DE102016011585A1 - Spinal implant and / or tool (s) therefor - Google Patents

Abstract

The invention relates to spinal implants, and tools therefor.

Description

The invention relates to spinal implants, as in particular by the in the DE 10 2013 005 692 A1 have become known for introduction by means of the tools created for this purpose between two vertebrae of a spine.

In this case, the implant is designed as an elongate body with a straight axis, with at least one of its end regions and within the body and on the said axis a first contour, such as a thread, provided as an attack surface for rigid, but releasable connection with a first tool is for driving the implant between two vertebrae in a position corresponding to the PLIF, after previously, as in the PLIF method, but only on one side of the spinous process, created a relatively small dorsal access in the skin and the facet joint of the corresponding vertebral body was partially prepared ,

The implant further has, also within its elongated body and also lying on said straight axis, seen from the rear, before the first contour - ie before the threaded portion - a second, in particular convex-hollow, concave, preferably kugelkalottenartige contour as an attack surface for a second tool, suitable for forming a temporarily articulated connection therewith, for further displacement of the implant between the two vertebrae in a position at least approximately corresponding to or even beyond that according to the TLIF method.

The implant also has at its rear portion a third attack contour, for placing the tine or fork-shaped distal end portion of a third tool, a "Einschlägers" to the implant, if this appears expedient to the surgeon, in the whirling room even further to twist or to relocate, as was done with the second tool or was possible.

The first tool - also referred to as "inserter" - consists of two parts, a straight hollow rod with fork or zinkenfömig trained distal end and a knob with gags on its proximal end and a rod-shaped inner part recorded in the hollow rod, also called inserter staff or soul , The inner rod has at the distal end to a threaded portion which projects from the hollow rod and on which the cage is screwed.

The proximal end contour of the knob serves as an abutment area for a button or rotary handle, which is fixed to the proximal end portion of the inner rod. By turning the head relative to the knob and thus of the inner rod relative to the hollow rod, the implant is firmly screwed or braced against the forked or prong-shaped end of the hollow rod.

After the implant has been brought into a position corresponding to the PLIF by means of the first tool, as mentioned, the first tool is removed from the implant by loosening the screw connection.

The second tool, also called "Ball Tool" is rod-shaped, has at its proximal end a handle and its distal end portion is bent and the end spherical, preferably spherical. This tool is inserted dorsally through the same preparation as previously the inserter and inserted with its spherical end in the spherical cap contour of the implant. By applying impact pulses to the proximal end, ie to the end of the grip region, the mentioned pivoting of the implant is brought into a more diagonal position than the position corresponding to the PLIF method, namely into an inclined or at least approximate to the TLIF Location.

However, should the implant be in a position that is not yet optimal for the surgeon, as already mentioned, in a third step, the position of the implant can be corrected by further pivoting, twisting or drifting or further driving in anterior direction become. This is done with a further tool referred to as a "follower", which in turn is inserted through the existing preparation and placed with its fork-shaped at the distal end of the area on the outside of the rear. By striking the proximal end area, ie the knob, the further displacement of the implant takes place. As such Nachschläger can be used advantageously the hollow rod of the inserter tool.

In rare cases, however, it may happen that the implant, z. B. in the opinion of the surgeon, too far driven, twisted or swiveled, or it turns out that not the optimal implant was used, for. B. because the conditions found during or after the insertion or rotation of the implant are different than those, after previously, based on a measurement of the vertebral space, the selection of the implant used in terms of its dimensions, in particular for height and length occurred. In these situations, there is a need to either correct the position of the implant, as the same again back to relocate or else, eg. B. for the above-mentioned reason even to remove, and indeed during or relatively soon after the operation, if possible within a period of time in which the implant has not solidified yet.

The object of the present invention was to provide or optimize implants and / or tools in order to correct the position, including the angular position, of an inserted implant, as well as a partial retraction of an implant driven too far, as it were a "backward correction". in particular of implants of the type mentioned at the beginning, but also of others, in which, during or after insertion, a rotation, torsion, pivoting, displacement or the like of the implant took place between two adjacent vertebrae - intended or not. In addition, an extraction should also be possible, for. B. if for the reasons mentioned, the optimal implant was not used.

This is achieved in particular with implants of the type mentioned in the introduction, in which both a first contour, such as a thread, and a second, spherical contour, such as a spherical cap, are provided at least approximately on the practically straight axis of the implant - Seen from the threaded portion in the direction of the inlet opening - initially widening dome-shaped area then merges into a further closing area, which ends in the tool inlet opening, and the contours of these re-closing areas, together with a corresponding tool, in particular the ball of a ball tool or this at least approximately equally effective or equivalent tool - are matched to one another so that tool and implant - after the spherical area is inserted through the inlet opening - so to speak, interlock with each other, so when applying a longitudinal Direction of the preparation directed tensile force on the ball tool at least a backward correction, such as a change in the angular position of the implant can be done. The cavity of the implant has a larger diameter than the inlet opening, it encompasses more than one hemisphere and the diameter of the ball is equal to or smaller than that of the inlet opening and smaller than the largest diameter of the cavity.

In some cases, the backward correction achieved in the above manner may be satisfactory.

However, should extraction be required, extraction may be accomplished in some cases by further extraction, ie application of a tensile force, possibly superimposed with an additional force component by which the ball is forced into the narrowing regions of the dome.

However, if this is not yet possible, for. B. because the implant is too tightly clamped, yet it can be created by changing the angular position thereof a situation that serves as a preparation for performing an extraction, namely by the introduction of a threaded tool at its distal end, which may also be the above-described inserter rod or a tool similar to this, can first be made by the existing preparation and then screwing the threaded portion into the threaded hole of the implant, after which this can be pulled out or-beaten.

Finding the threaded hole and the screwing of such a tool, so z. As an inserter rod or a similar tool, is greatly facilitated if, according to an additional and independent inventive idea, in the implant at the beginning of the internal thread Einfädelschräge, z. B. a funnel-like extension and / or a bevel of the thread is provided at the distal end of the rod-shaped tool. As a result, even if the axis of the internal thread does not coincide exactly with the insertion direction of the tool predetermined by the preparation, locating the internal thread, aligning the axis of the internal thread and the tool with each other, and screwing in the threaded rod are made possible or facilitated. This idea of the invention independently covers any implants which have an internal thread designed in this way, such an internal thread is already provided for introducing the implant by means of a corresponding tool, or such an internal thread has been specially introduced for the purpose of extraction, as well as the correspondingly executed tools for an extraction.

The effectiveness or the effectiveness of such a backward displacement or even an extraction can be further improved or facilitated if according to a further inventive concept between the correction / extraction tool and the implant, the adhesion-increasing means are provided. For this purpose, in the region of the dome-shaped contour and / or on the insertable into the implant areas of the ball tool, ie z. B. the ball thereof, at least the friction between increasing means may be provided.

Such, friction-increasing means can by one, on the ball and / or the inner contour of the calotte, but at least at areas with which these in the displacement of the implant in Come in contact, appropriate roughening be formed. But ball and / or dome can also be provided with a rough or hard surface, which is characterized by a coating z. B. can achieve with diamond chips. In some applications, another mineral coating or a titanium plasma coating may also be advantageous, the latter being able to be applied by a plasma spraying or deposition method. It may also be appropriate to make the rough or hard only one of the two parts and to use for the other generally much softer material.

However, it can also be advantageous to provide means on the implant and on an extraction tool with which a positive connection can be produced between the implant and the tool to be introduced through the preparation. Such can be z. B. implement by means that result in a bayonet connection. A positive connection between the implant and z. B. ball tool but can also make a particularly effective means of a ball tool or a tool similar to this at least, by a contour, such as a groove is provided on the ball, with the mating contours on the implant, as the inwardly aligned boundary areas the entrance opening, engage. The latter can also be designed claw-like or hook-like.

By the invention but also the relocation and / or the extraction of other implants are to be made possible, for. B. of those in which already a first and a second contour are already provided, of which the first may be an internal thread and the second a spherical cap and having a curved axis and a convex outer contour, ie of so-called banana cages, such as z. B. in the WO 2011/013047 described. Here, when the implant is introduced into the vertebral space, by means of a rod-shaped tool which is distally spherical and thus inserted into the dome of the implant, by applying impact pulses to the tool, the implant with its convex curved surface either by itself slide along the concave surface of the ring apophysis and twist, or the rotation is controlled from the outside, z. B. by wire drawing. Again, by the measures according to the invention, a correction of a too advanced position, such as the angular position, take place or an extraction of the implant can be made by the dome, seen in the direction of the inlet, merges into again narrowing areas, in the case of a spherical cap this So more than a hemisphere includes. Again, for extraction, but at least to prepare such, advantageously a tool is used, which is at least similar to a ball tool described, so rod-shaped, at the proximal end has a handle, and wherein the distally disposed ball relative to the handle is offset, that is mounted on the bent end portion of the rod. The largest diameter of the dome is also larger than that of the ball of the tool and the latter equal to or smaller than the inlet diameter. Furthermore, the described measures which increase at least the friction can be provided and also the threading aids on the implant and / or on the tool.

But even in accordance with the TLIF / PLIF procedure implants that usually have only one thread at one of the end portions for screwing a threaded rod to drive the implant between two vertebrae, one or more of the described inventive means, tools and process steps can be advantageous for Application come. Thus, by a relatively simple modification, namely by providing a dome-shaped, hemispherical space in front of the thread - as known from banana cage - and using a ball-tool or similar tool, the skew changes in certain orders of magnitude, in particular the position of a Inadvertently corrected in an inclined implant "backwards" corrected, or, if z. B. deemed appropriate by the surgeon, the skew even be increased.

By such a configuration of the cavity that this additionally receives a re-closing section, that surrounds more than half of the corresponding spherical space whose largest diameter is larger than the inlet opening and the latter equal to or larger than the ball of a ball tool at least Almost equivalent tool can, significantly more effective, a "correction backwards" or possibly even an extraction of the implant done, but at least a provision for such. The implementation of these steps can be significantly improved and simplified if at least the friction-increasing means are provided on calotte and / or ball, or means with which in the inserted state of the implant between this and a tool a positive connection can be achieved.

In the event that PLIF / TLIF implants should be predestined only for a possibly required extraction, especially in the event that it should prove necessary after removal of the rod for driving the implant, the provision of a threading bevel, bevel od. Like. At the beginning of the threaded hole and / or be a bevel of the thread on the tool advantageous.

Based on 1 - 8a let the invention be explained in more detail.

Show

the 1 - 4 various positions of the position correction and extraction of inventively designed implants of the type mentioned, and the tools required for this purpose; the 1a shows an enlarged view of the section Ia of 1 .

the 5 and 6 advantageous developments of implants of the above type, and associated tools,

the 7 . 8th and 8a the invention based on implants of other types, and a corresponding tool.

In 1 is the lower vortex 1 represented by two adjacent vertebrae of a spinal column, in its disc space 2 one according to the DE 10 2013 005 692 A1 trained and inserted implant 3 with straight axis A is. This points at its rear end 4 an entrance opening 5 for tools on, then a kugelkalottenfömigen cavity 6 and behind it an internal thread 7 , Between the latter and the front area 8th of the implant is a recess 9 intended for the reception of bone material and at the beginning of the thread 7 a funnel-shaped or conical inlet slope 10 ,

The spherical cavity extending from the threading slope 6 first has a widening section 6a on and then a further closing area 6b , The cavity 6 Closes further than a hemisphere, so it goes beyond the equator.

The implant has outside at its end 4 an assault area 4a for a "slapper".

By means of the narrowing area 6b and appropriate vote of the same with the ball 11b a tool 11 - wherein the inlet opening 5 is equal to or larger than the diameter of the sphere 11b , the largest diameter of the cavity 6 larger than the entrance opening 5 and the diameter of the ball 11b It is possible, according to one of the ideas of the present invention, a change in the sense of a return of the position of an intentionally or unintentionally introduced too far into the vertebral space, twisted or drifted implant 3 to perform z. B. to correct its skew, so it again shift back to, or else, z. For example, if it later turns out that the optimal implant has not been used to remove it from the area of the spine and dissection. The latter succeeds with the help of the tool 11 not so it can be changed so that the access of an extracting tool or at least facilitated so that the position of the implant.

It is assumed the implant 3 is located after driving in an in the opinion of the surgeon unintentionally too far swung position I the 1 and should instead be in a less oblique position.

The tool used to correct this situation 11 may be the "ball tool" used to drive the implant, it has a rod-shaped area 11a , at its proximal end portion a - not shown - - handle and its distal end is through the ball 11b educated. The distal end area is here by two bent areas 11c and 11d educated. The rod-shaped area is at 11e So on the ball 11b opposite side of the rod-shaped area 11a , flattened round rod.

The tool 11 becomes, with the spherical area 11b first, first through the preparations 12 in the tissue and 13 introduced on the vertebral body and finally the ball 11b through the entrance opening 5 in the cavity 6 of the implant 3 used. In some cases, it may be appropriate to mark on ball 11b and entrance opening 5 provided.

By applying a tensile force in the longitudinal direction of the rod-shaped region 11a can now the implant 3 be changed or set back at least in its oblique position until it reaches a favorable position to the surgeon and as in 2 as position II of the implant 3 is shown. Especially related to 1 can be seen that through the bent areas 11c . 11d a force component is generated which the ball 11b pushes into the cavity and so the ball and this cross-over area 6b keep in touch.

The tool 11 may be the ball tool already used when driving or another, suitably trained. It can also be provided a set of such tools that are designed differently, for. B. have differently shaped offsets.

In 3 is the implant 3 shown in a position III, in which it - in the presence of ideal conditions - by means of the tool 11 is extracted and just within the preparation 13 of the vortex 1 located. Extraction in this way, even in the presence of unfavorable conditions, can be markedly improved by providing at least friction-enhancing or positive-fit means on the implant and / or tool and acting as implanted, as exemplarily described below.

The representation in 4 assumes a situation that implants 3 using a ball tool or similar tool can not extract, z. B. because it is too tightly clamped between the vertebrae. However, it is z. B. by means of a tool 11 been erected so far in a position IV, that thereafter the introduction of a rod-shaped tool 14 attached threaded area 14a into the threaded hole 7 of the implant 3 is possible. By conical design 14b the distal end portion of the tool at the start of the thread and / or the area 10 as Einfädelschräge eigangs the threaded hole 7 , threading or intervention is the thread 7 and 14a allows or facilitates, even if their axes initially do not match. It is at least initiated by these Einfädelschrägen alignment thereof, which is further improved by threads at least partially over the conical areas 7 and or 14a run.

In the 5 and 6 Embodiments are shown in which the adherence of the implant and the tool during the position correction or the extraction is improved.

It is in 5 presented a way to increase the friction. This is from the areas 6a and 6b only the narrowing area 6b of the cavity 6 of the implant 3 with a coating 15 z. B. made of diamond splinters, as well as the ball 16a the one with a bend 16b provided tool 16 partly with such a coating 16c equipped. As with the previously described implants is an internal thread 7 with a threading slope 10 at its entrance, the investment area 4a and the inlet and outlet openings 5 available.

6 shows an embodiment in which a temporary positive connection between an implant 17 and an extract tool 18 can be produced. The thread of the threading 17a for the thread 17b from extending, dome-shaped, widening area 17c then continues into a narrowing area 17d by an inward facing edge area 17e of the implant is determined. This border may be circumferential or, as shown in the lower section, interruptions 17f have, so that individual claws or claws 17g remain and so the entrance opening 17h is formed.

The tool 18 is also similar to a ball tool, has a substantially straight rod 18a with a handle, not shown, and a bent portion relative to the rod 18b and at the distal end of a spherical trained here area 18c with a cut or a groove 18d , By means of this incision 18d becomes the tool 18 after passing through the inlet 17h is introduced in the edge 17e or the teeth or claws 17g used, so that it forms a positive connection and a displacement of the implant in the sense of a correction or removal is particularly safe and effective. Possibly. can with appropriate design of the positive connection, the introduction of a thread 17b and an insertion bevel 17a be dispensable.

The in 7 illustrated banana cage 19 with curved inner and outer contour 19a and 19b , Recess 19c and internal thread 19d is the beginning of the thread with an inlet cone 19e provided and the adjoining spherical space 19f owns next to the first expanding section 19g followed by a further closing section 19h in the entrance opening 19i for the ball 20a of the tool 20 ends.

The implant 19 can, as well as those described in the preceding figures, corrected in position, prepared for extraction, extracted and also according to the 5 and 6 be equipped.

It is assumed that the in 8th only partially shown, according to the PLIF or TLIF procedure to be introduced implant 21 merely to be extracted from a classical PLIF or TLIF location. This may be done by means of the thread already present in such implants 21a However, in the prior art at the beginning of the thread but at best may have a deburring, to be possible in itself, however, the finding and threading a threaded rod is greatly facilitated when entering the threaded hole according to the invention a Einfädelschräge 21b and / or a Einfädelschräge is provided on the threaded rod. This is of great advantage in particular when, intentionally or unintentionally, a change has taken place in the inclined position of the implant. If, on the other hand, it is intended to change the inclination of the implants introduced according to the PLIF or TLIF method, or to shift them further or to correct them and if necessary to be able to extract them, it may also be the case with such implants be advantageous to apply the measures of the preceding figures, as shown in 8a is shown and a spherical cavity 21c to provide with opening and then subsequently again further closing area 21d and 21e and behind the area 21c an inlet slope 21f and the internal thread 21g ,

• – alle Innen- und Außenkonturen, die zum Eintreiben des Implantats 3, 17, 21 dienen, wie das Gewinde 7, 17b, 21, 21g und der Angriffsbereich 4a (beide zusammen zum Verspannen auf dem Inserter und zum Einbringen zwischen zwei Wirbel) und der Angriffsbereich 4a für sich auch zur Erzielung einer noch weiteren Schräglage in einem ggf. erforderlichen, späteren Arbeitsschritt (mittels eines „Nachschlägers”),
• – die sphärische Kontur 6a, 17c, 21d zum Verbringen des Implantats in eine gegenüber der PLIF-Lage schrägere Lage (mittels eines „Ball-Tool”),
• – der sich verengende sphärische Bereich 6b, 17d, 21e zur „Rückwärts-Korrektur” der Lage des Implantats und gegebenenfalls zur Extraktion desselben oder zumindest zur Verbringung in eine Lage, als Vorbereitung einer Extraktion (mittels eines „Ball-Tool” oder ähnlichen Werkzeuges)
• – die durch den Endbereich des sich verengenden sphärischen Bereiches 6b, 17d, 21e definierte Ein- bzw. Austrittsöffnung 5, 17h, 21h
• – die Einfädelschräge 10, 17a, 21b, 21f (zur Erleichterung des „Fassens” des Gewindes des Extraktions-Werkzeuges 14 in der Gewindebohrung 7, 17b, 21, 21g)
• – die ggf. am Implantat 3 vorgesehenen Mittel 15 zur Reibungserhöhung (zwischen einem Werkzeug und dem im implantierten Zustand befindlichen Implantat zumindest an den Bereichen, mit denen Implantat und Werkzeug miteinander während der „Rückwärts-Korrektur” der Lage des Implantats und gegebenenfalls während der Extraktion desselben oder zumindest bei der Verbringung in eine Lage, als Vorbereitung einer Extraktion, in Berührung bringbar sind)
• – die ggf. am Implantat 17 vorgesehenen Mittel 17e, 17f, 17g zur Bildung eines Formschlusses (zwischen diesen und den an einem Werkzeug vorgesehenen Gegenkonturen des im implantierten Zustand befindlichen Implantats zur „Rückwärts-Korrektur” der Lage desselben oder gegebenenfalls zur Extraktion desselben oder zumindest zur Verbringung desselben in eine Lage, als Vorbereitung einer Extraktion)

sämtlich auf der bzw. symmetrisch um die gerade Achse A des gerade ausgebildeten Implantats 3, 17, 21 angeordnet sind.It can be seen that in the remarks of the 1 - 6 and particularly 8a

• - all internal and external contours necessary to drive in the implant 3 . 17 . 21 serve as the thread 7 . 17b . 21 . 21g and the attack area 4a (both together for clamping on the inserter and for insertion between two vertebrae) and the attack area 4a for itself also to achieve an even further tilt in an optionally required, later step (by means of a "follower"),
• - the spherical contour 6a . 17c . 21d for placing the implant in a position which is more oblique than the PLIF position (by means of a "ball tool"),
• - the narrowing spherical area 6b . 17d . 21e for the "backward correction" of the position of the implant and, if appropriate, for the extraction of the same or at least for the transfer to a position, as preparation for an extraction (by means of a "ball tool" or similar tool)
• - The through the end of the narrowing spherical area 6b . 17d . 21e defined inlet or outlet opening 5 . 17h . 21h
• - the threading slope 10 . 17a . 21b . 21f (To facilitate the "tapping" of the thread of the extraction tool 14 in the threaded hole 7 . 17b . 21 . 21g )
• - if necessary on the implant 3 provided for 15 for increasing the friction (between a tool and the implant in the implanted state at least at the areas with which implant and tool with each other during the "backward correction" of the position of the implant and optionally during the extraction of the same or at least when moving to a position, as preparation for an extraction, can be brought into contact)
• - if necessary on the implant 17 provided for 17e . 17f . 17g for forming a positive connection (between these and the counter contours provided on a tool of the implant in the implanted state for the "backward correction" of the position thereof or, if appropriate, for the extraction thereof or at least for the same in a position as preparation for an extraction)

all on or symmetrical about the straight axis A of the implant just formed 3 . 17 . 21 are arranged.

The space described above throughout as a spherical cap-shaped cavity can define at least approximately geometrically exact areas of a sphere, as well as the described ball of the ball tool. This term is exemplary, so that the invention also implants with other concave cavity molds and tools with differently than geometrically exactly spherical convex formed Gegenkontur- or vice versa - detected, with which the same or equivalent functions and effects can be achieved, namely a correction of the situation, especially one Back displacement of an implant or even an extraction of such, so for example, a cylindrical configuration of the end portion of a ball tool or the ball tool corresponding tool and designed with corresponding mating contours implants.

The further closing areas of the cavity can, as shown, for. B. be angled areas, so that here also a deviation from the ideal shape of a ball can be given.

The invention is not limited to the illustrated and described embodiments. It encompasses all embodiments, methods and working steps which make use of the knowledge that an implant inserted in the spinal space has a cavity at one of its end regions, which has a region which continues to close in the direction of the end region and which a tool inlet opening ends in the whirl space either correct in its position or remove it or spend in an extracting accessible position by a described ball tool or at least approximately equivalent tool through the preparation, through the inlet opening of the implant is introduced into the cavity until the re-closing areas of the cavity engages behind the ball and a tensile force is exerted in the longitudinal direction of the preparation.

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• DE 102013005692 A1 [0001, 0029]
• WO 2011/013047 [0020]

Claims (13)

Spine implant for insertion between two vertebrae of a spine as an elongated body with a straight axis, which has on at least one of its end portions an inlet or outlet for at least one tool, in its interior a first contour as an attack surface for rigid, but releasable Connection with a first tool for introduction into the swirling space, further comprising a second, convex-hollow, concave, in particular spherical cap contour lying between inlet and outlet opening and first contour as an attack surface, suitable for the temporary formation of an articulated connection with at least one other tool for displacing the implant between the two vertebrae, wherein the widening area of the dome-shaped contour of the implant merges into a further closing area that ends in the inlet opening and wherein the first and second contour, which closes again Nde area and the inlet opening are provided lying on the axis of the implant and the re-closing area serves as an attack contour for a tool for back-displacement of the implant between the two vertebrae or for removal thereof. Spine implant for insertion between two vertebrae of a spine as elongated curved body with curved axis having on at least one of its end portions an inlet or outlet for at least one tool, in its interior a first contour as a target surface for rigid, but releasable Connection with a first tool for introduction into the swirling space, further comprising a second, spherical-concave, in particular spherical cap-shaped contour lying between inlet and outlet opening and first contour as an attack surface, suitable for the temporary formation of an articulated connection with at least one further tool for Displacement of the implant between the two vertebrae, wherein the widening portion of the dome-shaped contour of the implant merges into a further closing area that ends in the inlet opening and wherein this re-closing area as An grip contour for a tool for returning the implant between the two vertebrae or for removal. Spine implant for insertion between two vertebrae of a spine as an elongate body with a straight axis, which has at least one of its end portions an inlet or outlet for at least one tool, behind a first contour as an attack surface for rigid, but releasable connection with a first tool for introducing the implant according to the TLIF or PLIF method and a further, between inlet and outlet opening and first contour lying second, convex-hollow, concave, in particular spherical cap, widening contour as an attack surface, suitable for temporary formation an articulated connection with another tool for displacing the implant between the two vertebrae or for removal therefrom. Spine implant, in particular according to claim 3, characterized in that the widening area of the dome-shaped contour of the implant merges into a further closing area that ends in the inlet opening and this re-closing area as an attack contour for a tool for returning Displacement of the implant between the two vertebrae serves or removes it. Spinal implant and / or tool for introducing, or changing the position, or for displacing, or back-displacing and / or extracting between two vertebrae of a spinal column and / or for extracting, in particular according to one of claims 1-4, characterized in that the tool consists of a substantially straight, rod-like portion with a handle at its proximal end and a bent relative to the rod-shaped portion distal end portion with a convex, preferably spherical convex engagement surface provided thereon as a counter contour to the concave contour of the implant. Spine implant and / or tool, in particular according to one of claims 1-5, characterized in that the diameter of the dome is greater than that of the ball of the tool and / or the diameter of the inlet or outlet opening is equal to or smaller than that Diameter of the ball. Spine implant and / or tool, in particular according to one of claims 1 to 6, characterized in that at least friction-increasing means are provided in the region of the inner space and / or on the insertable in these sections of the tool. Spine implant and / or tool, in particular according to one of claims 1 to 7, characterized in that the means are provided on the ball and / or the dome. Spine implant and / or tool, in particular according to one of the preceding claims, characterized in that the friction-increasing means are partially provided. Spine implant and / or tool, in particular according to one of the preceding claims, characterized in that the friction-increasing means are formed by a coating. Spine implant and / or tool, in particular according to one of the preceding claims, characterized in that the friction-increasing means consist of a diamond or mineral coating. Spine implant and / or tool, in particular according to one of the preceding claims, characterized in that the friction-increasing means are formed by a groove inserted in a ring, ring or the like. Of hard material. Spinal implant and / or tool for introducing, or changing the position, or for relocating, or back-displacing and / or extracting such between two vertebrae of a spine and / or for extracting, in particular according to one of the preceding claims, characterized in that means for forming a form-locking connection are provided in the region of the inner space and at the portions of a tool which is at least similar to the further tool and can be inserted in these.

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