CN111246823A - 椎间植入物 - Google Patents

椎间植入物 Download PDF

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Publication number
CN111246823A
CN111246823A CN201880066351.9A CN201880066351A CN111246823A CN 111246823 A CN111246823 A CN 111246823A CN 201880066351 A CN201880066351 A CN 201880066351A CN 111246823 A CN111246823 A CN 111246823A
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CN
China
Prior art keywords
implant
implant according
intervertebral
frame
section
Prior art date
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Granted
Application number
CN201880066351.9A
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English (en)
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CN111246823B (zh
Inventor
C.巴托尔德
W.里斯
A.杜尔
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Joimax GmbH
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Joimax GmbH
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Neurology (AREA)
  • Transplantation (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Public Health (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Cardiology (AREA)
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Abstract

为了改善椎间植入物与通过植入物保持距离的椎骨的朝向所述椎间植入物的下侧和上侧的轮廓的适配，对于这种具有支撑区段(1.1)和沿着纵向连接在所述支撑区段上的近端的作用区段(1.3)的椎间植入物，本发明规定，上侧(1.6)和下侧(1.7)相对于水平中间面(L‑Q)对称地构造，其中，支撑区段在其朝向作用区段(1.3)的过渡区域(U)和远离所述作用区段(1.3)的远端的端侧(1.2)之间的高度尤其大于在过渡区域(U)中和在远端的端侧(1.2)处的高度。

Description

椎间植入物
本发明涉及一种椎间植入物，其具有支撑区段和沿着纵向连接在所述支撑区段上的近端的作用区段。
椎间植入物也被称为椎间融合器
Figure BDA0002445927790000012
或者在英语中称为“Interbody Cages”。
对于一系列的脊椎损伤、尤其是椎间盘损伤、例如椎骨滑脱(Wirbelgleiten)和椎间盘突出之后的不稳定性；由于狭窄和退化，脊椎的硬化部在两个涉及损伤的椎骨体之间贯穿。为此，在将损伤的和/或损害(神经)的椎间盘从椎骨间隙或者椎间盘室中移除之后，将植入物置入脊椎的直接上下相邻的两节椎骨之间，以便使所述两节椎骨保持预设的距离。至少在这两节椎骨的区域中实现了脊椎的加强。这例如称为(腰)椎骨融合(LumbarInterbody Fusion-LIF)。必要时还在微创的脊柱外科手术中为椎骨配设杆-螺钉单元、小面关节螺钉(Facettengelenksschraube)或者穿层螺钉(
Figure BDA0002445927790000011
Schrauben)并且使所述椎骨撑靠在位于其间的植入物上。就此而言也期望的是，骨骼与植入物长在一起。这种植入物因此通常配设有粗糙的表面。
按照本发明所述类型的椎间植入物例如由专利文献DE 20 2014 003 441 U已知。
本发明所要解决的技术问题在于，如下改进按照本发明所述类型的椎间植入物，使得所述椎间植入物与相邻椎骨体的适配得到改善，同时建议一种用于置入这种植入物的方法。
按照本发明，所述技术问题在椎间植入物中由此解决，即上侧和下侧相对于水平中间面对称地构造。
植入物设计用于借助微创手术通过椎间孔作为单独植入物导入两节椎骨之间的椎骨间隙中。因此，所述植入物在椎骨间隙中既相对于矢状面也相对于额状面以有限的角(不等于0°的角)延伸。依此，用于置入椎间植入物的方法也是用于解决所述技术问题的技术方案，所述椎间植入物具有支撑区段和通过过渡区域连接在所述支撑区段上的近端或者说近身侧的作用区段，其中，椎间植入物的上侧和下侧相对于水平中间面对称地构造，其特征在于，所述椎间植入物微创地通过两节椎骨之间的椎间孔这样作为单独植入物置入椎骨间隙中，使得所述椎间植入物既相对于矢状面也相对于额状面形成有限的角地位于所述椎骨之间。
通过对称的设计在此实现了植入物在相邻的椎骨体处所期望的改善的适配。
一种扩展设计规定，在支撑区段和作用区段之间构造过渡区域。
为了进一步地支撑，在此在优选的设计方案中规定，支撑区段在朝向作用区段的过渡区域和远离所述作用区段的远端或者说远身侧的端侧之间的高度大于在过渡区域中和在远端的端侧处的高度，其中，最大的高度尤其构造在朝向作用区域的过渡区域和远离所述作用区域的远端的端侧之间的中心或者说中部。
一种扩展设计规定，支撑区段和作用区段之间的过渡区域凹形地构造。通过植入物的按照本发明的构造，其间布置有所述植入物的椎骨能够最佳地在所述植入物的上侧和下侧上沿着所有方向滚动并且因此尽管在置入了植入物的情况下也在已知植入物未实现的范围内提供了脊椎的活动性。
在植入物的近端的棱边上朝向远端的端侧和在植入物的最大高度的中间区域上的切线之间的角与患者的相应的脊椎前凸角适配地优选在10°至20°之间、尤其在12°至18°，即每条所述切线相对于植入物的纵向中间面形成5°至10°或者在优选的设计方案中形成6°至9°之间的角。由此有助于或者重新产生了腰脊柱的自然前凸。植入物的(最大)高度以优选的方式与患者的脊椎的身体结构或者与其中应当安装植入物的相应椎间区域适配，并且可以与此相应地具有适配的、在8mm至18mm、优选10mm至16mm的范围中的高度。这相应地适用于植入物的长度，所述长度应当为25mm至35mm、尤其在27mm至32mm之间。
在本发明的其它特别优选的设计方案中规定，植入物在一个纵向侧上的高度大于在对置的纵向侧上的高度。所述植入物由此在其高度方面相对于其竖直中间面不对称地构造。由此进一步有助于与其间布置有植入物的椎骨的上部或者下部的端侧的自然条件的适配。植入物不能够在中央地置入椎骨之间并且因此在所述椎骨之间不是沿着矢状面或者矢状轴的方向从后面或者背侧向前面或者腹侧定向。而是植入物通常通过椎间孔置入并且由此相对于矢状轴/矢状面形成有限的数量级约为45°的角。由此，通过植入物的两个侧面的不同高度(在所述两个侧面之间具有连续的过渡)实现了与椎骨之间的植入物的位置情况的更好适配。在此尤其规定，植入物在一个侧面上的高度比在另一个侧面上小2mm。通常将植入物这样置入椎骨之间，使得在看向患者的视角中观察，所述植入物从背侧的左侧向腹侧的右侧延伸。在这种情况下，在从侧向的近端的端侧(更准确地说起始面)看向远端的方向的视角中，植入物具有高度比右侧面更小的左侧面。
在其它优选的设计方案中，设置有由实心的承载部件构成的外部的框架和形式为格栅体的内部的芯，其中，尤其是所述格栅体只在平行地沿着横向延伸的面上与框架连接，而在以有限的角相对于所述面延伸的面和棱边中不与所述框架连接。
优选通过烧结、尤其是借助(选择性)电子束熔融((Selective)Electron BeamMelting，(S)EBM)或者借助激光烧结(LST)实现这种植入物的制造。因此通过烧结、例如借助电子束熔融或者激光烧结制造所述植入物。
网状的或者格栅状的区域优选从上表面或者侧面延伸至平行的对置的下表面或者侧面。由此实现了，骨骼组织不只在外部表面地长在植入物上，而且所述骨骼组织长入格栅状的或者网状的结构的空腔中并且因此能够完全地穿过所述植入物或者促进骨骼生长。由此实现了植入物和相邻的椎骨体之间的固定的连接。
通过由两个结构元件、即外部的由结构紧凑的坚实的材料构成的框架和具有所述网状或者格栅状的结构的内部的格栅体形成植入物，在保持前述的使骨骼材料完全地生长穿过植入物或者所述植入物的格栅状结构的优点的情况下赋予了所述植入物足够的强度和刚性。
此外，格栅体只在平行地沿着一个方向、即横向延伸的面上与框架连接，而在以有限的角相对于所述面延伸的面和棱边中不与所述框架连接。由此在一定程度上实现了植入物的外部框架与格栅体的脱耦，方式是所述外部框架与格栅体沿着植入物的纵向或者主延伸方向(所述植入物沿着导入方向比沿着横向和其高度方向更长)脱耦。如果框架例如在构成所述框架的肋的区域中在施加于所述框架上的压力下退让变形，则所述压力不会传递至格栅体上。所述格栅体由此保持不受影响并且长入所述格栅体中的骨骼结构也不会被影响或者被损伤。
在此，在优选的扩展设计中规定，在必要时考虑不高于0.3mm的公差的情况下，格栅体的上部的和下部的面具有与被框架部件包围的自由空间相同的尺寸，所述自由空间包围格栅体的所述面。
在按照本发明的植入物的其它设计方案中规定，框架包围出空腔，格栅体布置在所述空腔中。一种扩展设计规定，所述框架具有沿着其纵向延伸的纵向肋。一种特别优选的设计方案规定，相邻的纵向肋居中地通过横向肋连接。由此即使对于更长的植入物也提高了框架的稳定性并且由此提高了所述植入物自身的稳定性。植入物的格栅体的网状结构或者格栅结构可以以不同的方式设计。在特别优选的设计方案中规定，格栅区域或者格栅体具有金刚石结构。
也可以规定，所述植入物具有连续的通道。所述通道在此沿着纵向延伸穿过框架并且尤其也延伸穿过格栅体本身。由此实现了，借助置入工具经由横卧地处于椎骨间隙或者椎间盘室中的导针通过管状的鞘或者内窥镜管可以引入植入物。
按照本发明的植入物的一种优选的设计方案的特点在于，格栅状的区域或者格栅体具有每个开口为0.5mm至3.5mm的格栅开口直径，在此，优选在植入物外侧上具有每个开口在0.5mm至0.7mm数量级中的开口直径。
植入物能够如所述的那样尤其通过(选择性)电子束熔融((Selective)ElectronBeam Melting，(S)EBM)或者借助激光烧结技术(LST)由钛合金、尤其是按照ISO 5832-3的Ti6A14V制造。通过借助电子束或者激光束在高真空中熔化金属粉末来制造构件、即植入物。由此能够在不使用消失模或者型芯的情况下产生侧凹。在此通过作为能量源的电子束或者激光束有针对性地熔化金属粉末，由此能够直接由设计数据制造几乎任意几何形状的坚实的构件。借助刮板交替地将粉末层施加在之前的粉末层上并且借助电子束照射。以此方式逐层地生成期望的构件。
按照本发明的方法的另一种设计方案规定，植入物这样置入椎骨间隙中，使得所述植入物在那里相对于矢状面形成40°至50°、优选45°的角。在优选的设计方案中规定，所述方法使用按照本发明的植入物，其具有所述植入物的一个或者多个上述设计方案。
本发明的其它优点和特征由权利要求书和以下描述得出，在所述描述中在参照附图的情况下详细阐述按照本发明的植入物的实施例。在附图中：
图1在水平轴的视角中示出了按照本发明的植入物在两个椎骨之间的布置结构；
图2在沿着矢状轴的背侧的视图中示出了按照本发明的植入物在两个椎骨之间的布置结构；
图3示出了放置在下部的椎骨上的植入物的从上方的俯视图；
图4从近端的端部示出了植入物的外部轮廓的立体视图；
图5从远端的端部示出了所述植入物的外部轮廓的立体视图；
图6从上方示出了所述植入物的俯视图；
图7示出了所述植入物的侧视图；
图8示出了所述植入物的远端端侧的视图；
图9示出了植入物的作用区段的端侧的视图；并且
图10示出了植入物的格栅环圈(Gitterkranz)的立体视图。
如果由于患者的脊椎的椎间盘损伤而需要将所述椎间盘从两个相互叠置的椎骨3、4之间的椎骨间隙2中移除，则置入椎间植入物1来取代所述椎间盘，以便使椎骨3、4如图1和2所示的那样相互保持适宜的距离和适宜的定向。植入物1设计为，使得所述植入物能够与椎骨3、4长在一起。
按照本发明的植入物1微创地经由被扩大的入口通过在此为右侧的椎间孔6置入两个椎骨3、4之间并且因此如图3所示的那样作为单独植入物以其纵向中轴L与患者身体或者所述患者身体的脊椎的矢状轴S呈约45°角地设置，即所述植入物以其纵向中轴L大约沿着患者的身体的水平轴H和矢状轴S之间的角平分线设置。从看向患者的前侧的视角观察，植入物1在所示的实施例中通过左侧的椎间孔置入两个椎骨3、4之间，而所述植入物原则上也可以沿着右侧的椎间孔6置入。
以下针对所示的进入和所示的布置结构描述植入物；在通过右侧的椎间孔6进入时，植入物相对于所示的并且在以下描述的植入物的竖直的纵向中间面L-V(由水平的纵轴和横轴L、Q张开；以下将更确切地描述)镜像地构造。
在附图6-8中示出并且通过视图定义了植入物1的纵向中轴L、水平横轴Q和竖直或者说垂直轴V。植入物1具有沿着其纵向中轴L的纵向尺寸，所述纵向尺寸显著大于沿着垂直轴V和横轴Q的方向的尺寸，是所述沿着垂直轴V和横轴Q的方向的尺寸的至少1.5倍。由纵轴L和横轴Q确定水平中间面L-Q，由纵轴L和垂直轴V确定垂直面L-V并且通过横轴Q和垂直轴V确定横向面Q-V。
植入物具有支撑区段1.1，所述支撑区段具有远端的端侧1.2。近端的作用区段1.3在近端通过过渡区域U(与线条U对应)连接在所述支撑区段上，用于将植入物1置入椎骨间隙的工具能够尤其像专利文献DE 20 2013 007 361 U中描述的那样作用在所述作用区段上。通过这种角定向，以在所述专利文献中描述的方式通过扩大的椎间孔将植入物1置入椎骨3、4之间的椎骨间隙中。
按照本发明的植入物1以其上侧1.6和下侧1.7相对于水平中间面L-Q对称地构造。所述植入物或者其支撑区段1.1在垂直中轴V或者垂直面V-Q的区域中具有所述植入物的最大高度，而一方面在自由的远端的端侧1.1处的高度、另一方面在朝向作用区段1.3的过渡区段U中的高度相对于在垂直的中间面V-Q中的高度而言更小。因此，植入物1沿着纵向具有双楔形(Doppelkeil)的形状。
从作用区段1.3的近端的棱边1.3.1朝向支撑区段1.1的中间区域中的近端高度的切线T在此相互间具有10°至20°之间、优选12°至18°的角，相应地与纵向中轴或者平面L-Q具有5至10°、或者6°至9°的角。在与患者的其间置入植入物1的椎骨之间的脊椎前凸角适配时，针对所述脊椎前凸角选择如下植入物，所述植入物具有完全特定地适用于所述脊柱前凸角的角α或者β。
尤其从图8和图9可知，植入物1相对于纵向垂直面L-V不对称地构造。从看向近端的端侧1.3a的视角观察，所述植入物在左侧的垂直的纵向侧1.5的区域中具有比在右侧的纵向侧1.4中更大的高度(参见图9)。
两个纵向侧1.4、1.5在支撑区段1.1的中部的高度差在此分别为约1.5mm至3mm、优选2mm。与在上侧和下侧1.6、1.7平行地定向时的情况相比，植入物通过该高度差或者上侧1.6和下侧1.7的倾斜更好地与上部椎骨3的下侧和下部椎骨4的上侧的解剖学关系适配。
为了条理性应当再次指出，前述高度差或者上侧1.6和下侧1.7的倾斜参照的是需要通过按照定义的方式处于左侧的椎间孔置入的植入物，而在必要时需要通过右侧的椎间孔置入的植入物与此对应地相对于纵向垂直面L-V镜像对称地构造。
除了所述两个区段、即支撑区段1.1和作用区段1.3，按照本发明的植入物具有外部的刚性框架1.8的部件和形式为格栅体7的格栅状的内部的芯1.9的部件，所述格栅体在图10中示出。部件1.8和1.9一体件式地构成了植入物1。骨骼能够通过处于上部壁和纵向侧壁中的能够在外部框架1.8中看到的通孔长入格栅状的内部的芯1.9中，与所述芯长在一起并且由此形成稳定的连接。
格栅体7具有格栅结构、优选为带有薄的肋7.1和在所述肋之间的自由间隙的金刚石晶格结构，其中，所述肋7.1的尺寸、尤其是所述肋的厚度(所述厚度沿着垂直于肋7.1在两个节点之间的延伸方向的方向，所述肋在所述节点上分别与格栅的其它肋连接)相对于框架1.8的结构部件的整体尺寸、例如框架1.8的支撑条的宽度较小。尺寸比例至少为1：3。这相应地适用于格栅体7在两个节点之间的支撑条7.1的长度和框架1.8的结构部分、例如所述肋的纵向尺寸，因此所述比例在此也至少为1：3。
框架1.8具有四个纵向支撑条1.11，所述纵向支撑条将植入物1的远端的端侧1.2与近端的作用区段区域1.3连接并且与所述作用区段区域包围出空腔，在制造完成的植入物中，格栅体7位于所述空腔中。格栅体具有两个垂直的通孔7a。纵向支撑条1.11分别在端侧和中部、即大约在支撑区段1.1的长度的一半处通过横向肋1.12相互连接。因此在横向肋1.12之间保留有通道。相应的通道尤其也位于远端的端侧1.2上。
在特别优选的设计方案中，格栅体7和框架1.8只沿着垂直于纵向L的方向并且由此在横向延伸的(面)区域处相互一体件式地连接，在专利文献DE 20 2013 007 361 U中对此有更确切的描述。
与之相对，格栅体7的纵向面、例如7.8以及纵向棱边、例如7.9不与框架1.8固定连接。此外，尤其是上部的面7.10和在格栅体7的下侧上与所述上部的面平行地对置的下部的面的尺寸与开孔或者由纵向支撑条1.11、横向肋1.12和端侧区域1.2空出的区域对应。这使得在压力载荷通过椎骨体3、4作用在框架1.8的纵向肋上时，所述压力载荷不会在纵向侧上传递至格栅体7上并且所述格栅体7由此保持不变形并且即使在这些情况下也能够实现其功能，即确保骨骼材料长入格栅体7的这些蜂窝状空间或者间隙中。植入物1的连续的纵向通道实现了使所述植入物能够通过横置的导针导入椎间室中。
近端的作用区段1.3在其指向近端的端侧上具有齿部1.3.2。所述齿部用于，在通过在置入工具(参见专利文献DE 20 2013 007 361 U和EP 2 983 622 A2)的锤状的锁紧元件和所述置入工具的支座之间轴向地绷紧而将植入物1固定在置入工具的远端的端部上时，在置入工具和植入物1之间保证预设的角定向。齿部1.3.2由在圆弧上依次相续的齿构成。在近端的入口1.3.3或者植入物1在作用区段1.3的近端的端侧上的开口的每一侧上分别存在齿部1.3.2。
齿部1.3.1的设计(例如数量、距离、形状)可以与置入工具适配。由此一方面实现了与置入工具的最佳的兼容性、实现了置入工具的支座和植入物1的近端的作用区段1.3之间的连接的稳定性的提高并且另一方面实现了多种连接角。
按照本发明的植入物1的置入借助置入工具实现，在专利文献DE 20 2013 007361 U和EP 2 983 622 A2中示出并且描述了所述置入工具。锁紧元件具有能够围绕其纵轴转动的锤状的锁紧部件，所述锁紧部件以垂直的定向导引入植入物1的近端的作用区段1.3的通道1.3.2中。植入物1为此在其近端的端侧上具有侧凹的开口1.3.3，所述开口的开口横截面与置入工具的锁紧元件对应；侧凹的开口构成植入物1上的锁紧元件，由此实现了置入工具与植入物1的锁紧。
置入工具的锤状的锁紧部件随后相对于所设置的外部管偏转90°，从而使所述锁紧部件在侧凹部中抓持在近端的作用区段1.3的壁的内侧上。借助置入工具的近端的端部上的绷紧装置，所述锤状的锁紧部件和在设置于外部管远端的支座上的凹形弯曲的端棱在中间设有与锁紧部件咬合的齿部的情况下相互绷紧，所述齿部设置在植入物1的近端的作用区段1.3上。由此将植入物1固定地保持在置入工具上。由此实现了植入物1沿着所述植入物的延伸方向和具有朝向置入工具的延伸方向的分量的运动。只要植入物1的近端的作用区段1.3在所述作用区段的(外部的)近端的端侧上具有齿部，则由此也确保了置入工具和植入物1之间所形成的角位置。尽管如此，在置入工具和植入物之间，在沿着垂直于所述置入工具和植入物的纵向延伸L的方向上可以存在角度上的不同定向，这些明显的角可以高达30°并且更大。

Claims (24)

1.一种椎间植入物(1)，所述椎间植入物具有支撑区段(1.1)和沿着纵向连接在所述支撑区段上的近端的作用区段(1.3)，其特征在于，上侧(1.6)和下侧(1.7)相对于水平中间面(L-Q)对称地构造。
2.根据权利要求1所述的植入物，其特征在于，在所述支撑区段(1.1)和作用区段(1.3)之间构造有过渡区域(U)。
3.根据权利要求2所述的植入物，其特征在于，所述支撑区段(1.1)在朝向作用区段(1.3)的过渡区域(U)和远离所述作用区段(1.3)的远端的端侧(1.2)之间的高度大于在过渡区域(U)中和在远端的端侧(1.2)处的高度。
4.根据权利要求3所述的植入物，其特征在于，最大的高度构造在朝向作用区域(1.3)的过渡区域(U)和远离所述作用区域的远端的端侧(1.2)之间的中部。
5.根据前述权利要求之一所述的植入物，其特征在于，所述过渡区域(U)在支撑区段(1.1)和作用区段(1.3)之间凹形地构造。
6.根据前述权利要求之一所述的植入物，其特征在于，所述植入物在纵向侧(1.5)上的高度大于在对置的纵向侧(1.4)上的高度。
7.根据前述权利要求之一所述的植入物，其特征在于由实心的承载部件构成的外部的框架(1.8)和形式为格栅体(7)的内部的芯(1.9)。
8.根据权利要求7所述的植入物，其特征在于，所述格栅体(7)只在平行地沿着横向延伸的面(7.3-7.6)上与框架(1.8)连接，但在以有限的角相对于所述面(7.3-7.6)延伸的面(7.8)和棱边(7.9)中不与所述框架(1.8)连接。
9.根据权利要求7或8所述的植入物，其特征在于，确定了外部轮廓的框架(1.8)和位于所述框架内的芯(1.9)一体件式地构造。
10.根据前述权利要求之一所述的植入物，其特征在于，所述植入物通过烧结、例如借助激光烧结制造。
11.根据权利要求1至9之一所述的植入物，其特征在于，所述植入物借助电子束熔融、尤其是选择性电子束熔融制造。
12.根据权利要求7至11之一所述的植入物，其特征在于，芯(1.9)的上部的和下部的面(7.10)具有与被框架部件包围的自由空间相同的尺寸，所述自由空间包围格栅体的所述面(7.10)。
13.根据权利要求7至12之一所述的植入物，其特征在于，所述框架(1.8)围成空腔，构造为格栅体(7)的芯(1.9)布置在所述空腔中。
14.根据权利要求7至13之一所述的植入物，其特征在于，所述框架(1.8)具有沿着所述框架的纵向延伸的纵向肋，其中，尤其是相邻的纵向肋居中地通过横向肋连接。
15.根据权利要求7至14之一所述的植入物，其特征在于，所述格栅体(7)具有金刚石结构。
16.根据权利要求7至15之一所述的植入物，其特征在于，所述植入物具有沿着纵向中轴(L)的连续的通道。
17.根据权利要求7至16之一所述的植入物，其特征在于，所述格栅体(7)的每个开口的格栅开口直径为0.5mm至3.5mm。
18.根据权利要求17所述的植入物，其特征在于，所述格栅体(7)在其外侧上的每个开口的开口直径的数量级为0.5mm至0.7mm。
19.根据前述权利要求之一所述的植入物，其特征在于，为了将所述植入物与置入工具连接，近端的作用区域(1.3)在植入物的侧壁的内侧上具有侧凹的凹部，所述凹部实现了具有角活动性的侧凹的连接。
20.根据前述权利要求之一所述的植入物，其特征在于，所述作用区域(1.3)在上侧上具有缺口，所述缺口实现了植入物(1)的角活动性。
21.根据前述权利要求之一所述的植入物，其特征在于，所述作用区域(1.3)的近端的端侧具有齿部，其中，所述齿部尤其沿着垂直方向在圆弧区段上依次相续地构造并且所述齿部布置在近端的通道的两侧，所述近端的通道居中地构造在近端的端侧上。
22.一种用于置入椎间植入物的方法，所述椎间植入物具有支撑区段(1.1)和通过过渡区域(U)连接在所述支撑区段上的近端的作用区段(1.3)，其中，所述椎间植入物的上侧(1.6)和下侧(1.7)相对于水平中间面(L-Q)对称地构造，其特征在于，所述椎间植入物微创地通过两节椎骨之间的椎间孔作为单独植入物这样置入椎骨间隙中，使得所述椎间植入物既相对于矢状面也相对于额状面以有限的角位于椎骨之间。
23.根据权利要求22所述的方法，其特征在于，所述植入物这样置入椎骨间隙中，使得所述植入物在该处与矢状面形成40°至50°之间、优选45°的角。
24.根据权利要求21或22所述的方法，其特征在于，将具有权利要求2至20的一个或多个特征的椎间植入物置入两节椎骨之间的椎骨间隙中。
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