conform to the lumbar-sacral lordosis. Its upper and lower surfaces are grooved to ensure primary stability. The insert can be made from titanium or a polymer reinforced with carbon fibres.

Description

DlsltIf de stabilisation antérieure du rachis hmboe Mn
L'invention se rattache au secteur technique des implants rachidiens.DlsltIf of anterior stabilization of the spine hmboe Mn
The invention relates to the technical sector of spinal implants.

Le problème que se propose de résoudre rinvention, est de stabiliser les vertèbres lombaires et la charnière lombo-sacr8e, par voie antérieure. The problem which the invention proposes to solve is to stabilize the lumbar vertebrae and the lumbosacral hinge, by the anterior route.

Pour assurer une telle stabilisation, il est connu crutiliser des implants sous forme de plateaux, destinés à être inserrés entre les corps vertébraux. Le plateau n'est pas fixé mais est simplement impacté entre les deux corps vertébraux. Le plateau peut être conformé pour recevoir un greffon. Cette solution n'est cependant pas satisfaisante, étant donné qu'il peut y avoir des risques d'expulsion du greffon, en cas d'instabilité et de déplacement du plateau, qui n'est pas fixé. To ensure such stabilization, it is known to use implants in the form of plates, intended to be inserted between the vertebral bodies. The plate is not fixed but is simply impacted between the two vertebral bodies. The tray can be shaped to receive a graft. This solution is however not satisfactory, given that there may be risks of expulsion of the graft, in the event of instability and displacement of the plate, which is not fixed.

L'invention s'est fixée pour but de remédier à ces inconvénients, de manière simple, sûre, efficace et rationnelle. The object of the invention is to remedy these drawbacks in a simple, safe, effective and rational manner.

Le problème que se propose de résoudre l'invention, est d'apporter une stabilité des vertèbres lombaires concernées, au moyen d'un ensemble prothétique, en évitant tout risque d'expulsion de cet ensemble prothétique, et en tenant compte du fait qu'au niveau lombaire, il peut y avoir des risques vasculaires, étant donné que les vertèbres sont relativement proches des vaisseaux. The problem which the invention proposes to solve is to bring stability to the lumbar vertebrae concerned, by means of a prosthetic assembly, while avoiding any risk of expulsion of this prosthetic assembly, and taking into account that at the lumbar level, there may be vascular risks, since the vertebrae are relatively close to the vessels.

Pour résoudre un tel problème, il a été conçu et mis au point un dispositif de stabilisation antérieure du rachis lombo-sacré, qui comprend un élément apte à maintenir l'écartement entre les corps vertébraux du rachis lombaire tout en étant agencé pour recevoir des greffons spongieux et permettre leur fusion intersomatique, ledit élément présentant des trous orientés pour le passage et l'intégration d'organes de fixation coopérant avec les corps vertébraux sus et sous jacents. To solve such a problem, an anterior stabilization device of the lumbosacral spine has been designed and developed, which comprises an element capable of maintaining the spacing between the vertebral bodies of the lumbar spine while being arranged to receive grafts. spongy and allow their interbody fusion, said element having holes oriented for the passage and integration of fixing members cooperating with the vertebral bodies above and below.

Pour résoudre le problème posé d'intégrer les organes de fixation et pour permettre auxdits organes d'être implantés dans l'os corffoo spongieux des corps vertébraux, les trous constituent des chambrais internes formés à partir de la face antérieure de l'élément, I'un des chambrages étant dirigés vers le bas tandis que rautre est dirigé vers le haut, en étant orienté l'un par rapport à l'autre, selon un angle d'environ 90".  To solve the problem posed of integrating the fixing organs and to allow said organs to be implanted in the spongy corffoo bone of the vertebral bodies, the holes constitute internal chambers formed from the anterior face of the element, I 'one of the recesses being directed downwards while the other is directed upwards, being oriented relative to each other, at an angle of approximately 90 ".

Pour résoudre le problème posé d'éviter l'écrasement, tout en ayant pour objectif de permettre la fusion intersomatique des greffons,
I'élément est constitué par une structure volumétrique creuse de forme générale rectangulaire profilée pour correspondre à l'anatomie des corps vertébraux concernés. L'élément présente un bord postérieur concave en arrière et un bord antérieur arrondi pour épouser la face antérieure du corps vertébral.To solve the problem of avoiding overwriting, while having the objective of allowing the interbody fusion of grafts,
The element is constituted by a hollow volumetric structure of generally rectangular shape profiled to correspond to the anatomy of the vertebral bodies concerned. The element has a posterior concave rear edge and a rounded front edge to match the anterior face of the vertebral body.

Pour résoudre le problème posé de respecter la lordose lombo-sacrée, la hauteur de la face antérieure est supérieure à la hauteur de la face postérieure pour respecter la lordose lombo-sacrée.  To resolve the problem of respecting lumbosacral lordosis, the height of the anterior face is greater than the height of the posterior face to respect lumbosacral lordosis.

Les faces supérieure et inférieure de rélément sont crantées pour faciliter la stabilité primaire. The upper and lower element faces are notched to facilitate primary stability.

L'invention est exposée, ci-après plus en détail à l'aide des dessins annexés, dans lesquels:
La figure 1 est une vue en perspective du dispositif selon
I'invention.The invention is set out below in more detail using the appended drawings, in which:
Figure 1 is a perspective view of the device according
The invention.

La figure 2 est une we en plan du dispositif. Figure 2 is a we plan of the device.

La figure 3 est une vue en coupe montrant la fixation du dispositif entre deux plateaux des vertèbres lombaires. Figure 3 is a sectional view showing the attachment of the device between two plates of the lumbar vertebrae.

Comme le montre la figure 1, le dispositif comprend un élément (1) apte à maintenir l'écartement entre deux corps vertébraux (lui) et (L2) de la partie lombaire du rachis, y compris de la charnière lombosacrée. Cet élément (1) est agencé pour recevoir des greffons spongieux (G) et permettre leur fusion intersomatique. Les greffons sont avantageusement prélevés sur la crête iliaque ou dans l'extrémité supérieure du tibia
L'élément (1) est constitué par une structure volumétrique creuse de forme générale rectangulaire profilée, pour correspondre à l'anatomie des corps vertébraux (L1) (L2). Notamment, l'élément (1) présente un bord postérieur (1c) concave en arrière et un bord antérieur arrondi (nid). La hauteur de la face antérieure est supérieure à la hauteur de la face postérieure.As shown in Figure 1, the device comprises an element (1) capable of maintaining the spacing between two vertebral bodies (him) and (L2) of the lumbar part of the spine, including the lumbosacral hinge. This element (1) is arranged to receive spongy grafts (G) and allow their interbody fusion. The grafts are advantageously taken from the iliac crest or from the upper end of the tibia
Element (1) is constituted by a hollow volumetric structure of generally profiled rectangular shape, to correspond to the anatomy of the vertebral bodies (L1) (L2). In particular, the element (1) has a rear edge (1c) concave behind and a rounded front edge (nest). The height of the anterior face is greater than the height of the posterior face.

En outre, I'élément (1) présente deux ouvertures débouchantes et séparées (1a) (il), recevant chacune les greffons spongieux. On n'exclut pas de pratiquer dans l'épaisseur de l'élément (1), une seule ouverture débouchante, ou plus de deux ouvertures. In addition, the element (1) has two separate and through openings (1a) (ii), each receiving the spongy grafts. It is not excluded to practice in the thickness of the element (1), a single through opening, or more than two openings.

Suivant une caractéristique importante de l'invention,
I'élément (1) présente des trous orientés (lg) (1h), pour le passage et l'intégration d'organes de fixation (2) et (3), coopérant avec les corps vertébraux (L1) et (L2) sus et sous jacents audit élément (1). Comme le montre notamment la figure 3, les trous (lg) et (1h) constituent des chambrages internes établis à partir de la face antérieure (nid), à proximité des bords transversaux de l'élément (1). Le chambrage (lg) est orienté vers le haut, tandis que le chambrage (1h) est orienté vers le bas. Les deux chambrages (lg) et (1h) sont décalés angulairement d'environ 90". According to an important characteristic of the invention,
The element (1) has oriented holes (lg) (1h), for the passage and integration of fixing members (2) and (3), cooperating with the vertebral bodies (L1) and (L2) sus and underlying said element (1). As shown in particular in Figure 3, the holes (lg) and (1h) constitute internal recesses established from the front face (nest), near the transverse edges of the element (1). The recess (lg) is oriented upwards, while the recess (1h) is oriented downwards. The two recesses (lg) and (1h) are offset angularly by approximately 90 ".

En conséquence, après introduction des vis (2) et (3), rune d'entre elles (2) sera dirigée vers le bas, tandis que l'autre (3) sera dirigée vers le haut. A noter que ces vis sont orientées d'un angle de très sensiblement 45 , pour s'implanter dans l'os coraco-spongieux. des corps vertébraux (L1) (L2). Consequently, after introduction of the screws (2) and (3), one of them (2) will be directed downward, while the other (3) will be directed upward. Note that these screws are oriented at an angle of very substantially 45, to be implanted in the coraco-cancellous bone. vertebral bodies (L1) (L2).

Les têtes (2a) et (3a) des vis (2) et (3) sont noyées dans le chambrage1 en appui dans le fond de ce dernier, et ne débordent pas de la face antXrieure (1d).  The heads (2a) and (3a) of the screws (2) and (3) are embedded in the recess 1 resting in the bottom of the latter, and do not project beyond the front face (1d).

Les faces supérieure (1i) et inférieure (1j) sont crantées pour faciliter la stabilité primaire. L'élément (1) est exécuté en titane ou polymère renforcé de fibre de carbonne. The upper (1i) and lower (1j) faces are notched to facilitate primary stability. The element (1) is made of titanium or polymer reinforced with carbon fiber.

A noter que l'élément (1) est réalisé selon essentiellement trois tailles, à savoir:
- une petite taille correspondant à une largeur de rordre de 20mm et à une longueur de l'ordre de 30mm,
- une taille moyenne correspondant à une largeur de l'ordre de 25mm et à une bngueur de l'ordre de 35mm,
- une grande taille correspondant à une largeur de l'ordre de 30mm et à une longueur de rordre de 40mm. Note that the element (1) is produced in essentially three sizes, namely:
- a small size corresponding to a width of order of 20mm and a length of the order of 30mm,
- an average size corresponding to a width of around 25mm and a length of around 35mm,
- a large size corresponding to a width of around 30mm and a length of rorder of 40mm.

A noter également que ron distingue deux types d'éléments (1), selon qu'il concerne l'étage lombo-sacré L5-S1 ou les étages supérieures. A l'étage lombo-sacré, on utilise un élément dont robliquité est plus accentuée1 c'est-à-dire dont la hauteur de la face antérieure est nettement supérieure à celle de la face postérieure. Note also that ron distinguishes two types of elements (1), depending on whether it relates to the lumbo-sacral stage L5-S1 or the upper stages. On the lumbosacral stage, an element is used whose roughness is more accentuated, that is to say the height of the anterior face is clearly greater than that of the posterior face.

Trois types d'implants sont disponibles pour l'étage LiS1, dont les hauteurs antérieures sont respectivement de îOmm, 12mm et 14mm, tandis que les hauteurs postérieures 8mm, 10mm et 12mm. Pour les étages supérieurs L4, L5 et suivants, les hauteurs antérieure sont respectivement de 9mm, 11mm et 13mm, tandis que les hauteurs postérieures sont de 8mm, îOmm et 12mm. Three types of implants are available for the LiS1 stage, the anterior heights of 10 mm, 12 mm and 14 mm respectively, while the posterior heights 8 mm, 10 mm and 12 mm. For the upper floors L4, L5 and following, the anterior heights are 9mm, 11mm and 13mm respectively, while the posterior heights are 8mm, 10mm and 12mm.

On indique ci-après, le mode opératoire de mise en place du dispositif selon l'invention. The procedure for setting up the device according to the invention is indicated below.

Après ablation du disque intervertébral réalisée par une vo(e antérieure, la distraction vertébrale permet de récupérer la hauteur intervertébrale souhaitée. Cette distraction peut être réalisée par une traction appliquée sur le crane et est permise par la résection la plus large possible de tout le tissu discal jusqu'au niveau du ligament vertébral postérieur qui peut être également réséqué. Un distracteur intersomatique peut compléter l'espacement intervertébral, la hauteur de l'élément (1) étant calculée d'après des fantômes et après essai de la bonne taille de l'élément. L'élément (1) est rempli de greffons spongieux et est disposé dans l'espace intervertébral considéré (L1) (L2) par exemple.L'élément (1) est ensuite solidarisé aux vertèbres sus et sous jacentes au moyen des vis (2) et (3), qui coopèrent dans l'os cortico-spongieux des corps vertébraux. After ablation of the intervertebral disc by an anterior vein, the vertebral distraction makes it possible to recover the desired intervertebral height. This distraction can be achieved by a traction applied to the skull and is allowed by the widest possible resection of all the tissue disc to the level of the posterior vertebral ligament which can also be resected. An interbody distractor can complete the intervertebral spacing, the height of the element (1) being calculated according to ghosts and after testing the correct size of the The element (1) is filled with cancellous grafts and is placed in the intervertebral space considered (L1) (L2) for example. The element (1) is then secured to the vertebrae above and below by means of screws (2) and (3), which cooperate in the cortico-cancellous bone of the vertebral bodies.

Un contrôle radioscopique per-opératoire est nécessaire pour s'assurer de la bonne position du dispositif. An intraoperative fluoroscopic check is necessary to ensure the correct position of the device.

Ce dispositif est particulièrement bien adapté pour stabiliser un segment mobile du rachis lombaire ou lombosacré et s'adresse essentillement sot à la charnière lombosacrée sot aux vertèbres sus jacentes, notamment au niveau des espaces LOL4 et L4-L5. This device is particularly well suited for stabilizing a mobile segment of the lumbar or lumbosacral spine and is intended essentially for the lumbosacral hinge sot for the overlying vertebrae, in particular at the level of the LOL4 and L4-L5 spaces.

Les avantages ressortent bien de la description, en particulier on souligne et on rappelle que l'emploi des vis d'ostéosynthèse permet une stabilisation primaire, et permet d'éviter toute mobilisation des greffons spongieux, pendant le délai nécessaire à la repousse osseuse.  The advantages emerge clearly from the description, in particular it is emphasized and recalled that the use of osteosynthesis screws allows primary stabilization, and makes it possible to avoid any mobilization of the spongy grafts, during the time necessary for bone regrowth.

Claims (3)

REVENDICATIONS -1- Dispositif de stabilisation antérieure du rachis lombosacrX, carArisX en ce qu'il comprend un élément (1) apte à maintenir récartement entre les corps vertébraux (L1) (L2) du rachis lombaire tout en étant agencé pour recevoir des greffons spongieux et permettre leur fusion intersomatique, ledit élément (1) présentant des trous orientés (1g) (1h) pour le passage d'organes de fixation (2) et (3) coopérant avec les corps vertébraux sus et sous jacents.-1- Anterior stabilization device of the lumbosacrX spine, carArisX in that it comprises an element (1) capable of maintaining spacing between the vertebral bodies (L1) (L2) of the lumbar spine while being arranged to receive spongy grafts and allow their interbody fusion, said element (1) having oriented holes (1g) (1h) for the passage of fixing members (2) and (3) cooperating with the vertebral bodies above and below. -2-Dispositif selon la revendication 1, caractérisé en ce que les trous (1g) (1h) constituent des chambrages intemes formés à partir de la face antérieure (nid) de l'élément (1), I'un des chambrages étant dirigé vers le bas tandis que l'autre est dirigé vers le haut, en étant orientés run par rapport à l'autre, selon un angle d'environ 90". -2-Device according to claim 1, characterized in that the holes (1g) (1h) constitute internal recesses formed from the anterior face (nest) of the element (1), one of the recesses being directed down while the other is facing up, being run relative to the other, at an angle of approximately 90 ". -3- Dispositif selon la revendication 1, caractérisé en ce que rélément (1) est constitué par une structure volumétrique creuse de forme générale rectangulaire profilée pour correspondre à l'anatomie des corps vertébraux concemés.-3- Device according to claim 1, characterized in that element (1) is constituted by a hollow volumetric structure of generally rectangular shape profiled to correspond to the anatomy of the vertebral bodies concerned. + Dispositif selon la revendication 1, caractérisé en ce que l'élément présente un bord postérieur (tic) concave en arrière et un bord antérieur arrondi (Id) pour épouser la face antérieure du corps vertébral. + Device according to claim 1, characterized in that the element has a posterior edge (tic) concave behind and a rounded anterior edge (Id) to match the anterior face of the vertebral body. -5- Dispositif selon la revendication 1, caractérisé en ce que la hauteur de la face antérieure (Id) est supérieure à la hauteur de la face postérieure (lc) pour respecter la lordose lombosacrée. -5- Device according to claim 1, characterized in that the height of the anterior face (Id) is greater than the height of the posterior face (lc) to respect the lumbosacral lordosis. -S Dispositif selon la revendication 1, caractérisé en ce que les faces supérieure (lui) et inférieure (1j) de l'élément (1) sont crantées pour faciliter la stabilité primaire. -S Device according to claim 1, characterized in that the upper (him) and lower (1j) faces of the element (1) are notched to facilitate primary stability. -7- Dispositif selon la revendication 1, caractérisé en ce que I'élément (1) présente deux ouvertures débouchantes sépares (la) (lb) pour recevoir les greffons spongieux.-7- Device according to claim 1, characterized in that the element (1) has two separate through openings (la) (lb) for receiving the spongy grafts. -8- Dispositif selon la revendication 1, caractérisé en ce que l'élément (1) est réalisé en titane ou en polymère renforcé en fibres de carbone. -8- Device according to claim 1, characterized in that the element (1) is made of titanium or of polymer reinforced with carbon fibers.
FR9414067A 1994-11-18 1994-11-18 ANTERIOR STABILIZATION DEVICE OF THE LOMBO-SACRE SPINE Expired - Fee Related FR2727003B1 (en)

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