FR2799948A1 - Connecting bar esp for lumbar arthrodesis has lateral rod fixings and central anchor for interspinal prosthesis - Google Patents

Connecting bar esp for lumbar arthrodesis has lateral rod fixings and central anchor for interspinal prosthesis Download PDF

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FR2799948A1
FR2799948A1 FR9913465A FR9913465A FR2799948A1 FR 2799948 A1 FR2799948 A1 FR 2799948A1 FR 9913465 A FR9913465 A FR 9913465A FR 9913465 A FR9913465 A FR 9913465A FR 2799948 A1 FR2799948 A1 FR 2799948A1
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Prior art keywords
connecting bar
bar according
anchoring
anchoring means
prosthesis
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FR9913465A
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FR2799948B1 (en
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Jean Paul Fieschi
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TRANSCO ESQUISSE
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TRANSCO ESQUISSE
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    • 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
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
    • A61B17/7067—Devices bearing against one or more spinous processes and also attached to another part of the spine; Tools therefor
    • 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
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7049—Connectors, not bearing on the vertebrae, for linking longitudinal elements together
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30159—Concave polygonal shapes
    • A61F2002/30166—H-shaped or I-shaped
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0028—Shapes in the form of latin or greek characters

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Neurology (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)

Abstract

The connecting bar (7) has lateral fixings for attaching it to two rods (1, 2), and a central anchor (8) for an inter-spinal spacing and stabilising prosthesis (5). The anchor is in the general shape of a spinal apophysis, comprising a flat plate lying in the median perpendicular plane of the connecting bar and having a proximal extension with an elongated aperture for a bar fixing screw and a notch for the passage of one or more ligaments.

Description

BARRE DE LIAISON POUR L'ANCRAGE D'UNE PROTHESE INTER EPINEUSE La présente invention concerne le matériel orthopédique pour arthrodèses notamment lombaires. Elle concerne plus particulièrement une barre de liaison destinée à permettre l'ancrage d'une prothèse inter- épineuse dans le cas où l'arthrodèse a nécessité l'ablation d'une apophyse épineuse.  The present invention relates to orthopedic equipment for arthrodesis, in particular lumbar arthritis. It relates more particularly to a connecting bar intended to allow the anchoring of an interspinous prosthesis in the case where the arthrodesis required the ablation of a spinous process.

Les arthrodèses lombaires avec ostéosynthèse au moyen d'un matériel orthopédique implanté dans le rachis à l'aide de vis pédiculaires sont réputées induire, par phénomène de rupture de contrainte, une sollicitation accrue du segment vertébral sus- et sous- jacent qui peut conduire à une accélération de la dégénérescence discale . Les arthrodèses lombaires peuvent également accélérer une sténose suite à une hyper mobilité segmentaire à l'occasion d'une libération canalaire étendue et déstabilisante. Lumbar arthrodesis with osteosynthesis by means of orthopedic material implanted in the spine using pedicle screws are deemed to induce, by phenomenon of stress rupture, increased stress on the underlying and underlying vertebral segment which can lead to accelerated disc degeneration. Lumbar arthrodesis can also accelerate a stenosis following a segmental hyper mobility during an extensive and destabilizing canal release.

on a déjà cherché à diminuer non seulement les pressions intra discales mais également la mobilité interfacettaire en lien avec les segments sus- et sous- jacents en interposant une prothèse inter-épineuse d'écartement et de stabilisation. attempts have already been made to reduce not only the intra-disc pressures but also the interfacettal mobility in connection with the above and underlying segments by interposing an interspinous prosthesis for spacing and stabilization.

Une telle prothèse inter-épineuse se présente sous la forme d'une pièce monobloc moulée en résine synthétique ayant un corps central et deux branches latérales qui prolongent le corps central pour former une partie avant et une partie arrière toutes deux en V. La prothèse se place de telle sorte que le corps central soit entre les deux apophyses épineuses successives, lesdites apophyses pénétrant respectivement dans les zones échancrées en V de la partie avant et de la partie arrière. Such an interspinous prosthesis is in the form of a single piece molded of synthetic resin having a central body and two lateral branches which extend the central body to form a front part and a rear part, both in V. The prosthesis is places so that the central body is between the two successive spinous processes, said processes penetrating respectively into the V-shaped notched areas of the front part and of the rear part.

Les branches latérales permettent ainsi d'assurer l'ancrage de la prothèse sans autre moyen de fixation. Une difficulté intervient lorsque l'arthrodèse est due ou s'est accompagnée d'une laminectomie, c'est à dire l'ablation d'une partie ou de l'ensemble de l'arche osseuse des vertèbres qui entourent la moelle épinière, notamment l'apophyse épineuse. Cette ablation rend impossible la mise en place de la prothèse inter- épineuse précitée. The lateral branches thus make it possible to anchor the prosthesis without any other fixing means. A difficulty occurs when the arthrodesis is due or accompanied by a laminectomy, that is to say the removal of part or all of the bony arch of the vertebrae which surround the spinal cord, in particular the spinous process. This removal makes it impossible to place the aforementioned interspinous prosthesis.

Le but que s'est fixé le demandeur est d'apporter une solution à cette difficulté. The goal that the applicant has set is to provide a solution to this difficulty.

Ce but est parfaitement atteint par la barre de liaison de l'invention. I1 s'agit d'une barre de liaison pour arthrodèse notamment lombaire avec ablation d'une apophyse épineuse, barre de liaison qui comporte latéralement des moyens de fixation pour son montage sur deux tiges ; de plus elle comporte, en partie centrale, un moyen d'ancrage pour une prothèse inter-épineuse. This object is perfectly achieved by the link bar of the invention. I1 is a connecting bar for arthrodesis in particular lumbar with removal of a spinous process, connecting bar which laterally includes fixing means for mounting on two rods; moreover, it comprises, in the central part, an anchoring means for an interspinous prosthesis.

Certes il est connu dans le matériel orthopédique pour arthrodèse de mettre en oeuvre des barres de liaison entre deux tiges qui sont elles-mêmes fixées par des vis pédiculaires dans le tissu osseux vertébral. Le concept qui est à la base de l'invention a consisté à imaginer qu'il était possible d'utiliser une telle barre de liaison pour l'adapter en vue de réaliser l'ancrage d'une prothèse inter-épineuse en cas d'ablation d'une apophyse épineuse. It is certainly known in orthopedic material for arthrodesis to use connecting bars between two rods which are themselves fixed by pedicle screws in the vertebral bone tissue. The concept on which the invention is based consisted in imagining that it was possible to use such a connecting bar to adapt it in order to anchor an interspinous prosthesis in the event of removal of a spinous process.

Selon une première variante de réalisation, le moyen d'ancrage a la configuration générale d'une apophyse épineuse. Dans ce cas on essaie de reproduire la configuration anatomique de l'apophyse épineuse. According to a first alternative embodiment, the anchoring means has the general configuration of a spinous process. In this case we try to reproduce the anatomical configuration of the spinous process.

Dans un exemple de réalisation, le moyen d'ancrage est une plaque plane, qui est disposée dans le plan perpendiculaire médian de la barre de liaison. In an exemplary embodiment, the anchoring means is a flat plate, which is arranged in the perpendicular median plane of the connecting bar.

Cette plaque d'ancrage peut notamment être une pièce indépendante, ayant un prolongement proximal percé d'un trou oblong, la fixation de ladite plaque d'ancrage sur la barre de liaison se faisant par vissage à travers le trou oblong et un trou pratiqué dans la partie centrale de la barre de liaison. La présence du trou oblong permet un certain réglage du positionnement de la plaque d'ancrage par rapport à la barre de liaison notamment lors du placement de la prothèse. This anchoring plate may in particular be an independent piece, having a proximal extension pierced with an oblong hole, the fixing of said anchoring plate to the connecting bar being done by screwing through the oblong hole and a hole made in the central part of the link bar. The presence of the oblong hole allows a certain adjustment of the positioning of the anchoring plate with respect to the connecting bar, in particular when placing the prosthesis.

De préférence, dans ce cas, la partie centrale comporte une rainure transversale, servant de logement ajusté au prolongement proximal. L'avantage de cette rainure transversale est d'obtenir le calage de la plaque d'ancrage, empêchant son pivotement par rapport à la barre de liaison. Preferably, in this case, the central part has a transverse groove, serving as a housing adjusted to the proximal extension. The advantage of this transverse groove is to obtain the wedging of the anchor plate, preventing its pivoting relative to the connecting bar.

Dans une seconde variante de réalisation, le moyen d'ancrage est un plot vissé dans la partie médiane de la barre de liaison. I1 n'y a donc plus d'équivalence anatomique entre le moyen d'ancrage et l'apophyse épineuse à laquelle ce moyen d'ancrage se substitue. Cette configuration sous forme d'un plot cylindrique peut être suffisant dans la plupart des cas pour réaliser l'ancrage de la prothèse inter-épineuse. In a second alternative embodiment, the anchoring means is a stud screwed into the middle part of the connecting bar. There is therefore no longer any anatomical equivalence between the anchoring means and the spinous process for which this anchoring means replaces. This configuration in the form of a cylindrical stud may be sufficient in most cases to anchor the interspinous prosthesis.

De préférence la barre de liaison comporte deux fentes longitudinales oblongues, de part et d'autre de la partie centrale, ce qui permet le réglage du placement latéral des moyens de fixation. Preferably the connecting bar has two oblong longitudinal slots, on either side of the central part, which allows the adjustment of the lateral placement of the fixing means.

Dans ce cas, par exemple, les moyens de fixation sont des pièces comportant une partie inférieure en forme de crochet, et une partie supérieure au moins partiellement filetée, tandis que des écrous de blocage coopèrent avec la partie supérieure filetée de manière à bloquer entre lesdits écrous et le crochet d'une part la plaque de liaison et d'autre part la tige supportant ladite plaque. In this case, for example, the fastening means are parts comprising a lower hook-shaped part, and an upper part at least partially threaded, while locking nuts cooperate with the threaded upper part so as to block between said said nuts and the hook on the one hand the connecting plate and on the other hand the rod supporting said plate.

La présente invention sera mieux comprise à la lecture de la description qui va être faite d'un exemple de réalisation d'une barre de liaison comportant une plaque d'ancrage pour prothèse inter- épineuse, illustrée dans le dessin annexé dans lequel La figure 1 est une représentation schématique de dessus d'un matériel orthopédique pour arthrodèse avec ostéosynthèse comprenant deux tiges fixées par vis pédiculaires, la barre de liaison et son moyen d'ancrage ainsi qu'une prothèse inter-épineuse, La figure 2 est une représentation schématique de côté de la plaque d'ancrage, La figure 3 est une représentation schématique en coupe transversale selon l'axe III,III de la figure 1 de la barre de liaison proprement dite, et La figure 4 est une représentation schématique en perspective d'une prothèse inter-épineuse. The present invention will be better understood on reading the description which will be given of an exemplary embodiment of a connecting bar comprising an anchoring plate for interspinous prosthesis, illustrated in the appended drawing in which FIG. 1 is a schematic representation from above of an orthopedic material for arthrodesis with osteosynthesis comprising two rods fixed by pedicle screws, the connecting bar and its anchoring means as well as an interspinous prosthesis, FIG. 2 is a schematic representation of side of the anchor plate, FIG. 3 is a schematic representation in cross section along the axis III, III of FIG. 1 of the connecting bar proper, and FIG. 4 is a schematic perspective representation of a interspinous prosthesis.

Sur la figure 1, on a représenté un matériel orthopédique implanté dans le rachis lombaire dans le cadre d'une arthrodèse avec ostéosynthèse, ce matériel comprenant deux tiges 1, 2 fixées dans le tissu osseux vertébral grâce à des vis pédiculaires 3 et à des moyens adaptés pour liaisonner lesdites tiges 1, 2 auxdites vis 3, du type étrier ou autre. In Figure 1, there is shown an orthopedic material implanted in the lumbar spine as part of an arthrodesis with osteosynthesis, this material comprising two rods 1, 2 fixed in the vertebral bone tissue by means of pedicle screws 3 and means adapted to connect said rods 1, 2 to said screws 3, of the stirrup type or the like.

Dans le cadre de cette arthrodèse, il y eu ablation de l'apophyse épineuse d'une vertèbre donnée. Le but de l'invention est, malgré cette ablation, de pouvoir mettre en place une prothèse 5 d'écartement et de stabilisation, du type inter-épineuse, en appui sur l'apophyse épineuse 4 du segment vertébral sus- ou sous-jacent. As part of this arthrodesis, there was removal of the spinous process of a given vertebra. The object of the invention is, despite this ablation, to be able to put in place a spacing and stabilization prosthesis 5, of the interspinous type, bearing on the spinous process 4 of the overlying or underlying vertebral segment .

Pour cela, on fixe sur les deux tiges 1, 2 une barre de liaison 6 spécialement prévue à cet effet. Cette barre de liaison 6 comporte une barre proprement dite 7 formant entretoise entre les deux tiges 1, 2 et, dans la partie centrale 7a de ladite barre 7 des moyens d'ancrage 8 venant se substituer à l'apophyse épineuse dont l'ablation a été réalisée. For this, a connecting bar 6 specially provided for this purpose is fixed on the two rods 1, 2. This connecting bar 6 comprises a bar proper 7 forming a spacer between the two rods 1, 2 and, in the central part 7a of said bar 7 anchoring means 8 coming to replace the thorny process whose ablation has been carried out.

Ce moyen d'ancrage, dans l'exemple illustré à la figure 2, consiste dans une plaque plate ayant globalement la configuration d'une apophyse épneuse. This anchoring means, in the example illustrated in FIG. 2, consists of a flat plate generally having the configuration of a spinal apophysis.

Si l'on se reporte à la vue de côté, en plan, de ladite plaque tel qu'illustré à la figure 2, que l'on trace le carré ABCD dans lequel est circonscrit le contour extérieur de ladite plaque, que l'on trace les deux axes médians perpendiculaires EE' et FF', on observe - que le premier quart supérieur gauche de la plaque d'ancrage 9 est sensiblement un carré dont le sommet A, tronqué, est arrondi en arc de cercle - le second quart supérieur droit est un arc de cercle ayant pour centre le centre de symétrie O du carré ABCD - que le troisième quart inférieur droit est sensiblement un carré, - que le quatrième quart inférieur gauche est un carré tronqué, avec un décrochement intérieur depuis le sommet supérieur gauche F dudit carré selon une oblique formant un angle oc avec le côté AD sur une courte distance puis un second décrochement sensiblement parallèle ou légèrement oblique au côté AD qui coupe la base DE du carré au point G, situé à une distance d du sommet D qui est égal à environ le tiers du côté DE du carré constituant ce quatrième quart inférieur gauche. If we refer to the side view, in plan, of said plate as illustrated in Figure 2, we draw the square ABCD in which is circumscribed the outer contour of said plate, which we trace the two perpendicular median axes EE 'and FF', we observe - that the first upper left quarter of the anchor plate 9 is substantially a square whose vertex A, truncated, is rounded in an arc of a circle - the second upper quarter right is an arc of circle having for center the center of symmetry O of the square ABCD - that the third lower right quarter is substantially a square, - that the fourth lower left quarter is a truncated square, with an interior notch from the upper left vertex F of said square at an oblique angle oc with the AD side for a short distance then a second notch substantially parallel or slightly oblique to the AD side which cuts the base DE of the square at point G, located at a distance d from the vertex D which is equal to approximately one third of the side DE of the square constituting this fourth lower left quarter.

Le mode de réalisation qui est décrit ci-dessus n'est bien sûr pas exhaustif. I1 vise à reproduire sensiblement la configuration générale d'une apophyse épineuse. Cependant l'ancrage de la prothèse inter- épineuse peut être réalisée également en mettant en oeuvre un moyen d'ancrage plus simple , se présentant par exemple sous la forme d'un plot cylindrique qui serait vissé dans la partie centrale 7a de la plaque 7. The embodiment which is described above is of course not exhaustive. I1 aims to substantially reproduce the general configuration of a spinous process. However, the anchoring of the interspinous prosthesis can also be carried out by using a simpler anchoring means, for example in the form of a cylindrical stud which would be screwed into the central part 7a of the plate 7 .

Dans l'exemple illustré, la plaque d'ancrage 9 est une pièce indépendante de la plaque 7. Pour réaliser la fixation de cette plaque 9 sur la barre 7, la dite plaque 9 comporte un prolongement proximal 10, du troisième quart précité, qui est percé d'un trou oblong 11, tandis que la partie centrale 7a de la barre 7 est percée d'un trou circulaire 12. La fixation de la plaque 9 se fait grâce à un ensemble vis/écrou, la vis pénétrant dans l'alignement des deux trous 11 et 12 et l'écrou permettant le blocage en position de la barre 7 et du prolongement proximal 10. Elle peut aussi se faire à l'aide d'une seule vis, dans le cas où le trou circulaire 12 est lui-même taraudé. In the example illustrated, the anchoring plate 9 is an independent piece from the plate 7. To achieve the fixing of this plate 9 on the bar 7, said plate 9 has a proximal extension 10, of the aforementioned third quarter, which is pierced with an oblong hole 11, while the central part 7a of the bar 7 is pierced with a circular hole 12. The fixing of the plate 9 is done by means of a screw / nut assembly, the screw penetrating into the alignment of the two holes 11 and 12 and the nut allowing the bar 7 and the proximal extension to be locked in position 10. It can also be done using a single screw, in the case where the circular hole 12 is himself tapped.

De manière à éviter tout pivotement angulaire de la plaque 9 par rapport à la barre 7, une encoche transversale 13 est formée dans la zone centrale 7a de la barre 7. Cette encoche transversale 13 sert au moins en partie de logement au prolongement proximal 10 lors de sa mise en place. Cette encoche 13 a une largeur qui est ajustée à celle du prolongement 10 de manière à ce que celui-ci vienne s'emboîter le plus exactement possible dans l'encoche 13, avec possibilité de coulissement de manière à permettre le positionnement exact de la plaque d'ancrage 9 pour le placement de la prothèse inter-épineuse 5. In order to avoid any angular pivoting of the plate 9 relative to the bar 7, a transverse notch 13 is formed in the central zone 7a of the bar 7. This transverse notch 13 serves at least in part as a housing for the proximal extension 10 during of its implementation. This notch 13 has a width which is adjusted to that of the extension 10 so that it comes to fit as exactly as possible in the notch 13, with the possibility of sliding so as to allow the exact positioning of the plate anchor 9 for the placement of the interspinous prosthesis 5.

La fixation latérale de la barre 7 sur les deux tiges 1,2 est réalisée par tout moyen approprié, par exemple des pièces de fixation 14 ayant une portion inférieure 15 en forme de crochet et une portion supérieure 16 comportant une partie filetée. La fixation proprement dite est réalisée grâce à un écrou 17. The lateral fixing of the bar 7 on the two rods 1,2 is carried out by any suitable means, for example fixing pieces 14 having a lower portion 15 in the form of a hook and an upper portion 16 comprising a threaded part. The actual fixing is carried out by means of a nut 17.

La barre 7 est percée de deux fentes traversantes longitudinales oblongues 18, disposées de part et d'autre de la zone centrale 7a de la barre 7. The bar 7 is pierced with two oblong longitudinal through slots 18, disposed on either side of the central zone 7a of the bar 7.

Pour la fixation de la barre 7 sur les deux tiges 1 et 2, on opère de la manière suivante. On introduit la portion supérieure 16 d'une pièce de fixation 14 à travers une fente longitudinale 18 ; on insère la tige 1 dans le crochet 15 ; on visse l'écrou 17 sur la partie filetée de la portion supérieure 16 jusqu'à ce que l'écrou vienne s'appliquer sur la face supérieure de la plaque 7. on obtient de ce fait le coincement de la tige 1 entre le crochet 15 et la face inférieure de la plaque 7. on fait de même pour l'autre tige 2. For fixing the bar 7 on the two rods 1 and 2, the procedure is as follows. The upper portion 16 of a fastener 14 is introduced through a longitudinal slot 18; the rod 1 is inserted into the hook 15; the nut 17 is screwed onto the threaded part of the upper portion 16 until the nut comes to apply to the upper face of the plate 7. the rod 1 is thus wedged between the hook 15 and the underside of the plate 7. the same is done for the other rod 2.

on a représenté sur la figure 4 une vue en perspective d'un exemple de prothèse inter-épineuse 5. Cette prothèse est un bloc compact en résine synthétique relativement souple, ayant un corps central 5a et deux branches latérales 5b, 5c prolongeant de part et d'autre le corps central 5a et formant une partie avant 5d et une partie arrière 5e au-delà du corps central 5a, délimitant toutes deux une encoche en forme de V. there is shown in Figure 4 a perspective view of an example of interspinous prosthesis 5. This prosthesis is a compact block of relatively flexible synthetic resin, having a central body 5a and two lateral branches 5b, 5c extending from side and on the other, the central body 5a and forming a front part 5d and a rear part 5e beyond the central body 5a, both delimiting a V-shaped notch.

Habituellement lors de la mise en place de cette prothèse inter-épineuse 5, les deux apophyses épineuses adjacentes viennent se placer dans les encoches en forme de V des parties avant 5d et arrière 5e, sensiblement en appui contre le corps central 5a. Les propriétés du matériau constitutif de ladite prothèse sont déterminées pour qu'elle puisse remplir son rôle d'écartement et de stabilisation du segment vertébral sus- ou sous-jacent 4. Usually during the placement of this interspinous prosthesis 5, the two adjacent spinous processes come to be placed in the V-shaped notches of the front 5d and rear 5e parts, substantially in abutment against the central body 5a. The properties of the material constituting said prosthesis are determined so that it can fulfill its role of spacing and stabilization of the overlying or underlying vertebral segment 4.

Dans le cadre de la présente invention, la partie arrière 5e de la prothèse 5 sert de logement à la plaque d'ancrage 9, celle-ci venant en appui sensiblement au niveau des deux décrochements obliques entre les points F, G de la figure 2. In the context of the present invention, the rear part 5e of the prosthesis 5 serves as a housing for the anchoring plate 9, the latter coming to bear substantially at the level of the two oblique recesses between the points F, G of FIG. 2 .

La présente invention n'est pas limitée au mode de réalisation qui a été décrit à titre d'exemple non exhaustif. En particulier le moyen d'ancrage, notamment s'il s'agit d'une plaque disposée perpendiculairement à la barre 7 peut présenter une encoche susceptible de laisser passer un ou plusieurs ligaments cette disposition particulière permettant d'assurer une meilleure stabilité pour l'ensemble du matériel orthopédique implanté, notamment la plaque d'ancrage et la prothèse inter-épineuse. The present invention is not limited to the embodiment which has been described by way of non-exhaustive example. In particular the anchoring means, in particular if it is a plate arranged perpendicular to the bar 7 may have a notch capable of allowing one or more ligaments to pass through this particular arrangement making it possible to ensure better stability for the all the orthopedic equipment implanted, in particular the anchor plate and the interspinous prosthesis.

De plus afin de réaliser une certaine standardisation des pièces mises à la disposition du praticien, il est possible de prévoir une pièce d'ancrage réversible, c'est-à-dire une pièce comportant deux plaques d'ancrage telles que décrites ci-dessus disposées de part et d'autre du prolongement réalisant la fixation sur la barre de liaison. Ces deux plaques présentent des configurations différentes de sorte que le praticien peut mettre en oeuvre l'une ou l'autre desdites plaques selon l'encombrement qu'il découvre lors de l'intervention.In addition, in order to achieve a certain standardization of the parts made available to the practitioner, it is possible to provide a reversible anchoring part, that is to say a part comprising two anchoring plates as described above. arranged on either side of the extension providing the attachment to the connecting bar. These two plates have different configurations so that the practitioner can implement one or the other of said plates according to the space which he discovers during the intervention.

Claims (10)

REVENDICATIONS 1. Barre de liaison pour arthrodèse notamment lombaire avec ablation d'une apophyse épineuse, caractérisée en ce qu'elle comporte latéralement des moyens de fixation pour son montage sur deux tiges et , en partie centrale, un moyen d'ancrage pour une prothèse inter-épineuse.1. Connecting bar for in particular lumbar arthrodesis with ablation of a spinous process, characterized in that it laterally comprises fixing means for its mounting on two rods and, in the central part, an anchoring means for an inter prosthesis - thorny. 2. Barre de liaison selon la revendication 1 caractérisée en ce que le moyen d'ancrage a la configuration générale d'une apophyse épineuse.2. Connecting bar according to claim 1 characterized in that the anchoring means has the general configuration of a spinous process. 3. Barre de liaison selon l'une des revendications 1 ou 2 caractérisée en ce que le moyen d'ancrage est une plaque plane (9), qui est disposée dans le plan perpendiculaire médian de la barre de liaison (7).3. Connecting bar according to one of claims 1 or 2 characterized in that the anchoring means is a flat plate (9), which is arranged in the perpendicular median plane of the connecting bar (7). 4. Barre de liaison selon la revendication 3 caractérisée en ce que la plaque d'ancrage (9) est une pièce indépendante, ayant un prolongement proximal (10) percé d'un trou oblong (11) et en ce que la fixation de ladite plaque d'ancrage (9) sur la barre de liaison (7) se fait par vissage à travers le trou oblong (11) et un trou pratiqué dans la partie centrale (7a) de la barre de liaison (7).4. Connecting bar according to claim 3 characterized in that the anchoring plate (9) is an independent part, having a proximal extension (10) pierced with an oblong hole (11) and in that the fixing of said anchor plate (9) on the link bar (7) is made by screwing through the oblong hole (11) and a hole made in the central part (7a) of the link bar (7). 5. Barre de liaison selon la revendication 4 caractérisée en ce que la partie centrale (7a) comporte une rainure transversale servant de logement ajusté au prolongement proximal (10).5. Connecting bar according to claim 4 characterized in that the central part (7a) has a transverse groove serving as a housing adjusted to the proximal extension (10). 6. Barre de liaison selon la revendication 1 caractérisée en ce que le moyen d'ancrage est un plot vissé dans la partie médiane de la barre de liaison.6. Connecting bar according to claim 1 characterized in that the anchoring means is a stud screwed into the middle part of the connecting bar. 7. Barre de liaison selon l'une des revendications 1 à 6 caractérisée en ce que la barre de liaison (7) comporte deux fentes longitudinales oblongues, de part et d'autre de la partie centrale (7a) , pour le réglage du placement latéral des moyens de fixation.7. Connecting bar according to one of claims 1 to 6 characterized in that the connecting bar (7) has two oblong longitudinal slots, on either side of the central part (7a), for adjusting the placement lateral fixing means. 8. Barre de liaison selon la revendication 7 caractérisée en ce que les moyens de fixation sont cics pièces (14) comportant une partie infér_teure en forme de crochet (15), et une partie supérieure (16) au moins partiellement filetée, et en ce que des écrous de blocage (17) coopèrent avec la partie supérieure (16) filetée de manière à bloquer entre lesdits écrous (17) et le crochet (15) d'une part la barre de liaison (7) et d'autre part la tige (1) supportant ladite barre (7).8. Connecting bar according to claim 7 characterized in that the fixing means are snap-pieces (14) comprising a hook-shaped lower part (15), and an upper part (16) at least partially threaded, and in this that locking nuts (17) cooperate with the upper part (16) threaded so as to block between said nuts (17) and the hook (15) on the one hand the connecting bar (7) and on the other hand the rod (1) supporting said bar (7). 9. Barre de liaison selon l'une des revendication 1 à 8 caractérisée en ce que le moyen d'ancrage présente une encoche susceptible de laisser passer un ou plusieurs ligaments.9. Connecting bar according to one of claims 1 to 8 characterized in that the anchoring means has a notch capable of allowing one or more ligaments to pass. 10. Barre de liaison selon l'une des revendications 4 à 6 caractérisée en ce que le moyen d'ancrage est réversible avec une pièce comportant deux plaques d'ancrage présentant des configurations différentes.10. Connecting bar according to one of claims 4 to 6 characterized in that the anchoring means is reversible with a part comprising two anchoring plates having different configurations.
FR9913465A 1999-10-22 1999-10-22 CONNECTION BAR FOR ANCHORING AN INTER-THINNING PROSTHESIS Expired - Fee Related FR2799948B1 (en)

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