DE4012622C1 - Two-part metal vertebra implant - has parts locked by two toothed racks, pre-stressed by elastic cushion between both implant parts - Google Patents

Two-part metal vertebra implant - has parts locked by two toothed racks, pre-stressed by elastic cushion between both implant parts

Info

Publication number
DE4012622C1
DE4012622C1 DE19904012622 DE4012622A DE4012622C1 DE 4012622 C1 DE4012622 C1 DE 4012622C1 DE 19904012622 DE19904012622 DE 19904012622 DE 4012622 A DE4012622 A DE 4012622A DE 4012622 C1 DE4012622 C1 DE 4012622C1
Authority
DE
Grant status
Grant
Patent type
Prior art keywords
part
implant
parts
characterized
vertebral implant
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.)
Expired - Fee Related
Application number
DE19904012622
Other languages
German (de)
Inventor
Hans 2400 Luebeck De Grundei
Lothar Prof. Dr.Med. 1000 Berlin De Hanslik
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
"ESKA IMPLANTS GMBH & CO.", 23556 LUEBECK, DE
Original Assignee
Eska Medical Luebeck Medizintechnik & Co 2400 Luebeck De GmbH
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Grant date

Links

Classifications

    • AHUMAN NECESSITIES
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    • A61F2/00Filters 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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    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/4455Joints 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
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    • A61F2002/30433Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws
    • A61F2002/30434Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws using bolts
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Abstract

Metal vertebra implant comprises two mutually adjustable and lockable parts. They are held permanently in the required position by an arrester. The parts are locked by two toothed racks, which are prestressed using a flexible pad between the two omplant parts so that the racks can only move in one direction towards one another. Pref. the permanent arrester consists of an elongated hole in the leg of the first part to take a screw engaging a hole in the web of the second part. The flexible pads are sterilisable silicone components which are fixed to and reach into a recess on the first part. ADVANTAGE - Implant adjusts in situ to suit situation using latching racks to take load when engaged. (Previously notified in Week 9129)

Description

Die Erfindung betrifft ein Wirbelkörperimplantat aus Metall für die Implantation in der menschlichen Wirbelsäule. The invention relates to a vertebral implant made of metal for implantation in the human spine. Hierbei dient es je nach Indikation und dementsprechender Ausführungsform zum Ersatz eines Wirbelkörpers oder zur Fusion zweier Wirbelkörper. This is depending on the indication and corresponding thereto embodiment for the replacement of a vertebra or to the fusion of two vertebrae.

Es ist ein Wirbelkörperimplantat in Form eines sogenannten Keystone-Implantats bekannt. It is a vertebral body implant in the form of a so-called Keystone implant known. Dieser einstückige Metallblock dient zur ventralen Fusion zweier Wirbelkörper (DE 36 20 549 A1). This one-piece metal block serves to ventral fusion of two vertebral bodies (DE 36 20 549 A1).

Entsprechend den individuellen Patienten- Erfordernissen ist es notwendig, eine Vielzahl derartiger Implantate unterschiedlicher Größe herzustellen und beispielsweise in der Klinik auf Lager zu halten. According to the individual patient requirements, it is necessary to produce a plurality of such implants of different sizes and to hold, for example, in the clinic in stock. Dies verteuert die Herstellung und Verwendung des bekannten Implantats beträchtlich. This greatly increases the cost of manufacture and use of the known implant.

In ihrer Länge verstellbare Implantate sind aus der DE 37 29 600 C2 und der DE 30 23 942 C3 bekannt. In length adjustable implants are known from DE 37 29 600 C2 and DE 30 23 942 C3. Die erstgenannte Druckschrift zeigt ein Implantat, das aus zwei Teilen, einem caudalen und einem kranialen Teil, besteht. The former reference shows an implant which consists of two parts, a caudal and cranial part. An einem Teil ist eine sich in Richtung auf das andere Teil erstreckende Führungshülse mit einem Außengewinde vorgesehen. At a part extending in the direction of the other part of the guide sleeve is provided with an external thread. Das andere Teil weist einen in der Führungshülse verschieblichen Führungsstab mit ebenfalls einem Außengewinde auf. The other part has a sliding in the guide sleeve guide bar also having an external thread. Die Verbindung zwischen beiden Teilen wird durch eine Mutter hergestellt, die auf einer Seite eine Gewindebohrung entsprechend dem Außengewinde auf dem Führungsstab und auf der anderen Seite eine Gewindebohrung entsprechend dem Außengewinde der Führungshülse aufweist. The connection between both parts is formed by a nut having on one side a threaded hole corresponding to the external thread on the guide rod and on the other side a tapped hole corresponding to the outer thread of the guide sleeve. Die Längeneinstellung des Implantats erfolgt durch Verschiebung des Führungsstabs in der Führungshülse. If the length adjustment of the implant by displacement of the guide rod in the guide sleeve. Sie wird durch Anziehen der Mutter fixiert. It is fixed by tightening the nut.

Dieses Implantat läßt sich nur sehr ungenau einstellen. This implant can be set only very inaccurate. Insbesondere ist es praktisch unmöglich, die Längeneinstellung direkt am Ort der Implantation vorzunehmen, da erst in umständlicher Weise die einmal eingestellte Länge durch Anziehen der Mutter fixiert werden müßte. In particular, it is virtually impossible to make the length setting directly at the site of implantation, as only in cumbersome, the once set length would have to be fixed by tightening the nut.

Aus der DE 30 23 942 C2 ist ein zweistückiges Implantat bekannt, welches wie das vorbeschriebene an einem Teil eine Hülse und am anderen Teil eine Führungsstange aufweist, die in der Hülse längsverschieblich gelagert ist, um die Länge des Implantats einstellen zu können. From DE 30 23 942 C2 a two-piece implant is known which, like the previously described at a part of a sleeve and on the other part has a guide rod which is mounted longitudinally displaceably in the sleeve in order to adjust the length of the implant. Die Stange und die Hülse weisen Rasteinrichtungen, beispielsweise nur auf Teilen ihrer Peripherie zusammenwirkende Gewindegänge, auf, mit denen nach Einstellung der gewünschten Länge des Implantats die beiden Teile in Rasteingriff gebracht werden können, und zwar durch Verdrehen der Teile gegeneinander. The rod and the sleeve comprise locking means, for example, only on parts of its periphery cooperating threads, with which the two parts can be brought into locking engagement by setting the desired length of the implant, by rotating the parts relative to each other. Das Implantat soll im zusammengeschobenen Zustand an den Ort der Implantation gebracht werden können, wo es auf die gewünschte Länge distrahiert werden soll. The implant should be able to be brought to the site of implantation in the collapsed state where it is to be distracted to the desired length. Dazu müssen sich die beiden Teile in der Stellung befinden, in der sie in Längsrichtung gegeneinander verschiebbar sind. For this purpose, the two parts must be in the position in which they are mutually displaced in the longitudinal direction. Sie nehmen also nicht ihre Rasteinstellung ein. so do not take their rest setting. Nun herrschen aber in der Wirbelsäule erhebliche Kräfte, die beim Einsetzen eines Implantats zunächst einmal überwunden werden müssen. but in the spine now prevail substantial forces that must first be overcome once during insertion of an implant. Damit das erwähnte Implantat in seinem längsverschieblichen Zustand nicht aufgrund der erwähnten Kräfte einfach in seine Lage geringsten Ausmaßes zurückgedrängt wird, ist in der besagten Druckschrift eine Spezialzange erwähnt, mit der das Implantat auseinandergespreizt werden kann und schließlich das eine Teil gegen das andere in die Raststellung verdreht werden kann. Thus, the mentioned implant is not easily pushed back into its position slightest extent in its longitudinally displaceable state due to the above-mentioned forces in the said document, a special clamp is mentioned with which the implant can be spread apart, and finally the twisted one part against the other in the locking position can be.

Davon abgesehen, daß die gesamte Handhabung dieses Implantats sehr umständlich ist, muß in situ ein Teil gegen das andere verdreht werden, wodurch die exakte Position des Implantats in der Wirbelsäule nicht vorherbestimmbar ist. Apart from the fact that the whole handling of this implant is very complicated, has a part to be rotated relative to the other in situ, whereby the exact position of the implant in the spine can not be predetermined. Bedenkt man weiterhin die erwähnten Kompressionskräfte in der Wirbelsäule, kann nicht ausgeschlossen werden, daß das ganze Implantat bei der auszuführenden Drehung des einen Teils aus seiner Lage in der Wirbelsäule herausgedreht wird im Wege einer Ausgleichsbewegung. Considering further the above-mentioned compression forces in the spine can not be excluded that the entire implant to be performed in the rotation of the one part is rotated out of its position in the spinal column by way of a compensation movement. Diese Nachteile sind aus heutiger Sicht nicht mehr tragbar. These disadvantages are unsustainable at present.

Im Bereich von Körperimplantaten ist im übrigen die Verwendung von Zahnleisten als Rasteinrichtungen für eine Längeneinstellung eines aus mehreren Teilen bestehenden Implantats bekannt. In the field of body implants, the use of toothed racks as latching means for setting a length of a multi-part implant is otherwise known. So zeigt die DE 29 51 251 C2 eine Gelenkbandendoprothese, die eine am Knochen befestigbare Platte sowie als Gegenstück eine plattenförmige Verbindungseinrichtung aufweist. Thus, DE 29 51 251 C2 shows a Gelenkbandendoprothese having an attachable to the bone plate, as well as a counterpart of a plate-shaped connecting device. Beide Teile sind jeweils mit zueinander zugekehrten Zahnleisten versehen, mit deren Hilfe die Teile nach Einstellung der gewünschten Position verrastbar sind. Both parts are each provided with mutually facing toothed racks by means of which the parts are locked by setting the desired position. Die Dauerarretierung erfolgt mittels einer die Teile durchdringenden Knochenschraube. The permanent lock the parts by means of a penetrating bone screw.

Aufgabe der vorliegenden Erfindung ist es vor diesem Hintergrund, ein Wirbelkörperimplantat der vorerwähnten Art so weiterzubilden, daß es einfach und sicher handhabbar ist. Object of the present invention, it is against this background to develop a vertebral implant of the aforementioned type so that it is easy and safe to handle.

Gelöst wird diese Aufgabe durch ein Wirbelkörperimplantat mit den Merkmalen des kennzeichnenden Teils des Anspruchs 1. This object is achieved by a vertebral implant with the features of the characterizing portion of claim 1.

Es wird unterschieden zwischen Implantaten zum Ersatz eines Wirbelkörpers einerseits und Implantaten zur Fusion zweier Wirbelkörper andererseits. A distinction is made between implants for replacement of a vertebral body on one hand and implants for the fusion of two vertebrae on the other hand. Beiden Implantatarten ist zur Lösung der angegebenen Aufgabe gemeinsam, daß die Verrastung zwischen dem ersten Teil und dem zweiten Teil durch zwei Zahnleisten, die durch wenigstens ein zwischen dem ersten und dem zweiten Teil angeordnetes elastisches Polster vorgespannt sind und nur in einer Richtung gegeneinander bewegbar sind, wirkt. Two implant types is common for solving the given task, that the latching between the first part and the second part by two toothed strips which a valve disposed between the first and the second part of elastic pads are biased by at least, and are movable only in a direction against each other, acts.

Durch Verschiebung des ersten Teils gegenüber dem zweiten Teil kann die Größe bzw. Länge des Implantats individuell in situ eingestellt werden. By displacement of the first part relative to the second part, the size or length of the implant can be individually adjusted in situ. Damit beide Teile im expandierten Zustand des Implantats nicht ohne weiteres aufgrund der in der Wirbelsäule herrschenden Kräfte während der Implantation wieder in die entgegengesetzte Richtung gleiten können, also in den kontrahierten Zustand gelangen, ist als Sicherungsmaßnahme vorgesehen, daß zwischen beiden Teilen mittelbar oder unmittelbar eine Verrastung zwischen den Zahnleisten wirkt, so daß die Bewegung des ersten Teils gegenüber dem zweiten Teil in die erwähnte Richtung blockiert ist. This allows both parts in the expanded state of the implant not readily due to the pressure prevailing in the spine forces during implantation again slide in the opposite direction, move that is in the contracted state is provided as a safety measure in that between the two parts, directly or indirectly a latching acting between the toothed racks, so that the movement of the first part relative to the second part is blocked in the said direction. Zwischen den Teilen ist mindestens ein elastisches Polster vorgesehen, das bereits im nichtimplantierten Zustand des Implantats für einen federnden Eingriff der Zahnleisten sorgt. Between the parts of at least a resilient pad is provided, which provides to non-implanted state of the implant for a resilient engagement of the toothed racks. Diese Maßnahme gewährleistet, daß die Teile vor und während der Implantation kontrolliert zueinander positioniert werden können, wobei die erwähnte Verrastung bereits in diesem Zustand zum Tragen kommt. This measure ensures that can be positioned to each other, the parts before and during the implantation controlled, whereby the aforementioned locking takes effect already in this state. Zur Expansion des Implantats wird das erste Teil gegen das zweite Teil unter kurzzeitiger Aufhebung der erwähnten federnden Verrastung gegen die federnde Wirkung des oder der elastischen Polster um ein oder mehrere Zahnelemente der Zahnleisten verschoben, woraufhin aufgrund der durch das Polsterelement erzeugten Vorspannung die Verrastung sofort wieder hergestellt wird, so daß eine Bewegung der Teile zueinander in die Gegenrichtung unterbunden wird. For expansion of the implant, the first part against the second part under short-term abolition of said resilient latching against the resilient action of the or of the elastic cushion at one or more tooth elements of the toothed strips is shifted, whereupon the latching restored immediately due to heat generated by the pad member bias is such that a movement of the parts to each other is prevented in the opposite direction.

In der Ausbildung des erfindungsgemäßen Wirbelkörperimplantats als Wirbelkörperersatz weist das erste Teil einen im wesentlichen T-förmigen Querschnitt und das zweite Teil einen im wesentlichen U-förmigen Querschnitt auf, in dessen Ausnehmung der Steg des ersten Teils eingeführt werden kann, wobei die eine der für die Verrastung notwendigen Zahnleiste außen auf einer Seite am Steg des ersten Teils und die andere der Zahnleisten an der Innenseite eines Schenkels des zweiten Teils vorgesehen ist, wobei das elastische Polster zwischen der anderen Seite des Stegs und der Innenseite des anderen Schenkels angeordnet ist. In the formation of the vertebral body implant according to the invention as a vertebral body replacement, the first part has a substantially T-shaped cross section and the second part has a substantially U-shaped cross-section, can be inserted into the recess of the web of the first part, wherein the one of the latching necessary toothed rack is provided externally on one side of the web of the first part and the other of the toothed strips on the inside of a leg of the second part, wherein the elastic pad between the other side of the ridge and the inside of the other leg is arranged.

Vorzugsweise ist der im wesentlichen U-förmige Querschnitt des zweiten Teils im Bereich der Basis des "U" erweitert, so daß sich die Ausnehmung als Trapez darstellt. Preferably, the substantially U-shaped cross-section of the second part is extended in the region of the base of the "U", so that the recess is a trapezoidal. Diese Maßnahme gestattet während der Implantation eine Aufhebung der Verrastung beider Teile in dem Falle, daß das Implantat zu weit expandiert worden ist. This measure allows during implantation a lifting of the locking parts both in the event that the implant has been expanded too far. Hierzu wird das erste Teil in der Ausnehmung des zweiten Teils leicht gekippt, so daß die Zahnleisten außer Eingriff kommen und das erste Teil in Richtung der Basis der Ausnehmung des zweiten Teils gebracht werden kann, woraufhin das erwähnte elastische Polster dafür sorgt, daß die Zahnleisten wieder unter federnden Eingriff gelangen. For this purpose, the first part is tilted slightly in the recess of the second part, so that the toothed racks are disengaged and the first part can be brought towards the base of the recess of the second part, after which the said elastic cushion ensures that the toothed racks again pass under resilient engagement.

Das erwähnte Dauer-Arretierungsmittel kann gebildet sein aus einer in einem Schenkel des zweiten Teils vorgesehenen Längsbohrung, durch welche eine Schraube in eine Bohrung in dem Steg des ersten Teils greift. The above-mentioned permanent-locking means may be formed from a recess provided in a leg of the second part of the longitudinal bore through which a screw engages in a bore in the web of the first part. Für die Arretierung wird die Schraube fest angezogen. For locking the screw is tightened.

Als Dauer-Arretierungsmittel ist auch eine in einem Schenkel vorgesehene Nut möglich, in die ein abgeflachter Rundstift setzbar ist. A permanent-locking means also provided in a leg groove is possible in which a flattened round pin can be placed. Wenn die durch Drehung des Stifts in die Ausnehmung ragende Rundung in Anlage mit dem Steg des ersten Teils kommt, wird dieser dauerhaft in der Ausnehmung des zweiten Teils verspannt. When the rotation of the pin projecting through the recess in rounding comes into contact with the web of the first part, it is permanently clamped in the recess of the second part.

Das oder die elastischen Polster können bei der beschriebenen Ausführungsform als in die Ausnehmung des zweiten Teils ragende und an diesem befestigte sterilisierbare Silikon-Körper sein. The one or more resilient pads may be as projecting into the recess of the second part and fastened to this sterilizable silicone body in the described embodiment. Denkbar wäre beispielsweise auch eine Verwendung einer Blattfeder, um den gewünschten Effekt zu erzielen. One option would be a use of a leaf spring in order to achieve the desired effect.

Die Zahnleiste an der Innenseite der Ausnehmung eines Schenkels des zweiten Teils und an der Außenseite des Stegs des ersten Teils weisen vorteilhaft Zähne auf, deren Zahnflanken in Richtung der zulässigen Bewegung, dh in Expansionsrichtung des Implantats einen Anstiegswinkel zu dieser Richtung von etwa 30° aufweisen und deren abfallende Zahnflanken etwa senkrecht auf der genannten Richtung stehen. The toothed rack on the inside of the recess of a leg of the second part and on the outer side of the web of the first part advantageously have teeth whose tooth flanks in the direction of permitted movement, ie in the direction of expansion of the implant have a rising angle to this direction of about 30 ° and the falling tooth flanks are approximately perpendicular to said direction. Der Anstiegswinkel gestattet ein relativ leichtes Verschieben der Teile zueinander, während der Abfallswinkel von ca. 90° mit großer Sicherheit für ein Blockieren einer Bewegung in Gegenrichtung sorgt. The increase in angle to each other allows a relatively easy movement of the parts while the waste angle of approximately 90 °, makes great security for blocking a movement in the opposite direction.

In einer Ausführungsform des erfindungsgemäßen Implantats als Implantat zur ventralen Fusion zweier Wirbelkörper weist das erste Teil an der Innenseite eine keilförmige Aussparung auf, in der ein keilförmiger Gleitblock in eine Richtung verschieblich gelagert ist, die im wesentlichen senkrecht auf der Expansionsrichtung des Implantats steht. In one embodiment of the implant according to the invention as an implant for the anterior fusion of two vertebral bodies, the first part on the inside of a wedge-shaped recess in which a wedge-shaped slide block is slidably mounted in a direction that is substantially perpendicular to the expansion direction of the implant. Der Gleitblock ist auf der zu dem zweiten Teil gerichteten Seite mit einer Zahnleiste versehen, die mit der anderen Zahnleiste auf der Innenseite des zweiten Teils verrastbar ist, wobei das elastische Polster zwischen der Wand der keilförmigen Ausnehmung und der Seite des Gleitblocks angeordnet ist, die zum ersten Teil gerichtet ist. The slide block is provided on the side directed to the second portion side with a toothed bar, which can be latched with the other toothed strip on the inside of the second portion, wherein said resilient cushion between the wall of the wedge-shaped recess and the side of the slide block is arranged to the first part is directed. Bei dieser Ausführungsform wirkt die Verrastung zwischen dem ersten Teil und dem zweiten Teil mittelbar über den erwähnten Gleitblock. In this embodiment, the latching between the first part and the second part acts indirectly via the above-mentioned sliding block.

Während der Implantation kann beispielsweise über ein Getriebemechanismus, beispielsweise über ein Schneckengetriebe, der Gleitblock in die vorgesehene Richtung bewegt werden. During the implantation of the slide block can for example via a gear mechanism, for example via a worm gear, can be moved in the intended direction. Dabei sorgen wiederum die elastischen Polster für einen federnden Eingriff der Zahnleisten bereits im nichtimplantierten Zustand des Implantats. Here again provide the elastic cushion for a resilient engagement of the racks already in the non-implanted state of the implant.

Diese Ausführungsform ist vorteilhaft so weitergebildet, daß das erste Teil mit zwei an ihm befestigten, in horizontaler Richtung weisenden Führungsstiften versehen ist, welche in zwei entsprechenden Führungskanälen im zweiten Teil geführt sind, wobei die Führungsstifte zusammen mit den Führungskanälen die maximale Strecke der zulässigen Bewegung in horizontaler Richtung begrenzen. This embodiment is advantageously further developed such that the first part fixed with two in it, oriented in a horizontal direction guide pins being provided, which are led in two corresponding guide channels in the second part, wherein the guide pins with the guide channels, the maximum range of permitted movement in limit the horizontal direction.

Die Führungskanäle können in einer besonders einfachen Ausführung Stufenbohrungen sein. The guide channels can be stepped holes in a particularly simple embodiment. In diesem Falle können die Führungsstifte in diese Bohrung setzbare Zylinderkopfschrauben mit jeweils einem gewindelosen Schaft im Kopfbereich (Dünnschaft-Schrauben) und einem Gewinde sein, das in entsprechende Gewindebohrungen im ersten Teil schraubbar ist. In this case, the guide pins may be threaded and each having a non-threaded shank in the head region (thin shank screw) in this bore settable cylinder head bolts which can be screwed into corresponding threaded bores in the first part. Dabei bilden die erwähnten Schrauben gleichzeitig die Dauer-Arretierungsmittel des Implantats. The screw mentioned form the continuous locking of the implant at the same time.

Bei der vorerwähnten Ausführungsform weisen die Zahnflanken der Zahnleisten in der Gleitrichtung des Gleitblocks zu dieser einen Anstiegswinkel im Bereich von 30° auf. In the aforementioned embodiment, the tooth flanks of the toothed strips have to this an increase angle in the range of 30 ° to the sliding direction in the sliding block. Die abfallenden Zahnflanken stehen dagegen im wesentlichen senkrecht auf der erwähnten Richtung. The trailing tooth flanks, however, are substantially perpendicular to said direction. Hier gestattet der Anstiegswinkel wiederum ein relativ leichtes Verschieben des Gleitblocks in dessen Gleitrichtung, wohingegen der erwähnte Abfallswinkel von etwa 90° eine große Sicherheit gegen ein Zurückgleiten des Gleitblocks zwischen dem caudalen und dem kranialen Teil bietet. Here, the rise angle turn allows a relatively easy movement of the sliding block in the sliding direction, whereas the mentioned drop angle of about 90 ° provides a large security against sliding back of the sliding block between the caudal and cranial part.

Die Erfindung wird anhand zweier Ausführungsbeispiele anhand der Zeichnung näher erläutert. The invention will be explained in more detail using two embodiments with reference to the drawing.

Hierbei zeigt Here shows

Fig. 1 eine perspektivische Ansicht der Teile eines Wirbelkörperimplantats als Wirbelkörperersatz, Fig. 1 is a perspective view of the parts of a vertebral body implant and vertebral body replacement,

Fig. 2 eine Schnittansicht des Implantats gemäß Fig. 1, Fig. 2 is a sectional view of the implant of FIG. 1,

Fig. 3 eine perspektivische Ansicht der Teile eines Wirbelkörperimplantats zur ventralen Fusion zweier Wirbelkörper gemäß einer Ausführungsform, Fig. 3 is a perspective view of the parts of a vertebral implant for fusion of two anterior vertebral body according to one embodiment,

Fig. 4 eine Schnittansicht des Implantats nach Fig. 3, und Fig. 4 is a sectional view of the implant of FIG. 3, and

Fig. 5 eine Prinzipansicht zweier verwendeter Zahnleisten. Fig. 5 is a schematic view of two racks used.

Nachfolgend sind gleiche Teile mit denselben Bezugszeichen versehen. Hereinafter, like components are denoted by the same reference numerals.

In den Fig. 1 und 2 ist ein erstes Ausführungsbeispiel eines erfindungsgemäßen Wirbelkörperimplantats dargestellt, das als Wirbelkörperersatz ausgebildet ist. In Figs. 1 and 2, a first embodiment of an intervertebral implant according to the invention is shown, which is designed as a vertebral body replacement.

Das erste Teil 1 weist einen im wesentlichen T-förmigen Querschnitt auf. The first part 1 has a substantially T-shaped cross section.

Eine Zahnleiste 3 mit Zähnen 5 ist außen am Steg 11 vorgesehen. A rack 3 with teeth 5 is provided externally on the web. 11 Auf seiner oberen Seite ist das Teil 1 mit einem metallischen offenzelligen Belag 8 versehen. On its upper side, the part 1 is provided with a metallic open-cell lining. 8

Das zweite Teil 2 weist ventral gesehen einen im wesentlichen U-förmigen Querschnitt auf, in dessen leicht trapezförmige Ausnehmung 10 der Steg 11 des ersten Teils 1 einführbar ist. The second part 2 has ventral seen a substantially U-shaped cross-section, in which slightly trapezoidal-shaped recess 10 of the web 11 of the first part 1 is inserted. An der Innenseite des einen Schenkels 13 des Teils 2 ist eine Zahnleiste 4 vorgesehen, die mit der Zahnleiste 3 des Teils 1 verrastbar ist. On the inside of one leg 13 of the part 2, a rack 4 is provided which can be latched to the rack 3 of the part 1. Am gegenüberliegenden Schenkel 12 sind zwei in die Ausnehmung 10 ragende elastische Polster 30 , beispielsweise aus Silikon, befestigt. At the opposite legs 12 are two projecting into the recess 10 resilient pad 30, for example made of silicone, attached.

Eine Längsnut 32 im Schenkel 12 des zweiten Teils 2 bildet zusammen mit einem in diese einsetzbaren abgeflachten Rundstift 31 das Dauer-Arretierungsmittel in dem gezeigten Ausführungsbeispiel. A longitudinal groove 32 in the leg 12 of the second part 2 forms, together with a flattened in this round pin insertable 31, the permanent locking means in the embodiment shown.

Auf der unteren Seite ist das zweite Teil 2 mit einem offenzelligen metallischen Belag 8 versehen. On the lower side of the second part 2 is provided with an open-cell metallic coating. 8

Eine Ausnehmung 35 in der Basis des zweiten Teils 2 bietet eine Angriffsmöglichkeit für ein (nicht dargestelltes) Werkzeug, um die Verrastung der Zahnleisten 3, 4 erforderlichenfalls zu lösen, etwa wenn das erste Teil 1 zu weit aus dem zweiten Teil bewegt worden ist. A recess 35 in the base of the second part 2 has an engagement possibility for a (not shown) tool to the locking of the racks 3, 4 necessary to solve, for example when the first part 1 has been moved too far from the second part.

Beim Einführen des Stegs 11 in die Ausnehmung 10 werden die Polster 30 zusammengedrückt und dementsprechend unter Vorspannung gesetzt, so daß die Zahnleisten 3, 4 in federnden Eingriff kommen. Upon insertion of the ridge 11 in the recess 10, the pads 30 are pressed together and set accordingly under pretension, so that the toothed strips 3, 4 come into resilient engagement. Während der Implantation wird der Stift 31 in der Nut 32 so gedreht, daß sein abgeflachtes Segment zur Ausnehmung 10 hingewandt ist. During implantation, the pin 31 is rotated in the groove 32 so that its flattened segment is hingewandt to the recess 10th Der Operateur wird das erste Teil 1 mit einem Werkzeug (nicht dargestellt) gegenüber dem zweiten Teil in die Expansionsrichtung X in situ solange verschieben, bis das Implantat die erforderliche Länge erreicht hat. The surgeon is provided with a tool (not shown) to move the first part 1 relative to the second portion in the expansion direction X in situ until the implant has reached the required length. Die Bewegung wird dadurch ermöglicht, daß die Zahnleisten 3 und 4 , wie in Fig. 5 dargestellt, Zähne 5 aufweisen, deren Zahnflanken 6 einen Anstiegswinkel in Richtung X der Bewegung von etwa 30° zu dieser und deren abfallende Zahnflanken 7 einen Abfallswinkel von etwa 90° zur Richtung X aufweist. The movement is made possible in that the toothed racks 3 and 4, as shown in Fig. 5, have teeth 5, whose tooth flanks 6 is a rising angle in the direction X of movement of approximately 30 ° thereto and its trailing tooth flanks 7 a drop angle of about 90 having ° to the direction X. Der Anstiegswinkel von etwa 30° ermöglicht eine relativ leichte Bewegung des ersten Teils 1 gegenüber dem zweiten Teil 2 unter kurzzeitiger Aufhebung des federnden Eingriffs der Zahnleisten 3, 4 . The rise angle of about 30 ° allows relatively easy movement of the first part 1 relative to the second part 2 under brief lifting of the resilient engagement of the toothed racks 3 4. Nach Erreichen der nächsten Zahnreihe kommen die Zahnleisten 3, 4 wieder in einen federnden Eingriff. After reaching the next row of teeth, the toothed bars 3, 4 will be back in a resilient engagement.

In die Gegenrichtung ist das erste Teil 1 aufgrund der Ausbildung der Zähne 5 im beschriebenen Sinne nicht ohne weiteres möglich. In the opposite direction the first part 1 is 5 in the sense described not readily possible because of the formation of the teeth. Lediglich durch ein Ansetzen eines Werkzeugs in der Ausnehmung 35 kann ein Verschwenken des ersten Teils 1 in der trapezförmigen Ausnehmung 10 des Teils 2 erreicht werden mit der Wirkung, daß die Zahnleisten 3, 4 außer Eingriff kommen und das erste Teil 1 in Richtung versetzt werden kann. Merely by engaging a tool in the recess 35, a pivoting of the first part 1 in the trapezoidal recess 10 of the part 2 can be achieved with the effect that the toothed strips 3, 4 are disengaged and the first part 1 can be displaced in the direction , Letzteres wird - wie bereits erwähnt - nur dann erforderlich sein, wenn das Teil 1 zu weit aus der Ausnehmung 10 gezogen worden ist. The latter is - as already mentioned - only be needed when the part 1 has been pulled too far out of the recess 10th

Nach Einstellung der gewünschten Größe oder Länge des Implantats wird der Stift 32 so verdreht, daß sein runder Abschnitt in die Ausnehmung 10 ragt und in Anlage mit dem Schenkel 11 des ersten Teils 1 gelangt, wie dies in Fig. 2 dargestellt ist. After the desired size or length of the implant, the pin 32 is twisted so that its round portion projects into the recess 10 and comes into contact with the legs 11 of the first part 1, as shown in Fig. 2. Auf diese Weise kann eine dauerhafte Arretierung beider Teile 1, 2 vorgenommen werden. In this way, a permanent locking of the two parts 1 can be made. 2

In den Fig. 3 und 4 ist als weiteres Ausführungsbeispiel des erfindungsgemäßen Wirbelkörperimplantats eine erste Ausführungsform des Implantats für die ventrale Fusion zweier Wirbelkörper dargestellt. In FIGS. 3 and 4, a first embodiment of the implant for the anterior fusion of two vertebral bodies is illustrated as a further embodiment of the intervertebral implant according to the invention.

Das erste Teil 1 weist eine keilförmige Aussparung 17 auf. The first part 1 has a wedge-shaped recess 17th In dieser ist ein keilförmiger Gleitblock 18 in der Richtung Y verschieblich gelagert. In this a wedge-shaped slide block 18 in the Y direction is slidably mounted. Auf seiner Basis ist der Gleitblock 18 mit einer Zahnleiste 3 versehen, die einer Zahnleiste 4 auf der Innenseite des zweiten Teils 2 entspricht und mit dieser verrastbar ist. At its base, the slide block is provided with a rack 3 18 corresponding to a rack 4 on the inside of the second part 2 and can be latched therewith.

Ein elastisches Polster 30 in der keilförmigen Aussparung 17 des ersten Teils 1 sorgt nach dem Zusammenbau der Teile 1, 2 und 18 für einen federnden Eingriff der Zahnleisten 3, 4 . An elastic pad 30 in the wedge-shaped recess 17 of the first part 1 provides for the assembly of the parts 1, 2 and 18 for a resilient engagement of the toothed racks 3 4.

Als Dauer-Arretierungsmittel sind hier zwei Dünnschaftschrauben 20, 21 vorgesehen, die durch jeweils eine Stufenbohrung 22, 23 im zweiten Teil 2 hindurch in zwei entsprechend angeordneten Gewindebohrungen 33, 34 im ersten Teil verschraubbar sind. A permanent-locking two thin headless screws 20, 21 are provided here which pass correspondingly disposed by a respective stepped bore 22, 23 in the second part 2 into two threaded holes 33, 34 are screwed in the first part.

Die Schrauben 20, 21 bilden in die Richtung X der zulässigen Bewegung, also in Expansionsrichtung des Implantats, weisende Führungsstifte. The screws 20, 21 form in the direction X of the allowable movement, ie in the direction of expansion of the implant, pointing guide pins. Die Stufenbohrungen 22, 23 bilden dabei Führungskanäle. The stepped holes 22, 23 thereby form guide channels. Durch die Tiefe der Stufenbohrungen 22, 23 läßt sich demnach die maximale Expansionsbewegung des ersten Teils 1 gegenüber dem zweiten Teil 2 begrenzen. Due to the depth of the stepped bores 22, 23, therefore, the maximum expansion movement of the first part 1 relative to the second part 2 can be limited.

Die Zahnleisten 3, 4 sind vorliegend so ausgebildet, daß die Zahnflanken ihre Zähne in Richtung Y, also in Richtung der zulässigen Bewegung des Gleitblocks 18 , einen Anstiegswinkel zu dieser Richtung Y im Bereich von 30° aufweisen, während die abfallenden Zahnflanken im wesentlichen senkrecht auf der Richtung Y stehen. The toothed strips 3, 4 are present so designed that the tooth flanks of their teeth in the direction Y, ie in the direction of permitted movement of the slide block 18, having a rising angle to this direction Y in the range of 30 °, while the falling tooth flanks substantially perpendicular to the direction Y are provided. Hierdurch wird die Bewegung des Gleitblocks 18 in Richtung Y ermöglicht, in der Gegenrichtung aber sicher blockiert. In this way, the movement of the slide block 18 in the direction Y is made possible, but certainly blocked in the opposite direction.

Die Verrastung zwischen dem ersten Teil 1 und dem zweiten Teil 2 wirkt vorliegend mittelbar durch den Gleitblock 18 . The locking between the first part 1 and the second part 2 acts indirectly through the slide block present eighteenth Es ist verständlich, daß mit zunehmender Bewegungsstrecke des Gleitblocks 18 in Richtung Y sich das erste Teil 1 in Richtung X bewegt. It is understood that the first part 1 moves in the direction Y with increasing distance of movement of the slide block 18 in the direction X. Ermöglicht werden kann dies beispielsweise durch ein an den Gleitblock 18 angreifendes (nicht dargestelltes) Schneckengetriebe. This can be enabled for example, by engaging in the slide block 18 (not shown) worm gear.

Allen im Rahmen der Erfindung beanspruchten Wirbelkörperimplantate ist gemeinsam, daß mit einer zwischen dem ersten und dem zweiten Teil des Implantats wirkenden Verrastung für eine große Sicherheit gegen ein Verrutschen des einen gegenüber dem anderen Teil gesorgt ist, eine individuelle Einstellung auf die Patientenerfordernisse aufgrund der Ausbildung der Zahnleisten aber dennoch möglich ist. All claimed within the framework of the invention, the vertebral body implants have in common that is provided with a force acting between the first and the second part of the implant locking feature for a great safety against sliding of one relative to the other part, an individual adjustment on patient requirements due to the formation of the but racks is still possible.

Claims (8)

  1. 1. Wirbelkörperimplantat aus Metall, welches mindestens aus einem ersten Teil und aus einem zweiten Teil besteht, welche zueinander verschieblich und in ihrer gewünschten Endlage miteinander durch eine Verrastung festlegbar sind, und welches ein Dauerarretierungsmittel aufweist, welches beide Teile im implantierten Zustand dauerhaft miteinander verspannt, dadurch gekennzeichnet , daß die Verrastung zwischen dem ersten Teil ( 1 ) und dem zweiten Teil ( 2 ) durch zwei Zahnleisten ( 3, 4 ), die durch wenigstens ein zwischen dem ersten und dem zweiten Teil ( 1, 2 ) angeordnetes elastisches Polster ( 30 ) vorgespannt sind und nur in einer Richtung (x) gegeneinander bewegbar sind, wirkt. 1. vertebral implant of metal, which consists at least of a first part and a second part which are fixed to each other displaceable and in its desired end position to one another by a catch, and which has a Dauerarretierungsmittel which both parts in the implanted state permanently clamped to each other, characterized in that the latching between the first part (1) and the second part (2) by two toothed strips (3, 4) (through at least a valve disposed between the first and the second part (1, 2) elastic pad 30 ) are biased and (only in a direction x) are movable against one another, acts.
  2. 2. Wirbelkörperimplantat als Wirbelkörperersatz nach Anspruch 1, dadurch gekennzeichnet, daß das erste Teil ( 1 ) einen T-förmigen Querschnitt und das zweite Teil ( 2 ) einen U-förmigen Querschnitt aufweist, in dessen Ausnehmung ( 10 ) der Steg ( 11 ) des ersten Teils ( 1 ) einführbar ist, daß die eine der Zahnleisten ( 3 ) außen auf einer Seite am Steg ( 11 ) des ersten Teils ( 1 ) und die andere der Zahnleisten ( 4 ) an der Innenseite eines Schenkels ( 13 ) des zweiten Teils ( 2 ) vorgesehen ist und daß das elastische Polster ( 30 ) zwischen der anderen Seite des Stegs ( 11 ) und der Innenseite des anderen Schenkels ( 12 ) angeordnet ist. 2. vertebral implant as vertebral body replacement according to claim 1, characterized in that the first part (1) has a T-shaped cross section and the second part (2) has a U-shaped cross-section, in which recess (10) of the web (11) of the the first part (1) is insertable, that one of the toothed racks (3) on the outside of one side of the web (11) of the first part (1) and the other of the toothed strips (4) on the inside of a leg (13) of the second part (2) is provided and that the elastic pad (30) between the other side of the web (11) and the inside of the other leg (12) is arranged.
  3. 3. Wirbelkörperimplantat nach Anspruch 2, dadurch gekennzeichnet, daß das Dauer-Arretierungsmittel gebildet ist aus einer in dem Schenkel ( 12 ) des ersten Teils ( 1 ) vorgesehenen Längsbohrung, durch welche eine Schraube in eine Bohrung in dem Steg ( 11 ) des zweiten Teils ( 2 ) greift. 3. vertebral implant according to claim 2, characterized in that the permanent locking means is formed of a in the leg (12) of the first part (1) provided for the longitudinal bore through which a screw in a bore in the web (11) of the second part (2) engages.
  4. 4. Wirbelkörperimplantat nach Anspruch 2 oder 3, dadurch gekennzeichnet, daß die elastischen Polster ( 30 ) in die Ausnehmung ( 10 ) des ersten Teils ( 1 ) ragende und an diesem befestigte, sterilisierbare Silikonkörper sind. 4. vertebral implant according to claim 2 or 3, characterized in that the protruding elastic cushion (30) in the recess (10) of the first part (1) and are secured thereto, sterilizable silicone body.
  5. 5. Wirbelkörperimplantat nach einem der Ansprüche 1 bis 4, dadurch gekennzeichnet, daß die Zahnleisten ( 3, 4 ) Zähne ( 5 ) aufweisen, deren Zahnflanken ( 6 ) in Richtung (x) der zulässigen Bewegung einen Anstiegswinkel zur Richtung (x) von etwa 30° aufweisen und deren abfallende Zahnflanken ( 7 ) etwa senkrecht auf der Richtung (x) der zulässigen Bewegung stehen. 5. vertebral implant according to one of claims 1 to 4, characterized in that the toothed strips (3, 4) of teeth (5) whose tooth flanks (6) in the direction (x) of the permissible movement of a rising angle to the direction (x) of about comprise 30 °, and the falling tooth flanks (7) approximately perpendicular to the direction (x) are the permissible movement.
  6. 6. Wirbelkörperimplantat zur ventralen Fusion zweier Wirbelkörper nach Anspruch 1, dadurch gekennzeichnet, daß das erste Teil ( 1 ) an der Innenseite eine keilförmige Aussparung ( 17 ) aufweist, in der ein keilförmiger Gleitblock ( 18 ) in Richtung (y) verschieblich gelagert ist, welcher auf der zu dem zweiten Teil ( 2 ) gerichteten Seite mit einer Zahnleiste ( 3 ) versehen ist, die mit der anderen Zahnleiste ( 4 ) auf der Innenseite des zweiten Teils ( 2 ) verrastbar ist und daß das elastische Polster ( 30 ) zwischen der Wand der keilförmigen Ausnehmung ( 17 ) und der Seite des Gleitblocks ( 18 ) angeordnet ist, die zum Teil ( 1 ) gerichtet ist. 6. vertebral implant for anterior fusion of two vertebral bodies according to claim 1, characterized in that the first part (1) on the inside has a wedge-shaped recess (17) in which a wedge-shaped slide block (18) in the direction (y) is displaceably mounted, which directed to the to the second part (2) side is provided with a toothed bar (3) connected to the other toothed rack (4) on the inside of the second part (2) is lockable and that the elastic pad (30) between the wall of the wedge-shaped recess (17) and the side of the slide block (18) is arranged, which is directed, in part (1).
  7. 7. Wirbelkörperimplantat nach Anspruch 6, dadurch gekennzeichnet, daß in horizontaler Richtung (x) weisende Führungsstifte ( 20, 21 ) vorgesehen sind, welche in zwei entsprechenden Führungskanälen ( 22, 23 ) im zweiten Teil ( 2 ) geführt sind, und daß die Führungsstifte ( 20 , 21 ) zusammen mit den Führungskanälen ( 22, 23 ) die maximale Strecke der zulässigen Bewegung in horizontaler Richtung begrenzen. 7. vertebral implant according to claim 6, characterized in that in the horizontal direction (x) facing guide pins (20, 21) are provided, which in two corresponding guide channels (22, 23) in the second part (2) are guided, and that the guide pins (20, 21) together with the guide channels (22, 23) limit the maximum range of permitted movement in the horizontal direction.
  8. 8. Wirbelkörperimplantat nach Anspruch 6 oder 7, dadurch gekennzeichnet, daß die Zahnflanken ( 6 ) der Zahnleisten ( 3, 4 ) in vertikaler Richtung (y) einen Anstiegswinkel in vertikaler Richtung (y) von etwa 30° aufweisen und die Zahnflanken ( 7 ) etwa horizontal verlaufen. 8. vertebral implant according to claim 6 or 7, characterized in that the tooth flanks (6) of the toothed strips (3, 4) in the vertical direction (y) an increase angle in a vertical direction (y) of from about 30 ° and the tooth flanks (7) about running horizontally.
DE19904012622 1990-04-20 1990-04-20 Two-part metal vertebra implant - has parts locked by two toothed racks, pre-stressed by elastic cushion between both implant parts Expired - Fee Related DE4012622C1 (en)

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DE4323956C1 (en) * 1993-07-19 1994-10-27 Eska Medical Gmbh & Co Fusion dowel for vertebrae
FR2715293A1 (en) * 1994-01-26 1995-07-28 Biomat Vertebral intersomatic cage.
FR2717068A1 (en) * 1994-03-14 1995-09-15 Biomat Intersomatic cage insertable between two vertebral bodies
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