CN101175455A - Inserting anterior and posterior spinal prostheses - Google Patents

Abstract

Spinal apparatus including reference structure spatially fixed relative to a plurality of pedicle screws that are mounted in adjacent vertebrae of a patient, and a device connected to the reference structure which is adapted to install an anterior spinal prosthesis, wherein the reference structure defines a spatial relationship between the anterior spinal prosthesis and a posterior spinal prosthesis attached to the pedicle screws.

Description

Insert spinal column anterior prosthesis and spinal posterior prosthese

Cross reference

The temporary patent application sequence number No.60/669 that the application requires in submission on April 11st, 2005 according to 35 USC § 119,902 and the temporary patent application sequence number No.60/757 that submits on January 10th, 2006,467 priority, these applications are included in here by reference.

Technical field

The present invention relates to human prostheses, relate more specifically to spinal column spinal disc prothesis, and be used for the coordinate method of the harmonious accent of insertion between the prosthese in conjunction with the spinal column anterior prosthesis.

Background technology

The universal process that is used for fixing spinal column be by rigidity or elasticity are connected implant be connected to the anchor parts for example pedicle screw correct and support adjacent vertebra.Because the mobile problem of the adjacent level in spinal column is so rigidly fix (fusion) of spinal column can be disadvantageous.On the other hand, the dynamic fixing that is provided by flexible implant provides the probability of minimizing for the infringement of adjacent level.This is because it allows to carry out movement protection near the normal stress along spinal column distributes.

Method in common is an anterior portion method, and this front portion portion method comprises the abdominal part by patient.This is the process of a complexity, and comprises large-scale vasoconstriction in other difficulties of being everlasting.Posterior approach can be alleviated some of these problems.From the posterior transverse path implant is put into and has been described to allowing one-sided the disk space or bilateral disk space preparation and implant are inserted, thereby provide stationarity the purpose disk space.

Yet, when will be in conjunction with comprising the spinal posterior prothesis and for the process of the use of pedicle screw or when portion inserts disc prosthesis after this process, especially comprise the joint and when relevant with the dish type attitude, need consider the relative localization of disc prosthesis when at least one of disc prosthesis and posterior prosthesis with respect to posterior prosthesis with vertebra.

Summary of the invention

The object of the invention is to provide and the bonded spinal column spinal disc of posterior spinal prosthesis prosthese, and is provided for insertion and harmonious coordinate method between prosthese, following being shown in further detail.

According to some embodiments of the present invention, the pedicle screw placement of a plurality of (but for example not being restricted at least three) is gone up in position, preferably be placed in patient's the adjacent vertebrae, this is the suitable selection that is used to receive posterior prosthesis and disc prosthesis.In the art, the method for introducing pedicle screw is known.In case pedicle screw is arranged in position and goes up, then spinal disc is inserted device and be connected to and be inserted into two pedicle screws in the vertebra.Will coil insert device be connected to pedicle screw after portion, the method that can use traction apparatus to utilize art technology also to know is drawn two vertebras.

This device can define track or the path or the reference point of the insertion that is used for disc prosthesis.This track or path or reference point are guaranteed the implantation dish is placed on the precalculated position with respect to pre-insertion screw.Because screw is in vertebra and then will be placed on the relevant known location of rear portion implant on the pedicle screw, this device preferably will assist disc prosthesis is placed on the exact position relevant with the rear portion implant with vertebra via intervertebral spinal fusion method (dish insertion method for example as known in the art), thereby make human body error minimum.The locator qualification of pedicle screw the location of posterior prosthesis.

Devices in accordance with embodiments of the present invention is used predetermined logic OR reference point, combines the traction function of the function that is attached to pedicle screw, two vertebras and the insertion function of disc prosthesis.

Thus, according to embodiments of the invention, be provided for inserting the method for spinal prostheses, this method comprises: the reference configuration with respect to a plurality of pedicle screw fixed in space is provided, and these a plurality of pedicle screws are installed in patient's the adjacent vertebrae; Utilization is connected to the device of reference configuration, and anterior spinal prosthesis is installed; And posterior spinal prosthesis is installed on the pedicle screw, wherein, reference configuration is limited to the spatial relationship between anterior spinal prosthesis and the posterior spinal prosthesis.Before anterior spinal prosthesis is installed, can draw adjacent vertebra.Reference configuration defines the path that anterior spinal prosthesis is inserted in be used to relevant with pedicle screw.

Also provide spinal column equipment according to embodiments of the invention, this spinal column equipment comprises: reference configuration, by with respect to a plurality of pedicle screws space fix, pedicle screw is installed in patient's the adjacent vertebrae; And the device that is connected to reference configuration, this device is applicable to the installation anterior spinal prosthesis, wherein, reference configuration defines spinal prostheses forwardly and is attached to spatial relationship between the posterior spinal prosthesis of pedicle screw.

Spinal column equipment can also comprise positioning adapter, on this positioning adapter may be attached to a plurality of (for example at least 3) pedicle screw, positioning adapter comprises a pair of connecting device, each connecting device comprises a pair of arm, this to arm be installed in specific supraspinal a pair of pedicle screw and stretch out accordingly, these arms may be attached to this on the pedicle screw, wherein, utilize reference configuration to form connecting device, wherein, this device comprises dish implantation holder, this dish implantation holder is applicable to keeps anterior spinal prosthesis, and comprise that further Connection Element, this Connection Element are applicable to that dish is implanted holder to be fixed on the positioning adapter about reference configuration.

Positioning adapter may be attached to traction apparatus, and traction apparatus is applicable to that traction is attached with two vertebras of pedicle screw.

Description of drawings

Only show the present invention with reference to the accompanying drawings here by example.Pass through at length with reference to the accompanying drawings now, be stressed that, shown details only is as an example and just to the purpose of the detailed description that the preferred embodiments of the present invention are shown, and for the description of the most useful and easy understanding that is considered to principle of the present invention and notion aspect is provided.In this respect, do not attempt not illustrating than ultimate principle of the present invention understanding more detailed details, in conjunction with the accompanying drawings and describe, how a plurality of forms of the present invention realize it being conspicuous in practice.

In the accompanying drawings:

Fig. 1 is the axonometric chart of two vertebras, and wherein, pedicle screw is gone up in position, and positioning adapter is fixed on the pedicle screw;

Fig. 2 is the axonometric chart of positioning adapter and two traction apparatuss;

Fig. 3 A-D is axonometric chart and the top view that dish is implanted holder;

Fig. 4 is the top view of vertebra, and this vertebra has the dish that is connected to positioning adapter and implants holder;

Fig. 5 is the top view of vertebra, and this vertebra has the traction apparatus that the dish that is connected to positioning adapter is implanted holder and is positioned at the correct position place; And

Fig. 6 is the side view with two vertebras of the front discs prosthese that is in the appropriate position and posterior spinal prosthesis.

The specific embodiment

Before at least one embodiment of the present invention is explained in detail, know that application of the present invention is not limited to the structure and the arrangement details of elaboration in the following description or parts illustrated in the accompanying drawings.The present invention can be other embodiment that implement in many ways or realize.And, should be understood that the word and the term that adopt are for purpose of description here, and should not be considered to restriction.

With reference now to Fig. 1,, it illustrates the positioning adapter 10 that is attached to four pedicle screws 22, during pedicle screw 22 is anchored into two adjacent vertebrae, and for example L4 24 and L5 26.As is known to persons skilled in the art, at first screw 22 is placed in the pedicle of vertebral arch of vertebra.Pedicle screw 22 for example can be used to posterior spinal prosthesis is anchored to pedicle of vertebral arch.

Though in this non-limitative example of the application of positioning adapter 10, show four pedicle screws, for the successful execution of positioning adapter 10, minimum three for example the such anchoring element of pedicle screw is just enough.Attachment point from two vertebras limits the plane and connects two adjacent vertebras.

Positioning adapter 10 can comprise a pair of connecting device 12 and 14.Each connecting device can be shaped as the plain-straight-face flange with a pair of arm 28, and this stretches out accordingly to the spacing of arm 28 with pedicle screw 22.Arm 28 preferred long enoughs, thereby most any interval of adaptation screw 22.Selectively, can provide one group of positioning adapter 10, with the interval of any scope of striding across screw 22.In the head 30 that arm is inserted into screw 22, the arm 28 of positioning adapter 10 can be attached to vertebra.Because screw is disposed in its proper position, so present positioning adapter 10 is disposed in the proper position of the next stage that is used to perform the operation, the next stage of this operation is the traction of two vertebras.

Each vertebra has himself connecting device as shown in Figure 1.Can utilize reference configuration 16 to form connecting device 12 and 14, this reference configuration for example still is not limited to for example hole 16 of point, pivot or aperture.In a word, positioning adapter 10 is configured to be connected to pedicle screw 22 and has reference configuration 16 (also being become reference location point 16), is used for the front discs prosthese is carried out suitable layout and aligning with respect to posterior spinal prosthesis, as described in hereinafter.

With reference now to Fig. 2,, Fig. 2 is the side view that is attached to the traction apparatus that is in the appropriate position 32 of screw 22.Traction apparatus is well known in the art and can buys, for example by Synthes Spine, 1302 Wrights Line East, West Chester, the Distraction Forceps that PA 19380 makes with the hinged handle that is used for pedicle screw.The purpose of traction is interim exposed rear disk space, thereby is convenient to the transmission of diskectomy and dish implant.Fig. 2 illustrates the traction apparatus 32 that is assembled on the pedicle screw 22.Notice that positioning adapter 10 does not disturb the location or the function of traction apparatus 32.

After diskectomy and endplate preparation, can carry out next function of positioning adapter 10.With reference now to Fig. 3 A-3B,, these illustrate dish implant holder 46, and this dish implant holder 46 is used for artificial dish is inserted into intervertebral disc space, is provided at the freedom that moves in the work space of spinal column operation to the surgeon simultaneously.Dish implant holder 46 can comprise the handle 50 that is extended with proximal shaft 51.At pivot 52 places, distal shaft 55 can be pivotably attached to proximal shaft 51.Pivot 52 for example can be to allow proximal shaft 51 to connect with respect to the pin that distal shaft 55 moves freely.Selectively, pivot 52 can be for example to allow proximal shaft 51 to carry out the mobile ratchet of ratchet (ratcheted) with respect to distal shaft 55 to connect.Can provide pivot to connect, allow the axle of other degree to move more than one.Distal shaft 55 can comprise a pair of jaw 53.Jaw 53 can be setovered by spring, with normally closed, and can be by they are pushed or push so that its stretch out or, jaw 53 opened by more known handle or the cam opened in the field of anchor clamps, pliers or the like.Jaw 53 can tightly be clipped on artificial disc prosthesis or the implant 48 (also being become anterior prosthesis 48).

Anterior prosthesis 48 can still be not limited to articular prosthesis.Suitable joint anterior prosthesis is described in the U.S. Patent application 10/898,229 (corresponding to PCT application WO2005/084590) of Arnin etc., this application open by with reference to being included in here.WO2005/084590 has described a kind of endoprosthesis, comprising: first joint component is formed with recessed usually articular surface; And the second joint parts, being formed with the articular surface of common projection, this articular surface and recessed articular surface couple together with the joint, and each all has common smooth attaching surface for attachment to spine structure first and second joint component.

With reference now to Fig. 3 B-3D,, these illustrate the dish implant holder 46 in spinal procedure workspace.Spinal disc prosthesis or implant 48 may be attached to an end of dish implant holder 46, and handle 50 can be used to implant 48 is placed, guided and be pushed in the work space.Fig. 3 B illustrates and for example uses TLIF as known in the art (through neural root hole lumbar spinal fusion) operation that artificial dish is inserted into first step in the intervertebral disc space.Pivot 52 provides with respect to distal shaft 55 to the surgeon proximal shaft is swung the ability of about angle 54, thus the initial placement of convenient implant 48.The surgeon can use handle 46 to change angle 54 (Fig. 3 B, 3C and 3D) about pivot 52.

With reference now to Fig. 4.After the initial placement of implant 48, can utilize Connection Element 56 that positioning adapter 10 is connected to dish implant holder 46.Connection Element 56 will coil implant holder 46 and be fixed to positioning adapter 10.For example and without limitation, Connection Element 56 can comprise: the tube portion that the proximal shaft of confession dish implant holder 46 passes through; And flange portion, (Fig. 1) locates at reference location point 16, for example utilizes machanical fastener (for example pin, screw), and described flange portion is fixedly attached on the positioning adapter 10.The final location that Connection Element 56 limits with respect to the implant 48 of pedicle screw 22.Reference location point 16 is limited to the desirable relative localization between implant 48 and the screw 22.Implant 48 is provided and will be attached to the fusion of center of rotation of the spinal posterior implant of screw 22 with respect to the correct location of the implant 48 of screw 22.The correct load that can also be provided between anterior insertion and the rear portion insertion distributes.This distributes convenient load near normal range of moving and functional spinal unit.

Fig. 5 illustrates the work space of operation once more, wherein, for simplification device is described, from directly over only see L5.Traction apparatus 32, positioning adapter 10 and dish implant holder 46 are seen together, and positioning adapter 10 is connected at junction point 56 places with dish implant holder 46.

With reference now to Fig. 6.After inserting anterior prosthesis 48, posterior prosthesis 60 can be attached to pedicle screw 22.Fig. 6 illustrates has the anterior prosthesis 48 that relative to each other is in the respective correct place and two adjacent vertebrae of posterior prosthesis 60 according to an embodiment of the invention.In fact, according to embodiments of the invention, be connected (for example articular surface displacement) if artificial armor carries out the joint around the center identical with the rear portion implant, artificial dish will more effectively be worked.

In the United States Patent (USP) 7,011,685 of Arnin etc., suitable posterior prosthesis has been described, this patent open by with reference to being included in here.United States Patent (USP) 7,011,685 has described the spinal prostheses with single body, and this single body comprises the flexure that is positioned between first and second attachment members, wherein, the deflection of this flexure allows first attachment members is moved with respect to second attachment members.

Should know that of the present invention a plurality of features of describing in order to know also can be provided among the single embodiment combinedly in the context of each embodiment.On the contrary, for simplicity and of the present invention a plurality of features of in the context of single embodiment, describing also can be separated ground or provide with any suitable sub-portfolio.

Claims (8)

1. method that is used to insert spinal prostheses comprises:

Reference configuration is provided, described reference configuration with respect to a plurality of pedicle screws in the adjacent vertebrae that is installed in patient by the space fix;

Utilization is connected to the device of described reference configuration, inserts anterior spinal prosthesis; And

Posterior spinal prosthesis is installed to described pedicle screw, and wherein, described reference configuration defines the spatial relationship between described anterior spinal prosthesis and the posterior spinal prosthesis.

2. method according to claim 1 further comprises: before inserting described anterior spinal prosthesis, described adjacent vertebrae is drawn.

3. method according to claim 1, wherein, described reference configuration defines the path that be used to insert described anterior spinal prosthesis relevant with described pedicle screw.

4. spinal column equipment comprises:

Reference configuration, its with respect to a plurality of pedicle screws in the adjacent vertebrae that is installed in patient by the space fix; And

Be connected to the device of described reference configuration, described device is suitable for installing anterior spinal prosthesis, and wherein, described reference configuration defines described anterior spinal prosthesis and is attached to spatial relationship between the posterior spinal prosthesis on the described pedicle screw.

5. spinal column equipment according to claim 4 further comprises:

Positioning adapter, it can be attached to described a plurality of pedicle screw, described positioning adapter comprises a pair of connecting device, described each connecting device comprises a pair of arm, described arm stretches out corresponding to the interval that is installed in specific supraspinal a pair of pedicle screw, it is right that described arm may be attached to described pedicle screw, wherein, utilizes described reference configuration to form described connecting device;

Wherein, described device comprises dish implant holder, and described dish implant holder is suitable for the stationary forward spinal prostheses; And further comprise Connection Element, described Connection Element is applicable to respect to described reference configuration described dish implant holder is fixed to described positioning adapter.

6. spinal column equipment according to claim 5, wherein, described positioning adapter may be attached to traction apparatus, and described traction apparatus is suitable for drawing two vertebras that are attached with described pedicle screw.

7. spinal column equipment according to claim 5, wherein, described dish implant holder comprises handle and distal shaft, proximal shaft extends from described handle, and described distal shaft is pivotably attached to described proximal shaft at the pivot place, wherein, described distal shaft comprises a pair of jaw, and described jaw is suitable for fixing described anterior spinal prosthesis.

8. spinal column equipment according to claim 5, wherein, described Connection Element comprises: the described tube portion of tube portion that the part of the described dish implant holder of confession is passed through; And flange portion, at described reference configuration place, described flange portion can be fixedly attached to described positioning adapter.

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