FR2799949A1 - Spinal osteosynthesis apparatus has lengthwise supports in form of single or double spiral springs to allow for movement - Google Patents

Spinal osteosynthesis apparatus has lengthwise supports in form of single or double spiral springs to allow for movement Download PDF

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FR2799949A1
FR2799949A1 FR9913475A FR9913475A FR2799949A1 FR 2799949 A1 FR2799949 A1 FR 2799949A1 FR 9913475 A FR9913475 A FR 9913475A FR 9913475 A FR9913475 A FR 9913475A FR 2799949 A1 FR2799949 A1 FR 2799949A1
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spinal osteosynthesis
spinal
spine
osteosynthesis
holding element
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FR2799949B1 (en
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Abder Benazza
Herve Gloaguen
Herve Person
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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
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7032—Screws or hooks with U-shaped head or back through which longitudinal rods pass
    • 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
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
    • A61B17/7026—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other with a part that is flexible due to its form
    • A61B17/7028—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other with a part that is flexible due to its form the flexible part being a coil spring
    • 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
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
    • A61B17/7026—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other with a part that is flexible due to its form
    • A61B17/7029—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other with a part that is flexible due to its form the entire longitudinal element being flexible
    • 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
    • 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
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7004—Longitudinal elements, e.g. rods with a cross-section which varies along its length
    • 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
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7004—Longitudinal elements, e.g. rods with a cross-section which varies along its length
    • A61B17/7007—Parts of the longitudinal elements, e.g. their ends, being specially adapted to fit around the screw or hook heads
    • 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
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7011—Longitudinal element being non-straight, e.g. curved, angled or branched
    • 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
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7041—Screws or hooks combined with longitudinal elements which do not contact vertebrae with single longitudinal rod offset laterally from single row of screws or hooks

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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)
  • Surgical Instruments (AREA)

Abstract

The osteosynthesis apparatus (1) has fixings (2) implanted in certain segments of the spine (3), with lengthwise (4') and optionally transverse (4) supports between them. One or more of the supports has at least one supple section in the form of a single or double spiral spring (5) to allow for original spinal movements of forward, backward and lateral inclination and rotation. Each of the lengthwise supports corresponds to a space between two segments of the spine and has end tips in the form of straight cylinders to be held by clamps on the fixings.

Description

La présente invention se rapporte au domaine des dispositifs d'ostéosynthèse rachidienne et plus particulièrement au domaine des dispositifs d'ostéosynthèse rachidienne installés par voie postérieure, du type comportant des éléments de fixation destinés à être implantés partiellement dans certains segments du rachis ainsi que des éléments de maintien longitudinaux et éventuellement transversaux, destinés à maintenir lesdits segments du rachis entre eux, chaque élément de maintien coopérant avec au moins deux éléments de fixation. The present invention relates to the field of spinal osteosynthesis devices and more particularly to the field of posteriorly installed spinal osteosynthesis devices, of the type comprising fixation elements intended to be partially implanted in certain segments of the spine as well as elements longitudinal and possibly transverse holding means for holding said segments of the spine together, each holding element cooperating with at least two fastening elements.

Le but de ce genre de dispositif est de permettre de rétablir au moins partiellement la statique de la colonne vertébrale lorsque des instabilités apparaissent. The purpose of this type of device is to allow to restore at least partially the static of the spine when instabilities appear.

Les indications chirurgicales nécessitant une telle installation sont essentiellement de type dégénératif. The surgical indications requiring such an installation are essentially of the degenerative type.

Les dispositifs d'ostéosynthèse rachidienne se composent en général d'un ensemble de composants comprenant des éléments de fixation destinés à être vissés dans les pédicules des vertèbres, ainsi que des éléments de maintien rigides destinés à maintenir lesdits segments du rachis entre eux en prenant appui sur les éléments de fixation. Les élements de maintien se présentent souvent sous la forme d'une paire de barres sensiblement longitudinales, rigides, entre lesquelles peuvent éventuellement être positionnés un ou plusieurs éléments de maintien transversaux rigides ou semi-rigides. Chaque élément de maintien transversal ou longitudinal coopère toujours avec au moins deux éléments de fixation. The spinal osteosynthesis devices generally consist of a set of components comprising fastening elements intended to be screwed into the pedicles of the vertebrae, as well as rigid holding elements intended to maintain said segments of the spine between them by taking support on the fasteners. The holding elements are often in the form of a pair of substantially longitudinal rigid bars, between which may be positioned one or more transverse rigid or semi-rigid support elements. Each transverse or longitudinal holding element always cooperates with at least two fastening elements.

Ces dispositifs cherchent ainsi à créer une arthrodèse, c'est à dire une fusion des segments du rachis concernés. These devices thus seek to create an arthrodesis, ie a fusion of the segments of the spine concerned.

Ces dispositifs peuvent être installés, par exemple, entre la cinquième lombaire et le sacrum pour dispositifs appelés L5 - S1. Ces dispositifs réduisent alors la mobilité de la colonne vertébrale des patients, essentiellement pour les mouvements d'inclinaison avant, d'inclinaison arrière, d'inclinaison latérale et de rotation du tronc. These devices can be installed, for example, between the fifth lumbar and the sacrum for devices called L5 - S1. These devices then reduce the mobility of the patient's spine, primarily for forward tilting, tilting, tilting, and trunk rotation movements.

L'inconvénient majeur ces dispositifs réside dans le fait que les segments de la colonne vertébrale adjacents qui ne sont pas intégrés dans le dispositif d'ostéosynthèse, subissent alors des contraintes beaucoup plus importantes et se dégradent par conséquent plus vite car le dispositif d'ostéosynthèse étant très rigide, les segments maintenus par le dispositif d'ostéosynthèse ne peuvent plus jouer leurs rotes d'amortisseurs. The major disadvantage of these devices lies in the fact that the adjacent segments of the vertebral column which are not integrated into the osteosynthesis device then undergo much greater stresses and consequently degrade more quickly because the osteosynthesis device being very rigid, the segments maintained by the osteosynthesis device can no longer play their shock absorber rotations.

L'art antérieur connaît des dispositifs d'ostéosynthèse rachidienne qui cherchent à diminuer les effets de l'ostéosynthèse sur les segments adjacents en particulier, antérieur connaît la demande de brevet internationale N <B>98122033</B> porte sur un système d'ostéosynthèse comprenant un élément liaison transversal positionné entre les éléments de maintient longitudinaux et possèdent certaines qualités de déformation élastique. The prior art is aware of spinal osteosynthesis devices which seek to reduce the effects of osteosynthesis on adjacent segments, in particular anterior known international patent application N <B> 98122033 </ B> relates to a system of osteosynthesis comprising a transverse connection element positioned between the longitudinal holding elements and possess certain qualities of elastic deformation.

Ce dispositif est destiné à être disposé sur le segment sus-jacent immédiatement supérieur au dispositif d'ostéosynthèse et propose finalement d'intégrer élément sus-jacent dans le dispositif d'ostéosynthèse. This device is intended to be disposed on the overlying segment immediately superior to the osteosynthesis device and finally proposes to integrate overlying element in the osteosynthesis device.

L'inconvénient de ce dispositif réside dans le fait qu'il ne résout partiellement les problèmes de répartitions de contraintes car ce problème se pose également avec les autres segments sus-jacents. The disadvantage of this device lies in the fact that it does not partially solve the problems of distribution of constraints because this problem also arises with the other overlying segments.

Une solution pourrait consister à installer un dispositif d'ostéosynthèse qui maintienne la majeure partie de la colonne vertébrale, mais les dispositifs existants ne sont que très partiellement souples et uniquement selon la direction transversale. II est évident que la gêne alors procurée serait importante car, les mouvements d'inclinaison avant, d'inclinaison arrière, d'inclinaison latérale et de rotation du tronc seraient très limités par rapport à ceux originels. La présente invention entend remédier aux inconvénients de l'art antérieur en proposant un dispositif d'ostéosynthèse du type décrit ci-dessus dans lequel chaque élément de maintien longitudinal et éventuellement transversal comporte au moins une partie souple constituée d'un ressort hélicoïdal afin d'autoriser potentiellement tous les mouvements rachidiens originels d'inclinaison avant, d'inclinaison arrière, d'inclinaison latérale, de rotation et de translation mutlidirectionnelle selon le plan horizontal. One solution could be to install an osteosynthesis device that maintains most of the spine, but the existing devices are only very partially flexible and only in the transverse direction. It is obvious that the annoyance then provided would be important because the movements of forward inclination, rear tilt, lateral inclination and rotation of the trunk would be very limited compared to those original. The present invention intends to overcome the drawbacks of the prior art by proposing an osteosynthesis device of the type described above in which each longitudinal and possibly transverse holding member comprises at least one flexible part consisting of a helical spring so as to potentially allow all original spinal movements of forward tilt, backward tilt, lateral tilt, rotation and mutlidirectional translation along the horizontal plane.

Un important de l'invention est de permettre de rétablir la statique lombaire tout en limitant l'arthrodèse et seul un élément de maintien ou un ensemble d'eléments de maintien constitués au moins partiellement d'un ressort hélicoïdal permet à la fois de maintenir le rachis en compression, en extension en rotation. Avantageusement, le dispositif d'ostéosynthèse selon l'invention en mesure de se substituer complètement aux liaisons inter-segmentaires qui ne sont plus en mesure de remplir leur office de maintien, d'amortissement et d'articulation. Avantageusement, le dispositif d'ostéosynthèse selon l'invention permet, en en réduisant l'amplitude et en les freinant, les mouvements de flexion, d'extension, d'inclinaison latérale droite et gauche, de rotation droite et gauche et de translation mutlidirectionnelle selon le plan horizontal entre deux vertèbres. II permet ainsi de réduire les contraintes subies lors -de ces différents mouvements par les moyens d'union naturels intervertébraux inclus dans le dispositif. An important aspect of the invention is to allow the lumbar static to be restored while limiting the arthrodesis and only a holding element or a set of holding elements consisting at least partially of a helical spring makes it possible at the same time to maintain the spine in compression, in extension in rotation. Advantageously, the osteosynthesis device according to the invention able to completely replace the inter-segmental links which are no longer able to fulfill their office of maintenance, damping and articulation. Advantageously, the osteosynthesis device according to the invention makes it possible, by reducing the amplitude and braking them, the movements of flexion, extension, right and left lateral inclination, right and left rotation and mutlidirectional translation. along the horizontal plane between two vertebrae. It thus makes it possible to reduce the stresses experienced during these different movements by the natural intervertebral union means included in the device.

Avantageusement, le dispositif d'ostéosynthèse selon l'invention est en mesure de réaliser un système de protection des segments mobiles intervertebraux immédiatement sus-jacents en réduisant les contraintes qui pèsent sur et en ralentissant ainsi leurs dégénérescences naturelles. Advantageously, the osteosynthesis device according to the invention is capable of producing a protection system for the immediately overlying intervertebral mobile segments by reducing the stresses on and thus slowing down their natural degeneracies.

Avantageusement également, grâce au dispositif selon l'invention, il n'est plus nécessaire que le chirurgien procède au cintrage des éléments de maintien longitudinaux afin de les adapter à la courbure de la colonne vertébrale du patient car la souplesse des ressorts hélicoïdaux est telle qu'elle leur permet de s'adapter naturellement à la morphologie de chaque patient. Advantageously also, thanks to the device according to the invention, it is no longer necessary for the surgeon to bend the longitudinal retaining elements in order to adapt them to the curvature of the patient's spine because the flexibility of the helical springs is such that it allows them to adapt naturally to the morphology of each patient.

Avantageusement également, chaque élément de maintien longitudinal ou transversal se compose soit d'un seul ressort hélicoïdal, éventuellement doublé, soit d'une succession de ressorts hélicoïdaux, éventuellement doublés, telle que chaque ressort hélicoïdal unique ou doublé corresponde à un espace entre deux segments du rachis à maintenir ensemble. Advantageously also, each longitudinal or transverse holding member is composed of either a single helical spring, optionally doubled, or a succession of helical springs, possibly doubled, such that each single or double helical spring corresponds to a space between two segments of the spine to maintain together.

Chaque ressort hélicoïdal seul ou inclus dans une succession et éventuellement doublé, comporte à ses extrémités des embouts destinés, chacun, à coopérer avec un élément de fixation. Each helical spring alone or included in a succession and possibly doubled, has at its ends end pieces each intended to cooperate with a fastener.

Grâce dispositif selon l'invention, il est également possible d'imaginer que pour des applications thérapeutiques particulières, un ou plusieurs éléments de maintien transversaux, comportant au moins en partie des ressorts hélicoïdaux, soient disposes entre le pédicule droit d'une vertèbre et le pédicule gauche d'une vertèbre sus sous-jacente, ou inversement. Thanks to a device according to the invention, it is also possible to imagine that for particular therapeutic applications, one or more transverse holding elements, comprising at least partly helical springs, are arranged between the right pedicle of a vertebra and the left pedicle of an underlying supernal vertebra, or vice versa.

Le dispositif selon l'invention permet en outre de traiter facilement des pathologies particulières telles que la pathologie dégénérative appelée spondylolysthésis nécessitant d'opérer un rappel de vertèbres ou encore les pathologies scoliotiques. En effet, dans ce dernier cas, le dispositif selon l'invention peut être utilisé comme tuteur afin de stabiliser la colonne vertébrale. On comprendra mieux l'invention à l'aide de la description faite ci-après d'un mode de mise en ceuvre donné titre d'exemple non limitatif, en référence aux figures annexées dans lesquelles - la figure 1 illustre une vue postérieure et partielle d'un rachis équipé d'un dispositif d'ostéosynthèse selon l'invention à élément de maintien longitudinal constitué d'un seul ressort hélicoïdal ; - la figure 2 illustre une vue de profil d'un élément de fixation vis tulipe selon la figure 1 ; - la figure 3 illustre une vue de profil d'un autre élément de fixation vis tulipe ; - la figure 4 illustre une vue profil d'un dispositif d'ostéosynthèse selon l'invention utilisé pour effectuer rappel de vertèbre ; - la figure 5 illustre une vue de profil d'un élément de fixation vis tulipe à double évidement en U pour ressort hélicoïdal doublé ; - la figure 6 illustre une vue de profil d'un élément de maintien transversal tel que celui présenté figure 1 ; - la figure 7 illustre une vue postérieure et partielle d'un rachis équipé d'un dispositif d'ostéosynthèse selon l'invention à éléments de maintien longitudinaux constitués d'une succession de ressorts hélicoïdaux à embouts cylindriques ; - la figure 8 illustre une vue profil et partielle d'un agencement de deux éléments de fixation et d'un élément de maintient selon la figure 7 ; - la figure 9 illustre une vue de profil d'un élément de fixation vis tulipe à capuchon muni d'une cale de blocage libre selon la figure 7 ; - la figure 10 illustre une vue profil d'un élément de fixation vis tulipe à capuchon muni de deux cales blocage libres, ladite vis tulipe comportant un double évidement en U pour ressort hélicoïdal doublé ; - la figure 11 illustre une vue postérieure et partielle d'un rachis équipé d'un dispositif d'ostéosynthèse selon l'invention à éléments de maintien longitudinaux constitués d'une succession ressorts hélicoïdaux à embouts en forme de plaques présentant des lumières ; et - la figure 12 illustre une vue de face d'un élément de fixation selon la figure 11. Le dispositif (1) d'ostéosynthèse rachidienne selon l'invention est du type comportant des éléments de fixation (2) destinés à être implantés partiellement dans certains segments du rachis (3) et des éléments de maintien (4) sensiblement longitudinaux (4'), souvent au nombre de deux, et éventuellement transversaux (4") destinés à maintenir lesdits segments du rachis (3) entre eux, chaque élément de maintien (4) coopérant avec au moins deux éléments de fixation (2)_ éléments de fixation (2) sont, par exemple, des vis de fixation (8) appelées vis pédiculaires comportant une tige filetée destinée à être introduite dans les pédicules vertébraux lombaires ou thoraciques ou dans le sacrum, ainsi qu'une tête sur laquelle peut être maintenu, par différents moyens, un ou plusieurs éléments maintien longitudinal et l ou transversal. The device according to the invention also makes it possible to easily treat particular pathologies such as the degenerative pathology called spondylolysthesis requiring vertebral booster or scoliotic pathologies. Indeed, in the latter case, the device according to the invention can be used as a tutor to stabilize the spine. The invention will be better understood from the following description of an embodiment given by way of non-limiting example, with reference to the appended figures in which - Figure 1 illustrates a rear view and partial a spine equipped with an osteosynthesis device according to the invention with a longitudinal holding element consisting of a single coil spring; - Figure 2 illustrates a side view of a tulip screw fastener element according to Figure 1; FIG. 3 illustrates a profile view of another tulip screw fastener; FIG. 4 illustrates a profile view of an osteosynthesis device according to the invention used to perform vertebral abutment; FIG. 5 illustrates a profile view of a double U-shaped tapered screw fastening element for a doubled helical spring; - Figure 6 illustrates a side view of a transverse holding element such as that shown in Figure 1; FIG. 7 illustrates a posterior and partial view of a spine equipped with an osteosynthesis device according to the invention with longitudinal retaining elements consisting of a succession of helicoidal springs with cylindrical ends; - Figure 8 illustrates a profile and partial view of an arrangement of two fasteners and a holding member according to Figure 7; FIG. 9 illustrates a profile view of a cap tulip screw fastener element provided with a free blocking wedge according to FIG. 7; FIG. 10 illustrates a profile view of a cap tulip screw fixing element provided with two free blocking wedges, said tulip screw comprising a double U-shaped recess for a doubled helical spring; FIG. 11 illustrates a posterior and partial view of a spine equipped with an osteosynthesis device according to the invention with longitudinal holding elements consisting of a succession of helical springs with plate-shaped tips having lights; and FIG. 12 illustrates a front view of a fastening element according to FIG. 11. The spinal osteosynthesis device (1) according to the invention is of the type comprising fastening elements (2) intended to be partially implanted. in certain segments of the spine (3) and substantially longitudinal (4 '), often two, and possibly transverse (4 ") holding elements (4) intended to hold said segments of the spine (3) together, each holding element (4) cooperating with at least two fastening elements (2) _ fastening elements (2) are, for example, fixing screws (8) called pedicle screws having a threaded rod intended to be introduced into the pedicles vertebrae lumbar or thoracic or in the sacrum, and a head on which can be maintained, by various means, one or more elements longitudinal and l or transverse retention.

Le dispositif (1) d'ostéosynthèse rachidienne selon l'invention est caractérisé en ce qu'au moins un élément de maintien (4) comporte au moins une partie souple constïtuee d'un ressort hélicoïdal (5) afin d'autoriser potentiellement les mouvements rachidiens originels d'inclinaison avant, d'inclinaison arrière d'inclinaison latérale et de rotation. The device (1) for spinal osteosynthesis according to the invention is characterized in that at least one holding element (4) comprises at least one flexible part constituting a helical spring (5) in order to potentially allow the movements original spine tilt forward, tilt back side tilt and rotation.

Selon l'invention, ce sont les ressorts hélicoïdaux (5) qui assurent le maintien entre segments du rachis (3), et aucun autre élément rigide ou semi-rigide n'intervient. According to the invention, it is the helical springs (5) which maintain between segments of the spine (3), and no other rigid or semi-rigid element is involved.

Dans une première version de l'invention, illustrée figure 1, au moins élément maintien (4) et notamment de maintien longitudinal (4') se présente sous la forme d'un ressort hélicoïdal (5) unique. In a first version of the invention, illustrated in FIG. 1, at least one holding element (4) and in particular longitudinal retaining element (4 ') is in the form of a single helical spring (5).

Chaque liaison ressort hélicoïdal (5) I élément de fixation (2) peut alors être réalisée à l'aide d'un élément de fixation (2) se présentant sous la forme d'une tulipe (8') dont la tête comporte au moins un évidement (16) en U dans chacun desquels peut être positionné et maintenu au moins une partie du ressort hélicoïdal (5), chaque évidement (16) en U comportant à l'extrémité supérieure ses parois latérales, au moins une tige filetée (17) permettant de retenir un palier de maintien à l'aide d'un écrou (19). Le palier de maintien (18) a pour fonction de maintenir ressort hélicoïdal dans l'évidement (16). Each helical spring connection (5) I fastening element (2) can then be carried out using a fastening element (2) in the form of a tulip (8 ') whose head comprises at least a U-shaped recess (16) in which at least a portion of the helical spring (5) can be positioned and held, each U-shaped recess (16) having at the upper end its side walls, at least one threaded rod (17). ) for retaining a holding bearing with a nut (19). The maintenance bearing (18) serves to maintain a coil spring in the recess (16).

Dans le cas où le ressort hélicoïdal (5) n'est pas doublé, chaque évidement (16) en U peut comporter à l'extrémité supérieure de ses parois latérales, soit deux tiges filetées (17) permettant de retenir le palier de maintien (18) à l'aide de deux écrous (19), comme illustré figure 2, soit une seule tige filetée (17) permettant de retenir le palier de maintien (18) en forme de sabot à l'aide d'un seul écrou (1 comme illustré figure 3. Le principal avantage de cette dernière solution réside dans le fait que le dispositif d'ostéosynthèse rachidienne est alors plus simple à installer car il comporte moins d'écrous. Dans une variante de la première version, les éléments de maintien (4) et notamment les éléments de maintien longitudinaux (4') sont réalisés chacun à l'aide de deux ressorts hélicoïdaux (5) disposés côte à côte. In the case where the helical spring (5) is not doubled, each U-shaped recess (16) may comprise at the upper end of its side walls, two threaded rods (17) making it possible to retain the support bearing ( 18) by means of two nuts (19), as shown in FIG. 2, or a single threaded rod (17) for retaining the shoe-shaped holding bearing (18) with a single nut ( 1, as illustrated in FIG. 3. The main advantage of this latter solution lies in the fact that the spinal osteosynthesis device is then simpler to install because it has fewer nuts.In a variant of the first version, the holding elements (4) and in particular the longitudinal retaining elements (4 ') are each made using two helical springs (5) arranged side by side.

Dans ce cas, chaque liaison ressort hélicoïdal (5) I élément de fixation (2) peut alors être réalisée à l'aide d'un élément de fixation (2) se présentant sous la forme d'une vis tulipe (8') dont la tête comporte deux évidements (16) en U, comme illustré figure 4, dans lesquels peuvent être positionnés et maintenus au moins une partie ressorts hélicoïdaux (5). Quelque soit le type de fixation de palier de maintien (18) et quelque soit le nombre ressorts hélicoïdaux, il est possible de réaliser un ou plusieurs éléments de fixation rallongés (2') dont la longueur de la ou des tiges filetées 7') est plus importante, afin de permettre de réaliser un rappel de vertèbre, comme illustré figure 5. In this case, each helical spring connection (5) I fastening element (2) can then be carried out using a fastening element (2) in the form of a tulip screw (8 ') which the head comprises two U-shaped recesses (16), as shown in FIG. 4, in which at least one helical coil portion (5) can be positioned and held. Whatever the type of retaining bearing (18) and irrespective of the number of helical springs, it is possible to produce one or more elongated fastening elements (2 ') whose length of the threaded rod or rods 7') is more important, to allow to perform a vertebra reminder, as shown in Figure 5.

Ainsi, le segment ou les segments de vertèbre qui comportent éléments de fixati rallongés (2') subissent une traction selon la flèche F tend à les ramener niveau des autres segments. Dans cette première version de l'invention illustrée figure 1, il possible de prévoir un élément de maintien transversal (4") réalisé à l'aide d'une tige d'union (20) présentant une courbure adaptée ou d'un ressort hélicoïdal, coulissant, dont extrémités sont rectilignes et filetées, comme illustré figure . La liaison entre l'élément de maintien transversal (4") et les éléments de fixation peut alors être realisée à l'aide de paliers de maintien à fourreau (18') présentant chacun un fourreau (21) dans lequel peut être positionnée et maintenue une extrémité de l'élément de maintien transversal (4"). Pour adapter la longueur de l'élément de maintien transversal (4"), et pour parfaire le maintien, il est préférable de prévoir en outre oeillets de serrage (22), traversant de part en part les fourreaux (21) et les extrémites filetées de l'élément de maintien transversal (4"). Thus, the segment or vertebral segments which comprise lengthened fixati elements (2 ') undergo a traction along the arrow F tends to bring them level of the other segments. In this first version of the invention illustrated in FIG. 1, it is possible to provide a transverse holding element (4 ") made using a union rod (20) having a suitable curvature or a helical spring. sliding, whose ends are rectilinear and threaded, as shown in figure The connection between the transverse holding element (4 ") and the fastening elements can then be achieved by means of sleeve bearing bearings (18 ') each having a sleeve (21) in which can be positioned and held one end of the transverse holding member (4 ") .To adapt the length of the transverse holding member (4"), and to complete the maintenance, it is preferable to further provide clamping eyelets (22), passing right through the sleeves (21) and the threaded ends of the transverse holding member (4 ").

Dans une deuxième version de l'invention, illustrée figure 7, chaque élément de maintien longitudinal (4') se compose d'une succession ressorts hélicoïdaux (5), éventuellement doublés, chaque ressort hélicoïdal ou double ressort hélicoïdal,_correspondant à un espace entre deux segments rachis (3) à maintenir ensemble. Chaque ressort hélicoïdal (5) comporte alors, à ses extrémités, un embout (6), partie intégrante du ressort hélicoïdal (5) ou sertis à ce dernier destiné à coopérer avec un élément de fixation (2). In a second version of the invention, illustrated in FIG. 7, each longitudinal holding element (4 ') is composed of a succession of helical springs (5), possibly doubled, each helical spring or double helical spring, corresponding to a space between two spine segments (3) to maintain together. Each coil spring (5) then comprises, at its ends, a tip (6) integral with the coil spring (5) or crimped to the latter for cooperating with a fastening element (2).

liaison embout (6)-élément de fixation (2) peut être de plusieurs types. première solution consiste, par exemple, à réaliser lesdits embouts sous forme de cylindres (7), droits, comme illustré figure 8. Les cylindres peuvent être réalisés soit en modifiant des parties du ou des ressorts hélicoïdaux de façon à les rendre sensiblement rectilignes, soit en introduisant des éléments cylindriques sertis aux extrémités des ressorts hélicoïdaux (5). connection tip (6) -adjoint element (2) can be of several types. The first solution consists, for example, in making said end pieces in the form of cylinders (7), straight, as shown in FIG. 8. The cylinders can be made either by modifying parts of the coil spring (s) so as to make them substantially rectilinear or by introducing cylindrical elements crimped at the ends of the coil springs (5).

Lesdits éléments de fixation (2) peuvent alors se présenter sous la forme vis tulipes (8') dont les têtes comportent chacune au moins un évidement (16) en éventuellement doublé, dans chacun desquels peut être positionnée et maintenue au moins une partie dudit embout (6), les parois extérieures de l'évidement (16) de la pluralité d'évidements (16) étant filetées de manière à permettre de visser capuchon (9) à cale(s) de blocage (10) libre(s), comme illustré figures 9 et 10. Said fastening elements (2) can then be in the form of tulip screws (8 ') whose heads each comprise at least one recess (16) possibly doubled, in each of which can be positioned and maintained at least a portion of said endpiece (6), the outer walls of the recess (16) of the plurality of recesses (16) being threaded so as to allow to screw cap (9) free wedge (s) (10) free (s), as illustrated in FIGS. 9 and 10.

Dans le cas où chaque élément maintien longitudinal (4') se compose d'une succession de ressorts hélicoïdaux (5) doublés, les vis tulipes (8') comportent alors deux évidements (16) en U, comme illustré figure 10, et le capuchon (9) comporte alors deux cales de blocage (10) libres. In the case where each longitudinal retaining element (4 ') consists of a succession of helical coil springs (5) doubled, the tulip screws (8') then comprise two U-shaped recesses (16), as shown in FIG. cap (9) then comprises two free blocking wedges (10).

deuxième solution consiste à réaliser lesdits embouts (6) sous la forme de plaques (11), par exemple serties aux extrémités des ressorts hélicoïdaux (5), chaque plaque (11) étant munie d'au moins une lumière (12), comme illustré figure 1 . second solution consists in producing said tips (6) in the form of plates (11), for example crimped at the ends of the coil springs (5), each plate (11) being provided with at least one lumen (12), as illustrated figure 1 .

Lesdits éléments de fixation (2) peuvent alors se présenter sous la forme vis de fixation (8) munies d'au moins un pas de vis supérieur (13) dont le diamètre est inférieur à la largeur de ladite lumière (12), comme illustré figure 12, afin permettre de régler l'espace nécessaire entre chaque élément du rachis qui doit être soutenu. Said fixing elements (2) can then be in the form of fixing screws (8) provided with at least one upper screw thread (13) whose diameter is smaller than the width of said light (12), as illustrated Figure 12, to adjust the space required between each element of the spine to be supported.

La plaque (11) est alors bloquée dans la lumière (12) à l'aide d'un écrou (1 et éventuellement d'une cale (14). The plate (11) is then locked in the slot (12) using a nut (1 and possibly a shim (14).

D'une manière générale, l'utilisation des embouts (6), sous forme cylindres droits (7) ou de plaques (11) comportant des lumières (12), permet simplifier considérablement l'ajustement du dispositif d'ostéosynthèse à morphologie du patient. Pour la fixation des éléments de maintien longitudinaux (4') sur le sacrum, il peut être prévu un embout (6') comportant deux trous. In general, the use of the endpieces (6), in the form of straight cylinders (7) or plates (11) comprising lights (12), makes it possible to considerably simplify the adjustment of the osteosynthesis device to the morphology of the patient. . For fixing the longitudinal retaining elements (4 ') on the sacrum, there may be provided a tip (6') having two holes.

Un dispositif de rappel de vertèbres pour le traitement du spondylolysthésis peut également être réalisé sur la base de cette deuxième solution. ressorts hélicoïdaux (5) peuvent être réalisés, par exemple, en alli de titane type Ta6V4. A vertebral return device for treating spondylolysthesis can also be provided based on this second solution. helical springs (5) can be made, for example, titanium alloy type Ta6V4.

diamètre du fil utilisé pour réaliser les ressorts hélicoïdaux (5), doublés, de l'ordre de 2 à 3 millimètres et le diamètre total des ressorts hélicoïdaux est de l'ordre de 8 millimètres. diameter of the wire used to produce the helical springs (5), lined, of the order of 2 to 3 millimeters and the total diameter of the coil springs is of the order of 8 millimeters.

apparaît que, grâce à ce genre d'alliage et grâce surtout à la structure souple dispositif d'ostéosynthèse rachidienne, les frottements engendrés ' l'intérieur dispositif ne génèrent que peu de débris d'usure. Pour empêcher que les écrous (15 ou 19) ne se dévissent, il peut être prévu des stries sous la base de ces écrous ainsi que sur la surface supérieure des plaques ou des paliers de maintien (18). It appears that, thanks to this kind of alloy and thanks above all to the flexible structure of the spinal osteosynthesis device, the friction generated inside the device generates only a small amount of wear debris. To prevent the nuts (15 or 19) from being unscrewed, striations may be provided under the base of these nuts as well as on the upper surface of the plates or holding bearings (18).

ecrous autobloquants peuvent également être utilisés. interlocking nuts can also be used.

Claims (1)

REVENDICATIONS 1- Dispositif (1) d'ostéosynthèse rachidienne, du type comportant des éléments de fixation (2) destinés à être implantés partiellement dans certains segments du rachis (3) et des éléments de maintien (4) sensiblement longitudinaux (4') et éventuellement transversaux (4") destinés à maintenir lesdits segments du rachis (3) entre eux, chaque élément de maintien (4) coopérant avec au moins deux éléments de fixation (2), caractérisé en ce qu'au moins un élément de maintien (4) comporte au moins une partie souple constituée d'un ressort hélicoïdal (5) afin d'autoriser potentiellement les mouvements rachidiens originels d'inclinaison avant, d'inclinaison arrière, d'inclinaison latérale et de rotation. 2- Dispositif d'ostéosynthèse rachidienne selon la revendication 1, caractérisé en ce 'au moins un élément de maintien (4) se présente sous la forme d'un seul ressort helicoïdal (5). 3- Dispositif (1 d'ostéosynthèse rachidienne selon la revendication 1, caractérisé en ce 'au moins un élément de maintien (4) se présente sous la forme de deux ressorts hélicoïdaux (5) disposés côte à côte. 4- Dispositif d'ostéosynthèse rachidienne selon la revendication 1, caractérisé en ce chaque élément de maintien longitudinal (4') se compose d'une succession ressorts hélicoïdaux (5), éventuellement doublés, chaque ressort hélicoïdal , ou double ressort hélicoïdal, correspondant à un espace entre deux segments rachis (3) à maintenir ensemble. 5- Dispositif d'ostéosynthèse rachidienne selon l'une quelconque des revendications 1 ' caractérisé en ce que chaque ressort hélicoïdal (5) comporte à ses extrémités embout (6) destiné à coopérer avec un élément de fixation (2). 6- Dispositif d'ostéosynthèse rachidienne selon la revendication 5, caractérisé en ce lesdits embouts (6) sont sertis à l'extrémité des ressorts hélicoïdaux (5). 7- Dispositif d'ostéosynthèse rachidienne selon la revendication 5 ou la revendication 6, caractérisé en ce que lesdits embouts (6) se présentent sous la forme de cylindres droits. 8- Dispositif d'ostéosynthèse rachidienne selon l'une quelconque des revendications 5 7, caractérisé en ce que lesdits éléments de fixation (2) se présentent sous la forme de vis tulipes (8') dont les têtes comportent chacune au moins un évidement (16) en U dans chacun desquels peut être positionnée et maintenue au moins une partie dudit embout (6), les parois extérieures de l'évidement 6) ou la pluralité d'évidements (16) étant filetées de manière à permettre visser un capuchon (9) à cale(s) de blocage (10) libre(s). 9- Dispositif (1) d'ostéosynthèse rachidienne selon la revendication 5 ou la revendication 6, caractérisé en ce que lesdits embouts (6) se présentent sous la forme de plaques (11), chaque plaque (11) étant munie d'au moins une lumière (12). 10- Dispositif (1) d'ostéosynthèse rachidienne selon la revendication caractérisé en ce que lesdits éléments de fixation (2) se présentent sous la forme vis de fixation (8) munies d'au moins un pas de vis supérieur (13) dont le diamètre est inférieur ' la largeur de ladite lumière (12), la plaque (11) étant bloquée dans lumière (12) l'aide d'un écrou (15). 11- Dispositif (1) d'ostéosynthèse rachidienne selon l'une quelconque revendications 1 à 3, caractérisé en ce que lesdits éléments de fixation (2) présentent sous la forme de vis tulipes (8') dont les têtes comportent chacune moins un évidement (16) en U dans chacun desquels peut être positionné maintenu au moins une partie du ressort hélicoïdal (5), chaque évidement (16) en comportant l'extrémité supérieure de ses parois latérales, au moins une tige filetée (17) permettant de retenir un palier de maintien (18) à l'aide d'un écrou (19). 12- Dispositif (1) d'ostéosynthèse rachidienne selon la revendication 1 , caractérisé ce qu'il comporte des paliers de maintien à fourreau (18') présentant chacun un fourreau (21) dans lequel peut être positionnée et maintenue une extrémité d'un élément de maintien transversal (4").1. Device (1) for spinal osteosynthesis, of the type comprising fastening elements (2) to be partially implanted in certain segments of the spine (3) and substantially longitudinal retaining elements (4) (4 ') and optionally transverse (4 ") for holding said segments of the spine (3) together, each holding element (4) cooperating with at least two fastening elements (2), characterized in that at least one holding element ( 4) comprises at least one flexible portion consisting of a helical spring (5) to potentially allow the original spinal movements of forward inclination, rear tilt, lateral inclination and rotation.-Osteosynthesis device spinal cord according to claim 1, characterized in that 'at least one holding element (4) is in the form of a single helical spring (5) 3- Device (1 of spinal osteosynthesis) e according to claim 1, characterized in that at least one holding element (4) is in the form of two helical springs (5) arranged side by side. 4- Spinal osteosynthesis device according to claim 1, characterized in that each longitudinal holding element (4 ') is composed of a succession of helical springs (5), possibly doubled, each helical spring, or double coil spring, corresponding to a space between two spine segments (3) to hold together. 5- spinal osteosynthesis device according to any one of claims 1 'characterized in that each coil spring (5) has at its ends tip (6) for cooperating with a fastening element (2). 6- spinal osteosynthesis device according to claim 5, characterized in that said end pieces (6) are crimped at the end of the coil springs (5). 7- spinal osteosynthesis device according to claim 5 or claim 6, characterized in that said tips (6) are in the form of straight cylinders. 8- spinal osteosynthesis device according to any one of claims 7 to 7, characterized in that said fastening elements (2) are in the form of tulip screws (8 ') whose heads each comprise at least one recess ( 16) in each of which can be positioned and held at least a portion of said tip (6), the outer walls of the recess 6) or the plurality of recesses (16) being threaded so as to allow a cap ( 9) free blocking wedge (s) (10). 9- Device (1) of spinal osteosynthesis according to claim 5 or claim 6, characterized in that said tips (6) are in the form of plates (11), each plate (11) being provided with at least a light (12). 10- Device (1) of spinal osteosynthesis according to claim characterized in that said fastening elements (2) are in the form of fixing screws (8) provided with at least one upper screw thread (13) whose The diameter is smaller than the width of said lumen (12), the plate (11) being locked in a lumen (12) by means of a nut (15). 11- Device (1) of spinal osteosynthesis according to any one of claims 1 to 3, characterized in that said fastening elements (2) present in the form of tulip screws (8 ') whose heads each comprise less than one recess (16) in each of which can be positioned held at least a portion of the coil spring (5), each recess (16) having the upper end of its side walls, at least one threaded rod (17) for retaining a holding bearing (18) with a nut (19). 12- Device (1) of spinal osteosynthesis according to claim 1, characterized in that it comprises sleeve bearing bearings (18 ') each having a sleeve (21) in which can be positioned and maintained an end of a transverse holding element (4 ").
FR9913475A 1999-10-22 1999-10-22 SPINAL OSTETHOSYNTHESIS DEVICE Expired - Fee Related FR2799949B1 (en)

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US9770265B2 (en) 2012-11-21 2017-09-26 Roger P. Jackson Splay control closure for open bone anchor
US10058354B2 (en) 2013-01-28 2018-08-28 Roger P. Jackson Pivotal bone anchor assembly with frictional shank head seating surfaces
US11369484B2 (en) 2013-02-20 2022-06-28 Flexuspine Inc. Expandable fusion device for positioning between adjacent vertebral bodies
US11766341B2 (en) 2013-02-20 2023-09-26 Tyler Fusion Technologies, Llc Expandable fusion device for positioning between adjacent vertebral bodies
US9717533B2 (en) 2013-12-12 2017-08-01 Roger P. Jackson Bone anchor closure pivot-splay control flange form guide and advancement structure
US10603091B2 (en) 2014-02-24 2020-03-31 Curtin University Of Technology Fastener
US10064658B2 (en) 2014-06-04 2018-09-04 Roger P. Jackson Polyaxial bone anchor with insert guides
US10729480B2 (en) 2016-03-18 2020-08-04 Curtin University Expandable fastener for orthopaedic applications

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