CN101257853A - Device for preparing an intervertebral disc compartment - Google Patents

Abstract

The invention relates to a preparation device for preparing an intervertebral disc compartment (14) which is delimited by a first and a second vertebra (16, 18). Such a preparation is carried out prior to the insertion of an intervertebral disc prosthesis (110), in order to guarantee a correct positioning of the intervertebral disc prosthesis between the vertebrae (16, 18) . The preparation device (10) comprises a reference frame (22), which is capable of being fastened above an operating table (12), and a first fixing element (58) which is capable of being rigidly connected to the first vertebra (16) ard capable of being fastened to the reference frame (22) in varying first positions. A second fixing element (68) is capable of being rigidly connected to the second vertebra (18) and capable of being fastened to the reference frame (22) in varying second positions. A material-abrading tool (78) is capable of being fastened to the reference frame (22), preferably in varying positions.

Description

Be used to prepare the preparation facilities of intervertebral-disc compartment

The cross reference of related application

The application requires in the rights and interests of the U.S. Provisional Patent Application sequence number No.60/696881 of application on July 6th, 2005 and requires in the rights and interests of the European patent application EP 06002766.0 of application on February 10th, 2006.These whole disclosures of early applying for all are combined in herein as a reference.

Technical field

The present invention relates to a kind of preparation facilities that is used to prepare intervertebral-disc compartment (intervertebral disccompartment), described intervertebral-disc compartment is defined by first and second vertebras.This preparation is to carry out before inserting intervertebral disk prosthesis, correctly locatees between vertebra so that guarantee intervertebral disk prosthesis.

Background technology

US2002/0161446A1 discloses a kind of instrument of wear material, and the instrument of this wear material can be fastened on the reference frame with respect to the position of vertical line with different angles.Before the preparation intervertebral-disc compartment, carry out radiography for from the side above-mentioned spinal column segmentation.According to this radiography, determine that instrument on the reference frame with respect to the established angle of vertical line, is being fastened to reference frame on the operating-table on the side then, make reference frame cross the patient and extend to patient's outside.(ventral access canal) exposes above-mentioned cervical vertebra by the front side access road, the intervertebral disc that exists is removed, and wedge tool inserted the intervertebral-disc compartment that exposes with pre-determined established angle, by this instrument, in this way the vertebra that defines intervertebral-disc compartment is carried out machined, the feasible plane interface that is formed for intervertebral disk prosthesis.

Yet, obviously, utilizing known preparation facilities to implement disease often to occur in the process of intervertebral disc operation, its reason is the sectional incorrect stand under load of above-mentioned spinal column.

Summary of the invention

For this reason, the purpose of this invention is to provide a kind of preparation facilities, adopt described preparation facilities to reduce after the danger of this type disease.

This purpose realizes that by a kind of preparation facilities that is used to prepare the intervertebral-disc compartment that is used to insert intervertebral disk prosthesis above-mentioned intervertebral-disc compartment is defined by first and second vertebras, and this preparation facilities has:

A) reference frame, described reference frame can be fastened on the top of operating-table;

B) first retaining element, described first retaining element can be connected on first vertebra rigidly, and can be fastened to primary importances different on the reference frame;

C) second retaining element, described second retaining element can be connected on second vertebra rigidly, and can be fastened to the second positions different on the reference frame;

D) randomly, the instrument of wear material, the instrument of described wear material can be fastened to diverse location on the reference frame.

The present invention is based on following viewpoint, promptly intervertebral disk prosthesis can only alleviate the disease of spinal column effectively, perhaps eliminates a disease fully when considering that as far as possible the sectional dissection of above-mentioned spinal column is detailed.Especially, these comprise that consideration makes the activity centre keep far away as much as possible in the location intervertebral disk prosthesis like this, and above-mentioned activity centre is pre-determined by the vertebra of adjacency intervertebral-disc compartment.The activity centre can be corresponding around its rotation axis that rotates relative to one another or the point of rotation with two vertebras.Or rather, the activity centre is by front side intervertebral disc system and also next definite by two dorsal joint parts (dorsal joint part) of spinal canal.

Muscle around the above-mentioned spinal column segmentation and ligament organ and described activity centre coupling.

But, if predetermined activity centre is not an optimum matching on the connection of intervertebral disk prosthesis and the anatomy, when then this intervertebral disk prosthesis inserted intervertebral-disc compartment, this muscle and ligament organ unnecessarily bore load, and this generally can cause the patient to produce disease.

Under the situation of known devices from the US2002/0161446A1 that begins to mention, utilize the intervertebral disk prosthesis of implanting to obtain predetermined activity centre on the anatomy.This is on the one hand relevant with the following fact, i.e. the radiograph of taking before the operation form alignment ridge column sectional---determining the established angle of instrument according to this radiography---and taken a picture in the disease patient with it.Yet in this state, vertebra may be because very different former thereby displacement-for example hyperostosis or intervertebral disc deformations-make the position of vertebra and the position of healthy spine that a great difference is arranged like this.If determine the established angle of instrument according to this radiograph, then intervertebral disk prosthesis finally is implanted to and makes it only replace a part of affected spinal column, but affected spinal column is not moved back into healthy position.

On the other hand, especially in the operation process of the cervical vertebra section of spinal column, less neck bone often takes place be shifted in the process that exposes the front side access road.These displacements do not take in removing material with instrument and implant subsequently in the process of intervertebral disk prosthesis, because determining of established angle only is that radiograph according to shooting before the operation carries out.

On the other hand, by means of according to retaining element of the present invention, can be at first transfer to the corresponding position of healthy spine section with the patient who under prescribed condition, undergos surgery by means of the vertebra that can aligned retaining element will define intervertebral-disc compartment.

In order to determine this position, can adopt diverse ways.

If also have the old radiograph of patient's unaffected spinal column up to now to utilize, then the position of vertebra can be determined according to these radiographs.In addition, can infer the position of the vertebra that defines intervertebral-disc compartment from the position of adjacent vertebrae, as what can under the situation of healthy spine, observe.Another kind of probability is by means of retaining element vertebra to be diverged at intra-operative.If ligament organ on every side is protected, then vertebra itself has been positioned at the position that can observe as under the situation of healthy spine.

Conventional intervertebral disk prosthesis comprises two support plates, and described two support plates respectively carry a part of ball-and-socket and connect.Described support plate has flat outer surface, and they are bearing on the flat interface of milling of vertebra by flat outer surface.Therefore the determining positions of interface the position of intervertebral disk prosthesis between two vertebras.Part ball-and-socket connection part is fastened on the support plate replaceably, so that consider to change the gap between the vertebra.

But, under the situation of this known intervertebral disk prosthesis, have only when preparing to wear away relatively large healthy vertebra material, could obtain the activity centre reliably.For fear of this point, the wherein all removable intervertebral disk prosthesis of two parts ball-and-socket connection part is used in suggestion.Can make spacing between spherical ball surface and interface be suitable for the intervertebral-disc compartment height like this and be suitable for the position of activity centre.Such intervertebral disk prosthesis is existing introduction the in the international patent application of " intervertebral disk prosthesis " at the title of being applied on the same day by the applicant, and this full content of applying in addition all is combined in herein with for referencial use.

Another advantage of utilizing retaining element is that the required power of aligning is to apply from the outside, rather than applies by adjacent vertebra.In addition, even when the dorsal part that is used for intervertebral disk prosthesis or front side access road just form in the time after a while, the retaining element of introducing by means of percutaneous also is feasible at external aligning.

Description of drawings

Can be more readily understood various feature and advantage of the present invention with reference to the detailed description of doing below in conjunction with accompanying drawing, wherein:

Fig. 1 is the diagrammatic side view according to preparation facilities of the present invention;

Fig. 2 is the top view of the preparation facilities shown in Fig. 1;

Fig. 3-13 is illustrated under the situation of utilizing the preparation facilities shown in Fig. 1 and 2, and the intervertebral-disc compartment between two adjacent vertebras is in before the preparation, during the preparation and the different conditions after the preparation.

The specific embodiment

Fig. 1 and 2 illustrates according to preparation facilities of the present invention with very simple side view and vertical view respectively.Preparation facilities is represented with label 10 as a whole, and is fastened on the operating-table 12.Device 10 is used for preparing the intervertebral-disc compartment 14 that is used to insert intervertebral disk prosthesis, and this intervertebral-disc compartment 14 forms between patient 20 first vertebra 16 and second vertebra 18.In the embodiment shown in Fig. 1 and 2, vertebra 16,18 is a cervical vertebra, and for simplicity, above-mentioned cervical vertebra illustrates that not have the dorsal part vertebra prominent.

Preparation facilities 10 is used for before inserting prosthese vertebra 16,18 being moved to tram on the anatomy.Correct position is meant if patient's the spinal column position that vertebra 16,18 has when still healthy on the anatomy.Before or after vertebra entered position correct on its anatomy, intervertebral-disc compartment 14 can carry out machined by means of the instrument of wear material, made intervertebral disk prosthesis to be inserted intervertebral-disc compartment with the optimum position.

Preparation facilities 10 has a reference frame 22, and described reference frame 22 is arranged on patient 20 top, and patient 20 lies on the operating-table 12 with dorsal part.Reference frame 22 has two domed support 24,26, and each carriage has circular cross section.Two carriages 24,26 interconnect by cross bar 28,30, and described cross bar 28,30 also has circular cross section.This connection forms by connection element (jointelement) 32a, 32b, 32c, 32d, at Fig. 1 and 2 described connection element 32a, 32b, 32c, 32d is shown in a schematic way and can be fixed into ball-and-socket and connects.As can best finding out in Fig. 1, connection element 32a, 32b, 32c, 32d can rotate carriage 24,26 with respect to cross bar 28,30.In Fig. 1, rotatory power is represented with arrow 34,36.

Carriage the 24, the 26th, so wide, so that in position, oblique angle shown in Figure 1, they cross patient 20 head 38 and chest 40.Therefore cross bar 28,30 can drop to very the cervical region near patient 20, and significantly access road is not limited in the neck region for the surgeon.

Carriage 24,26 is engaged by the first supporting member 42a, 42b and the second supporting member 42c, 42d respectively, and the described first supporting member 42a, 42b and the second supporting member 42c, 42d make reference frame 22 aim at respect to operating-table 12., in height-adjustable mode supporting member 42a, 42b, 42c, 42d are contained in respectively among socket component 44a, 44b, 44c, the 44d, described socket component 44a, 44b, 44c, 44d are connected on the operating-table 12 firmly for this reason.But supporting member 42a, 42b displaceability is in vertical direction represented by arrow 47a, 47b in Fig. 1.

By the second connection element 46a, 46b and 46c, 46d supporting member 42a, 42b and 42c, 42d are fastened on the carriage 24,26 respectively.The second connection element 46a, 46b, 46c, 46d design by this way, make carriage 24,26 can be fixed on position, different angle.Carriage 24,26 is represented by arrow 48a, 48c in Fig. 1 with respect to the direction of rotation of supporting member 42a, 42b, 42c, 42d.

In addition, the second connection element 46a, 46b, 46c, 46d can make whole reference frame 22 tilt around the longitudinal axis that a longitudinal direction that is parallel to operating-table 12 extends.Except that tiltable, the second connection element 46a, 46b, 46c, 46d surround tubular brackets 24,26, make that the carriage 24,26 among the second connection element 46a, 46b, 46c, the 46d also can promote after above-mentioned longitudinal direction is gone forward.This inclination can be for example by being positioned at supporting member 42a, 42c on operating-table 12 1 sides respectively from socket component 44a with 44c pulls out or further push and produce.If available socket component 44a, 44b, 44c, 44d can not implement adjustable height on operating-table, then supporting member 42a, 42b, 42c, 42d also can for example have the design of adjustable in length by means of threaded pinion.

Its two ends of first sliding part, 50 usefulness are enclosed within on the cross bar 28,30 by this way, make it to move, and can be locked at any lengthwise position by means of lock- screw 54a, 54b or similar fixture at the longitudinal direction of cross bar 28,30 upper edge arrows 52 indications.First sliding part 50 has first clamping element 56, and described first clamping element 56 is connected on first sliding part 50 firmly, but it also can be fixed on diverse location along the longitudinal direction of first sliding part 50.First clamping element 56 is used for first hold-down screw 58 is fixed on positions, angle different in the Plane of rotation, and above-mentioned Plane of rotation is perpendicular to by cross bar 28,30 reference plane that limited and be parallel to cross bar 28,30 and extend.For this reason, clamping element 56 can comprise cylinder for example with holes, and above-mentioned cylinder so supports so that can rotate, and first hold-down screw 58 can insert and be fixed in the above-mentioned hole.

Second sliding part 60 can move with the direction of vertical displaceable mode at cross bar 28,30 upper edge arrows 62 indications equally, and can be fixed on any lengthwise position on the cross bar 28,30 by means of lock-screw 64a, 64b.Second sliding part 60 has second clamping element 66, and described second clamping element 66 is configured to similar and be used for fixing second hold-down screw 68 with first clamping element 56.

The 3rd sliding part 70, the three sliding parts 70 are installed between two sliding parts 50,60 can be moved at the longitudinal direction of cross bar 28,30 upper edge arrows 72 indications equally also and can be fixed on desirable position by means of lock-screw 74a, 74b.The 3rd sliding part 70 has the 3rd clamping element 76, and described the 3rd clamping element 76 is used for receiving milling cutter 78.Milling cutter 78 has milling head 80, and can be fastened on equally and be in different positions, angle on the 3rd clamping element 76.In addition, the 3rd clamping element 76 can move by the horizontal direction along arrow 84 indications in guide groove 82.

Below, illustrate the function of preparation facilities 10 in more detail with reference to Fig. 3-10, Fig. 3-10 usefulness enlarged side view is illustrated in two vertebras 16,18 that are in the preparation process under the different coherent state.

At first, in a kind of so known mode patient is aimed at and is fixed on the operating-table 12.Reference frame 22 be installed on patient 20 above after, the front side access road of vertebra 16,18 is led in surgeon preparation, described front side access road is represented with label 90 in Fig. 2.In principle, if patient lies on the operating-table by his/her chest, then the dorsal part access road is equally also suitable.Needed for this reason scraper can be fastened on the cross bar 28,30.

In next step, reference frame 22 can tilt around its longitudinal axis (randomly) as mentioned above.Because the result of this inclination can consider reversing of spinal column---, because producing, the result that bone pathology changes but also may produce as being owing to the result of exposure front side access road 90.In order to detect this reversing, from the side patient 20 is carried out x-ray irradiation.Operating-table 12 is tilted around its longitudinal axis, make the transverse process (not shown in Fig. 1 and 2) of vertebra 16,18 aim at.Reference frame 22 is tilted, when under fluoroscopy, being arranged on Kong Zhongwei in the alignment member 22 and detecting dual edge till, above-mentioned alignment member 22 is fastened on the cross bar 30.Like this, accurately be parallel to the transverse process extension of vertebra 16,18 by cross bar 28,30 reference plane that limited.Other particularss that relate to this type of alignment have been done introduction at title for the international patent application of " being used for making the instrument of wear material with respect to the aligned system of intervertebral-disc compartment ", and above-mentioned international patent application is being applied on the same day by applicant and the application.Whole disclosures of this patent application all are combined in herein with for referencial use.

After reference frame 22 was aimed at respect to patient 20 spinal column (randomly), according to first embodiment, the front side access road 90 by prior exposure was screwed into hold- down screw 58,68 in the vertebra 16,18.Screw is screwed into to operate among Fig. 3 to be represented with arrow 94,96.In this operating process, hold-down screw 58,68 so is screwed into, make their preferably two cortex formulas run through the bottom slab of vertebra 16,18, described bottom slab is away from intervertebral-disc compartment 14, as shown in Figure 4.Like this, hold-down screw 58,68 is connected to respectively on first vertebra 16 and second vertebra 18 rigidly.Because the bottom slab can be easy to detect with radiography, so hold-down screw 58,68 is easier to respect to the precision positioning ratio of vertebra 16,18.

In next procedure, make two vertebras 16,18 enter their correct naturally anatomical location.If this is interpreted as that the meaning is meant that such position---promptly the patient is in posture vertebra 16,18 position occupied of standing and not bending over, and does not have pathological change when no matter occurring what situation for example as the apophysis on lower panel.Under the situation of the natural anatomical location that can not establish patient 20 according to old radiography, also can seek help from the sectional biostatistics's investigation of above-mentioned spinal column.In addition, the surgeon can diverge to two hold-down screws 58,68 with hands.Under the situation that function muscle and ligament organ work, two vertebras 16,18 arrive its natural anatomical positions.

Transfer in the process of their natural anatomical positions at vertebra 16,18, the angle between two hold-down screws 58,68 generally must change.Two clamping elements 56,66 that hold-down screw 58,68 runs through respectively wherein allow hold-down screw to rotate towards direction preceding and backward in a Plane of rotation, and above-mentioned Plane of rotation extends perpendicular to the reference plane that limited by cross bar 28,30.Transfer in the process of its natural anatomical position at vertebra 16,18, generally must on cross bar 28,30, move two sliding parts 50,60 in addition, and make retaining element 58,68 rotation in clamping element 56 and 66 respectively simultaneously.

In case obtain the natural anatomical position of vertebra 16,18, just respectively by means of clamping element 56,66 and hold- down screw 58,68 is fixing by means of lock- screw 54a, 54b and 64a, 64b.

Among the embodiment shown here, suppose that the angle between two vertebras 16,18 must be littler, so that two hold- down screws 58,68 are represented as arrow among Fig. 5 98,100 to internal rotation.

Fig. 6 illustrates two vertebras 16,18 that are in its natural anatomical position, and described natural anatomical position is as by making two hold- down screws 58,68 formed with respect to 22 rotations of fixed reference frame.

At this fixed natural anatomical position, now vertebra 16,18 adjacent slabs aligned with each other are carried out machined by means of milling cutter 78 in the mode of wear material.This is normally necessary, so that remove the pathology ostealleosis, described pathology ostealleosis stretches into spinal canal, and usually causes patient's serious pain.As side effect, the flat abutment faces of the intervertebral disk prosthesis that is used to be inserted into is operated and is prepared by this pin that mills.

In this embodiment, suppose that at first the lower panel that first vertebra 16 is aimed at second vertebra 18 carries out machined.For this reason, milling cutter 78 is fixed on the 3rd clamping element 76 by this way, makes the longitudinal axis of milling head 80 form a predetermined angular with respect to first hold-down screw 58.This angle can for example be 2 °.In order to adjust the angle between the milling cutter 78 and first hold-down screw 58, can be with in the space between a wedge shape template 102 insertion first hold-down screws 58 and the milling cutter 78, as represented as arrow among Fig. 1 104.If between the milling cutter 78 and first hold-down screw 58, adjust another angle, then can use another template with suitable shape.

Spacing between the 3rd sliding part 70 and first sliding part 50 is so selected, makes when milling cutter 78 work, can produce flat interface, and need not remove unnecessary, a large amount of bone material.

Fig. 7 illustrates the position of milling cutter 80 when the beginning milling machine operation.By means of clamping element 56 and 76 and limit by means of sliding part 50 and 70 respectively, described sliding part 50,70 is fixed on the cross bar 28,30 respectively for angle between first hold-down screw 58 and the milling head 80 and spacing.By move the 3rd clamping element 70 along guide groove 82, perhaps, on first vertebra 16, be formed for the flat abutment faces of the support plate of intervertebral disk prosthesis now in the plane that guide groove 82 is limited by milling head 80 is rotated, represented as label among Fig. 8 106.

Now second vertebra, 18 usefulness the same manners are repeated this operation, as represented among Fig. 8.Thus on second vertebra 18 formed interface with Fig. 9 in label 108 represent.

After finishing by means of milling cutter 78 machined vertebras 16,18, the space between the preparation vertebra 16,18 is to be used to insert intervertebral disk prosthesis.As shown in Figure 9, two interfaces the 106, the 108th that present vertebra 16,18 faces with each other are flat.If as selecting template 102 suitably, then interface 106,108 forms the natural anatomical angulation of intervertebral-disc compartments.

In next step, can intervertebral disk prosthesis 110 be inserted the space that makes between the vertebra 16,18 by the front side access road of prior formation now, as shown in figure 10.Intervertebral disk prosthesis 110 comprises two support plates 112,114, and described two support plates 112,114 lean against milling on flat surface 106 and 108 of vertebra 16,18 with their sides outward respectively.Have coupling part 116,118 on the inboard of support plate 112,114, described coupling part 116,118 forms ball-and-socket together and connects.

Should be appreciated that many modification of said method are feasible, and still within the scope of the invention.For example, according to the method described above, before milling machine operation, vertebra 16,18 is transferred to their correct anatomical position by means of screw 58,68.If use the prosthese with Fixed Design, then this is favourable.In this case, must prepare intervertebral-disc compartment, so that prosthese is contained in its optimum position by milling.Therefore make intervertebral-disc compartment be applicable to described prosthese.

But in many cases, the prosthese that makes the shape of intervertebral-disc compartment be suitable for being inserted into is impossible or not gear to actual circumstances.On the contrary, it usually is favourable making prosthese be suitable for intervertebral-disc compartment.A kind of approach in back is normally preferred because the surgeon judge at him should be free as much as possible must remove which part osseous tissue the time.If the surgeon finds essential a large portion vertebra of removing owing to the result of bone degeneration during implanting surgical operation, should not consider then this position to prosthese has anything to involve.

If make prosthese be suitable for intervertebral-disc compartment, then after milling machine operation, be enough to vertebra is transferred to its correct anatomical position.For vertebrae immobiles during milling machine operation, can use for example carriage of other conventional equipment.

Figure 11 illustrates wherein quite a large amount of bone material must be by the situation of surgeon with milling cutter 78 removings.After removing bone material, now screw 58,68 to be inserted vertebra 16,18, and utilize preparation facilities 10 that vertebra 16,18 is transferred to position correct on their anatomy, described correct position is determined according to biometric data in advance.Yet in this position, the lacuna between the vertebra 16,18 has unknown shape.In order to determine shape, in the lacuna finishing regulating step after between vertebra 16,18 that a template 120 insertions (seeing Figure 12) are adjacent.In an illustrated embodiment, suppose that template 120 has adjustable blade (not shown), thereby template 120 can have different geometries.Regulate blade until they are close on the surface of milling of vertebra 16,18 along its blade till.

Then template 120 is regained, and according to the geometry by means of template 120 determined lacunas, can be assembled prosthese now, described prosthese is coupled in the lacuna between the vertebra 16,18 capitally.The specially suitable intervertebral disk prosthesis that is used for this purpose is introduced for the international patent application of " intervertebral disk prosthesis " is existing at title, and described international patent application is being applied on the same day by the applicant.These whole disclosures of early applying for all are combined in herein with for referencial use.In one embodiment, provide a plurality of different coupling parts 116,118, the surgeon selects suitable one group from described different coupling parts 116,118.This makes and can change the center of curvature that ball-and-socket connects, and therefore can determine may moving of adjacent vertebrae.The center of curvature that it is desirable to the ball-and-socket connection should be as far as possible near predetermined activity centre on the anatomy of two vertebras 16,18.This position can be determined with fluoroscopy or simulation program.Selectively, perhaps in addition, can locate the center of curvature in order with the support plate 112,114 of different-thickness.

Be used for as far as possible being to use as shown in figure 13 extra plate or wedge 122,124 near the alternative that location, activity centre ball-and-socket predetermined on the anatomy connects the center of curvature.Replace to use the support plate 112,114 (or in addition) of different-thickness, wedge 122,124 can be inserted between the outer surface and adjacent vertebra 16,18 of support plate 112,114 of intervertebral disk prosthesis 110.Wedge 122,124 can be selected from one group of wedge, and described one group of wedge has two and be parallel to each other (that is the angle of wedge equals 0 °) or form the plane of the angle of wedge between 0 ° and 45 ° therebetween.Each wedge is different with regard to the distance between the plane and the angle of wedge.Suitable wedge the 122, the 124th, selected according to the shape of the lacuna that records by means of template 122.Now intervertebral disk prosthesis 110 is inserted in the lacuna with wedge 122,124, as top illustrated with reference to Figure 10.In this embodiment, surgeon or can directly assemble intervertebral disk prosthesis 110 before intervertebral disk prosthesis 110 inserts intervertebral-disc compartments is perhaps at lacuna mounted inside intervertebral disk prosthesis 110.For this reason, the surgeon will directly utilize a large amount of difform wedge, thereby intervertebral disk prosthesis 110 can be adjusted to almost any arbitrary shape.

Claims (17)

1. be used for the preparation facilities that preparation is used to insert the intervertebral-disc compartment (14) of intervertebral disk prosthesis (110), described intervertebral-disc compartment (14) is formed between first and second vertebras (16,18), and above-mentioned preparation facilities comprises:

A) reference frame (22), described reference frame (22) can be fastened on the top of operating-table (12);

B) first retaining element (58), described first retaining element (58) can be connected on first vertebra (16) rigidly, and can be fastened to upward different primary importance of reference frame (22);

C) second retaining element (68), described second retaining element (68) can be connected on second vertebra (18) rigidly, and can be fastened to the upward different second position of reference frame (22).

2. according to the described preparation facilities of claim 1, it is characterized in that described first and second retaining elements (58,68) can be fastened on the reference frame (22) by this way, make that the angle that forms is between 2 ° and 10 ° between them.

3. according to the described preparation facilities of claim 2, it is characterized in that described first and second retaining elements (58,68) can be fastened on the reference frame (22) by this way, make that the angle that forms is between 4 ° and 8 ° between them.

4. according to the described preparation facilities of one of aforementioned claim, it is characterized in that having the instrument (78) of wear material, the instrument of described wear material (78) can be fastened on the reference frame (22).

5. according to the described preparation facilities of claim 4, it is characterized in that the instrument of described wear material (78) is designed for first flat abutment faces (106) that is formed for intervertebral disk prosthesis (110) on first vertebra (16).

6. according to claim 4 or 5 described preparation facilitiess, it is characterized in that the instrument of described wear material (78) comprises milling head (80).

7. according to the described preparation facilities of one of claim 4-6, it is characterized in that the instrument of described wear material (78) can be fastened to diverse location on the reference frame.

8. according to the described preparation facilities of one of aforementioned claim, it is characterized in that described retaining element is bone screw (58,68).

9. be used for the support plate (12) of intervertebral disk prosthesis is inserted the method that is formed on the intervertebral-disc compartment between first and second vertebras (V1, V2), this method feature is to have the following step:

A) expose the access road that leads to intervertebral-disc compartment;

B) first retaining element (58) is connected on first vertebra (16);

C) second retaining element (68) is connected on second vertebra (16);

D) regulate the position of first and second vertebras (16,18) by moving first and second retaining elements (58,68);

E) intervertebral disk prosthesis (110) is inserted in the intervertebral-disc compartment.

10. in accordance with the method for claim 9, it is characterized in that, at step a) and b) between and/or step d) and e) between have the additional step of removing material from least one vertebra (16,18).

11., it is characterized in that, at step d) and e according to claim 9 or 10 described methods) between determine the geometry of intervertebral-disc compartment.

12. in accordance with the method for claim 11, it is characterized in that, an adjustable formwork (120) is inserted in the intervertebral-disc compartment, to be used for determining the geometry of intervertebral-disc compartment.

13., it is characterized in that at least one spacer element (122,124) is introduced in the intervertebral-disc compartment, and above-mentioned spacer element is arranged between vertebra (16,18) and the intervertebral disk prosthesis (110) according to the described method of one of claim 9-12.

14. in accordance with the method for claim 13, it is characterized in that described at least one spacer element (122,124) is a wedge shape.

15., it is characterized in that described at least one spacer element (122,124) is selected from multiple distance piece with different geometries according to claim 13 or 14 described methods.

16., it is characterized in that described at least one spacer element (122,124) is selected according to the geometry of the intervertebral-disc compartment of determining by means of adjustable formwork (120) according to claim 15 and the described method of claim 10.

17. be used for the different interval element group between vertebra and intervertebral disk prosthesis, introduced, wherein each spacer element (122,124) all has two plane surfaces that are parallel to each other or are formed on the angle of wedge between 1 ° and 45 ° betwixt, and wherein said spacer element is different with regard to the distance between the plane surface and the angle of wedge.

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