FR2727004A1 - Lumbar and lumbar-sacral posterior stabiliser - Google Patents

Lumbar and lumbar-sacral posterior stabiliser Download PDF

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Publication number
FR2727004A1
FR2727004A1 FR9414068A FR9414068A FR2727004A1 FR 2727004 A1 FR2727004 A1 FR 2727004A1 FR 9414068 A FR9414068 A FR 9414068A FR 9414068 A FR9414068 A FR 9414068A FR 2727004 A1 FR2727004 A1 FR 2727004A1
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France
Prior art keywords
lumbar
posterior
elements
stabiliser
grafts
Prior art date
Legal status (The legal status 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 status listed.)
Pending
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FR9414068A
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French (fr)
Inventor
Philippe Tisserand
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Euros SAS
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Euros SAS
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Application filed by Euros SAS filed Critical Euros SAS
Priority to FR9414068A priority Critical patent/FR2727004A1/en
Publication of FR2727004A1 publication Critical patent/FR2727004A1/en
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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
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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
    • A61F2/447—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 substantially parallelepipedal, e.g. having a rectangular or trapezoidal cross-section
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    • A61F2310/00011—Metals or alloys
    • 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 comprises two components (1) located on either side of the spinal apophysis and designed to maintain the spacing between two adjacent vertebrae (L<1>, L<2>). They are made hollow so they can receive spongy grafts which permit inter-somatic fusion.Each of the components is parallelepiped in shape, with a hollow three-dimensional cage structure and apertures (1a, 1b, 1d, 1e) in its walls. The upper and lower surfaces of each component are striated to facilitate primary stability, and they are made from titanium or carbon fibre reinforced polymer.

Description

Dispositif de stablllsatlon oostXrleure du rachis lombaire et lombo-sacr*. Lumbar and lumbosacral spine stabilization device *.

L'invention se rattache au secteur technique des implants rachidiens. The invention relates to the technical sector of spinal implants.

Le problème que se propose de résoudre l'invention, est de stabiliser les vertèbres lombaires et lombo-sacrées, par voie postérieure. The problem which the invention proposes to solve is to stabilize the lumbar and lumbosacral vertebrae, by the posterior route.

Dans certains cas de figures, il n'est plus possible d'intervenir au niveau du rachis, en utilisant la voie antérieure. Ce peut être le cas, par exemple, pour un sujet qui a été opéré plusieurs fois. Or, il est souvent intéressant de pouvoir aborder le sujet dans une zone saine, en évitant les inconvénients d'une reprise. In some cases, it is no longer possible to intervene in the spine, using the anterior route. This may be the case, for example, for a subject who has been operated on several times. However, it is often interesting to be able to broach the subject in a healthy area, while avoiding the drawbacks of a recovery.

Toutefois, une intervention par la voie postérieure, est beaucoup plus délicate à réaliser que par la voie antérieure, compte-tenu notamment, de la présence du système nerveux. However, an intervention by the posterior route, is much more difficult to achieve than by the anterior route, in particular taking into account the presence of the nervous system.

Dans ces conditions, il existe peu d'implants aptes à assurer, par la voie postérieure, une stabilité intersomatique, pour le rétablissement de la lordose lombaire et un recalibrage des foramens intervertébraux
Pour résoudre un tel problème, il a été conçu et mis au point, un dispositif de stabilisation postérieure du rachis lombaire et lombo-sacré, qui présente deux éléments disposés de part et d'autre de l'apophyse épineuse en étant aptes à maintenir l'écartement entre les corps vertébraux concernés, chacun desdits éléments étant agencé pour recevoir des greffons spongieux et permettre une fusion intersomatique. Under these conditions, there are few implants capable of ensuring, via the posterior route, interbody stability, for the reestablishment of lumbar lordosis and recalibration of the intervertebral foramina.
To solve such a problem, it has been designed and developed, a device for posterior stabilization of the lumbar and lumbosacral spine, which has two elements arranged on either side of the spinous process while being able to maintain the lumbar spine. 'spacing between the vertebral bodies concerned, each of said elements being arranged to receive cancellous grafts and allow interbody fusion.

Pour résoudre le problème posé d'éviter tout écrasement, tout en ayant pour objectif de permettre la fusion intersomatique des greffons spongieux, chaque élément est constitué par une structure volumétrique creuse sous forme d'une cage dont les parois présentent des ouvertures de mise en communication. To solve the problem posed of avoiding any crushing, while having the objective of allowing the intersomatic fusion of the spongy grafts, each element is constituted by a hollow volumetric structure in the form of a cage, the walls of which have openings for placing in communication. .

Pour résoudre le problème posé de respecter la lordose lombaire, chaque élément est de forme générale parallèlépipédique dont la hauteur de la face antérieure est supérieure à celle de la face postérieure. To solve the problem of respecting the lumbar lordosis, each element is of generally parallelepipedal shape, the height of the anterior face of which is greater than that of the posterior face.

Pour résoudre le problème posé de faciliter la stabilité primaire, les faces supérieure et inférieure de chaque élément présentent des aspérités pour faciliter la stabilité primaire. To solve the problem posed of facilitating primary stability, the upper and lower faces of each element have asperities 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 de l'un des éléments.The invention is explained below in more detail with the aid of the accompanying drawings, in which:
Figure 1 is a perspective view of one of the elements.

La figure 2 est une vue de dessus de l'élément
La figure 3 est une vue de face de l'élément.Figure 2 is a top view of the element
Figure 3 is a front view of the element.

La figure 4 est une vue en coupe montrant la mise en place de l'élément au niveau lombaire. FIG. 4 is a sectional view showing the positioning of the element at the lumbar level.

La figure 5 est une vue en coupe transversale, considérée selon la ligne 5.5 de la figure 4. Figure 5 is a cross-sectional view, taken along line 5.5 of Figure 4.

Selon l'invention, le dispositif présente deux éléments identiques (1), disposés de part et d'autre de l'apophyse épineuse (A), en étant aptes à maintenir l'écartement entre les corps vertébraux concemés (L1) et (L2). Comme indiqué, les éléments (1) sont introduits par voie postérieure. Chacun des éléments (1) est agencé pour recevoir des greffons spongieux et permettre leur fusion intersomatique. Les greffons sont avantageusement prélevés sur la crête iliaque ou dans l'extrémité supérieure du tibia
Chaque élément (1) est constitué par une structure volumétrique creuse, sous forme d'une cage sensiblement parailèlépipédique et dont les parois présentent des ouvertures (la) (lob) (tic) (Id) de mise en communication. La face postérieure peut également présenter une ouverture (le).La hauteur de la face antérieure (If) est supérieure à la hauteur de la face postérieure (lu). Chaque élément (1) est donc oblique d'avant en arrière pour respecter la lordose lombaire.According to the invention, the device has two identical elements (1), arranged on either side of the spinous process (A), being able to maintain the distance between the vertebral bodies concerned (L1) and (L2 ). As indicated, the elements (1) are introduced posteriorly. Each of the elements (1) is designed to receive spongy grafts and allow their interbody fusion. The grafts are advantageously taken from the iliac crest or from the upper end of the tibia.
Each element (1) consists of a hollow volumetric structure, in the form of a substantially parailèlépipédique cage and the walls of which have openings (la) (lob) (tic) (Id) for placing in communication. The posterior surface may also have an opening (le). The height of the anterior surface (If) is greater than the height of the posterior surface (lu). Each element (1) is therefore oblique from front to back to respect the lumbar lordosis.

A titre indicatif, chaque élément peut avoir une longueur d'environ 25mm et une largeur de îOmm, tandis que la hauteur peut présenter trois tailles possibles, à savoir pour la face antérieure 9mm, 11mm et 13mm, et pour la face postérieure, 8mm, îOmm et 12mm. On n'exclut pas de réaliser un élément de hauteurs inférieures, à savoir par exemple 6mm pour la face antérieure et Smm pour la face postérieure. As an indication, each element can have a length of about 25mm and a width of 1mm, while the height can have three possible sizes, namely for the anterior face 9mm, 11mm and 13mm, and for the posterior face, 8mm, îOmm and 12mm. We do not exclude making an element of lower heights, namely for example 6mm for the anterior face and Smm for the posterior face.

Chaque élément (1) est réalisé en titane ou en polymère renforcé en fibres de carbone. Les faces supérieure et inférieure de l'élément (1) peuvent présenter des aspérités aptes à faciliter la stabilité primaire. Each element (1) is made of titanium or of a polymer reinforced with carbon fibers. The upper and lower faces of the element (1) may have asperities capable of facilitating the primary stability.

On indique, ci-après, le mode opératoire de mise en place du dispositif selon l'invention:
Après abord postérieur et repérage précis du segment mobile à arthrodéser, le canal vertébral est ouvert par résection du ligament jaune.The procedure for fitting the device according to the invention is indicated below:
After a posterior approach and precise identification of the mobile segment to be arthrodesed, the vertebral canal is opened by resection of the yellow ligament.

on procède alors à la résection partielle des lames sus et sousjacentes et à la résection partielle des massifs articulaires. Les racines sont soigneusement libérées, permettant ainsi d'aborder facilement la face postéro-latérale du disque intervertébral de chaque côté de l'apophyse épineuse. Le disque intervertébral est incisé, cureté, tandis que les plateaux vertébraux sus et sous-jacents sont avivés sans entamer le cortex. Une distraction vertébrale est réalisée par l'intermédiaire d'espaceurs, de taille croissante, introduits progressivement de chaque côté et permettant de distracter l'espace intervertébral de manière progressive.we then proceed to partial resection of the upper and subjacent blades and partial resection of the joint massifs. The roots are carefully released, allowing easy access to the posterolateral aspect of the intervertebral disc on either side of the spinous process. The intervertebral disc is incised, curved, while the upper and underlying endplates are sharpened without cutting into the cortex. A vertebral distraction is achieved by means of spacers, of increasing size, introduced gradually on each side and allowing the intervertebral space to be distracted in a progressive manner.

Cette distraction intervertébrale peut être également réalisée au moyen d'un dispositif complémentaire d'ostéosynthèse postérieure, quatre vis pédiculaires ayant été préalablement mises en place dans les vertèbres considérées. Ces vis sont reliées transversalement par des plaques, la distraction pouvant s'effectuer soit entre chaque vis, soit entre les deux plaques supérieures et inférieures. Dans ce cas, la distraction est essentiellement postérieure et permet de faciliter le premier temps de préparation discale et de distraction intervertébrale. This intervertebral distraction can also be carried out by means of a complementary posterior osteosynthesis device, four pedicle screws having been previously placed in the vertebrae considered. These screws are connected transversely by plates, the distraction being able to take place either between each screw or between the two upper and lower plates. In this case, the distraction is essentially posterior and makes it possible to facilitate the first stage of disc preparation and intervertebral distraction.

Lorsque la hauteur intervertévrale souhaitée est obtenue, les deux éléments (1) remplis de greffons spongieux, sont mis en place alternativement d'un côté de l'apophyse épineuse, puis de l'autre. La hauteur de la face antérieure (1f) étant légèrement supérieure à la hauteur de la face postérieure (1 (lu), une distraction légèrement supérieure à la taille de l'élément (1) est nécessaire pour pouvoir disposer correctement celui-ci dans l'espace intersomatique. When the desired intervertebral height is obtained, the two elements (1) filled with spongy grafts are placed alternately on one side of the spinous process, then on the other. Since the height of the anterior face (1f) is slightly greater than the height of the posterior face (1 (lu), a distraction slightly greater than the size of the element (1) is necessary in order to be able to place it correctly in the interbody space.

Une radioscopie de contrôle permet de s'assurer de la bonne position de l'élément. La distraction étant supprimée, un dispositif de compression postérieure est alors nécessaire pour récupérer la lordose physiologique et mettre en charge la partie postérieure de l'élément. A control fluoroscopy ensures the correct position of the element. The distraction being removed, a posterior compression device is then necessary to recover the physiological lordosis and to load the posterior part of the element.

Les avantages ressortent bien de la description, en particulier on souligne et on rappelle:
- la stabilité vertébrale par l'intermédiaire d'une fusion intersomatique par voie postérieure,
- la mise en place de façon bi-latérale des éléments du dispositif,
- la hauteur de chaque élément permet de recalibrer les foramens intervertébraux, de remettre en tension les fibres annulaires périphériques du disque intervertébral,
- de stabiliser et d'immobiliser d'une manière satisfaisante, un ou plusieurs segments mobiles rachidiens, lombaires et lombo-sacrés,
- I'obliquité d'avant en arrière de l'élément, malgré le fait qu'il soit mis en place par voie postérieure. The advantages emerge clearly from the description, in particular we underline and recall:
- vertebral stability via an interbody fusion via the posterior route,
- the bi-lateral positioning of the elements of the device,
- the height of each element makes it possible to recalibrate the intervertebral foramina, to put in tension the peripheral annular fibers of the intervertebral disc,
- to stabilize and immobilize in a satisfactory manner, one or more mobile spinal, lumbar and lumbosacral segments,
- the obliquity from front to back of the element, despite the fact that it is placed by the posterior approach.

Claims (4)

REVENDICATIONS -1- Dispositif de stabilisation postérieure du rachis lombaire et lombosacré, caractérisé en ce qu'il présente deux éléments (1) disposés de part et d'autre de l'apophyse épineuse en étant aptes à maintenir récartement entre les corps vertébraux concernés (L1) (L2), chacun desdits éléments (1) étant agencé pour recevoir des greffons spongieux et permettre une fusion intersomatique.-1- Device for posterior stabilization of the lumbar and lumbosacral spine, characterized in that it has two elements (1) arranged on either side of the spinous process while being able to maintain spacing between the vertebral bodies concerned (L1 ) (L2), each of said elements (1) being arranged to receive cancellous grafts and allow interbody fusion. -2- Dispositif selon la revendication 1, caractérisé en ce que chaque élément (1) est constitué par une structure volumétrique creuse sous forme d'une cage dont les parois présentent des ouvertures de mise en communication (la) (lob) (tic) (Id) (te). -2- Device according to claim 1, characterized in that each element (1) consists of a hollow volumetric structure in the form of a cage, the walls of which have openings for placing in communication (la) (lob) (tic) (Id) (te). -3- Dispositif selon la revendication 1, caractérisé en ce que chaque élément (1) est de forme générale parallèlépipédique dont la hauteur de la face antérieure (1f) est supérieure à celle de la face postérieure (lu). -3- Device according to claim 1, characterized in that each element (1) is of generally parallelepipedal shape, the height of the front face (1f) of which is greater than that of the rear face (lu). -4- Dispositif selon la revendication 1, caractérisé en ce que les faces supérieure et inférieure de chaque élément (1) présentent des aspérités pour faciliter la stabilité primaire.-4- Device according to claim 1, characterized in that the upper and lower faces of each element (1) have asperities to facilitate primary stability. -S Dispositif selon la revendication 1, caractérisé en ce que chaque élément (1) est réalisé en titane ou polymère renforcé en fibre de carbone -S Device according to claim 1, characterized in that each element (1) is made of titanium or polymer reinforced with carbon fiber
FR9414068A 1994-11-18 1994-11-18 Lumbar and lumbar-sacral posterior stabiliser Pending FR2727004A1 (en)

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EP0966929A3 (en) * 1998-06-22 2001-09-12 Ulrich GmbH & Co. KG Implant for fusing two vertebrae
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US8840666B2 (en) 1997-04-25 2014-09-23 Stryker France Two part intersomatic implant
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US7169183B2 (en) 2000-03-14 2007-01-30 Warsaw Orthopedic, Inc. Vertebral implant for promoting arthrodesis of the spine
USRE46647E1 (en) 2001-05-03 2017-12-26 DePuy Synthes Products, Inc. Intervertebral implant for transforaminal posterior lumbar interbody fusion procedure
US8435300B2 (en) 2001-05-03 2013-05-07 DePuy Synthes Products, LLC Intervertebral implant for transforaminal posterior lumbar interbody fusion procedure
US8690949B2 (en) 2001-05-03 2014-04-08 DePuy Synthes Products, LLC Intervertebral implant for transforaminal posterior lumbar interbody fusion procedure
US6719794B2 (en) 2001-05-03 2004-04-13 Synthes (U.S.A.) Intervertebral implant for transforaminal posterior lumbar interbody fusion procedure
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