DE10253169A1 - Implant used in procedures for stiffening the vertebral column consists of a compression-resistant hollow body made from two open receptacles which are pressed apart with insertion of filler material - Google Patents
Implant used in procedures for stiffening the vertebral column consists of a compression-resistant hollow body made from two open receptacles which are pressed apart with insertion of filler material Download PDFInfo
- Publication number
- DE10253169A1 DE10253169A1 DE2002153169 DE10253169A DE10253169A1 DE 10253169 A1 DE10253169 A1 DE 10253169A1 DE 2002153169 DE2002153169 DE 2002153169 DE 10253169 A DE10253169 A DE 10253169A DE 10253169 A1 DE10253169 A1 DE 10253169A1
- Authority
- DE
- Germany
- Prior art keywords
- hollow body
- implant
- implant according
- elastomer
- filled
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Ceased
Links
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- 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
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
- A61F2/4465—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages having a circular or kidney shaped cross-section substantially perpendicular to the axis of the spine
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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
- A61F2/02—Prostheses implantable into the body
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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
- A61F2/02—Prostheses implantable into the body
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- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
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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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Landscapes
- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Neurology (AREA)
- Transplantation (AREA)
- Heart & Thoracic Surgery (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Cardiology (AREA)
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Abstract
Description
Die Erfindung betrifft ein Implantat zum Einsatz bei Versteifungsoperationen an der Wirbelsäule.The invention relates to an implant for use in stiffening operations on the spine.
Die chirurgische Versteifung eines Abschnitts der Wirbelsäule bezeichnet man als Spondylodese. Mit konservativen Behandlungsmaßnahmen nicht beeinflussbare Schmerzen, Rückenmarks- oder Nervenwurzelkompressionen sowie Fehlstellungen sind Indikationen für Spondylodesen. Schmerzen können von allen krankhaft veränderten Strukturen der Wirbelsäule ausgehen. In den vielen Fällen beruhen sie auf einer "Instabilität" des Bewegungssegments, hervorgerufen durch degenerative Veränderungen der Bandscheibe und Zwischenwirbelgelenke des Bewegungssegments. Für die Entwicklung von Rückenmarks- oder Nervenwurzelkompressionen sind Verengungen des Wirbelkanals oder der Zwischenwirbellöcher verantwortlich. Mit dem chirurgischen Eingriff werden die pathologischen Veränderungen beseitigt und die Stabilität der Wirbelsäule durch die Spondylodese wieder hergestellt.The surgical stiffening of a Section of the spine is called spinal fusion. Not with conservative treatment measures influenceable pain, spinal cord or nerve root compression and malposition are indications for spondylodesis. Pain of all morbidly changed Spine structures out. In many cases are they based on an "instability" of the movement segment, caused by degenerative changes in the intervertebral disc and Intervertebral joints of the movement segment. For the development of spinal cord or nerve root compressions Narrowing of the spinal canal or the intervertebral holes is responsible. With the surgical intervention, the pathological changes eliminated and stability through the spine the spinal fusion restored.
Bei einer Spondylodese wird Knochen- oder Knochenersatzmaterial zwischen zwei oder mehreren Wirbelkörpern eingesetzt (interkorporelle Spondylodese) oder über die hinteren Wirbelelemente zweier oder mehrerer Wirbel angelagert (dorsale Spondylodese). Im Verlaufe mehrerer Monate entsteht dadurch eine knöcherne Brücke, welche die Wirbel verbindet und so die Schmerzen verursachende Instabilität eliminiert. Voraussetzung für die Verknöcherung ist, dass der betreffende Abschnitt der Wirbelsäule ruhig gestellt wird bis die Knochenbrücke genügend fest ist.Spinal fusion is bone or bone replacement material between two or more vertebral bodies (interbody spondylodesis) or via the posterior vertebrae of two or several vertebrae attached (dorsal spondylodesis). During For several months, this creates a bony bridge that connects the vertebrae thus eliminating the instability that causes pain. requirement for the ossification is that the section of the spine in question is immobilized until the bone bridge enough is firm.
Im Rahmen einer Spondylodese sind ferner die infolge Bandscheibenverschmälerung verringerten vertikalen Abstände zwischen den Wirbelkörpern zu normalisieren und Achsenabweichungen der Wirbelsäule zu beseitigen. Da allein schon die Vergrößerung der vertikalen Wirbelkörperdistanz durch instrumentell erwirkte "Distraktion" einen starken de komprimierenden Effekt sowohl auf die nervalen Gebilde als auch auf die Zwischenwirbelgelenke hat, ist die Distraktion immer ein wesentlicher Bestandteil des Eingriffs.Are part of a spinal fusion also the reduced vertical as a result of intervertebral disc narrowing distances between the vertebral bodies too normalize and eliminate axis deviations of the spine. Because alone already the enlargement of the vertical vertebral distance through instrumental "distraction" a strong de-compressing Effect both on the nervous structures and on the intervertebral joints distraction is always an integral part of the procedure.
Weil bei interkorporeller Spondylodese immer zumindest Bandscheiben ausgeräumt werden, ist die Stabilität der Wirbelsäule in jedem Fall wieder herzustellen. Dies kann z. B. mit vom Patienten stammenden druckfesten Knochenspänen geschehen. Weil die Belastbarkeit solcher Späne oft unsicher und ihre Verfügbarkeit begrenzt ist, und zudem die durch eine Spanentnahme verursachte Morbidität erheblich sein kann, benutzt man anstelle von autogenen Knochenspänen zunehmend Knochenersatzmaterialien sowie druckfeste Intervertebralimplantate (auch Cages genannt).Because with inter-corporeal spinal fusion always at least spinal discs are cleared, is the stability of the spine in everyone Restore case. This can e.g. B. from the patient flameproof bone chips happen. Because the resilience of such chips is often uncertain and their availability is limited, and also that caused by chip removal morbidity can be significant, one uses increasingly instead of autogenous bone chips Bone replacement materials and pressure-resistant intervertebral implants (also called cages).
Intervertebralimplantate kann man in allen Bereichen der Wirbelsäule von vorne einsetzen (ALIF = anterior lumbar interbody fusion); an der Lendenwirbelsäule darüber hinaus auch von hinten (PLIF = posterior lumbar interbody fusion), von der Seite oder von seitlich hinten. Pro Bandscheibenraum werden ein oder zwei Implantate eingesetzt. Wenn zwei Implantate von hinten durch zwei separate Öffnungen des Bandscheibenrings eingesetzt werden, spricht man von einer biportalen Implantation. Bei einer uniportalen Implantation wird der Bandscheibenring nur an einer Stelle eröffnet.One can use intervertebral implants in all areas of the spine insert from the front (ALIF = anterior lumbar interbody fusion); on the lumbar spine about that also from behind (PLIF = posterior lumbar interbody fusion), from the side or from the side rear. Per disc space one or two implants inserted. If two implants from behind through two separate openings of the intervertebral disc ring, one speaks of a biportal Implantation. With a uniportal implantation, the intervertebral disc ring only opened at one point.
Ein Intervertebralimplantat funktioniert als druckaufnehmender Platzhalter, welcher die Spondylodese stabilisiert, die Einstellung der Wirbelkörper zueinander sichert und gewährleistet, dass sich zwischen den Wirbelkörpern eine solide Knochenbrücke bilden kann. In die Implantate eingefülltes und/oder um sie herum angelagertes Knochen- oder Knochenersatzmaterial bildet die Matrix für die Knochenneubildung. Für den Ossifikationsprozess spielt die Stabilität der Spondylodese eine entscheidende Rolle. Innerhalb der Spondylodese stattfindende Bewegungen verzögern oder verhindern deren knöcherne Konsolidierung. Für die zusätzliche Stabilsierung der Spondylodesen werden Pedikelsysteme oder translaminäre Verschraubungen verwendet.An intervertebral implant works as a pressure-absorbing placeholder that stabilizes spinal fusion, the adjustment of the vertebrae to each other secures and guarantees that between the vertebrae form a solid bone bridge can. Filled in the implants and / or bone or bone substitute material deposited around them forms the matrix for the new bone formation. For The stability of spinal fusion plays a crucial role in the ossification process Role. Movements within the spinal fusion delay or prevent their bony consolidation. For the additional Stabilization of the spondylodesis becomes pedicle systems or translaminar screw connections used.
Die Distraktion hat neben der therapeutischen auch noch eine mechanische Bedeutung: Die damit einhergehende Dehnung der Weichteile generiert eine Kraft, welche die Intervertebralimplantate zwischen den Wirbelkörpern verklemmt. Dies verhindert Bewegungen innerhalb der Spondylodese und vermindert darüber hinaus auch das Risiko einer mitunter folgenschweren sekundären Implantatdislokation.The distraction has in addition to the therapeutic also a mechanical meaning: the associated elongation the soft tissue generates a force that the intervertebral implants between the vertebral bodies jammed. This prevents movements within the spinal fusion and diminishes above there is also the risk of secondary implant dislocation, which can be serious.
Bei der Implantation von Intervertebralimplantaten ist es oft und insbesondere bei minimal invasiver und einseitiger (uniportaler) Implantationstechnik sehr schwierig, wirksame Distraktion zu erzielen.When implanting intervertebral implants it is often and especially with minimally invasive and one-sided (Uniportal) implantation technique very difficult, effective distraction to achieve.
Die Erfindung hat sich zur Aufgabe gestellt, ein elastisches intervertebrales Implantat zu schaffen, um den knöchernen Durchbau der Spondylodese zu fördern, indem sowohl die in der Kontaktzone des Knochens auftretenden Spannungsdifferenzen reduziert werden als auch die Knochenneubildung durch die Elastizität bzw. Reduktion des "stress shieldings" stimuliert wird. Das Implantat soll darüber hinaus auch eine Erweiterung der vertikalen Wirbelkörperdistanz bewirken.The invention has for its object to create an elastic intervertebral implant, around the bony Promote the development of spinal fusion, by both reducing the voltage differences occurring in the contact zone of the bone as well as new bone formation due to the elasticity or reduction stress shielding is stimulated. The implant should go over it also an expansion of the vertical vertebral body distance cause.
Erfindungsgemäß gelingt dies dadurch, dass dass das Implantat aus einem mit Elastomer gefüllten Hohlkörper gebildet ist und dieser Hohlkörper aus mindestens zwei schachtelartig ineinander gesteckten und in der Körperlängsachse gegeneinander teleskopartig beweglichen Teilen besteht.According to the invention, this is achieved in that the implant is formed from a hollow body filled with elastomer and this hollow body from at least two nested and in the body longitudinal axis against each other telescopically movable parts.
Bei der Verwendung eines Intervertebralimplantats kann die Differenz zwischen der Elastizität des Knochens und der des Implantats eine bedeutende Rolle spielen. Der Knochen des Wirbelkörpers ist elastisch stärker deformierbarerer als die aus Metall oder Polymer hergestellten Implantate. Unter den tausendfachen täglichen Belastungsänderungen treten deshalb in der Kontaktzone des Knochens Spannungsspitzen auf, welche Mikrofrakturen im Knochen der Kontaktzone infolge Materialermüdung verursachen können. Der geschädigte Knochen wird dann abgebaut und durch Bindegewebe ersetzt. Dieser Ersatz ist radiologisch an einem den Cage umgebenden mehr oder weniger breiten Aufhellungssaum gut zu erkennen. Der Ersatz des festen Knochens durch weiches Bindegewebe führt zur Lockerung des Cages (Implantats) bzw. zur Instabilität der Spondylodese. Als Folge der Instabilität kann auch die Ausbildung der knöchernen Brücke zwischen den Wirbelkörpern unterbleiben, d. h. es kann eine Pseudarthrose entstehen. Dies ist dann gleichbedeutend mit einem Misserfolg der Behandlung.When using an intervertebral implant, the difference between the elasticity of the bone and that of the implant can play a significant role. The bone of the vertebral body is elastically more deformable than the implants made of metal or polymer. Among the thousandfold daily changes in stress Therefore, stress peaks occur in the contact zone of the bone, which can cause microfractures in the bone of the contact zone as a result of material fatigue. The damaged bone is then broken down and replaced with connective tissue. This replacement can be recognized radiologically from a more or less wide brightening hem surrounding the cage. The replacement of the solid bone with soft connective tissue leads to loosening of the cage (implant) or to instability of the spinal fusion. As a result of the instability, the formation of the bony bridge between the vertebral bodies can also be omitted, ie pseudarthrosis can occur. This is tantamount to treatment failure.
Verstärkt wird der beschriebene Prozess, wenn die Spondylodese a priori nicht ganz stabil ist, d.h. wenn von Anfang an Bewegungen zwischen den Wirbelkörpern und dem Implantat möglich sind. Wenn sich der Wirbelkörper z. B. bei Rückwärtsneigung etwas vom Implan tat weg bewegen kann fällt die Spannung im Knochen auf Null ab. Weil in einem solchen Fall die Spannungen jeweils von Null bis zum Maximum ansteigen können, werden die für die Ermüdungsfrakturen verantwortlichen Spannungsdifferenzen besonders gross.The process described is reinforced if a priori spinal fusion is not entirely stable, i.e. if from the beginning movements between the vertebral bodies and the implant are possible. If the vertebral body z. B. with backward tilt The tension in the bone drops something that can move away from the implant to zero. Because in such a case the voltages of Can rise from zero to the maximum, will be the for the fatigue fractures responsible voltage differences are particularly large.
Durch die vorliegende Erfindung wird nun ein elastischer Hohlkörper (HK) zur Wiederherstellung der Wirbelsäulen (WS)-Stabilität geschaffen, der im Rahmen von interkorporellen Spondylodesen zwischen den Wirbelkörpern in den Bandscheibenraum oder in Defekte der Wirbelkörpersäule (WkS) einsetzbarer ist. Der Hohlkörper besteht aus zwei schachtelartig ineinander gesteckten Teilen und ist mit einem gewebeverträglichen Elastomer gefüllt. Durch Annäherung der Elastizität des Implantats an die des Knochens können hohe Spannungsänderungen vermieden werden, die bei zyklischer Belastung in der Kontaktzone des Knochens mit dem Implantat auftreten und dort zum Abbau des Knochens mit nachfolgender Instabilität führen würden. Die Ossifikation des Knochentransplantats durch Annäherung der Elastizität des Implantats an die des Knochens wird gefördert und damit wird der Erfolg bei einer interkorporellen Spondylodese gesichert.By the present invention now an elastic hollow body (HK) created to restore spine (WS) stability, which is part of interbody spondylodesis between the vertebral bodies in the intervertebral disc space or in defects of the vertebral body column (WkS) can be used The hollow body consists of two box-like parts and is compatible with tissue Filled with elastomer. By approximation of elasticity of the implant to that of the bone can cause high changes in tension be avoided with cyclical loading in the contact zone of the bone with the implant and there to break down the Bone with subsequent instability. Bone graft ossification by approximation of elasticity of the implant to that of the bone is promoted and with it the success secured with an interbody spinal fusion.
Bei einer Ausführungsvariante ist vorgesehen, dass das Elastomer in den inneren Teil des Hohlkörpers eingefüllt ist. Damit hat das Elastomer rein die Funktion der Bildung der gewünschten Elastizität, so dass also das Elastomer nie direkt mit dem Umgebungsbereich des Implantates in Verbindung kommt.In one embodiment variant, that the elastomer is filled into the inner part of the hollow body. The elastomer thus has the purely the function of forming the desired one Elasticity, so that the elastomer never directly matches the surrounding area of the Implant comes into contact.
Dabei sieht eine Ausführung vor, dass das Elastomer den Hohlkörper ganz oder teilweise ausfüllt. Es können dadurch noch Variationsmöglichkeiten geschaffen werden, u.a. auch mit verschiedenen Bereichen unterschiedlicher Elastizität. Vorzugsweise soll das Elastomer den Innenraum des Implantats ganz ausfüllen, um zu vermeiden, dass bei Be- und Entlastung jeweils Gas oder Flüssigkeit aus dem Implantat ausgepresst oder in das Implantat eingesogen wird.An execution provides that the elastomer is the hollow body completely or partially. It can thereby still possible variations created, among other things even with different areas different Elasticity. The elastomer should preferably completely cover the interior of the implant to complete, in order to avoid gas or liquid in each case during loading and unloading is pressed out of the implant or sucked into the implant.
In diesem Zusammenhang ist es auch möglich, dass das in den Hohlkörper eingefüllte Elastomer an den inneren Seitenwänden des Hohlkörpers locker oder fest und abdichtend anliegt.In this context it is also possible, that that's in the hollow body filled Elastomer on the inner side walls of the hollow body loose or tight and tight.
Wenn ferner vorgesehen wird, dass die inneren Oberflächen der Ober- und Unterwand der schachtelartig ineinander gesteckten Teile des Hohlkörpers bei Belastung in das eingefüll te Elastomer eindringen, kann auf verschiedenste Kräfteverteilung und verschiedenes Kraftaufkommen im implantierten Zustand des Implantates speziell eingegangen werden.If it is further provided that the inner surfaces the top and bottom wall of the box-like one inside the other Parts of the hollow body when loaded into the filled Penetrating elastomer can have a wide variety of forces and different Special force in the implanted state of the implant To be received.
Bei einer weiteren Ausführungsvariante ist vorgesehen, dass unter dem eingefüllten Elastomer, d.h. zwischen Elastomer und der Unterwand der schachtelartig ineinander gesteckten Teile des Hohlkörpers ein Hohlraum belassen ist. Dadurch kann die Elastizität des Implantates noch weiter erhöht werden, oder es können zusätzliche Mittel zur Veränderung oder zur Erhöhung der Elastizität eingesetzt werden.In a further variant it is envisaged that under the filled elastomer, i.e. between Elastomer and the bottom wall of the box-like nested Parts of the hollow body a cavity is left. This can increase the elasticity of the implant increased even further become, or can additional Means of change or to increase of elasticity be used.
Bei einer speziellen Ausführung kann vorgesehen werden, dass im Elastomer eine hermetisch abgedichtete Gasblase eingearbeitet ist. Dies bedeutet eine sehr einfache und auch konstruktiv sehr wirksame Ausgestaltung zur Erhöhung der Elastizität.With a special version can be provided that a hermetically sealed in the elastomer Gas bubble is incorporated. This means a very simple and also structurally very effective design to increase the Elasticity.
Bei einer besonderen Ausführungsvariante wird vorgeschlagen, dass am Hohlkörper eine Vorrichtung z.B. in Form einer Klemmschraube angebracht ist, um den vor der Implantation auf verminderte Höhe zusammengepressten Hohlkörper nach der Implantation expandieren zu lassen. Dies erleichtert die Implantation und kann darüber hinaus eine Vergrösserung der vertikalen Wirbelkörperdistanz (Distraktion) herbei führen. Zudem erhält das Intervertebralimplantat dadurch eine Vorspannung, welche das Implantat in ständigem Kontakt mit dem Wirbelkörper hält und die schädlichen Spannungsdifferenzen vermindert.In a special design variant suggested that on the hollow body a device e.g. is attached in the form of a clamping screw, around the hollow body compressed to a reduced height before the implantation to expand the implantation. This makes implantation easier and can about it also an enlargement the vertical vertebral distance Bring about (distraction). Also receives the intervertebral implant thereby preloading the implant in constant Maintains contact with the vertebral body and the harmful Voltage differences reduced.
Für eine optimale Möglichkeit der Einbringung des Implantates wird eine Ausgestaltung vorgeschlagen, bei der der äußere Teil des schachtelartigen Hohlkörpers ein keilförmiges Einführungsende aufweist. Damit kann die distrahierende Wirkung noch wesentlich verbessert werden.For an optimal possibility a design is proposed for the insertion of the implant, where the outer part of the box-like hollow body a wedge-shaped Has insertion end. This can significantly improve the distracting effect become.
In konstruktiv einfacher Weise ist je nach besonders zu wählender Form und je nach speziellem Einsatzzweck des Implantates vorgesehen, dass dieses aus Metall, aus Polymer oder einem Verbundwerkstoff gefertigt sind.Is in a constructively simple manner depending on the particular one to be chosen Shape and depending on the specific application of the implant, that this is made of metal, polymer or a composite material are made.
Weiter wird vorgeschlagen, dass bei der Fertigung aus Polymer oder Verbundwerkstoff radiologische Schatten gebende Elemente oder Materialien in die Implantate eingearbeitet sind. Damit können die Implantate radiologisch sichtbar gemacht werden.It is also proposed that at manufacturing of polymer or composite radiological shadows incorporating elements or materials into the implants are. So that can the implants are made radiologically visible.
Eine konstruktive Gestaltung des erfindungsgemäßen Implantats ist an sich auf verschiedene Art und Weise möglich. Eine vorteilhafte Ausgestaltung ist jedoch dann gegeben, wenn die druckaufnehmenden Teile des Hohlkörpers die Form eines niedrigen Zylinders oder Prismas haben, wobei ebene oder leicht gewölbte, zueinander parallele oder leicht gegeneinander geneigte Grund- und Deckplatten vorgesehen sind.A constructive design of the implant according to the invention is per se possible in various ways. An advantageous embodiment is given, however, if the pressure-absorbing parts of the hollow body have the shape of a low cylinder or prism, with flat or slightly curved, mutually parallel or slightly inclined base and cover plates are provided.
Damit das Implantat auch in einfacher Weise implantiert werden kann, wird vorgeschlagen, dass dieses zum Ansetzen eines Implantationsinstruments ausgebildet ist. Damit ist am Implantat selbst schon dafür gesorgt, dass ein gutes Erfassen und Einführen desselben gewährleistet ist.So that the implant is also easier Can be implanted, it is suggested that this be used for Attaching an implantation instrument is formed. So that is on the implant itself for that ensured that a good grasping and insertion of the same is guaranteed is.
Eine vorteilhafte Ausgestaltung sieht ferner vor, dass die Oberfläche des Implantates strukturiert und/oder beschichtet ausgeführt sind. Damit wird zusätzlich für eine optimale Lagesicherung des Implantates in der implantierten Stellung und bessere Integrierung in das knöcherne Implantatbett gesorgt.See an advantageous embodiment furthermore that the surface of the implant are structured and / or coated. This will add for one optimal positional securing of the implant in the implanted position and better integration into the bony implant bed.
Weitere erfindungsgemäße Merkmale und besondere Vorteile werden in der nachstehenden Beschreibung anhand der Zeichnungen noch näher erläutert. Es zeigen:Further features according to the invention and particular advantages will appear in the description below based on the drawings explained. Show it:
Nach der vorliegenden Erfindung wird
also das Implantat als ein mit einem Elastomer
Die inneren Oberflächen der
Oberwand
Am Implantat ist eine Vorrichtung
angebracht, z. B. in Form einer Klemmschraube
Zur Erhöhung der erwähnten distrahierenden
Wirkung kann der äussere
Teil
In funktioneller Hinsicht besteht
ein solches Intervertebralimplantat mit Keilende aus zwei Teilen. In
Die Implantatteile
Der druckaufnehmende Teile
Die elastischen Intervertebralimplantate können aus Metall, Polymer oder Verbundwerkstoff bestehen. Um die Lage von radiologisch nicht sichtbaren, aus Polymer oder Verbundwerkstoff hergestellten Implantaten im Körper sichtbar zu machen, werden radiologische Schatten gebende Elemente oder Materialien in die Implantate eingearbeitet.The elastic intervertebral implants can consist of metal, polymer or composite material. To the location from radiologically invisible, from polymer or composite material manufactured implants in the body Making radiological shadows visible or materials incorporated into the implants.
Im Rahmen der Erfindung ist es möglich, den Hohlkörper
Mit dem erfindungsgemäßen Implantat
ist die nachstehende Implantationstechnik möglich geworden: Nach eventuell
vorgängiger
Erweiterung des Bandscheibenraums bzw. des Defekts mit einem geeigneten
Instrument (z.B. einer Spreizzange) wird die Höhe der vertikalen Wirbelkörperdistanz
gemessen und jenes Implantat gewählt,
das in zusammengepresstem (höhenvermindertem)
Zustand noch in den Bandscheibenraum einführbar ist. Das Implantat wird in
den Bandscheibenraum eingepresst oder eingehämmert, eventuell mit Hilfe
eines daran befestigten Implantationsinstruments. Nach der endgültigen Positionierung
wird die Klemmschraube
Bei uniportaler dorsaler oder dorsolateraler Applikationstechnik müssen die Implantate während der Implantation aus der initial sagittalen oder schrägen Implantationsrichtung in frontale Richtung gedreht werden, insbesondere, wenn nur ein Implantat in den Bandscheibenraum eingesetzt wird. Bei der wünschbaren Verklemmung des Implantats kann dessen Drehung erheblich Schwierigkeiten bereiten oder unmöglich sein.With uniportal dorsal or dorsolateral application technique have to the implants during the Implantation from the initial sagittal or oblique direction of implantation be rotated in the frontal direction, especially if only one Implant is inserted into the intervertebral disc space. At the desired Jamming the implant can make it difficult to rotate prepare or impossible his.
Das uniportale Intervertebralimplantat
hat im wesentlichen folgende Vorrichtungen und Merkmale: Das Implantat
hat Bohnenform (siehe insbesondere
Zur Erleichterung der Drehung des
Implantats sind folgende Vorrichtungen vorgesehen: Vom Übergang
des Teiles
Schon beim Einführen des Implantats von hinten
oder seitlich hinten in den Bandscheibenraum schneiden die scharfen
Kanten und die Führungsnuten
in die Deckplatten ein. Das Implantat beginnt sich demzufolge schon
beim Einsetzen in die erwünschte Richtung
zu drehen. Durch ein an seinem Hinterende befestigtes stangenförmiges Einführungsinstrument, welches
gleichzeitig als Klemmschraube
Derartige Intervertebralimplantate sind grundsätzlich in allen Bereichen der Wirbelsäule einsetzbar: An der Hals-, Brust- und Lendenwirbelsäule von vorne, und an der Lendenwirbelsäule zusätzlich uni- oder biportal von hinten, von seitlich oder von seitlich hinten. Voraussetzung für die Anwendbarkeit ist, dass die Form der beiden Implantatteile sowohl den anatomischen Gegebenheiten der vorgesehen Implantationsstelle (Region der Wirbelsäule) als auch der vorgesehenen Implantationstechnik entsprechend speziell gestaltet wird.Such intervertebral implants are fundamental in all areas of the spine applicable: on the cervical, thoracic and lumbar spine of in front, and on the lumbar spine additionally uni- or biportal from behind, from the side or from the side behind. requirement for the applicability is that the shape of the two implant parts both the anatomical conditions of the intended implantation site (region The spine) as well as the intended implantation technique is designed.
Anstelle der im Elastomer
Da das Elastomer
Claims (14)
Priority Applications (8)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE2002153169 DE10253169A1 (en) | 2002-11-14 | 2002-11-14 | Implant used in procedures for stiffening the vertebral column consists of a compression-resistant hollow body made from two open receptacles which are pressed apart with insertion of filler material |
DE10253170A DE10253170A1 (en) | 2002-11-14 | 2002-11-14 | Implant used in procedures for stiffening the vertebral column consists of a compression-resistant hollow body made from two open receptacles which are pressed apart with insertion of filler material |
PCT/EP2003/012762 WO2004043304A2 (en) | 2002-11-14 | 2003-11-14 | Implant used in procedures for stiffening the vertebral column |
JP2004551025A JP2006506116A (en) | 2002-11-14 | 2003-11-14 | Implant for insertion in spinal reinforcement surgery |
AU2003301949A AU2003301949A1 (en) | 2002-11-14 | 2003-11-14 | Implant used in procedures for stiffening the vertebral column |
US10/534,293 US20060116767A1 (en) | 2002-11-14 | 2003-11-14 | Implant Used in Procedures for Stiffening the Vertebral Column |
EP03810989A EP1572040A2 (en) | 2002-11-14 | 2003-11-14 | Implant used in procedures for stiffening the vertebral column |
CA002505926A CA2505926A1 (en) | 2002-11-14 | 2003-11-14 | Implant used in procedures for stiffening the vertebral column |
Applications Claiming Priority (1)
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DE2002153169 DE10253169A1 (en) | 2002-11-14 | 2002-11-14 | Implant used in procedures for stiffening the vertebral column consists of a compression-resistant hollow body made from two open receptacles which are pressed apart with insertion of filler material |
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DE10253169A1 true DE10253169A1 (en) | 2004-08-05 |
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Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2007077319A2 (en) * | 2005-12-20 | 2007-07-12 | Spineart Sa | Anatomic intervertebral spacer and the applications thereof |
ITPI20120106A1 (en) * | 2012-10-19 | 2014-04-20 | Giancarlo Guizzardi | DEVICE AND SYSTEM FOR VERTEBRAL ARTHRODES |
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Cited By (5)
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WO2007077319A2 (en) * | 2005-12-20 | 2007-07-12 | Spineart Sa | Anatomic intervertebral spacer and the applications thereof |
WO2007077319A3 (en) * | 2005-12-20 | 2007-08-30 | Spineart Sa | Anatomic intervertebral spacer and the applications thereof |
ITPI20120106A1 (en) * | 2012-10-19 | 2014-04-20 | Giancarlo Guizzardi | DEVICE AND SYSTEM FOR VERTEBRAL ARTHRODES |
WO2014061005A3 (en) * | 2012-10-19 | 2014-06-12 | Tsunami S.R.L. | Vertebral fusion device and system |
US10159580B2 (en) | 2012-10-19 | 2018-12-25 | Tsunami S.R.L. | Vertebral fusion device and system |
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