CN101180012A

CN101180012A - Minimally invasive spine restoration systems, devices, methods and kits

Info

Publication number: CN101180012A
Application number: CNA200680015503XA
Authority: CN
Inventors: M·K·库伊珀; L·R·琼斯; A·V·菲纳佐; S·S-H·苏; J·A·奥尔特; R·J·布罗曼; C·阿比丁; M·J·芬克; H·尤安; P·伯格; M·A·赖利; M·K·斯通; D·斯廷森; M·奎斯特
Original assignee: Archus Orthopedics Inc
Current assignee: Archus Orthopedics Inc
Priority date: 2005-03-22
Filing date: 2006-03-22
Publication date: 2008-05-14

Abstract

The present invention discloses methods and devices for repairing, replacing and/or augmenting natural facet joint surfaces and/or facet capsules. A facet joint restoration device (410) of the invention for use in a restoring a facet joi nt surface comprises: a cephalad facet joint element comprising a flexible member (422) adapted to engage a first vertebrae and an artificial cephalad joint (426) ; and a caudad facet joint element comprising a connector adapted for fixation to a second vertebrae and an artificial caudad joint (428) adapted to engage the cephalad facet joint. In another embodiment, the invention discloses a facet joint replacement device for use in replacing all or a portion of a natural facet joint between a first vertebrae and a second vertebrae.

Description

Minimally invasive spine restoration systems, equipment, method and kit utility

Cross reference

The application requires denomination of invention that people such as Michael J.Funk submits on March 22nd, the 2005 U.S. Provisional Application No.60/664 for " Minimally Invasive Facet Replacement ", 441, people such as Michael J.Funk are the U.S. Provisional Application No.60/719 of " Prosthesis; Tools and Methods for Replacementof Natural Facet Joints with Artificial Facet Joint Surfaces " in the denomination of invention of JIUYUE in 2005 application on the 22nd, 427 and people such as Christopher Ralph be the U.S. Provisional Application No.60/752 of " Spinal Joint ReplacementSystems " in the denomination of invention of December in 2005 application on the 20th, 277 priority, the open of above-mentioned application is incorporated in this fully with for referencial use.

Technical field

The present invention relates to the equipment and the surgical method of all kinds disease that is used for the treatment of spinal column on the whole.More specifically, the present invention relates to be used for the treatment of several dissimilar Wicresoft's equipment, method, system and the kit utility of adjacent anatomical structures of facet joint, articuli intervertebrales and the spinal column of damage or pathological changes.

Background technology

Backache is a commonly encountered diseases, particularly in " back lumbar part " shown in Fig. 1 or waist sacrum (L4-S1) zone.In many cases, pain seriously limits people's Functional Capability and quality of life.Such pain can produce from various disorder of the vertebral column.By i or I, the facet of vertebral plate, spinous process, articular process or one or more vertebral bodys can be damaged, and makes vertebra connect or correct the aligning in the joint no longer each other.This can cause nonideal anatomical structure, activeness forfeiture and pain or uncomfortable.

In many cases, the vertebra facet joint can damage by wound or by the various diseases process.These lysises comprise osteoarthritis, ankylosing spondylitis spondylolysis and degenerated spine slippage.And facet joint is considered to the potential cause of patient's cervicodynia of ACTS.Except the pain from facet self, this damage of facet joint usually can cause final degeneration, scratch or the wearing and tearing of facet joint, finally causes compression of nerves, and be also referred to as and turning round nerve damage, or nerve compression or pinching.The result is further pain, anatomical structure misalignment and corresponding activeness forfeiture.Do not have at facet joint compression of nerves can occur under the situation of the anatomy of disease or disease or function performance, for example because intervertebral disk hernia yet.

Require to repair and/or degeneration, disease and/or dysfunction that many disorder of the vertebral column of displacement intervertebral disc (comprising the current many disorder of the vertebral column that can treat by traction and/or dynamic stability between spinal fusion, sour jujube) usually can be traced back to facet joint.The change of the facet joint biomechanics that is produced by the anatomy of disease or function performance can influence the load and the biomechanics of intervertebral disc unfriendly, finally causes degeneration, damage and/or the dysfunction of intervertebral disc.

One type of the conventional therapy of facet joint disease is spinal stabilization, is also referred to as interbody stabilizer.Interbody stabilizer prevents the relative motion between the vertebra of spinal column ideally.By preventing motion, can reduce pain.Stable can the realization by the whole bag of tricks.A kind of antihunt means are spinal fusion.The vertebra that another kind of antihunt means are fixation of any number is to stablize and to prevent the motion of vertebra.In addition, under compression that intervertebral disc and/or facet joint take place or sagging situation, the internist can utilize fusion device (for example pedicle screw and lever system, or between vertebral body fusion cage) to promote or " picking-up " compressing position, obtains more normal anatomy ideally at interval between vertebral body.

Known various device is used for fixing the rumpbone of spinal column and/or adjacent vertebrae, and the connection device that is used for fixing is well known in the art, comprise: the U.S. Patent No. 6 of Ganem, 290,703, relate to the equipment (Device for Fixing the Sacral Bone to Adjacent VertebraeDuring Osteosynthesis of the Backbone) that is used between the bone joint aging time of spine, rumpbone being fixed to adjacent vertebrae; Harkey, people's such as III 6,547,790 relate to orthopedic rod/plate locking mechanism and surgical method (Orthopaedic Rod/Plate LockingMechanisms and Surgical Methods); People's such as Metz-Stavenhagen 6,074,391 relate to the receiving unit (ReceivingPart for a Retaining Component of a Vertebral Column Implant) of the retention feature that is used for spinal implant; 5,569,247 of Morrison relates to enhancing variable angle bone bolt (Enhanced VariableAngle Bone Bolt); People's such as Morrison 5,891,145 relate to multi-axial screws (Multi-Axial Screw); 6,090,111 of Nichols relates to the equipment (Device for Securing Spinal Rods) that is used for fixing rods; People's such as Ralph 6,451,021 relate to the multiaxis pedicle screw (Polyaxial Pedicle ScrewHaving a Rotating Locking Element) with spin locking element; People's such as Richelsoph 5,683,392 relate to and are used for the fixed many planes of bone locking mechanism (Multi-Planar Locking Mechanismfor Bone Fixation); 5,863,293 of Richelsoph relates to spinal implant fixation kit (Spinal Implant Fixation Assembly); 5,964,760 of Richelsoph relates to spinal implant fixation kit (Spinal Implant Fixation Assembly); People's such as Richelsoph 6,010,503 relate to locking mechanism (Locking Mechanism); 6,019,759 of Rogozinski relates to the multidirectional securing member or the adhesion equipment (Multi-Directional Fasteners or Attachment Devices for SpinalImplant Elements) that are used for the spinal implant element; People's such as Schafer 6,540,749 relate to bone screw (BoneScrew); 6,077,262 of Schlapfer relates to posterior spinal implant (Posterior SpinalImplant); People's such as Schlapfer 6,248,105 relate to the equipment (Device for Connecting a Longitudinal Support witha Pedicle Screw) that is used to connect longitudinal bracing spare and pedicle screw; People's such as Selvitelli 6,524,315 relate to orthopedic rod/plate locking mechanism (Orthopaedic Rod/Plate Locking Mechanism); People's such as Sherman 5,797,911 relate to multiaxis bone screw assembly (Multi-Axial Bone Screw Assembly); People's such as Sherman 5,879,350 relate to multiaxis bone screw assembly (Multi-Axial BoneScrew Assembly); 5,885,285 of Simonson relates to spinal implant coupling assembling (Spinal Implant Connection Assembly); 5,643,263 of Simonson relates to spinal implant coupling assembling (Spinal Implant Connection Assembly); People's such as Yuan 6,565,565 relate to the equipment (Device forSecuring Spinal Rods) that is used for fixing rods; People's such as Biederman 5,725,527 relate to anchoring element (Anchoring Member); People's such as Biederman 6,471,705 relate to bone screw (Bone Screw); People's such as Errico 5,575,792, relate to the stretching, extension hook and the multiaxis coupling element equipment (Extending Hook and PolyaxialCoupling Element Device for Use with Top Loading Rod FixationDevices) that use with top dress bar fixing device; People's such as Errico 5,688,274 relate to the spinal column with single center-pole and claw hook and implant equipment (Spinal Implant Device having a Single Central Rod andClaw Hooks); People's such as Errico 5,690,630 relate to multiaxis pedicle screw (Polyaxial Pedicle Screw); 6 of Ganem, 022,350, relate to bone fixation apparatus, be particularly useful between the bone joint aging time of spine, being fixed to rumpbone (Bone Fixing Device, inParticular for Fixing to the Sacrum during Osteosynthesis of theBackbone); People's such as Puno 4,805,602 relate to pedicle screw and lever system (Transpedicular Screw and Rod System); People's such as Puno 5,474,555 relate to spinal implant system (Spinal Implant System); 4,611,581 of Steffee relates to the device (Apparatus for Straightening SpinalColumns) that is used to align spinal column; People's such as Asher 5,129,900 relate to spinal column maintenance method and apparatus (SpinalColumn Retaining Method and Apparatus); People's such as Krag 5,741,255 relate to spinal column fixing device (Spinal Column Retaining Apparatus); 6,132,430 of Wagner relates to spinal fixation system (Spinal Fixation System); People's such as Yuan U.S. Patent Publication No.2002/0120272 relates to the equipment (Device for Securing Spinal Rods) that is used for fixing rods.

Another type of conventional spinal treatment is a decompressive laminectomy.Cause at spinal stenosis (or other disorder of the vertebral column) under the situation of ridge pipe and/or intervertebral foramina (spinal nerves leaves spinal column by it) constriction and neural pinching, compressing and/or pain generation, cause the tissue (one or more) (hard and/or soft tissue) of constriction may need cut and/or removal.Relate to cut-out or whole vertebral plates and its hetero-organization and be called as decompressive laminectomy with the process of alleviating nerve compression.For example, relate to vertebrae plate resection surgical procedure (Laminectomy Surgical Process) referring to the U.S. Patent No. 5,019,081 of Watanabe; 5,000,165 of Watanabe relates to spinal column mast fixed system (Lumbar Spine Rod FixationSystem); With people's such as Spann 4,210,317, relate to the device (Apparatus for Supporting and Positioning the Arm andShoulder) that is used to support with registration arm and shoulder.The degree that depends on decompression, for example facet joint and/or connective tissue (being removed structure or cut with near operative site because these tissues are connected to) can cause the unstability of spinal column to remove supporting construction, the supplemental support that certain form must be arranged, for example above-mentioned spinal fusion.

Summary of the invention

Although spinal fusion has become " golden standard " of the many disorder of the vertebral column of treatment, comprise such as neurological associated conditions, intractable pain, unstable spine and deciding and/or degeneration of intervertebral disc, but wish by providing the stable or equipment that keeps of the activity that makes the movable section of spinal column and system to reduce and/or avoiding the spinal fusion program (is included but not limited to facet joint reparation or displacement, intervertebral disc replacement or enlargement of lymph nodes displacement, the implantation of sour jujube interbody spacer thing and/or dynamic stability equipment, and/or facet injection) needs.

The present invention recognizes, degeneration, disease and/or handicapped certain mode of finally needing operating many disorder of the vertebral column can trace back to facet joint their early stage (one or more).And the spinal fusion process finally needs further surgical intervention.For example, the degeneration of facet joint can cause the non-natural application of load of intervertebral disc, finally causes intervertebral disk injury, comprises ring uplift and/or wearing and tearing.Similarly, the degeneration of facet joint and/or dysfunction can cause vertebral body slip relative to each other potentially, cause the compressing of spondylolisthesis and/or nerve fiber potentially.In addition, the degeneration of facet joint self utmost point pain that can become causes additional intervention procedure, for example facet injection, nerve block, facet removal, facet replacement and/or spinal fusion.Thereby, if the degeneration facet joint can be treated in early days, then can avoid needs, and can slow down, end even reverse for example damage of oneself generation of the intervertebral disc of therapentic part (and the intervertebral disc of other spinal column positions and/or facet) of spine structure the bigger process of additional wound.

In addition, the present invention has on the Most patients crowd anatomy of adaptation transmutability to treat the ability of all vertebrae positions, comprises L3-L4, L4-L5 and L5-S1.

Various embodiments open here and that discuss can be used for recovering and/or keeping activity or activeness and/or the movable quality that keeps or the change level of state of the vertebral body of treatment.Depend on the degree of facet joint degeneration and the therapeutic scheme of selection (one or more), the quality or the state of might be on the movable section of whole spinal column, on one or more facet joints, reactivating fully, or recover facet joint (one or more) and go up the needs of limited activity to reduce or to avoid the movable section of spinal column is further treated.

The facet joint restorer that is used to recover the facet joint surface comprises: a side facet joint element, and it comprises that (1) is suitable for engaging flexible member and (2) artificial head side joint of first vertebra; With tail side facet joint element, it comprises that (1) is suitable for being fixed to the artificial tail side joint that adapter on second vertebra and (2) are suitable for engagement head side facet joint.In some embodiments, flexible member is suitable for engaging the vertebral plate of first vertebra.In other embodiments, a side facet joint also comprises plate, and this strip has and is suitable for the anchoring mechanism that engages with the vertebral plate of first vertebra.Anchoring mechanism can be any suitable mechanism, for example comprises being selected from one or more in the group that tooth, ridge, caking, sawtooth, granulation surface, bar, screw and spike form.In some embodiments, a side facet joint element can be further adapted for and comprise that second anchoring mechanism is to be used for that a side facet joint element is fixed to first vertebra.In addition, adapter can be suitable for being provided to pedicle of vertebral arch fixing of second vertebra.In some embodiments, it is desirable to second anchoring mechanism and further comprise the inside growing surface of bone.It will be understood by those of skill in the art that in other other embodiments equipment can be configured to replace the tissue of removing from facet joint, for example in the cut place of facet joint.In other other embodiments, equipment is suitable for recovering or keeping the activity or the activeness of facet joint.In addition, a side facet joint element can be suitable for conforming to relative match surface profile with one surface in the tail side facet joint element.For example, artificial tail side joint is the tail side cup with recessed surface.In some embodiments, flexible member is a flexible cable.Flexible cable can by circumference of cannon bone around and/or can be further adapted for connection locking device.Can use the spring washer on the surface that is suitable for engaging first or second vertebra if necessary in some embodiments.In addition, it is desirable to utilize in other embodiments the extending plate supporting member side facet joint element during implanting that is suitable for engaging lamina surface.

The facet joint replacing apparatus that is used to replace the natural facet joint of all or part between first vertebra and second vertebra comprises: the first tail side facet joint element and having is suitable for first side facet joint element of the retaining element that engages with the vertebral plate or the spinous process of first vertebra, and the first tail side facet joint element comprises and is suitable for the artificial tail side faceted surface that is fixed to the second epicentral first tail side-connector and is suitable for engaging with a side facet joint element.In some embodiments, retaining element is a flexible cable.Second the side facet joint element and first cross bar can be suitable for first side facet joint element is connected to second side facet joint element in some embodiments.In other other embodiments, the second tail side facet joint element and first cross bar are suitable for the first tail side facet joint element is connected to the second tail side facet joint element.It will be appreciated by those skilled in the art that the second tail side facet joint element and second cross bar that are suitable for the first tail side facet joint element is connected to the second tail side facet joint element need in other other embodiments.Equipment of the present invention can be further adapted for and comprise the vertebral plate clip.In some embodiments, it is desirable to the vertebral plate clip and be suitable for engaging first side facet joint element.In other embodiments, the vertebral plate clip also comprises the tooth that is used to engage lamina surface.The vertebral plate clip can also be made up of first parts and second parts that are suitable for adjustable ground joint vertebral plate.In some embodiments, first side facet joint element is suitable for extending from the vertebral plate clip.In addition, in other embodiments, it is desirable to artificial tail side faceted surface and be further adapted for and comprise tail side cup.In some cases, first side facet joint element can be suitable for rotatably engage fixation elements in some embodiments.In other other embodiments, it is desirable to flexible cable by circumference of cannon bone around.The facet replacement equipment of an embodiment can be further adapted for and comprise extending plate, and this extending plate is suitable for engaging lamina surface with supporting member side facet joint element.

The spinal function unit recovery system that vertebrae position place in spinal column is used in the spinal function unit comprises: first and second side facet joint elements; The first and second tail side facet joint elements, it comprises adapter that is suitable for fixing vertebral body and the artificial tail side joint that is suitable for engagement head side facet joint; Cross bar, it is suitable for engaging at the first end place the first tail side facet joint element and engages the second tail side facet joint element at the second end place; And artificial intervertebral disc.In some embodiments of the present invention, anchor is a flexible cable.Side facet joint may further include plate, and this strip has the anchoring mechanism that is suitable for engaging vertebral plate.Anchoring mechanism comprises the one or more anchoring mechanisms in the group that is selected from tooth, ridge, caking, sawtooth, granulation surface, bar and spike composition in other other embodiments.Plate can be further adapted for and comprise the threaded rod that is suitable for and is configured to engage the screwed hole of support member.Described equipment also can be by being suitable for forming natural material, pottery, metal or the polymer of described equipment or their combination is constructed.In the operation of embodiment, described equipment recovers the unitary biomechanics operation of spinal function.Degeneration or pathological tissues in the described equipment therapeutic goal spinal function unit.In some embodiments, described equipment is suitable for recovering or keeping unitary activity of target spinal function or activeness.In some cases, a side joint is suitable for conforming to relative match surface profile with one surface in the tail side joint.In other cases, a side joint is suitable for conforming to relative match surface profile with one surface in the tail side joint.Flexible cable can be suitable for connection locking device in some embodiments.In other other embodiments, described system further comprises the vertebral plate clip.The vertebral plate clip can be suitable for engaging cross bar.In addition, the vertebral plate clip can comprise the tooth that is used to engage lamina surface.In some embodiments, the vertebral plate clip can further be made up of first parts and second parts that are suitable for adjustable ground joint vertebral plate.Side joint is suitable for extending from the vertebral plate clip.In addition, the vertebral plate clip can be suitable for engaging cross bar.In some embodiments, first side joint is different from the direction of second side joint to the second tail side joint to the direction in the first tail side joint.In other other embodiments, the vertebral plate clip can be regulated along the length that is parallel to the spinal column centrage.Identical with other embodiments, artificial tail side joint can be suitable for forming tail side cup.In other other embodiments, artificial head side joint rotatably engages flexible cable; Flexible cable can by circumference of cannon bone around.In some cases, spring washer can be used to engage the surface of vertebral body.Further embodiment can be suitable for engaging extending plate, and this extending plate engages lamina surface with supporting member side joint component during implanting.

Being used for recovering the unitary kit utility of spinal function at the vertebrae position place of spinal column comprises: first and second side facet joint elements; The first and second tail side facet joint elements, it comprises adapter that is suitable for fixing vertebral body and the artificial tail side joint that is suitable for engagement head side facet joint; Cross bar, it is suitable for engaging at the first end place the first tail side facet joint element and engages the second tail side facet joint element at the second end place; And artificial intervertebral disc.

All publications and the patent application mentioned in this description are comprised in here by reference, just as pointing out that particularly and individually each independent publication or patent application are included in here by reference.

Description of drawings

In the appended claims book, set forth novel feature of the present invention especially.The better understanding that will obtain the features and advantages of the present invention with accompanying drawing that the following specifically describes by reference illustrated example embodiment has utilized principle of the present invention in said embodiment, in the accompanying drawings:

Fig. 1 is the side view of normal person's spinal column;

Fig. 2 A is the vertical view of normal person's lumbar vertebra;

Fig. 2 B is the side view that forms unitary two vertebral bodys of spinal function;

Fig. 2 C forms the rearview of unitary two vertebral bodys of spinal function and the coronal plane that passes facet joint is shown;

Fig. 2 D is the sectional view of the single facet joint in the spinal column that obtains along coronal plane;

Fig. 2 E is the back outer side elevation view of vertebra of people's spinal column;

Fig. 3 is the planar perspective view of the anatomy of human body;

Fig. 4 has described an embodiment according to facet replacement equipment of the present invention;

Fig. 5 shows according to bilateral facet replacement of the present invention system;

Fig. 6 A shows two parts of facet replacement system;

Fig. 6 B-C shows the combination of two parts shown in Fig. 6 A from different perspectives;

Fig. 7 A-C shows according to the facet replacement equipment after the implantation of the present invention from backsight and side-looking angle;

Fig. 8 A-D shows the facet replacement equipment after the implantation of another embodiment according to the present invention from backsight and side-looking angle;

Fig. 9 A-B is from side-looking and overlook the facet replacement equipment that shows the another embodiment according to the present invention;

Figure 10 A-C shows the facet replacement equipment of Fig. 9 A-B after the implantation from backsight and side-looking;

Figure 11 shows the bilateral facet replacement system that has cross bar;

Figure 12 A-B shows the bilateral facet replacement system that has cross bar of another embodiment according to the present invention;

Figure 12 C-D shows the facet replacement system after the implantation from different perspectives;

Figure 13 A-B shows has tail side cup, the facet replacement system of cross bar and vertebral plate clip;

Figure 13 C-D shows the clip portion of the system after the implantation;

Figure 14 A shows the facet replacement system according to alternate embodiments, and wherein the vertebral plate clip has tooth;

Figure 14 B-D shows the facet replacement system of Fig. 1 4A after the implantation from backsight and side-looking;

Figure 15 A-E shows the facet replacement system according to alternate embodiments after the implantation from various angles;

Figure 16 A shows the facet replacement system according to alternate embodiments, and wherein the vertebral plate clip has the modularity clip assembly;

Figure 16 B-C shows the facet replacement system of Figure 16 A after the implantation from various angles;

Figure 17 A-C shows according to the facet replacement system of alternate embodiments and the system after the implantation from various angles;

Figure 18 A shows the facet replacement system according to alternate embodiments, and wherein the vertebral plate clip is adjustable c clevis;

Figure 18 B-C shows the facet replacement system of Figure 18 A after the implantation from various angles;

Figure 19 A shows the facet replacement system according to alternate embodiments, and wherein the vertebral plate clip has adjustable lever;

Figure 19 B-C shows the facet replacement system of Figure 19 A after the implantation from various angles;

Figure 19 D shows the facet replacement system according to alternate embodiments, and wherein the vertebral plate clip has adjustable lever;

Figure 19 E shows the facet replacement system of Figure 19 D after the implantation;

Figure 20 A shows the facet replacement system according to alternate embodiments, and wherein at least a portion with adjustable lever and transverse arm of vertebral plate clip can directly be anchored in the side vertebra;

Figure 20 B-D shows the facet replacement system of Figure 20 A after the implantation from various angles;

Figure 21 A shows the facet replacement system according to alternate embodiments, and wherein the vertebral plate clip has bindiny mechanism;

Figure 21 B-D shows the facet replacement system of Figure 21 A after the implantation from various angles;

Figure 22 A shows the facet replacement system according to alternate embodiments, and wherein the vertebral plate clip has the forward direction hook portion that is used to engage a vertebral body part;

Figure 22 B-D shows the facet replacement system of Figure 22 A after the implantation from various angles;

Figure 23 is the side view of a side of facet replacement system;

Figure 24 A is the perspective view of cross bar installed part;

Figure 24 B-C shows the cross bar installed part of Figure 24 A after the implantation from backsight and side-looking;

Figure 25 A is the vertical view according to of the present invention side interconnect equipment;

Figure 25 B-D from backsight, overlook the cross bar installed part that shows Figure 25 A after the implantation with side-looking;

Figure 26 is the perspective view of the special suitable well facet joint formation system that is used in combination with artificial intervertebral disc displacement (not shown);

Figure 27 A-H shows the parts through vertebral plate facet joint forming head side tectonic system;

Figure 28 A-B show show its structure and operation through vertebral plate facet joint forming head side tectonic system;

Figure 29 A-C show show its structure and operation according to alternate embodiments through vertebral plate facet joint forming head side tectonic system;

Figure 30 A-C show show its structure according to alternate embodiments through vertebral plate facet joint forming head side tectonic system;

Figure 31 A-B shows and is fit to the plate that uses with fixed support described herein system;

Figure 32 A-C shows the cross section of alternate side support fixation system;

Figure 33 A-F shows the various views of the fixing device that is suitable for use in the sacrum position of bone;

Figure 34 A-B show the use that comprises spring washer through the vertebral plate fixed system;

Figure 35 A-B shows the intervertebral disc replacement equipment that has the facet replacement parts; With

Figure 36 A-B shows the intervertebral disc replacement equipment that has the facet replacement parts according to alternate embodiments.

The specific embodiment

The present invention relate on the whole be suitable in the implant into body with recover, increase and/or displacement comprise bone and cartilage sclerous tissues, soft tissue and/or connective tissue implantable devices, device or mechanism and be used for the treatment of damage or the disease for example anatomy of disorder of the vertebral column or the system of function performance.In some cases, implantable devices can comprise body part or the structure that is designed to replace disappearance, that remove or excision.Implantable devices, device or mechanism are configured to make described equipment to be formed by the part of forming described equipment alone or in combination, element or parts.Implantable devices can be configured to also make that one or more elements or parts form to realize physiology, operation or the function result of expection, makes described parts finish equipment.Function result can comprise that the surgery in joint recovers and Functional Capability; The Functional Capability in control, restriction or change joint; And/or by preventing the Functional Capability in joint motion elimination joint.The part of described equipment can be configured to replace or increase existing anatomical structure and/or implantation equipment, and/or is used in combination with the excision or the removal of existing anatomical structure.

Equipment of the present invention is designed to and people's as shown in fig. 1 spinal column 10 interacts, and described spinal column is made up of a series of 33 the stacked vertebras 12 that are divided into five zones.Neck region comprises seven vertebras, is called as C1-C7.The territory, regio pectoris comprises 12 vertebras, is called as T1-T12.The territory, lumbar region comprises five vertebras, is called as L1-L5.Sacrum area is made up of five normal vertebras that merge, and be called as S1-S5, and tailbone region comprises four fused vertebrae, is called as Co1-Co4.

The example of a vertebra has been shown in Fig. 2 A, and this figure has described the plan view from above of normal person's lumbar vertebra 12.Although people's lumbar vertebra position changes slightly, vertebra has many common traits.Each vertebra 12 comprises vertebral body 14.Two short bone projections (being pedicle of vertebral arch 16,16 ') are extended the vertebral arch 18 that limits vertebral foramen 19 to form from each side direction dorsal part of vertebral body 14.

In the rear end of each pedicle of vertebral arch 16, vertebral arch 18 flare ups are called as the wide hone lamella of vertebral plate 20.Vertebral plate 20 merges each other to form spinous process 22.Spinous process 22 provides muscle to be connected with ligament.20 seamlessly transit from pedicle of vertebral arch 16 to vertebral plate owing to the formation of a series of projections is interrupted.

Ground of two transverse process 24,24 ' every sides is extruded from the pedicle of vertebral arch 16 and the joint side direction of vertebral plate 20.Transverse process 24,24 ' serves as muscle and is attached to lever on the vertebra 12.Four articular processes promptly dash forward 28,28 ' down for two upward prominent 26,26 ' and two, and also the joint from pedicle of vertebral arch 16 and vertebral plate 20 raises.Superior articular process 26,26 ' is the sharp oval hone lamella that upwards raises on each side of vertebra, and descends prominent 28,28 ' to be the oval hone lamella that stretches out on each side downwards.Also referring to Fig. 2 B and 2D.

Upper and lower articular process 26 and 28 all has the nature bone structure that is called as facet.Superior articular facet 30 is upward to the inboard, and inferior articular facet 31 (referring to Fig. 2 B-E) is downwards in the face of the outside.Punctual when 12 pairs of adjacent vertebras, be stamped smooth articular cartilage and the facet 30 that coats by ligament and 31 interlockings to form facet joint 32.Facet joint is the apophyseal joint with loose capsule and synovial membrane lining.

As mentioned above, facet joint 32 is made up of last facet and following facet.Last facet is formed by the vertebrae position under the joint 32, and down facet is formed in the vertebrae position on the joint 32.For example, in the L4-L5 facet joint shown in Fig. 2 B, the last facet in joint 32 by the bone structure on the L5 vertebra (promptly, a upper joint surface and a support bone 26 on the L5 vertebra) form, and the following facet in joint 32 is formed by the bone structure on the L4 vertebra (that is, a surface of the hypozygal on the L4 vertebra and a support bone 28).Change according to the position of vertebral body with respect to the angle that the centrage of spinal column forms by the facet joint between last facet and following facet along spinal column 10 (Fig. 1).Facet joint self does not mainly support axial load alone, unless spinal column is in straight position (lordosis).The direction that it will be understood by those of skill in the art that the facet joint of specific a pair of vertebral body changes from the thoracic vertebra to the lumbar vertebra significantly, to adapt to the ability of joint opposing flexion-extension, lateral thrust and rotation.

Slip between the intervertebral disc 34 operation vertebras 12 between each adjacent vertebrae 12 (have and in Fig. 2 B, C, E, be shown as 14,15 stacked vertebral body).The structure of vertebra 12 and arrangement thereby permission vertebra 12 are relative to each other done the motion of certain limit.Fig. 2 E shows the back outer side elevation view of vertebra 12, further shows the curved surfaces of superior articular facet 30 and the raised structures of the following facet 31 that is suitable for mating with relative superior articular facet.As mentioned above, the position of following facet 31 and last facet 30 changes the expection bio-mechanical property with the zone of realizing spinal column on specific vertebral body.

Thereby, overall spinal column comprises a series of spinal column functional units, the movable section that described spinal function unit is made up of two adjacent vertebral bodies (for example 14 of Fig. 2 B, C, E, 15), intervertebral disc (for example 34 of Fig. 2 B, C, E), related ligament and facet joint (for example 32 of Fig. 2 D).Referring to Posner, IDeng people's " biomechanical analysis of the clinical stability of lumbar vertebra and waist sacral ", Spine, 7:374-389 (1982).

As discussed previously, natural facet joint, for example facet joint 32 (Fig. 2 B-D) has last facet 30 and following facet 31 (shown in Fig. 2 B, C, the E).In anatomical terms, the last facet in joint is formed by the vertebrae position under the joint, because it is anatomically more near people's coccyx or foot thereby can be called as " tail side " part of facet joint.The following facet of facet joint is formed by the vertebrae position on the joint, because it is anatomically more near people's head thereby be called as " side " part of facet joint.Thereby the equipment of in use replacing natural facet joint tail side part (that is last facet 30) can be called as " tail side " equipment.Similarly, the equipment of in use replacing the rostral components (that is following facet 31) of natural facet joint can be called as " side " equipment.

It will be understood by those of skill in the art that accurate dimension that the surgeon may be difficult to determine that implantable devices is required and/or shape are up to the actual receiving equipment that is ready to of operative site.Under these circumstances, the surgeon wishes to have at the intra-operative rapid deployment a series of equipment and/or the part of appliance of different size and/or shape usually.Thereby the embodiment of spinal column equipment of the present invention comprises configurable and adaptable modularized design.In addition, various embodiments disclosed herein also can form " kit utility " or the system of modular member, and described modular member can be assembled on the spot to produce patient's specified scheme.It will be understood by those of skill in the art that because imaging technique improves the mechanism's (for example software tool) that is used for the interpretation image improves, utilize patient's ad hoc structure of these notions before operation, to be configured or to make.Thereby, for patient's particular device provides pre-configured integrally formed parts within the scope of the invention.

Equipment of the present invention is to can be configured to make that the implantable devices that forms is selected and be positioned to meet specific anatomical structure or the expection surgical outcome.Can during implantation or revisional operation, selecting the adaptation aspect of embodiments of the present invention for the surgeon provides customization.The adaptability of this equipment and system also provides the adjusting of parts to guarantee meeting expection anatomical orientation or surgical outcome best during implant surgery.The relation that adapts between modularized equipment permission various parts of adjusting and the parts of the present invention.An example of the relation between parts and the parts is the various angular relationships between anchoring device and the equipment for the treatment of anchoring.Other examples of the adaptability of modularized equipment of the present invention as following more specifically as described in.Configurability can be considered to the selection of the specific dimensions of parts, and this selection forms the implantable devices of " customization next to the shin " with the miscellaneous part size Selection.So adaptability can refer to being implanted into and regulating single parts at position range in such a way makes to be that single patient is finely tuned " customization next to the shin " equipment.To be modular, configurable, adaptable spinal column equipment of the present invention and system allowing the surgeon to change size, direction and relation between each parts of equipment to meet patient's specific needs to final result during the actual surgery.

In order to prepare to be used to implant the anatomical structure of equipment disclosed herein and system, need to change or remove anatomical structure from the patient.For example, the part of a common ligament (such as capsular ligaments, anterior longitudinal ligament, interspinal ligaments and/or ligamenta flava) and a side and/or tail side vertebra (comprising down/go up facet or its part) can be changed or remove.Alternately, so low wound and/or minimally invasive surgical tools and technology can be provided, wherein, described surgical technique and tools and technology can limit the needs to the excision and/or the change of this anatomical structure, this allows maintenance natural anatomic feature better ideally, described feature can (1) stabilizing spine, reduce the load that stood by facet replacement equipment thus ideally, and/or (2) shares load with the facet joint replacing apparatus in the supporting physiological stress.

In order to understand configurability of the present invention, adaptability and operating aspect, helpful is the anatomy benchmark of understanding health 50, and its equipment and position component thereof and operation are described with respect to described anatomy benchmark.In anatomy, use three anatomy planes to describe human body and the intravital structure of people usually: axial plane 52, sagittal plane 54 and coronal plane 56 (referring to Fig. 3).In addition, understand the operation of equipment and equipment better with respect to tail side direction 60 and/or a side direction 62.Be positioned at the intravital equipment of body dorsally 70 (or backward) orientation make the placement of equipment or operation towards the back or the rear portion of health.Alternately, equipment 72 (or onwards) location makes the placement of equipment or the operation front portion towards health ventrally.The various embodiments of spinal column equipment of the present invention and system are configurable and variable with respect to single anatomy plane or with respect to two or more anatomy planes.For example, parts can be described as and be positioned at single plane and have adaptability about single plane.For example, anchoring device can be positioned in the desired location and can adapt between the position or move in position range many with respect to axial plane.Similarly, various parts can comprise different size and/or shape so that adapt to different patient's sizes and/or the expection load.

Return Fig. 2 D, for example to the small part cross section, having described vertebral body 14 and in coronal plane 56, having described facet joint 32 along sagittal plane 54.Should be appreciated that the position of particular joint changed in the direction of facet joint 32 in any plane of health was according to spinal column, this example only is provided for illustrative purposes.

Facet joint 32 is formed by superior articular facet 30 and inferior articular facet 31.Inferior articular facet 31 has a side faceted surface, and superior articular facet 30 has tail side faceted surface.When healthy and just often, these surfaces all have the localized joint of contiguous faceted surface and connect the motion of cartilage layers with raising facet joint 32 in operation.Except the tail side faceted surface and a side faceted surface that comprise relative articular surface, superior articular facet 30 and inferior articular facet 31 all can have additional surface on the side of facet.Facet capsule 86 also is provided, and it is communicated with around facet joint 32 and with each surface on the side of superior articular facet 30 and inferior articular facet 31.Anatomy or function in disease show the place that causes disorder of the vertebral column, and facet joint degeneration can take place, and it comprises that joint of facet joint connects the wearing and tearing on surface.Usually, the peripheral cortex ring in joint is unaffected, perhaps is subjected to very little influence.If the facet hypertrophy is arranged, the effect of the quality of cortical bone and hyperosteogeny can make facet bigger than normally when the facet degeneration.When facet began to wear and tear, the unitary biomechanics of spinal function was changed, and this can cause the further damage and the pain of facet joint.And, such biomechanics changes the integrity that can damage the unitary remainder of spinal function, and cause disc degeneration and damage, the further degeneration and the damage of facet joint, spondylolisthesis and/or disc height reduce/change, and the potential appearance of spinal stenosis (all these will not occur over just affected spinal column position, and also occur in other spinal column positions).

Fig. 4 has described a kind of embodiment according to facet replacement equipment of the present invention.This equipment is the artificial facet joint replacing apparatus 410 that is configured to replace the part of natural facet joint.Equipment 410 comprises retaining element 412 and 422, and described retaining element is connected to the tail side of the natural facet joint of support and the corresponding spinal structure of cephalic region spare with equipment 410.In this embodiment, the tail side component of equipment 410 comprises screw or the bar as retaining element 412, its be connected in the pedicle of vertebral arch of tail pleurocentrum or near.Adjustable connector 414 is connected to artificial tail side joint 428 with the pedestal 416 of retaining element 412, thus allow along and/or regulate with respect to retaining element 412 and/or rotate artificial tail side joint 428 around one or more axles.Ideally, this structure be suitable for and be configured to allow by facet joint element and retaining element around and/or carry out successive adjusting along the relative adjustable extent that turns over of a plurality of disalignments up to the limitation of motion that is provided by limit stops (if any).But in other embodiments, the quantity of rotating shaft can be limited, and can only allow to move in the mode of discrete increment.In various embodiments, the facet joint element can with respect to retaining element inwards, towards the outside, move up and/or down.Side retaining element 422 comprises cable, and described cable for example can fix by vertebral plate or spinous process (Fig. 2 A-D, 22) by using anchor 424.Ideally, the use of flexible cable allows to change the orientation of cable with respect to artificial head side joint 426.For example, the surgeon may wish to make opening by vertebral plate and/or spinous process, and this constant intensity for anchor is best, but can not extend along the predetermined longitudinal axis in artificial head side joint 426.Under these circumstances, opening can have infinite variability with respect to the actual direction of the desired location in artificial head side joint, and this can easily be adapted to by flexible cable.Ideally, cable contacts tractive artificial head side joint with the intimate of a pleurocentrum, thus with arthrodesis to vertebral body and make joint support loading (if necessary) and be convenient to fixing and/or bone inwardly grows in the joint immediately.For directed artificial head side joint correctly, the surface of a pleurocentrum can make when artificial head side joint closely contacts with target vertebra surface by preform, it and preformed surperficial the coupling, thereby occupy desired location and/or direction.The artificial head side joint of a series of different sizes and/or shape alternately, can be provided.Side support member 426 is connected to artificial head side joint, and support member 426 has the apparent surface interactional surperficial 427 who is suitable for artificial tail side joint 428.If necessary, the side support member that a series of difformities, size and/or direction and/or length can be provided is to adapt to different target, comprise with respect to retaining element and change bearing height/direction to adapt to different load condition owing to other surgical interventions (that is, reparation, enlargement of lymph nodes displacement, dynamic stability, sour jujube interbody spacer device and/or phase ortho position fusion device are replaced, encircled to artificial intervertebral discs identical or other spinal column positions).Artificial tail side joint is configured to have surface 429, and this surface receives the surface 427 of a side support member 426.Thereby for example, the protruding/recessed surface that forms coupling is so that the motion of each parts of facet joint element 420.The pedestal 416 that artificial tail side joint is further adapted for engage fixation elements 412 makes artificial tail side joint and/or to be conditioned afterwards during implanting retaining element, uses pedestal anchor 418 locks in place then.Pedestal anchor 418 can be suitable for engaging for example driver (for example flat head screw bottle opener, Phillippe's screw driver or outer-hexagonal bottle opener) towards outer surface.Pedestal anchor 418 is further adapted for the pedestal 416 that artificial tail side joint 428 is fixed to adjustable connector 414.Comprise screw thread to be fixed to vertebral body although the retaining element 412 of multiaxis adapter 414 is depicted as, should be understood that and to use other a large amount of fixed mechanisms, comprise the inside growing surface of hair side/bone, expansion anchor clip and/or binding agent.

The retaining element 412 of artificial facet joint 410 and 422 relative position and/or direction are determined by patient's natural anatomical structure (for example position, direction and/or the situation of pedicle of vertebral arch, vertebral plate, spinous process and/or vertebral body self) and operating target with in tissue and structure that the surgery intra-operative is removed and/or revises usually.Ideally, these retaining elements will be placed best and be used for secure fixation.Yet, the best that is used for secure fixation is placed the best of the correct function of the various parts can always not equal to be used for facet replacement equipment and is placed, thereby needs to regulate and/or change artificial head side and tail side joint 426 and 428 position (one or more) and/or directions (one or more) (it can be adapted to by the controllability of previously described tail side and cephalic region spare ideally) with respect to their retaining elements separately.Therefore, after implanting and regulating, artificial tail side joint 428 and artificial head side joint 426 can be in the anatomy tram in the patient body (increasing and/or metathetical anatomical structure with respect to them) or be in the non-anatomy tram, this depend on the clinical effectiveness of expection and the situation of anatomy of spine structure (for example comprise vertebra whether anatomically by operation or be changed naturally) and any other consideration and the requirement of situation.

In a kind of alternate embodiments, retaining element can comprise cable 3230 and intubate 3235 (referring to Figure 32 A), and intubate is passed the targeted bone structure of vertebral plate and/or spinous process and along at least a portion of its length around cable.Cable 3230 can promote the flexible of the artificial facet joint 3100 implanted ideally, and except other, and it is long-pending that intubate can significantly increase the cross-sectional surface of cable, reduces cable thus by the chance of laterally " extracting " from bone.One end of support engages cable and anchor engage the opposite end.Alternately, retaining element can comprise that solid threaded rod 3230 (referring to Figure 32 B) with flexible or scalable joint element 3250 (referring to Figure 32 C) or solid hopkinson bar are with some variations between the longitudinal axis of the direction that allows a side support member and bar.In these embodiments, the cross section of cable/bar has enough sizes ideally and surpasses the ability that vertebral plate is resisted this power to prevent the power that cable is applied in the vertebral plate, that is, the insufficient cable of diameter can provide enough big power to tear vertebral plate.And, it is circular that the cross section of cable/bar needs not be, but can be Any shape, comprise irregularly shaped, thereby the bone around being desirably provides the surface, this surface (1) enough big (and/or enough smooth) " is extracted " length of cable (for example along) with opposing by bone, and (2) be non-circular resisting the rotation of cable/bar, and/or the surface area that (3) have an increase inwardly grows in cable/bar with the promotion bone.Anchor can be further adapted for and provide female thread to make can perhaps can be suitable for providing perforate by on the end of thread that anchor is screwed to cable anchor being fixed to cable, and this perforate allows anchor to snap fit onto on the end of cable.Other configurations will be conspicuous for a person skilled in the art.

Equipment 410 can be attached to the cutting or the cut-out of vertebra.The rostral components of equipment 410 by pass vertebral plate (referring to Fig. 2 A 20) extension cable 422 be fixed to vertebra, and the tail side of equipment part for example is fixed to vertebra by the pedicle of vertebral arch anchor.It will be understood by those of skill in the art that stayed surface 427,429 can be smooth, spheric or have the concavity/convexity of certain limit and can change use in combination.The bone dividing surface of equipment can be configured to by preventing relative motion and/or promoting in the ingrown various surfaces of bone any one to form.In addition, pit or recess can be provided to carry the material (for example, BMP, bone graft, bone graft substitute etc.) that stimulates local osteogenesis, in case and osteogenesis occurs in recess or pit then serve as the relative motion limiter.And cable 422 permission equipment are realized best angle and deep flexion.Further select the length of cable 422 can further optimize the performance of implanting back equipment 410, reason is that the variable-length of cable can solve the more anatomy of spine structure of wide region.In addition, cable 422 can be strained by the surgeon as required, thereby makes equipment further be fit to treat corrigent specific physiological condition.

The part of vertebra can be removed by surgery ground or change, for example to allow last facet approaching and removal tail side vertebra.Pedicle of vertebral arch anchor 412 is arranged then and tail side support fixation arrives anchor.Can be by parts and the configuration of change and the controllability (for example using multiaxis anchor, cone, interlocking spinal column etc.) that cooperation realizes implantation equipment 410 of using change in size.Also can use Minimally Invasive Surgical Technology to realize the implantation of equipment.Also can use limited open, the open and/or complete open surgical procedures of variation to carry out reparation, displacement and/or increase.For example, must carry out facet joint displacement but in the spinal canal and/or near removal soft and/or sclerous tissues be (not being under the situation of focal point for example) under the unallowed or nonideal situation at spinal stenosis and neural pinching, can use one or more intubate to come implantation equipment and related hardware with the minimum mode of infection, thereby realize the reparation and/or the displacement of one or more facet joints.Replacedly, removal at facet joint 32 and/or vertebral plate 20 is (as shown in Figure 2) under the necessary information, such process can realize by the combination of open, semi-open and/or Minimally Invasive Surgery, to minimize damage and/or the destruction to surrounding soft tissue's structure.In such operation, one or more facet joint peplos can for example be exposed (to allow easily to excise and remove facet joint by the expansion intubate by open otch or semi-open operation, allow easily to introduce the big parts of facet joint, and/or around anatomical structure), and the cephalic region spare of facet replacement thing can be transferred by intubate or other Wicresoft's carrying methods and passes through vertebral plate.

Another advantage of this embodiment be equipment when being positioned in the vertebral plate only the finite part of implant stretch out from vertebral body.This layout offers surrounding soft tissue's structure with smaller profile, causes the less interaction between equipment and the surrounding soft tissue, and causes the less displacement of natural tissues owing to the existence of implant.And, the rostral components of equipment is anchored to the chance that reduces in vertebral plate and/or the spinous process and/or eliminated the unfavorable contact between spinal dura mater and the implantation equipment.Ideally, in case the facet replacement parts are implanted, equipment will cause healing reaction in patient's body, cause forming around the joint Connection Element of facet replacement prosthese the peplos or the pseudocapsule of soft tissue (comprising scar tissue).

In addition, based on the surface-supported part of tail side, can be by placing through vertebral plate perforate or hole through the leather point side path at surface-supported.By tail side path (its can be similarly Wicresoft, limited open, open or by the expansion intubate), a side support section of equipment be placed on desired location/direction and tension cable 422 with retrograde mode be pulled by be formed in vertebral plate or the spinous process through the vertebral plate opening.Cable is tightened up and is fixed to the top of vertebral plate 20 then.In case cable 422 is fixed to the top of vertebral plate, the rostral components of equipment is fixed on the cutting surface that leans against down facet.Use such minimally invasive surgery method, except facet and facet peplos, it is interference-free that rear structure can keep.

When looking back whole description, should be appreciated that equipment 410 also will combine work with whole intervertebral disc replacement.Use the solution of the whole intervertebral disc replacement contraindication that the facet degeneration is provided with whole intervertebral disc replacement.Before implanting facet restorer 410, implant whole intervertebral disc replacement equipment and opened intervertebral disc space, thereby help any decompression in necessary joint.Character and the stage of depending on disease, equipment can by unilaterally or bilateral ground use, and can be used in a plurality of spinal columns position.Similarly, the removal of the part or all of facet-structure of target vertebrae position (with vertebral plate etc.) can allow artificial intervertebral disc substitute (or enlargement of lymph nodes substitute or ring repair materials and their instruments separately) one or more parts via the outside, the outside, back and/or back side path by removed little covering weave.The facet replacement prosthese replaces by implanting as described herein then to be removed the function of tissue.

Fig. 5 show with the facet replacement equipment class of Fig. 4 like the bilateral facet replacement system 500 that is illustrated as bilateral solution (for example on the both sides of the centrage of spinal column, treating facet joint).This equipment be the artificial facet joint replacing apparatus 510 that is configured to replace the part of natural facet joint, 510 ' and permission equipment 510,510 ' for example be connected to retaining element 512,512 ' on the facet joint by adjustable connector 514,514 '.Adapter 514,514 ' allows to regulate artificial tail side joint 528,528 ', 520,520 ' and tail side group seat 516,516 ' with respect to retaining element 512,512 ' around more than one axis.As mentioned above, structure can be suitable for and be configured to allowing to regulate continuously around the relative adjustable extent that turns over of a plurality of disalignments with retaining element by the facet joint element, up to the limitation of motion that limit stops provided.In other embodiments, yet the quantity of rotating shaft can be limited, and can only allow to move in the mode of discrete increment.In various embodiments, the facet joint element can with respect to retaining element inwards, towards the outside, move up and/or down.Facet joint element 520,520 ' further is made up of flexible or inflexibility bar or cable 522,522 ', and described bar or cable for example can fixedly carry out fastening by vertebral plate and/or spinous process by using anchor 524,524 '.Cable 522,522 ' is suitable for engaging artificial head side joint 526,526 ', and described side joint has the surface 527,527 ' that is suitable for artificial tail side joint 528,528 ' facing surfaces coupling.Artificial tail side joint is configured to have the surface 529,529 ' that receives artificial head side joint.Thereby for example, the protruding/recessed surface that forms coupling is so that facet joint element 520, a side of 520 ' and the motion of tail side component 526,528.Artificial tail side joint is further adapted for engage fixation elements 512,512 ' tail side group seat 516,516 ', makes artificial tail side joint to be conditioned during implanting, and uses pedestal anchor locks in place then.

Can be before implanting, after implanting or simultaneously before implanting and be provided with afterwards facet joint 510,510 ' with retaining element 512,512 ' relative position.After implanting and regulating, artificial tail side joint 528,528 ' and artificial head side joint 526,526 ' can be in the anatomy tram in the patient body or be in the non-anatomy tram, this depend on expection clinical effectiveness and anatomy of spine structure situation (for example vertebra whether anatomically operation ground or be changed naturally) and any other consideration and the requirement of situation.In this embodiment, the cephalic region spare of equipment uses on the vertebral plate (20 shown in Fig. 2 A-D) of flexible cable or bar 522,522 ' fixing pleurocentrum to the end (for example 14 of Fig. 2 B).For example will understand better with reference to figure 7, cable 522,522 ' can be configured to pass some or all of lamina surface.Side facet joint parts 526,526 ' inner surface 511,511 ' can be further adapted for and be configured to comprise hair side, the biological or inside growing surface of bone, this surface promotes and/or allows inwardly grow biology, promotes the parts on surface to be attached to vertebral body thus.Being suitable for the ingrown promotion of bone for example can use can absorbing bone cement again and providing of surface strength is provided.Equipment also can be used in combination with bone filler or allograft material.Suitable filling material of bone comprises the use of the bone material that is derived from demineralization allogeneic or xenogenesis bone, and can comprise such material, for example causes the bone morphogenetic protein of osteanagenesis in defect.Referring to people's such as O ' Leary U.S. Patent No. 5405390, skeletonization constituent and the implant (Osteogenic Compositionand Implant Containing Same) that comprises it; People's such as Prewett 5314476, demineralization osseous granules and the flowed skeletonization constituent (Demineralized BoneParticles and Flowable Osteogenic Composition Containing Same) that comprises them; People's such as Bogdansky 5284655, swelling demineralization osseous granules, the flowed skeletonization constituent and the purposes (SwollenDemineralized Bone Particles, Flowable Osteogenic CompositionContaining Same and Use of the Compositions in the Repair of OsseousDefects) of described constituent in repairing bone defect that comprise them; People's such as Prewett 5510396, the method (Process for Producing Flowable OsteogenicComposition Containing Demineralized Bone Particles) of producing the flowed skeletonization constituent that comprises the demineralization osseous granules; 4394370 of Jeffries is used for damaged bone grafting material of bone and manufacture method thereof (Bone GraftMaterial for Osseous Defects and Method of Making Same); With 4472840 of Jeffries, cause osteoplastic method (Method of Inducing Osseous Formation by Implanting Bone GraftMaterial) by the implantable bone graft materials, above-mentioned patent disclosure comprise the constituent of demineralization bone meal.Also referring to the U.S. Patent No. 6340477 of Anderson, bone matrix constituent and production and preparation method thereof (Bone Matrix Composition and Methods for Making and UsingSame), this patent disclosure the bone matrix constituent.

One or more tips or projection 518,519 are positioned on the inner surface of the pedestal 517 of side facet joint parts to prevent rotation and/or parts are fixed to vertebral plate.For example, projection 518 is positioned such that they penetrate lamina surface, and flat projection 519 is oriented to be positioned at ideally near the outer surface of vertebral plate or by thereon.Those skilled in the art is to be understood that, can be before implantation equipment for example connect faceted surface and/or lamina surface and prepare lamina surface so that following surface to be provided by the excision joint, when adjacency cephalic region spare this surface will be with respect to the tail side support component of adjacency correctly directed and positioning head side component.Side facet joint parts 526 have stayed surface 527, the stayed surface 529 of these support surface engages tail side facet joint parts 528.

Described parts can be fixed to the pedicle of vertebral arch of vertebral body and pass pedicle of vertebral arch.Multiaxis or multiaxial type anchor can be used to allow original position to regulate tail side stayed surface.Replacedly, can use the adjusting part that allows adjusting.It will be understood by those of skill in the art that and to utilize other anchors without departing from the scope of the invention.

Fig. 6 A shows two parts of a side facet joint part of the facet replacement system shown in Fig. 4-5.One or more tips or projection 618,619 are positioned on the inner surface 611 of side facet joint parts to prevent to rotate and/or parts are fixed to the vertebral plate of vertebral body.Artificial head side joint component 626 has stayed surface 627, and this stayed surface is suitable for allowing the tail side articular surface of this surface engagement coupling.Artificial head side joint component 626 is configured to can remove from base element by perforate 621 on the use joint component and the screw thread 623 on the base component.Can by the rotation of the screw thread 623 of control joint component on the base component regulate between the surface of the upper surface of joint component and base component apart from d.Thereby, depend on joint component is pivotally lowered into the equipment that how far will influence on the cervical region of screw base element total height.Thereby adaptability allows equipment to be regulated so that better anatomic fit to be provided in particular patient by original position.Fig. 6 B-C shows two parts shown in Fig. 6 A from different perspectives in combination.As an alternative, the artificial head side joint component 626 that a series of difformities, size and/or direction and/or length can be provided is to adapt to different target, comprise with respect to retaining element and change bearing height/direction, to adapt to different load condition owing to other surgical interventions (that is, merge and/or facet replacement equipment at artificial intervertebral discs displacement, ring reparation, enlargement of lymph nodes displacement, dynamic stability, sour jujube interbody spacer device and/or phase ortho positions identical or other spinal column positions).And, in order to adapt to different designs (constraint intervertebral disc-nothing constraint intervertebral disc is promptly arranged) and/or the layout/location that is used in the artificial intervertebral disc replacing apparatus on the identical or different spinal column position, artificial head side joint component 626 (with they artificial tail side joint component separately) can have difformity, size, direction and/or length to adapt to the different load profile that is caused or expected by the artificial intervertebral disc replacing apparatus.

Fig. 7 A-C has described to be similar to the alternate embodiments of the facet replacement equipment in the vertebral body 14 of implanting shown in Fig. 4-6.As shown in Figure 7, during implanting, can prepare a side faceted surface, the near-end with flexible cable or bar 722 is fixed to vertebral body then.As seen from Figure 7, equipment 710 is configured to replace the part of natural facet joint when implanting.Retaining element allows equipment 710 to be connected to facet joint.Facet joint element 720 further is made up of flexibility bar or cable 722, and described bar or cable for example can be fixed by vertebral plate and/or spinous process 22 by using anchor 724.Cable 722 is suitable for engaging artificial head side joint 726, and described side joint has the surface 727 that is suitable for apparent surface's coupling in artificial tail side joint 728.During surgery is implanted, can before implantation equipment, prepare the side faceted surface of vertebral body.Thereafter, the near-end of flexible cable or bar is inserted into and passes vertebral plate/spinous process along anticipated orientation and orientation, and first end of cable 722 is attached to artificial head side joint component 726, the second ends and is suitable for engaging anchor 724 or cable lock.Anchor or other fixing device (not shown)s can connect (for example twist) to the end of cable 722 and against the vertebral plate 20 of vertebral body 14.Tightener and/or crimper or similar devices can be used to strain cable, draw the projection of tail side group seat 716 thus towards lamina surface.It will be understood by those of skill in the art that projection (shown in Fig. 4-6) can be drawn in the vertebral plate and/or against vertebral plate when towards lamina surface traction pedestal, this depends on the actual disposition of projection.Thereafter, in case reach expection tension force, then can be by fixing equipment with anchoring device 724 locking cables.If necessary, can excise unnecessary cable.With reference to as described in the figure 6, cephalic region spare (and tail side component separately) can be configured to provide scalable and/or dismountable stayed surface as top.Thereby the stayed surface position can be adjusted the performance requirement with the facet replacement equipment of realizing particular patient.

Tail side component 728 also can be fixed to the pedicle of vertebral arch of tail pleurocentrum and pass pedicle of vertebral arch.As shown in this embodiment, the tail side component is fixed to vertebral body by using retaining element 712.

Fig. 8 A-D shows according to the facet replacement equipment after the implantation of another embodiment of the present invention.Equipment 810 is configured to replace the part of natural facet joint when implanting.Retaining element allows equipment 810 for example to be connected to facet joint by multiaxis adapter 814.Adapter 814 allows to regulate artificial tail side joint 828 and tail side group seat 816 with respect to retaining element 812 around an above axis in the patient.By look back Fig. 8 be appreciated that the facet joint element can with respect to the retaining element that is attached to vertebral body inwards, towards the outside, move up and/or down.Facet joint element 820 further is made up of anchor rod 822, and described anchor rod for example can be fixed by vertebral plate and/or spinous process 22 by using lock 824.Anchor rod 822 is suitable for engaging artificial head side joint 826, and this side joint has the surface 827 that is suitable for apparent surface 829 coupling in artificial tail side joint 828.During surgery is implanted, can before implantation equipment, prepare the side faceted surface of vertebral body.Thereafter, the near-end of flexible cable or bar is inserted in vertebral plate/spinous process along anticipated orientation and orientation and passes vertebral plate/spinous process, and first end of anchor rod 822 is connected to artificial head side joint component 826, the second ends and is suitable for engaging anchor 824 or cable lock.Anchor or other fixing devices can connect (for example twist) to the end of anchoring device 822 and against the vertebral plate 20 of vertebral body 14.The moment of torsion that tightener and/or crimper or similar devices can be used to provide enough to be to lock onto anchor rod 822 with anchor 824, thus towards the projection of lamina surface drawing head side group seat 817.As mentioned above, when towards lamina surface traction pedestal, projection can be drawn in the vertebral plate and/or against vertebral plate, and this depends on the actual disposition of projection.Thereafter, in case reach expection tension force, then can be by fixing equipment with anchoring device 824 locking anchor rods 822.With reference to as described in the figure 6, cephalic region spare (and tail side stayed surface separately) can be configured to provide scalable and/or dismountable stayed surface as top.Thereby stayed surface (one or more) can be adjusted the performance requirement with the facet replacement equipment of realizing particular patient.As top further as described in, the tail side component in this embodiment is configured to comprise multiaxis or multiaxial type parts, it is adjustable to allow original position to regulate tail side stayed surface.

Fig. 9 A-B shows the facet replacement equipment of another embodiment according to the present invention from side-looking and top view.Equipment 910 can be implanted to replace the part of natural facet joint.Retaining element 912 permission equipment 910 for example are connected to facet joint by scalable (for example multiaxis) adapter 914.If necessary, adapter 914 allows artificial tail side joint 928 and tail side group seat 916 to center on more than one axle rotation in the patient with respect to retaining element 912.By look back Fig. 9 be appreciated that the facet joint element can with respect to be connected to epicentral retaining element inwards, towards the outside, move up and/or down.Facet joint element 920 further is made up of a side screw thread anchor rod 922, and described anchor rod is for example can be by vertebral plate and/or spinous process 22 fixing and be fixed on near-end by lock 924.Anchor rod 922 is suitable for engaging artificial head side joint 926, and this side joint has the surface 927 that is suitable for apparent surface 929 coupling in artificial tail side joint 928.Tail side joint 928 is configured to the engage threads anchor rod.Thereby when anchor rod was fixed to vertebra, the position of tail side articular surface 929 can be conditioned to optimize tail side joint with respect to a position in side joint.

Identical with aforementioned embodiments, during surgery is implanted, can before implantation equipment, prepare the side faceted surface of vertebral body.Thereafter, the near-end of cable or bar (it can be flexible or inflexibility) is inserted in vertebral plate/spinous process along anticipated orientation and orientation and passes vertebral plate/spinous process, first end of anchor rod 922 is connected to artificial head side joint component 926, the second ends and is suitable for engaging anchor 924 or cable lock.Anchor or other fixing devices can connect (for example twist) to the end of anchoring device 922 and the vertebral plate 20 of opposing bone surface or vertebral body 14.The moment of torsion that tightener and/or crimper or similar devices can be used to provide enough draws the projection of pedestal 916 thus anchor 924 is locked onto anchor rod 922 (if necessary) towards lamina surface.As mentioned above, when towards lamina surface traction pedestal, projection can be drawn in the vertebral plate and/or against vertebral plate, and this depends on the actual disposition of projection.Thereafter, in case reach expection tension force, then can be by fixing equipment with anchoring device 924 locking anchor rods 922.Ideally, this layout will allow artificial head side joint component 926 suffered a large amount of loads to compress in fact, allow these a large amount of power directly to transfer in the lamina surface thus, rather than transfer to cable or bar 922.With reference to as described in the figure 6, cephalic region spare can be configured to provide scalable and/or dismountable stayed surface as top.Thereby the stayed surface position can be adjusted the performance requirement with the facet replacement equipment of realizing particular patient.As top further as described in, the tail side component in this embodiment is configured to comprise adjustable multiaxis or multiaxial type parts, it is adjustable to allow original position to regulate tail side stayed surface.

Figure 10 A-C is from the facet replacement equipment of Fig. 9 A-B of back after showing implantation with lateral angles.In this embodiment, the connection of tail side is cutting on faceted surface.This groove allows the ready or cut surface of device engagement when implanting.

Forward Figure 11 now to, show the bilateral facet replacement system that has tail side cross bar.This equipment comprises a pair of artificial facet joint replacing apparatus 1110,1110 ' of the part of the natural facet joint on the both sides that are configured to replace vertebral body, and described artificial facet joint replacing apparatus comprises that permission equipment 1110,1110 ' for example is connected to retaining element 1112,1112 ' on the tail pleurocentrum by multiaxis adapter 1114,1114 '.Provide cross bar 1130 to locate to connect facet joint replacing apparatus 1110, each tail side component of 1110 ' at the adjustable connector separately 1114,1114 ' of artificial facet joint replacing apparatus.Cross bar is formed by the bar with a plurality of curves, and described curve allows it to avoid anatomy of spine structural damage part when implanting.Can be screwed into cross bar by the opening of wherein making then, thereby realize the implantation of cross bar in Wicresoft's mode by making little vertical incision in the interspinal ligaments on the movable section of target spinal column.Ideally, cross bar will prevent the rotation of tail side component and allow their load sharings between the anchor separately.

As mentioned above, this structure can be suitable for and be configured to allowing regulating continuously around the relative adjustable extent that turns over of a plurality of disalignments with retaining element by the facet joint element.In other embodiments, yet the quantity of rotating shaft can be limited, and can only allow to move in the mode of discrete increment.In various embodiments, the facet joint element can with respect to retaining element inwards, towards the outside, move up and/or down.Facet joint element 1120,1120 ' further is made up of anchor rod 1122,1122 ', and anchor rod for example can fix by vertebral plate and/or spinous process.Anchor rod 1122,1122 ' is suitable for engaging artificial head side joint 1126,1126 ', and this side joint has the surface that is suitable for artificial tail side joint 1128, apparent surface's coupling of 1128 '.Artificial tail side joint is configured to have the surface that receives artificial head side joint.Thereby, for example, form coupling protruding/recessed stayed surface so that the motion of each stature side of facet joint element 1120 and tail side component 1126,1128 take place more smoothly.Artificial tail side joint is further adapted for engage fixation elements 1112,1112 ' pedestal 1116,1116 ', makes artificial tail side joint to be conditioned during implanting, and uses pedestal anchor locks in place then.

Can be before implanting, after implanting or simultaneously before implanting and facet joint 1110,1110 ' and retaining element 1112,1112 ' relative position is set afterwards.After implanting and regulating, artificial tail side joint 1128,1128 ' and artificial head side joint 1126,1126 ' can be in the anatomy tram in the patient body or be in the non-anatomy tram, this depend on expection clinical effectiveness and/or anatomy of spine structure situation (for example vertebra whether anatomically operation ground or be changed naturally) and any other consideration and the requirement of situation.In this embodiment, the cephalic region spare of equipment uses on the vertebral plate (20 shown in Fig. 2 A-D) of anchor rod 1122,1122 ' fixing pleurocentrum to the end (for example 14 of Fig. 2 B).Anchor rod can have the screw thread 1109 of being convenient to zeugopodium, 1109 ' or be suitable at its terminal anchor that engages.It will be understood by those of skill in the art that with in this embodiment anchor rod can be solid hopkinson bar, perhaps can be the cable shown in Fig. 5 for example, and it is configured to pass lamina surface some or all.Cross bar 1130 is suitable for traversing the centrage of spinal column when equipment is implanted, and is suitable for joining connector 1114,1114 ' pedestal 1116,1116 '.

The facet replacement parts can be further adapted for and comprise in articulating arm and/or by the prosthetic ligament between the treatment vertebral body.Replacedly, equipment can comprise around the flexible peplos of some or all of facet/joint connection articular surface.It will be understood by those of skill in the art that for example by using perforate, hole, hook etc. can have a plurality of junction points.When surgery surgeon's knot bundle, connect the soft or sclerous tissues of existing ligament, tendon and/or other to promote healing and further to stablize affected area.And the body's natural healing reaction can be connected the pseudocapsule that the surface produces soft and/or scar tissue around a side of facet replacement equipment with tail side joint, and described pseudocapsule can be used to duplicate some functions of natural facet peplos in some way.

Figure 12 A-B has described to have the bilateral facet replacement system of cross bar.Be similar to the embodiment shown in Figure 11, this equipment comprises a pair of artificial facet joint replacing apparatus 1210,1210 ' of the part of the natural facet joint on the both sides that are configured to replace vertebral body, and described artificial facet joint replacing apparatus comprises that permission equipment 1210,1210 ' for example is connected to retaining element 1212,1212 ' on the tail pleurocentrum by

adjustable connector

1214,1214 '.Provide cross bar 1230 the adjustable connector separately 1214,1214 ' of artificial facet joint replacing apparatus locate to connect facet joint replacing apparatus 1210,1210 ' each.Cross bar can be formed by bow, and described bow is suitable for following the outer curve of vertebral body.More than one adjustable connector can be located at the ability that adapts to varied anatomy difference on each side of equipment with enhancing equipment when implanting.

Be similar to other embodiments, adapter 1214,1214 ' allow artificial tail side joint 1228,1228 ' and tail side group seat 1216,1216 ' move and/or rotation with respect to retaining

element

1212,1212 '.Facet joint element 1220,1220 ' further comprises anchor rod 1222,1222 ', and described anchor rod for example can be fixed by vertebral plate and/or spinous process.Anchor rod 1222,1222 ' is suitable for engaging artificial head side joint 1226,1226 ', and this side joint has the surface 1227,1227 ' that is suitable for artificial tail side joint 1228, apparent surface's coupling of 1228 '.Artificial tail side joint is configured to have the surface 1229,1229 ' that receives artificial head side joint.

Identical with other embodiments, can be before implanting, after implanting or simultaneously before implanting and be provided with afterwards facet joint 1210,1210 ' with retaining element 1212,1212 ' relative position.After implanting and regulating, artificial tail side joint 1228,1228 ' can be in the interior anatomy tram of patient body with artificial head side joint 1226,1226 ' or be in the non-anatomy tram, and this depends on expection clinical effectiveness and/or the situation of anatomy of spine structure and any other consideration and the requirement of situation.Figure 12 C-D is from the facet replacement system of back after showing implantation with lateral angles.

Figure 13 A shows another embodiment of the facet replacement system with tail side cup, cross bar and vertebral plate clip/connection device.Joint of vertebral column former 1300 comprises cross bar 1330 and has tail side cup 1333,1333 ' a pair of tail side arm 1332,1332 '.In this illustrative embodiments, the facet of spinal column (referring to Fig. 2,30) by cross bar 1330 and with vertebral plate clip 1340 join the cross bar installed part 1334 on the cross bar 1330 to, 1334 ' compounding practice is replaced.Cross bar and tail side arm 1332,1332 ' interacts, and described tail side arm forms cup 1333,1333 ' to receive cross bar 1330.The parts of arthroplasty equipment 1300 are configured to specify morbid state, patient's specific anatomical structure and implant the spinal column position that takes place provides suitable configurability and adaptability.

Cross bar 1330 has first end 1331 and second end 1331 '.In illustrated embodiment, cross bar 1330 is three-member type bars, wherein terminal 1331,1331 ' forms male thread portion.The female thread ball 1336,1336 ' that size is determined to be the screw thread that receives cross bar 1330 is connected to each cross bar end 1331,1331 '.The width that the described end of thread allows to regulate cross bar with and tail side anchor 1332,1332 ' between the width coupling.The additional alternate embodiments of cross bar 1330 can comprise a series of solid cross bar of width and/or varied in thickness, or has the locking of certain form or the scalable cross bar of bias mechanism (for example spring loaded in tension device or detent mechanism etc.).

Cross bar installed part 1334,1334 ' is the syndeton that vertebral plate clip 1340 is coupled to cross bar 1330.The vertebral plate clip has the end that extends through the groove in the cross bar installed

part

1334,1334 '.In illustrated embodiment, cross bar installed part 1334,1334 ' comprises vertebral plate anchoring bonding part, cross bar bonding part and retaining

element

1338,1338 '.Retaining element 1338,1338 ' comes anchoring vertebral plate anchored end with cross bar installed part 1334,1334 ' groove.Retaining element can be screw, bar, gimlet, silk thread, bail, binding agent, bone and the other materials that is suitable for this design.As described in below inciting somebody to action more specifically, the embodiment of cross bar installed part 1330 provides adaptability.

In the embodiment shown in Figure 13 B, be fitted to groove in compare, vertebral plate clip 1340 is directly connected to cross bar installed part 1334,1334 ', and retaining element 1338,1338 ' anchoring cross bar.

Figure 13 C-D shows the clip portion that is implanted to intravertebral system from the rearview (Figure 13 C) of spinal column and the side view (Figure 13 D) of spinal column.Describe should be appreciated that from these cross bar is installed to first vertebral body in the ground floor position 1 of spinal column, vertebral plate clip or other vertebral plate fixing device engage vertebral plate and/or spinous process in the second layer position 2 of spinal column.As shown in the figure, second layer position adjacent first layer position.Best as seen, ground floor position 1 is that (referring to Fig. 1, L5-S5), and second layer position 2 is the layer position between L4 and the L5 vertebral body for layer position between lumbar vertebra body and the rumpbone in Figure 13 C.This embodiment thereby be suitable for particularly well a side facet replacement parts is connected to the L5 vertebral body, reason are that the vertebral plate of L5 vertebral body is thinner and (will significantly reduce through the available vertebral plate that vertebral plate equipment be attached to the there) more built on the sand than the vertebral plate of other lumbar vertebra bodies usually.

Figure 14 A shows the facet replacement system according to the alternate embodiments structure, and wherein vertebral plate clip 1440 and cross bar installed part 1434,1434 ' have optional anchoring device 1435,1443.Anchoring device is configured to tooth, and described tooth allows vertebral plate clip 1440 and cross bar the installed part vertebral plate and/or the spinous process of (with intrusively potential) joint spinal column securely.In addition, as mentioned above, retaining element 1412,1412 ' can be suitable for providing superficial makings or other features to promote bone inwardly growth or increase constant intensity.Figure 14 B-D shows the facet replacement system of Figure 14 A after the implantation from various angles.It may not be the anatomical location of preferred plan that the facet replacement equipment of Figure 14 is fit to connect through vertebral plate particularly well, and is fit to bad vertebral plate bone mass and/or the anatomy restriction stops the position of using through the vertebral plate anchor.For example, at the L5-S1 vertebrae position, the L5 vertebral plate vertebral plate than other vertebrae positions usually is thinner and more weak.Stress on the facet joint of this layer position normally in the spinal column the highest and angle facet joint be substantially perpendicular to the axis of vertebral plate.Additional hook portion 1444 can be located on the vertebral plate clip 1440, and it allows vertebral plate clip 1440 by engaging vertebral arch and being positioned at that (referring to Fig. 2,1819) comes further vertebral plate clip 1440 to be fixed to vertebral body in the vertebral foramen.It will be understood by those of skill in the art that the vertebral plate anchor can be configured to make its to oppress spinous process (for example pivot by the position in contiguous hook portion 1444, oppress the spinous process between the arm of vertebral plate anchor thus).

Figure 15 A-C shows the facet replacement system 1500 that constructs according to alternate embodiments from various angles.It may not be the anatomical location of preferred plan that this embodiment of facet replacement system is suitable for connecting through vertebral plate particularly well, and is suitable for bad vertebral plate bone mass and/or the anatomy restriction stops the position of using through the vertebral plate anchor.For example, about 50% of current intervertebral disc replacement operation occurs in the L5-S1 vertebrae position, and the L5 vertebral plate vertebral plate than other vertebrae positions usually is thinner and more weak.Stress on the facet joint of this layer position normally in the spinal column the highest and angle facet joint be substantially perpendicular to the axis of vertebral plate.Tail side cup 1533,1533 ' is configured to rely on the rumpbone.As shown in Figure 15 C and 15D, the part of cross bar can in abutting connection with and/or the vertebral plate of contact head pleurocentrum and/or the downside of spinous process, and opposite side has the stayed surface with tail side cup 1533 coupling.Vertebral plate clip 1540 is suitable for traversing the top of vertebral plate/spinous process, and cross bar traverses the below of vertebral plate/spinous process.The vertebral plate clip is fixed to cross bar 1530 with an offside screw 1538.In this embodiment, vertebral plate clip and cross bar are oppressed vertebral plate/spinous process therebetween ideally.

Figure 16 A shows the facet replacement system 1600 according to alternate embodiments, and wherein vertebral plate clip 1640 comprises the modularity clip assembly.Cross bar 1630 further is configured to partly integrated with retaining element 1612 at least.Provide tail side stage shoulder 1633,1633 ' to engage the stayed surface 1646 that extends laterally from vertebral plate clip 1640.Providing for example can be by using two meshing opposed U-shaped clips 1647,1647 ' of the first U-shaped clip, and the described first U-shaped clip engages the lip-deep helical teeth of the second relative U-shaped clip.In operation, ratch mechanism only allows along a direction activity and vertebral plate clip 1640 quilts fastening around spinous process.Figure 16 B-C shows the facet replacement system of Figure 16 A after the implantation from various angles.It may not be the anatomical location of preferred plan that this embodiment of facet replacement system 1600 also is fit to connect through vertebral plate well, and is fit to bad vertebral plate bone mass and/or the anatomy restriction stops the position of using through the vertebral plate anchor.And, identical with other similar embodiments, this embodiment can be used in following various spinal columns position: natural pedicle of vertebral arch is not suitable for use in anchor point in described position, spinal column hardware and/or bone cement have occupied one or more pedicles of vertebral arch (for example from previous spinal fusion, other spinal operations that relate to pedicle of vertebral arch hardware, or kyphosis is shaped or the vertebra plastic operation has been finished or the position of being attempted), perhaps wish or need be based on the additional support (for example pedicle of vertebral arch and vertebral plate/spinous process supports all needs to be provided enough supports) of the spinal instrumentation of pedicle of vertebral arch.As shown in the figure, implant the facet replacement system at the L5-S1 vertebrae position.In this embodiment, support member is configured to fit in the rotatable shell.

Figure 17 A-C shows according to the facet replacement system 1700 of another alternate embodiments of the present invention and the system 1700 after the implantation from various angles.This system has the vertebral plate clip 1740 that is formed by two relative modularity clip assemblies.Replace cross bar (referring to Figure 16 1630), by rotatable mechanism multiaxis connector engages for example, described multiaxis connector engages one correct side ball, described side ball are suitable for engaging stayed surface 1746 separately to vertebral plate clip 1740 on both sides.Providing for example can be by using two meshing opposed U-shaped clips 1747,1747 ' of the first U-shaped clip, and the described first U-shaped clip is suitable for engaging the lip-deep helical teeth or the ratchet of the second relative U-shaped clip.In operation, ratch mechanism only allows along a direction activity and vertebral plate clip 1740 fastening around spinous process.For vertebral plate clip (for example in order to provide than loose fit) is provided, promote inboard clip towards relative clip a little, oppress the side element of U-shaped clip simultaneously.Thereafter, inboard clip is retracted back into desired location, perhaps is removed fully.

As shown in the figure, on a side, stayed surface has cross bar 1750,1750 ', and described cross bar extends the U-shaped clip 1747 ' that is positioned at the outside with joint from stayed surface 1746.As shown here, be suitable for the circular pommel that (for example forming pod 1752) receives cross bar near the surface of the clip of tail side cup 1733 '.On the opposite side of equipment, one or more joints 1752 ' are provided, can use

locking mechanism

1754,1754 ', 1754 " cross bar 1753,1753 ' is locked in the described joint.More than one cross bar permission equipment is set on the both sides of the vertebral plate clip 1740 that has the multiaxis adapter realizes bigger flexibility ratio.

Figure 17 B-C shows the facet replacement system of Figure 17 A after the implantation from various angles.It may not be the anatomical location of preferred plan that this embodiment of facet replacement system 1700 also is fit to connect through vertebral plate well, and is fit to bad vertebral plate bone mass and/or the anatomy restriction stops the position of using through the vertebral plate anchor.As shown in the figure, implant the facet replacement system at the L5-S1 vertebrae position.

Figure 18 A shows the facet replacement system according to alternate embodiments, and wherein vertebral plate/spinous process clip is adjustable C-clamp.System 1800 has clip 1840, and this clip can be formed by two relative modularity clip assemblies.Replace cross bar (referring to Figure 16 1630), clip 1840 is engaged by adjustable mechanism on both sides, described adjustable mechanism carries a correct side ball at their far-end.Tail side cup 1833,1833 ' is located on the tail side component of facet replacement system the stayed surface separately 1846 with engagement head side ball.Provide can meshing one-tenth C-clamp two relative clips 1847,1847 '.For example, first clamp engages the lip-deep helical teeth of relative second clamp; Clip forms C shape when combination.If meshing fully, the flared end of clip can join (if necessary).In operation, ratch mechanism only allows along a direction activity and vertebral plate clip 1840 fastened around spinous process.As shown in the figure, on a side, stayed surface has 1850,1851 and second groups of cross bars 1850 ', 1851 ' of first group of cross bar.First group of cross bar from stayed surface 1846,1846 ' extend with at 1847 ', the second group of cross bar of a side position engaging clip in tail side position engaging clip.As shown here, the surface of clip is suitable for the circular pommel that (for example forming pod) receives cross bar.On the opposite side of equipment, one or more joints 1852 are provided, can use locking mechanism 1854,1854 ', 1854 " cross bar 1851,1851 ' is locked in the described joint.On the both sides of vertebral plate clip 1840, provide more than one cross bar permission equipment to realize bigger flexibility ratio and intensity.

Figure 18 B-C shows the facet replacement system of Figure 18 A after the implantation from various angles.Identical with previous embodiment, it may not be the anatomical location of preferred plan that this embodiment of facet replacement system 1800 also is fit to connect through vertebral plate well, and is fit to bad vertebral plate bone mass and/or the anatomy restriction stops the position of using through the vertebral plate anchor.As shown in the figure, implant the facet replacement system at the L5-S1 vertebrae position.

Turn to Figure 19 A now, show facet replacement system 1900 according to alternate embodiments, wherein vertebral plate clip 1940 comprises adjustable lever and cross bar scalable (for example cross the centrage of spinal column, formed by sagittal plane 54, be arranged in axial plane 52 simultaneously) on length.Provide have tail side cup 1932,1932 ' retaining element 1912,1912 ', described tail side cup is used to receive the respective support surface 1936,1936 ' of cross bar 1930, and described stayed surface is suitable for providing the part of the lower arcuate surface of notch (divot) 1955 to receive spinous process and can be further adapted for provides adjustable length.With top described identical about other embodiments, retaining element 1912,1912 ' can be suitable for providing superficial makings or other features inwardly to grow to promote bone.In addition, vertebral plate clip 1940 has prop clip 1954, and this prop clip is suitable for for example by providing size to be determined to be the upper surface that the notch 1955 ' that receives spinous process engages spinous process 22.Prop clip 1954 engages a pair of vertical adjustable lever 1956,1956 ', and described adjustable lever can have labelling 1957, for example to allow the surgeon to estimate the length of the equipment of implanting.The length of adjusting rod as required.After passing perforate in the prop clip 1954, bar can provide additional female thread medicated cap 1958,1958 ' to engage the end of adjustable lever 1956.Figure 19 B-C shows the facet replacement system of Figure 19 A after the implantation from various rearviews and side view.If necessary, vertical adjustable lever 1956,1956 ' size and location also can be determined to be the side that is suitable for around spinous process and/or vertebral plate provides the side direction chucking power.

For above-mentioned reasons, it may not be the anatomical location of preferred plan that the facet replacement equipment of Figure 19 A also is fit to connect through vertebral plate well, and is fit to bad vertebral plate bone mass and/or the anatomy restriction stops the position of using through the vertebral plate anchor.Figure 19 D shows the facet replacement system according to alternate embodiments, and wherein cross bar 1930 has a pair of coupling bar 1959,1959 ', and described coupling bar is fixed to female thread support member 1936,1936 ' by anchor 1954,1954 '.The position that coupling bar 1959,1959 ' allows cross bar 1930 pivots with respect to the position of the support member 1936 in the tail side cup 1933,1933 '.Figure 19 E shows the facet replacement system of Figure 19 D after the implantation.Be appreciated that from this diagram tail side cup 1933,1933 ' relative to each other is implanted to the cup that the cup that makes in the plane on patient the right is higher than the patient left side.Yet cross bar 1930 is oriented to cross spinal column with respect to vertebral plate between the cup and/or spinous process.Because coupling bar, cross bar member can remain on the neutral position, considers the location of tail side cup simultaneously, by the axis inclined support with respect to cross bar support member is positioned in the tail side cup best.Solid hopkinson bar fits in the lower cross arm and allows shaft length to change.If necessary, lock (for example clip 1954) permission equipment is fixed in the customized configuration.Alternately, clip can serve as pivotal point, thereby allows the equipment original position dynamically to adapt to patient's anatomical structure during daily routines.

Figure 20 A shows the facet replacement system according to alternate embodiments, wherein at least a portion with adjustable lever 2056 and transverse arm 2030 of vertebral plate clip 2040 can directly anchor to (and/or entering) vertebral body, vertebral plate and/or spinous process by using hold-down screw or pin (not shown), described hold-down screw or pin extend upward by the opening in the transverse arm 2,030 2031 and against and/or the target approach bone structure.The end of cross bar 2030 can be configured to carry one or more stayed surface (not shown)s in tail side cup 2033 separately.Figure 20 B-D shows the facet replacement system of Figure 20 A after the implantation from rearview, side view and perspective view.The configuration of this embodiment allows transverse arm to move with respect to tail side cup 2033.In addition, transverse arm 2030 can rotate with respect to vertebral body and/or with respect to the tail side lever.

Figure 21 A shows the facet replacement system according to alternate embodiments, and wherein vertebral plate clip 2140 has articulated type bindiny mechanism 2162, and this articulated type bindiny mechanism permission vertebral plate clip can have and have certain position range in the time of in being positioned at spinal column.This articulated type bindiny mechanism has two stayed surfaces that have the lockable joint.Two stayed surfaces engage the vertebral plate clip movably.The 3rd stayed surface (a side stayed surface) engages (or joint connection) tail side cup 2133 movably.Lock is controlled to be the angle between the bar that each clip or cup position provide support, thereby permission equipment is positioned in the spinal column, simultaneously the relation between the fixed support surface.Yet lock does not prevent that the side stayed surface from moving with respect to tail side cup.Figure 21 B-D shows the facet replacement system of Figure 21 A after the implantation from rearview, side view and perspective view.The use of the equipment of Figure 21 allows the internist to introduce two or more elements during implanting, and described then element is assembled into final equipment.

Figure 22 A shows the facet replacement system according to alternate embodiments, and wherein vertebral plate clip 2240 is modularity clips, and this modularity clip has and is suitable for when disposing around vertebral plate and/or spinous process the last retained part and the following retained part of fluid-tight engagement each other.Forward direction hook portion 2244 is located on the vertebral plate clip 2240 to be used to engage the part of vertebral body.Hook portion 2244 allows vertebral plate clips 2240 by engaging vertebral arch and being positioned at that (referring to Fig. 2,18,19) comes further vertebral plate clip 2240 to be fixed to vertebral body in the vertebral foramen.Also provide coupling bar to be suitable for being connected to allow vertebral plate clip 2240 with tail side cup 2233 joints with support component.Adapt to surface-supported this motility permission equipment and be positioned at the feasible operation of optimizing equipment about natural or cut anatomical structure in the spinal column.Figure 22 B-D shows the facet replacement system of Figure 22 A after the implantation from rearview, side view and perspective view.In operation, equipment can clip on vertebral plate and/or the spinous process.Right upward relative clip 2244 ' can be suitable for extending with further joint vertebral body from cross bar part 2230.In addition, solid cross bar part can be suitable for engaging vertebral plate clip 2240.Lockable coupling bar 2259 can be provided, and it is suitable for extending to engage tail side cup 2233,2233 ' from cross bar 2230; Allow the further configurability and the motility of equipment thus.

Figure 23 is the side view of a side of a part that the facet replacement system of connection features is shown.As comprise the connection of more above-mentioned embodiments and connect as shown in this embodiment of feature that parts can link together and make parts inflexibility or be connected flexibly to allow the joint between the parts (for example stayed surface) to connect.Alternately, parts can be connected to allow motion and/or the displacement between the parts.If necessary, at least one end of connection device can comprise that the multiaxial type adapter is to connect one or more parts of facet replacement system.In alternate embodiments, this connection can be suitable for passing the one or more openings by the various parts formation of system.In this embodiment, provide two fixed

mechanisms

2312,2312 '.As shown in the figure, the turn retaining element is anchored in the target part of spinal column to allow screwing element, for example the pedicle of vertebral arch of rumpbone or other vertebral bodys.The support member that forms a side articular surface 2326 fits in the tail side cup 2333.This support member is suitable for engaging lockable privot mechanism 2366, and this privot mechanism allows the position of a customization side support member in tail side cup.

Figure 24 A-C is the various views of the facet replacement system of Figure 23.Equipment 2400 is configurable and adaptable spinal column restorers of assembling.This embodiment show can how to select with the various parts of configuration device to adapt to individual anatomical structure.

Figure 25 A is the vertical view according to a side interconnect equipment of various instruction structures of the present invention; Figure 25 B-D shows the equipment that combines the Figure 25 after implanting with the tail side interconnect equipment that comprises tail side cross bar from rearview, vertical view and side view.Many parts are similar to the parts in the previous embodiment, for example comprise using retaining element 2512.In this embodiment, provide two

cross bars

2530,2530 '.First cross bar 2530 is suitable for connecting to the end the solid system of side anchor, and the solid system of this side anchor has and is positioned at epicentral two anchoring devices of a side (or on).Second cross bar 2530 ' is positioned under first cross bar and is suitable for connecting two tail side apparatus 2528.

Figure 27 A-H shows for example at the parts through vertebral plate facet joint forming head side tectonic system described in Figure 25 A-D.Figure 27 A shows pedicle screw or bar 2701; Figure 27 B shows left shell 2702; Figure 27 C shows right casing 2703; Figure 27 D shows shell medicated cap 2704; Figure 27 E shows pedicle screw medicated cap 2705; Figure 27 F shows hold-down screw 2706; Figure 27 G shows cross bar press-fit assemblies 2707; Figure 27 H shows a side arm press-fit assemblies 2708.Pedicle screw 2701 has slender axles, and these slender axles have the tube-like envelope of fluting, and described tube-like envelope is suitable for the support member reception is engaged the cross bar related with support member in the enclosure and by the groove on it.Left side shell 2702 and right casing 2703 are configured at one end provide circular support, and the tube-like envelope of fluting is provided in the opposite end.Tube-like envelope is suitable for receiving in the enclosure support member and engages the cross bar related with support member by groove.Shell medicated cap 2704 and pedicle screw medicated cap 2705 can be suitable for fitting in the opening of slender axles so that support member is fixed in the axle.Hold-down screw 2706 can be further adapted in any one that fits in shell medicated cap 2704 and the pedicle screw medicated cap 2705 further medicated cap is fixed to for example pedicle screw.Cross bar press-fit assemblies 2707 is suitable for engaging pedicle screw or a left side or right casing and can further be configured to for example have the diameter of about 4mm, and it is 5/16 that diameter is arranged on the two ends " two support members.Side arm press-fit assemblies 2708 also can be configured to engage pedicle screw or shell and have the diameter of 5mm, and it carries out the transition to the bar that diameter is 4.5mm; It is 5/16 that diameter is also arranged on the two ends " two support members.This outside side arm press-fit assemblies can further be made axle be made up of more than one element by modularity.In addition, those skilled in the art is to be understood that equipment can have whole structure.

Figure 28 A-B shows at the textural parts through vertebral plate facet joint forming head side tectonic system as shown in Figure 27.As shown in Figure 28 B, cross bar matable assembly 2807 slides into and makes the cross bar of matable assembly 2807 and the slender axles of shell 2802 form angle, for example right angle as shown in the figure in the left shell 2802.Thereafter, a side pressure matable assembly 2808 slides into and makes in the shell 2802 that assembly 2808 is positioned on the assembly 2807.The cross bar of press-fit assemblies 2808 slides into and makes in the shell that assembly forms the angle with respect to axle.Although cross bar matable assembly 2802 and press-fit assemblies 2808 can be configured to be arranged in parallel plane, as shown in the figure, from vertical view as seen each assembly will extend from the axle of shell 2802 makes, is that focus forms the angle between assembly with the axle.Described configuration can be held in place with shell medicated cap 2804.

Figure 29 A-C shows the facet joint formation system head side structure according to the alternate embodiments of the parts that utilize Figure 27.Can see that in Figure 29 A the groove in the axle is configured to allow assembly 2907 to slide in the axle downwards, then along with enter the vertical groove of groove and turn to (thereby form " L " shape groove).As shown in Figure 29 B-C, in case assembly is positioned in the axle, the bottom can be configured to make arm to extend with the angle except 90 ° from shell.The axle of matable assembly 2907 can be further adapted for and flexible make that provide can be inwardly or outwards slide with a lap that prolongs or shorten spool.

Figure 30 A-C shows the facet joint forming head side tectonic system according to alternate embodiments.This system comprises the round flange shell, and hold-down screw is placed in the described round flange shell so that system is anchored at together.Hold-down screw elongated insertion part side arm and outside lock locking cross bar.

Figure 31 A-B shows another parts that are fit to the tectonic system that intervertebral disc-the facet joint formation system uses.Ductile or preformed plate 3100 is provided, and it is suitable for a side support member is fixed to bone.Cap 3101 fits on the side of vertebral plate, and can form a side stayed surface if necessary.Bar can be inserted into (this bar can comprise as discussed previously through vertebral plate head side fixed mechanism) by the medicated cap on vertebral plate one side and by the perforate in the arm on the vertebral plate opposite side 3103.Arm 3102 is fixed to vertebral plate with a side support member, and it can use the vertebral plate screw to be enhanced by the one or more residue perforates in the plate.This system can be fit to be used in combination through the solid system of vertebral plate head side anchor with various especially well, various systems shown in Fig. 4-12 for example, and can be used to if necessary connect and pass a pair of through the vertebral plate anchoring device of identical vertebral plate and/or spinous process.

Figure 33 A-F shows each view of the fixing device that is used in the rumpbone junction that is suitable for tail side cup 3333.The bone mass that it will be understood by those of skill in the art that rumpbone may not be that any spinal implant in the strongest and/or the rumpbone may be subjected to compression the highest in the spinal column and bend loading.Therefore, plant equipment is fixed to rumpbone and runs into extra challenge.A kind of mechanism that is used to overcome this challenge provides for example in the design of the double fixed tail side cup shown in Figure 33 A-F 3300.Double fixed equipment 3300 allows by using two retaining elements 3312,3312 ' from two fixed angle tail side cups 3333.This design allows tail side cup is fixed to rumpbone better.In disclosed embodiment, fixing devices of equipment 3300 usefulness (being hold-down screw) are fixed to rumpbone ideally with each tail side cup 3333, and are fixed to the sacrum wing with second fixing device (i.e. second hold-down screw).

Figure 34 A-B shows a side of the use that comprises spring washer 3400 through the vertebral plate fixed system.Meet irregular bone surface with petal design configurations spring washer to allow gasket edges.The elasticity of packing ring produces tension force, and this tension force is fixed to bone better with equipment.Packing ring can be used in equipment and be suitable for any position of zeugopodium and be suitable for arbitrary embodiment disclosed herein.Packing ring also can comprise the inside growing surface of veining or bone to be fixed to promote bone.

Figure 35 A-B shows the intervertebral disc replacement equipment 3500 with the facet replacement unit construction.This equipment is suitable for being connected to the part of facet replacement equipment.Then, the part of each vertebral body of facet replacement device engagement (although in alternate embodiments, facet replacement equipment can only anchor to intervertebral disc replacement equipment, and intervertebral disc replacement equipment can anchoring or do not anchor to around vertebral body).The intervertebral disc parts of this equipment can be active naturally anyone manufacturing apparatus that can recover intervertebral disc to small part.This intervertebral disc can be articulated type intervertebral disc, buffering intervertebral disc and based on the intervertebral disc of spring.Described various intervertebral disc replacement equipment in following patent: people's such as Stefee United States Patent (USP) 5071437 relates to artificial intervertebral disc (Artificial disc); People's such as Gill 6113637 relate to the artificial (Artificial intervertebral jointpermitting translation and rotational motion) that allows translation and rotary moveable; People's such as Bryan 6001130 relate to hinged human intervertebral disc prosthese (Human spinal discprosthesis with hinges); People's such as Hedman 4759769 relate to artificial intervertebral disc (Artificial spinal disc); People's such as Ray 5527312 relate to facet screw anchor (Facet screw Anchor); People's such as Ray 5824094 relate to intervertebral disc (Spinal disc); 5401269 of Buttner-Janz relates to prosthese (Intervertebral disc endoprosthesis) in the intervertebral disc; People's such as Serhan 5824094 relate to intervertebral disc (Spinal disc); 5556431 of Buttner-Janz relates to prosthese (Intervertebral disc endoprosthesis) in the intervertebral disc; People's such as Bryan 5674296 relate to human intervertebral disc prosthese (Human spinal disc prosthesis); U.S. Patent Publication US2005/0055096A1 with people such as Serhan relates to spinal function unit prosthese (Functional spinal unit prosthetic).The joint motion intervertebral disc can have three partial design 3510,3512,3514, and it has 3510,3514 and enlargement of lymph nodes 3512 of two end plates.Each plate can have a recessed surface that is suitable for receiving the nonreentrant surface that enlargement of lymph nodes has; Thereby formation ball and pod joint.

Figure 36 A-B shows the intervertebral disc replacement equipment 3600 between vertebral body according to alternate embodiments, and this equipment has facet replacement parts and artificial connecting rod 3610.In this embodiment, the part of intervertebral disc replacement device engagement facet replacement equipment and the part of vertebral body.And, this embodiment be included between the parts of facet replacement equipment through the vertebra adapter, described parts can for example comprise titanium, rustless steel or radioparent polymeric material by various material manufacture, for example polyether-ether-ketone (the PEEK that is provided by Victrex PLC (Britain) ^TM).Can yes or no inflexible through the vertebra adapter, for example referring to the U.S. Patent Publication US2005/0033434A1 of Berry, relate to the movable restorer (Posterior elements motion restoring device) of back element.Connection between facet prosthese and the intervertebral disc not only reduces or has avoided the chance of artificial intervertebral disc substitute migration, it also strengthens and/or has increased the facet replacement parts and anchors to vertebral body, and prevent the depression of artificial intervertebral disc substitute to by the treatment vertebral body each on or in the bottom plate.And such connection allows to utilize bindiny mechanism in Wicresoft's mode, with the reorientation of artificial intervertebral disc substitute in intervertebral disc space (forward direction/back to and/or side direction, or their combination).

In addition, if necessary, the connection between facet prosthese and the intervertebral disc can change the loading of artificial intervertebral disc substitute.For example, at artificial intervertebral disc (for example at the front side of intervertebral disc loading days) under situation about breaking down under the certain operations pattern, the reorientation of intervertebral disc replacement thing can be changed to the loading of intervertebral disc direction after more leaning in more forward position, prolong thus need to remove, displacement and/or life-span of repairing (getting involved) intervertebral disc replacement thing before with surgery subsequently.In a similar manner, utilize the asymmetric connection between preceding and the postcentrum can allow preferentially to load the intervertebral disc replacement prosthese, perhaps solve the anatomy deformity that hinders or stop the insertion of symmetry (being standard) joint of vertebral column replacing apparatus in asymmetric mode.

Figure 26 is the perspective view that comprises the implant system of artificial intervertebral disc substitute (not shown) and facet joint formation system.System 2600 can use above-mentioned feature by modularity, perhaps can form make provide for complete must or necessary parts operate with uniform way with permission equipment.Alternately, system can form and make parts interconnect with seamless way.This embodiment is configured to allow to use percutaneous to perform the operation deployment facility.Support member is squeezed to allow Wicresoft approaching.Center head side-connector 2690 is fixed during installation with center tail side-connector 2630 combination permission parts or is linked together, and is removed then.If necessary, can limit or stop the joint to connect.Bindiny mechanism also can be located between connecting rod and the artificial intervertebral disc; Such mechanism can be further used for increasing the stability and the long term survival power of artificial intervertebral disc substitute and/or facet replacement equipment.Center tail side-connector 2630 may further include forward direction adjutage (not shown), and this arm extends through the opening that is formed in the artificial intervertebral disc substitute and further extends along end plate along the end plate of vertebral body.Described arm can be suitable for further the distributing load of intervertebral disc on the end plate reduces and/or eliminates that the depression of intervertebral disc replacement thing is gone into and/or by the vertebra end plate.The load distribution is to take place on the bigger surface area owing to the effect with power is distributed in.The various embodiments of arm can comprise flat or semicircular cross section, and plane section is located towards end plate.

The present invention includes such system, described system comprises single spinal function unit joint replacement system.Here the equipment that provides, system and method reduce and/or have eliminated in the displacement of the life period of implant, repair the displacement with respect to vertebral body of artificial intervertebral disc replacing apparatus and/or artificial intervertebral disc replacing apparatus.By the intervertebral disc replacement thing is connected to the facet replacement thing, can obtain to reduce or the additional benefit of the load of the spinal column anchor that distributes again (pedicle of vertebral arch, vertebral plate, spinous process and/or their combination).

In some embodiments, it is desirable to comprise prosthetic ligament in articulating arm and/or between by the treatment vertebral body.In addition, in some embodiments, some or all that it is desirable to around facet/articulated joint or its surface comprise flexible peplos.Alternately, facet replacement equipment can be suitable for being included in and be attached to existing ligament, tendon and/or other a plurality of attachment points (perforate, hole, hook etc.) soft or sclerous tissues when surgical operation finishes, with healing and further the stablizing that promotes affected area.

Equipment disclosed herein and parts can be formed by various materials as known in the art.For example, have at equipment under the situation on stayed surface (surface that promptly contacts with each other), described surface can be by biocompatible metal, for example formation such as cochrome, surgery steel, titanium, titanium alloy (for example Nitinol), tantalum, tantalum alloy, aluminum.Also can use suitable pottery (comprising RESEARCH OF PYROCARBON) and other suitable biocompatible materials as known in the art.Suitable polymers comprises polyester, aromatic ester, for example polyolefin terephthalate, polyamide, polyolefin, poly-(vinyl) fluoride, PTFE, poly-aryl methyl ketone (polyarylethyl ketone) and other materials well known by persons skilled in the art.The various alternate embodiments of spinal column equipment and/or parts can comprise flexomer part (biological example compatible polymeric), and this polymer moieties is by rigidity or semi-rigid fixedly make polymer flexing or joint connect to allow vertebral body relative to each other to connect in the joint.

Various embodiment of the present invention relates to a kind of whole joint of vertebral column exchange system, and it comprises and the bonded modularity facet joint of artificial intervertebral disc replacing apparatus substitute.In fact can be in every way and artificial intervertebral disc replacing apparatus with different effectiveness, and enlargement of lymph nodes repair system and replacing apparatus, vertebral body interbody spacer thing, dynamic stability equipment, joint connecting rod and screw system, opisthodetic ligament or ring repairs and/or combinations such as increase equipment, sour jujube interbody spacer thing, faceted surface rebuilding equipment utilize all various embodiments disclosed herein.

Various embodiment of the present invention connects facet replacement prosthese and artificial intervertebral disc replacement prosthesis in every way ideally.This connection can be an one, make two parts " connect " (inflexibility or flexible together firmly, to allow and/or forbid that the joint between the parts connects), perhaps parts can " be flexible coupling " together, with allow between the parts move and/or displacement reaches certain expection limit.If necessary, at least one end of connection device can comprise that multiaxial type connects to be connected to one or more parts of facet replacement prosthese.In alternate embodiments, this connection can be passed the one or more openings that form by various facet replacement parts similarly.

Ideally, can be by such system in combination being reduced, minimizes and/or eliminate facet replacement system and the inherent restriction of institute of many artificial intervertebral disc exchange systems or the shortcoming of many prior aries in the single spinal function unit joint replacement system.For example, can reduce and/or eliminate by the intervertebral disc replacement thing being connected to the facet replacement prosthese in the life period intervertebral disc replacement thing of implant chance with respect to vertebral body migration and/or displacement.Similarly, the intervertebral disc replacement thing is connected to the facet replacement thing anchor (pedicle of vertebral arch that reduces (or distributing again) facet replacement prosthese can be provided, vertebral plate, the attendant advantages of load certain combination of spinous process and/or they), vice versa (the intervertebral disc replacement thing is attached to the load that the facet replacement thing influences the intervertebral disc replacement thing).And, the power that acts on the parts (being the artificial intervertebral disc replacing apparatus) of equipment can be come balance and/or counteracting by the various power on another parts (being the facet joint replacing apparatus) of the equipment of acting on, thereby reduces and/or the power of balanced action on total and/or its anchoring device.

In one embodiment, the bindiny mechanism between connecting rod and the artificial intervertebral disc substitute can be further used for increasing the stability and the long term survival power of artificial intervertebral disc substitute.In this embodiment, connecting rod comprises the longitudinal extension arm, and this arm extends through the opening that is formed in the artificial intervertebral disc substitute along the end plate of vertebral body, and further extends along end plate.Ideally, this arm will be used to distribute load of intervertebral disc on the end plate reduces and/or eliminates that the depression of intervertebral disc replacement thing is gone into and/or by vertebra end plate (using the distribute mode of rescuer's weight of ladder of rescuing to be similar on thin ice).The various embodiments of arm can comprise flat or semicircular cross section, and the plane section of (towards end plate) comprises that biological activity and/or inside growing surface are to promote biological fixation to surrounding tissue.Pitman arm can comprise flexible or rigid material.

In a kind of alternate embodiments, pitman arm is non-parallel and/or asymmetric between upper and lower pitman arm (it is connected respectively to the upper and lower parts of intervertebral disc replacement thing) ideally, so that provide side direction and front/rear support to move, and/or when the control link arm, more easily allow the controlled displacement of intervertebral disc replacement thing to prevent intervertebral disc replacement equipment.

If necessary, can be shifted/relocatable intervertebral disc replacement system (as above described in the figure) can comprise one or more " settings ", described be provided with can allow the internist to control, limit, reduce, increase or prevent the intervertebral disc replacement thing and/or the activity of facet replacement equipment (to produce some clinical benefits, comprise causing that spinal fusion, restriction joint connect with healing, the restriction that promotes spinal tissues or allow small activity to promote that bone inwardly grows in the equipment, perhaps the clinical effectiveness of some other needs).

In various embodiments, connecting rod between facet replacement prosthese and the intervertebral disc replacement equipment is convenient to each prosthese/equipment location (reorientation) relative to each other, thereby more easily allow the kinesiology of prosthese/equipment and/or match each other (or compatibility) of Performance Characteristics (natural imitation joint of vertebral column ideally).

In various embodiments, intervertebral disc replacement equipment can comprise opening or other butt joints (docking) feature, afterwards the time (for example during surgical operation subsequently), described opening or butt joint feature can be used for facet replacement equipment (as described herein) is connected to the intervertebral disc replacement thing.For example, implanted and patient is by this operation healing at the intervertebral disc replacement thing, but suffer in future under the situation of spinal column degeneration (for example by facet degeneration, spinal stenosis and/or the spondylolishesis of treatment spinal column position), can open described position again, facet replacement equipment is connected to existing intervertebral disc replacement implant, and finishes surgical operation.The facet replacement equipment that has opening or butt joint feature for initial implantation can be expected similar arrangements, is utilized during implanting the artificial intervertebral disc replacement prosthesis subsequently after described opening or the butt joint feature.

Various alternate embodiments of the present invention relates to the system based on vertebral plate and/or pedicle of vertebral arch that is used to replace natural facet, is using or is not using cement and/or the inside growing surface of bone to increase under the fixed situation, and described system anchors to vertebral body.

It will be understood by those of skill in the art that disclosed various embodiments for example can be suitable for solving during implanting position, length and the direction of the vertebral plate passage of being made by the surgeon here.Various embodiments also can be suitable for solving the anatomy constraint of single patient.Thereby, can dispose the part dimension of limited quantity and/or shape to adapt to multiple anatomical variations possible the patient from kit utility.For example, comprise that a kit utility of side implant can comprise having the side implant that length changes from 20mm to 70mm, its length for example with 5 or the increment of 10mm increase, to adapt to passage/vertebral plate with different length/thickness.Similarly, the degree of depth of the perforate of adaptation parts also can be suitable for adapting to the patient.

Another advantage of various embodiments is to use vertebral plate and spinous process to allow implantation equipment as the anchor point of equipment, avoids the pedicle of vertebral arch of vertebral body simultaneously.Alternately, it is desirable to utilize the anchor point of the pedicle of vertebral arch of vertebral body, avoid vertebral plate and spinous process simultaneously as equipment.In various embodiments, the combination (or both mixing) that is connected with pedicle of vertebral arch through vertebral plate is best for the patient.For example, be implanted under the situation of a plurality of spinal columns position (for example cross in the L4-S1 position each implant facet replacement equipment) at facet replacement equipment, side can be used in the L4-L5 position through vertebral plate facet replacement equipment (in the L4 vertebra) and being used in combination of tail side pedicle of vertebral arch anchoring facet replacement equipment (in the L5 vertebra), and a side pedicle of vertebral arch anchoring facet replacement equipment (in the L5 vertebra-may utilize the pedicle of vertebral arch anchor identical with the anchor that is used for L4-L5 position tail side component) and being used in combination of tail side pedicle of vertebral arch anchoring device (at rumpbone) can be used in the L5-S1 position.Such layout thereby can avoid need using obviously more weak L5 vertebral plate as anchor point still allows the multidigit displacement of facet joint.Certainly, such mixing apparatus can be used in combination with the spinal treatments equipment of form of ownership similarly, comprises artificial intervertebral disc substitute, ring restoration, enlargement of lymph nodes substitute, dynamic stability device, ligament repair and substitute, sour jujube interbody spacer thing, joint connecting rod and the screw system and/or the ortho position fusion device of one or more spinal columns position.

What help when relating to intervertebral disc to understand scope of the present invention and instruction openly is in addition: people's such as Serhan U.S. Patent Publication US2005/0055096A1 relates to spinal function unit prosthese (Functional spinal unit prosthetic); With the US2005/0033434A1 of Berry, relate to the movable restorer (Posterior elementsmotion restoring device) of back element.

Help further openly comprising of scope of the present invention and instruction: the U.S. Patent No. 6610091 of Mark A.Reiley relates to facet joint former and method (Facetarthroplasty devices and methods); The open No.US2005/0283238A1 of the U.S. of Mark A.Reiley relates to facet joint former and method; The US2005/0234552A1 of MarkA.Reiley relates to facet joint former and method; People's such as Mark A.Reiley US2005/0267579A1 relates to and is used for the metathetical implantable devices of facet joint (Implantable device for facet joint replacement); The US2006/0009849A1 of Mark A.Reiley relates to facet joint former and method; The US2006/0009848A1 of Mark A.Reiley relates to facet joint former and method; The US2006/0009847A1 of Mark A.Reiley relates to facet joint former and method; The US2004/0006391A1 of Mark A.Reiley relates to facet joint former and method; The US2004/0111154A1 of Mark A.Reiley relates to facet joint former and method; The US2004/0049276A1 of Mark A.Reiley relates to facet joint former and method; The US2005/0251256A1 of Mark A.Reiley relates to facet joint former and method; The US2004/0049273A1 of Mark A.Reiley relates to facet joint former and method; The US2004/0049281A1 of Mark A.Reiley relates to facet joint former and method; The US2004/0049275A1 of Mark A.Reiley relates to facet joint former and method; The U.S. Patent No. 6949123B2 of MarkA.Reiley relates to facet joint former and method; The open No.US2004/0049274A1 of the U.S. of Mark A.Reiley relates to facet joint former and method; The US2004/0049278A1 of Mark A.Reiley relates to facet joint former and method; The US2004/0049277A1 of Mark A.Reiley relates to facet joint former and method; The US2005/0137706A1 of Mark A.Reiley relates to facet joint former and method; The US2005/0137705A1 of Mark A.Reiley relates to facet joint former and method; The US2005/0149190A1 of Mark A.Reiley relates to facet joint former and method; The US2005/0043799A1 of MarkA.Reiley relates to facet joint former and method; The US2002/0123806A1 of Mark A.Reiley relates to facet joint former and method; People's such as Mark A.Reiley U.S. Patent No. 6974478, relate to prosthese, system and method (Prostheses, systems and methods for replacement of natural facet jointswith artificial facet joint surfaces) with the natural facet joint of artificial facet joint surface replacement; People's such as Mark Kuiper US2005/0240265A1 relates to cross bar spinal prostheses and relevant method for implantation (Crossbar spinal prosthesis having a modular design andrelated implantation methods) with modularized design; People's such as Mark A.Reiley US2005/0119748A1 relates to prosthese, system and method with the natural facet joint of artificial facet joint surface replacement; The US2005/0027361A1 of Mark A.Reiley relates to facet joint former and method; People's such as Mark Kuiper US2005/0240266A1 relates to cross bar spinal prostheses and relevant method for implantation with modularized design; People's such as Mark Kuiper US2005/0261770A1 relates to cross bar spinal prostheses and relevant method for implantation with modularized design; People's such as Hansen Yuan US2004/0230201A1 relates to prosthese, system and method with the natural facet joint of artificial facet joint surface replacement; People's such as Hansen Yuan US2005/0143818A1 relates to prosthese, system and method with the natural facet joint of artificial facet joint surface replacement; People's such as David Stinson US2005/0010291A1 relates to prosthese, system and method with the natural facet joint of artificial facet joint surface replacement; People's such as David Stinson U. S. application No.11/275447 relates to prosthese, system and method with the natural facet joint of artificial facet joint surface replacement; People's such as Hansen Yuan US2004/030304A1 relates to prosthese, system and method with the natural facet joint of artificial facet joint surface replacement; People's such as Mark A.Reiley US2005/0131406A1, the multiaxis that relates to facet joint prosthesis is regulated (Polyaxial adjustment of facet jointprostheses); People's such as Leonard Tokish US2005/0240264A1 relates to the anti-rotation retaining element (Anti-rotation fixation element forspinal prostheses) of spinal prostheses; People's such as Teena M.Augostino US2005/0235508A1 relates to facet joint prosthesis and measures and implanting instrument (Facet joint prosthesesmeasurement and implant tools); The U. S. application No.11/236323 of Michael J.Funk relates to implantable orthopedic equipment parts and selects apparatus and method (Implantable orthopedic device component selection instrumentand methods); People's such as Richard Broman U. S. application No.11/206676 relates to implantable spinal column equipment update the system (Implantable spinal device revisionsystem); People's such as Teena M.Augostino US2006/0041211A1, relate to ortho position facet joint former, spinal stabilization system and method (Adjacent level facetarthroplasty devices, spine stabilization systems, andmethods); The US2006/0041311A1 of Thomas J.McLeer relates to the equipment and the method (Devices and methods for treating facetjoints) that are used for the treatment of facet joint; The U. S. application No.11/140570 of Thomas J.McLeer relates to and improves the method and apparatus (Methods and devices for improved bondingto bone) that is bonded to bone; With 11/244420 of Thomas J.McLeer, relate to polymer joint complex and using method (Polymeric joint complex and methods of use).

Although here show and described preferred implementation of the present invention, clearly, only the mode by example provides these embodiments to those skilled in the art.Those skilled in the art will expect many variations, change and replacement and not break away from the present invention now.Various the substituting that should be understood that embodiments of the present invention described here can be used to put into practice the present invention.The method and structure that following claim is intended to limit in the scope of scope of the present invention and these claim and equivalent thereof is contained thus.

Claims

1. facet joint restorer that is used to recover the facet joint surface comprises:

(a) a side facet joint element, it comprises that (1) can engage flexible member and (2) artificial head side joint of first vertebra; With

(b) tail side facet joint element, it comprises that (1) can be fixed to the artificial tail side joint that the adapter of second vertebra and (2) can engagement head side facet joints.

2. facet joint restorer according to claim 1, wherein said flexible member can engage the vertebral plate of first vertebra.

3. facet joint restorer according to claim 1, wherein said side facet joint element also comprises plate, described strip has the anchoring mechanism that can engage with the vertebral plate of first vertebra.

4. facet joint restorer according to claim 3, wherein said anchoring mechanism comprise the anchoring mechanism in the group that is selected from tooth, ridge, caking, sawtooth, granulation surface, bar, screw and spike composition.

5. facet joint restorer according to claim 2, wherein said side facet joint element also comprises second anchoring mechanism, is used for a side facet joint element is fixed to first vertebra.

6. facet joint restorer according to claim 2, wherein said adapter can be fixed on the pedicle of vertebral arch of second vertebra.

7. facet joint restorer according to claim 5, wherein said second anchoring mechanism comprises the inside growing surface of bone.

8. facet joint restorer according to claim 1, the tissue that wherein said equipment displacement is removed from facet joint.

9. facet joint restorer according to claim 1, wherein said equipment can recover or keep the activity or the activeness of facet joint.

10. facet joint restorer according to claim 1, wherein said side facet joint element can conform to relative match surface profile with one surface in the tail side facet joint element.

11. facet joint restorer according to claim 1, wherein said artificial tail side joint is the tail side cup with recessed surface.

12. facet joint restorer according to claim 1, wherein said flexible member is a flexible cable.

13. facet joint restorer according to claim 12, wherein said flexible cable by circumference of cannon bone around.

14. facet joint restorer according to claim 12, wherein said flexible cable can connection locking device.

15. facet joint restorer according to claim 1, also comprise can with the spring washer of the surface engagement of first vertebra.

16. facet joint restorer according to claim 1 also comprises extending plate, it can engage lamina surface with supporting member side facet joint element during implanting.

17. a facet joint replacing apparatus that is used to replace all or part of natural facet joint between first vertebra and second vertebra comprises:

(a) first side facet joint element, it has the retaining element that can engage with the vertebral plate or the spinous process of first vertebra; With

(b) the first tail side facet joint element, the described first tail side facet joint element comprise the artificial tail side faceted surface that can be fixed to the second epicentral first tail side-connector and can engage with a side facet joint element.

18. facet joint replacing apparatus according to claim 17, wherein said retaining element is a flexible cable.

19. facet joint replacing apparatus according to claim 17 also comprises second the side facet joint element and first cross bar, described first cross bar can be connected to second side facet joint element with first side facet joint element.

20. facet joint replacing apparatus according to claim 17 also comprises the second tail side facet joint element and first cross bar, described first cross bar can be connected to the second tail side facet joint element with the first tail side facet joint element.

21. facet joint replacing apparatus according to claim 19 also comprises the second tail side facet joint element and second cross bar, described second cross bar can be connected to the second tail side facet joint element with the first tail side facet joint element.

22. facet joint replacing apparatus according to claim 17 also comprises the vertebral plate clip.

23. facet joint replacing apparatus according to claim 22, wherein said vertebral plate clip can engage first side facet joint element.

24. facet joint replacing apparatus according to claim 23, wherein said vertebral plate clip also comprises the tooth that is used to engage lamina surface.

25. facet joint replacing apparatus according to claim 23, wherein said vertebral plate clip also comprise first parts and second parts that can adjustable ground engage vertebral plate.

26. facet joint replacing apparatus according to claim 23, wherein said first side facet joint element can extend from the vertebral plate clip.

27. facet joint replacing apparatus according to claim 17, wherein said artificial tail side faceted surface comprises tail side cup.

28. facet joint replacing apparatus according to claim 17, wherein said first side facet joint element rotatably engages described retaining element.

29. facet joint replacing apparatus according to claim 18, wherein said flexible cable by circumference of cannon bone around.

30. facet joint replacing apparatus according to claim 17 also comprises extending plate, it can engage lamina surface with supporting member side facet joint element.

31. the vertebrae position place in spinal column is used in the spinal function unit recovery system in the spinal function unit, comprising:

(a) first side facet joint element and second side facet joint element;

(b) the first tail side facet joint element and the second tail side facet joint element, they comprise adapter of fixing vertebral body and artificial tail side joint that can engagement head side facet joint;

(c) cross bar, it can engage the first tail side facet joint element and engage the second tail side facet joint element at the second end place at the first end place; With

(d) artificial intervertebral disc.

32. spinal function according to claim 31 unit recovery system, wherein anchor is a flexible cable.

33. spinal function according to claim 31 unit recovery system, wherein said side facet joint element also comprises plate, and described strip has the anchoring mechanism that can engage vertebral plate.

34. spinal function according to claim 33 unit recovery system, wherein said anchoring mechanism comprise the anchoring mechanism in the group that is selected from tooth, ridge, caking, sawtooth, granulation surface, bar and spike composition.

35. spinal function according to claim 33 unit recovery system, wherein said plate also comprise the screw rod that can and be configured to the engage threaded of support member.

36. spinal function according to claim 31 unit recovery system, wherein said equipment comprises pottery, metal, polymer or their combination by the material structure of the natural appearance that can form described equipment.

37. spinal function according to claim 31 unit recovery system, wherein said equipment recover the unitary biomechanics operation of described spinal function.

38. spinal function according to claim 31 unit recovery system, degeneration or pathological tissues in the wherein said equipment therapeutic goal spinal function unit.

39. spinal function according to claim 31 unit recovery system, wherein said equipment can recover or keep unitary activity of target spinal function or activeness.

40. spinal function according to claim 31 unit recovery system, wherein a side joint can conform to relative match surface profile with one surface in the tail side joint.

41. spinal function according to claim 31 unit recovery system, wherein a side joint can conform to relative match surface profile with one surface in the tail side joint.

42. spinal function according to claim 32 unit recovery system, wherein said flexible cable can connection locking device.

43. spinal function according to claim 31 unit recovery system also comprises the vertebral plate clip.

44. according to the described spinal function of claim 43 unit recovery system, wherein said vertebral plate clip can engage described cross bar.

45. according to the described spinal function of claim 43 unit recovery system, wherein said vertebral plate clip also comprises the tooth that is used to engage lamina surface.

46. according to the described spinal function of claim 43 unit recovery system, wherein said vertebral plate clip also comprises first parts and second parts that can adjustable ground engage vertebral plate.

47. according to the described spinal function of claim 43 unit recovery system, wherein said side joint can be extended from the vertebral plate clip.

48. according to the described spinal function of claim 43 unit recovery system, wherein said vertebral plate clip can also engage described cross bar.

49. according to the described spinal function of claim 43 unit recovery system, wherein said first side joint is different from the direction of second side joint to the second tail side joint to the direction in the first tail side joint.

50. according to the described spinal function of claim 43 unit recovery system, the adjustable in length that is parallel to the spinal column centrage of wherein said vertebral plate clip.

51. spinal function according to claim 31 unit recovery system, wherein said artificial tail side joint is a tail side cup.

52. spinal function according to claim 31 unit recovery system, wherein said artificial head side joint rotatably engages flexible cable.

53. spinal function according to claim 31 unit recovery system, wherein said flexible cable by circumference of cannon bone around.

54. spinal function according to claim 31 unit recovery system also comprises spring washer, it can engage the surface of vertebral body.

55. spinal function according to claim 31 unit recovery system also comprises extending plate, it can engage lamina surface with supporting member side joint component during implanting.

56. one kind is used for recovering the unitary kit utility of spinal function at the vertebrae position place of spinal column, comprises:

(a) first side facet joint element and second side facet joint element;

(d) artificial intervertebral disc.