EP0793463A1 - Implant permettant la fusion de deux corps osseux adjacents, notamment de deux vertebres consecutives - Google Patents
Implant permettant la fusion de deux corps osseux adjacents, notamment de deux vertebres consecutivesInfo
- Publication number
- EP0793463A1 EP0793463A1 EP95940320A EP95940320A EP0793463A1 EP 0793463 A1 EP0793463 A1 EP 0793463A1 EP 95940320 A EP95940320 A EP 95940320A EP 95940320 A EP95940320 A EP 95940320A EP 0793463 A1 EP0793463 A1 EP 0793463A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- implant
- blades
- fusion
- graft
- vertebrae
- 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.)
- Withdrawn
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
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4684—Trial or dummy prostheses
-
- A—HUMAN NECESSITIES
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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
- 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
- A61F2/447—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 substantially parallelepipedal, e.g. having a rectangular or trapezoidal cross-section
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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
- A61F2/30—Joints
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-
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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
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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
- A61F2/28—Bones
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- 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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- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups 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
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups 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
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
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- A61F2002/30108—Shapes
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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
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30593—Special structural features of bone or joint prostheses not otherwise provided for hollow
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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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- 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
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0017—Angular shapes
- A61F2230/0026—Angular shapes trapezoidal
-
- 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
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0028—Shapes in the form of latin or greek characters
- A61F2230/0047—Pi-shaped
-
- 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
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0063—Three-dimensional shapes
- A61F2230/0082—Three-dimensional shapes parallelepipedal
-
- 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
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00011—Metals or alloys
- A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni alloys
Definitions
- the present invention relates to an implant allowing the fusion of two adjacent bone bodies.
- This implant is mainly intended to be used to obtain the fusion of two consecutive vertebrae, but can also be used for arthrodeses under Astragalian or Tibio-Astragalian.
- intervertebral arthrodesis in cases of disc pathologies, in order to restore an adequate disc height, in cases of narrowing of the lumbar canal, in order to achieve the anterior stabilization of the vertebrae made necessary by the weakening of the posterior arch, or in cases of vertebral instabilities, in order to achieve the fusion of the vertebrae which have become unstable.
- This arthrodesis is generally obtained by the establishment of a posterolateral bone graft, implanted on the articular processes, on the transverse processes and on the intervertebral blades.
- the grafts are placed only in the posterolateral grooves, then a metallic stabilization material is implanted to immobilize the spine while the fusion takes place.
- This technique has the drawback of being relatively complex and time-consuming to implement, taking into account the addition of this stabilization material, and of not making it possible to restore sufficient disc height.
- One technique consists of implanting intervertebral cages at the level of the affected disc, on either side of the axis of the spine.
- These cages are cylindrical, hollow, externally threaded and include side windows. They receive a filling of bone particles taken from a cancellous bone, then are engaged by screwing in intervertebral housings previously drilled in the plates of the vertebrae to be fused.
- Each cage must be positioned so that two opposite windows are in contact with the trays, in order to make possible bone growth inside the cage.
- This technique has the disadvantage of involving the use of a means of temporary distraction of the vertebrae, which is fairly traumatic, during the time necessary for drilling the housings, filling and placing the cages.
- the duration of intervention is also important, which is hardly desirable for the patient.
- This cage is also intended to be furnished with pieces of cancellous bone, then is compacted in the intervertebral housings, previously arranged.
- the present invention aims to remedy the aforementioned drawbacks of the prior techniques. It provides an intervertebral implant allowing the perfect fusion of the vertebrae, with adequate enhancement of the intervertebral disc and guaranteed stability over time. This implant must be able to be placed posteriorly, without risk of nerve damage at the level of the hard mother or at the level of the roots, by a relatively simple and rapid technique of implementation.
- the implant has a general U-shape, that is to say is constituted by two lateral blades connected to each other, at one end, by a heel, at least one of which comprises a sharp edge at its free end, this implant being shaped to allow the removal of a one-piece bone graft itself.
- the implant is not intended to be filled with spongy spongy bone particles, with the risk of inclusion of air bubbles, as may be the case with conventional intervertebral cages.
- it is itself used for the removal, preferably in the iliac crest of the patient, of a graft constituted by cancellous bone "of mass", clearly denser than an agglomeration of bone particles. This density corresponds substantially to that of the cancellous bone of the vertebrae.
- the graft removed comes to completely fill the implant, and is maintained in the latter, so that it can be cut again if necessary.
- the upper and lower openings delimited by the blades have much larger dimensions than the windows in the existing cages, and allow large areas of contact of the graft with the cancellous bone of the vertebrae.
- the graft is held laterally in the intervertebral space by the implant blades. All of these factors allow obtaining a perfect fusion of the vertebrae and the graft, without crushing or inserting the graft into the cancellous bone. The fusion thus obtained gives any guarantee of stability over time.
- the blades have on their upper and / or lower edges teeth of the "harpoon” or "fir" type.
- teeth are intended to be inserted into the cancellous bone of the vertebral plates, and to prevent any possibility of movement of the implant backwards.
- their insertion into the bone allows compression of the graft, the latter having, thanks to direct sampling, a width which corresponds perfectly to the maximum width of the implant, including teeth.
- This compression ensures perfect application and total immobilization of the graft relative to the vertebrae, which is entirely favorable for good bone growth, and therefore for obtaining a perfect fusion.
- the penetration of the teeth inside the vertebrae also promotes the initiation of bone growth to achieve fusion.
- the length of the blades is uneven, in order to facilitate the removal of the graft.
- the blades can be rectangular, trapezoidal, or in the shape of a parallelogram.
- At least one of the two blades may include a lateral lumen, to also allow bone growth in this lateral direction.
- the heel connecting the two blades is pierced with a threaded hole allowing the mounting of the implant on the end of an impacting tool, for the removal of the graft then for the placement of the implant in its intervertebral housing.
- the distance separating the blades is determined so that the area occupied by the bone graft at the upper and lower faces of the implant represents at least 50% of the total area of these faces.
- Figure 1 is a perspective view
- Figure 2 is a side view, after removal of the graft intended to garnish it
- Figure 3 is a top view
- Figure 4 is an end view, on the rear side
- Figure 5 is a rear view of two implants placed in an intervertebral space
- Figure 6 is a side view of one of the two implants, after placement in an intervertebral space.
- the figures represent, from different angles, an implant 2 making it possible to obtain the fusion of two consecutive vertebrae 3,4, at the level of an intervertebral disc 5.
- This implant 2 has a general U shape, that is to say is constituted by two rectangular lateral blades 10, connected to each other, at one end, by a heel 11.
- the blades 10 have a length uneven and have sharp edges 12 at their ends free, delimited by their internal faces and by beveled end faces.
- the blades 10 include teeth 13 of the "harpoon” or “fir” type on their upper and lower edges, and lateral slots 14.
- the heel 11 connecting the two blades 10 is pierced with a threaded hole 15 allowing the mounting of the implant 2 on the end of an impaction tool (not shown).
- the implant 2 once mounted on this tool, allows direct removal of a monobloc bone graft 16 consisting of cancellous bone "of mass", preferably originating from the iliac crest of the patient.
- the unequal length of the blades 10 facilitates the removal of the graft 16. It appears in FIGS. 2 to 4 that the graft 16 thus obtained completely fills the space delimited by the blades 10 and the heel 11, and that it has a corresponding width at the maximum width of the implant 2, teeth 13 included.
- the graft 16 is perfectly maintained in the implant 2 and can be resized if necessary.
- intervertebral housings are drilled in the plates of the vertebrae 3 and 4 to be fused, on either side of the axis of the spine, to receive two implants 2 provided with a plugin 16.
- These implants 2 are impacted in the housings by means of the aforementioned tool. When they are fully inserted into the housings, the tool is removed. The teeth 13 are inserted into the cancellous bone of the vertebral plates, and prevent any possibility of movement of the implants 2 backwards.
- This insertion causes the grafts 16 to compress over a height corresponding to that of the teeth 13, that is to say approximately 2 millimeters for each row of teeth. This compression allows perfect application and total immobilization of the grafts 16 relative to the vertebrae 3,4, which is entirely favorable for obtaining good bone growth, and therefore perfect fusion. .
- the penetration of the teeth 13 inside the vertebrae promotes the initiation of bone growth from which the fusion takes place.
- the density of the grafts 16 corresponds substantially to that of the cancellous bone of the vertebrae 3,4, and the grafts 16 are held in place laterally by the blades 10 in the intervertebral housings.
- the distance separating the blades 10 is determined so that the surface occupied by the graft 16 at the level of the upper and lower faces of the implant 2 represents at least 50% of the total surface of these faces.
- the upper and lower openings delimited by these blades 10 thus allow wide contact surfaces of the graft 16 and of the cancellous bone of the vertebrae 3,4.
- the lateral lights also allow bone growth in this lateral direction.
- the invention thus provides an intervertebral implant making it possible to obtain perfect fusion of the vertebrae, with adequate enhancement of the intervertebral disc and guarantee of stability over time, this implant being able to be placed by posterior route, according to a relatively simple technique. and quick to implement.
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- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Biomedical Technology (AREA)
- Transplantation (AREA)
- Heart & Thoracic Surgery (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Cardiology (AREA)
- Vascular Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
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- Physical Education & Sports Medicine (AREA)
- Prostheses (AREA)
Abstract
Selon l'invention, cet implant (2) présente une forme générale en U, c'est-à-dire est constitué par deux lames latérales (10) reliées l'une à l'autre, à une extrémité, par un talon (11), dont au moins une comporte une arête tranchante (12) à son extrémité libre, cet implant (2) étant conformé pour permettre lui-même le prélèvement d'un greffon osseux monobloc (16).
Description
IMPLANT PERMETTANT LA FUSION DE DEUX CORPS OSSEUX ADJACENTS, NOTAMMENT DE DEUX VERTEBRES CONSECUTIVES
La présente invention concerne un implant permettant la fusion de deux corps osseux adjacents. Cet implant est principalement destiné à être utilisé pour obtenir la fusion de deux vertèbres consécutives, mais peut également servir à des arthrodèses sous Astragalienne ou Tibio-Astragalienne.
II est connu de recourir à une arthrodèse intervertébrale dans les cas de pathologies discales, afin de rétablir une hauteur discale adéquate, dans les cas d'étroitesse du canal lombaire, afin de réaliser la stabilisation antérieure des vertèbres rendue nécessaire par la fragilisation de l'arc postérieur, ou dans les cas d'instabilités vertébrales, afin de réaliser la fusion des vertèbres devenues instables.
Cette arthrodèse est généralement obtenue par la mise en place d'une greffe osseuse postéro-latérale, implantée sur les apophyses articulaires, sur les apophyses transverses et sur les lames intervertébrales. En cas d'absence des lames vertébrales par suite de laminectomie, les greffes sont mises en place uniquement dans les gouttières postéro-latérales, puis un matériel métallique de stabilisation est implanté pour immobiliser le rachis le temps que la fusion s'opère.
Cette technique a pour inconvénient d'être relativement complexe et longue de mise en oeuvre, compte tenu de l'adjonction de ce matériel de stabilisation, et de ne pas permettre de rétablir une hauteur discale suffisante.
Il est également connu d'implanter un greffon osseux dans l'espace intervertébral, après excision complète du disque abîmé. Toutefois, l'obtention d'une fusion solide est incertaine, du fait des contraintes s'exerçant sur le greffon et sur les interfaces greffon-vertèbres. Ces contraintes conduisent fréquemment
à un écrasement et une incorporation du greffon dans l'une ou 1•autre des vertèbres.
Une technique consiste à implanter des cages intervertébrales au niveau du disque affecté, de part et d'autre de l'axe du rachis.
Ces cages sont cylindriques, creuses, filetées extérieurement et comprennent des fenêtres latérales. Elles reçoivent un remplissage de particules osseuses prélevées sur un os spongieux, puis sont engagées par vissage dans des logements intervertébraux préalablement forés dans les plateaux des vertèbres à fusionner.
Chaque cage doit être positionnée de manière à ce que deux fenêtres opposées se trouvent en contact avec les plateaux, afin de rendre possible la croissance osseuse à l'intérieur de la cage.
Cette technique a pour inconvénient d'impliquer l'emploi d'un moyen de distraction temporaire des vertèbres, assez traumatisant, durant le temps nécessaire au forage des logements, au remplissage et à la mise en place des cages.
De plus et surtout, il apparaît que la stabilité de la fusion obtenue par ces cages n'est pas garantie dans le temps.
La durée d'intervention est par ailleurs importante, ce qui n'est guère souhaitable pour le patient.
Il est également connu par le brevet européen EP 0 307 241 de réaliser une cage de forme parallélépipédique, comprenant des fenêtres supérieure, inférieure et latérales. Les surfaces extérieures de cette cage sont rugueuses, pour permettre le maintien de la cage dans son logement et favoriser la croissance osseuse.
Cette cage est également destinée à être garnie de morceaux d'os spongieux, puis est i pactée dans les logements intervertébraux, préalablement aménagés.
La présente invention a pour but de remédier aux inconvénients précités des techniques antérieures. Elle fournit un implant intervertébral permettant l'obtention d'une parfaite fusion des vertèbres, avec rehaussement adéquat du disque intervertébral et garantie de stabilité dans le temps. Cet implant doit pouvoir être mis en place par voie postérieure, sans risque de lésion nerveuse au niveau de la Dure Mère ou au niveau des racines, par une technique relativement simple et rapide de mise en oeuvre. Selon l'invention, l'implant présente une forme générale en U, c'est-à-dire est constitué par deux lames latérales reliées l'une à l'autre, à une extrémité, par un talon, dont au moins une comporte une arête tranchante à son extrémité libre, cet implant étant conformé pour permettre lui-même le prélèvement d'un greffon osseux monobloc.
Ainsi, l'implant n'est pas destiné à être rempli de particules d'os spongieux peu denses, avec risque d'inclusion de bulles d'air, comme cela peut être le cas avec les cages intervertébrales classiques. Au contraire, il sert lui-même au prélèvement, de préférence dans la crête iliaque du patient, d'un greffon constitué par de l'os spongieux "de masse", nettement plus dense qu'une agglomération de particules d'os. Cette densité correspond sensiblement à celle de l'os spongieux des vertèbres.
Le greffon prélevé vient totalement remplir l'implant, et est maintenu dans ce dernier, de sorte qu'il peut être retaillé si nécessaire. Les ouvertures supérieure et inférieure délimitées par les lames ont des dimensions nettement plus importantes que les fenêtres aménagées dans les cages existantes, et permettent de larges surfaces de contact du greffon avec l'os spongieux des vertèbres. En outre, le greffon est maintenu latéralement dans l'espace intervertébral par les lames de l'implant.
L'ensemble de ces facteurs permet l'obtention d'une parfaite fusion des vertèbres et du greffon, sans écrasement ni insertion du greffon dans l'os spongieux. La fusion ainsi obtenue donne toute garantie de stabilité dans le temps.
De plus, l'opération classique de remplissage de l'implant est éliminée, ce qui permet un gain appréciable au niveau de la durée d'intervention.
Avantageusement, les lames comportent sur leurs bords supérieurs et/ou inférieurs des dents de type "harpon" ou "en sapin".
Ces dents sont destinées à s'insérer dans l'os spongieux des plateaux vertébraux, et à empêcher toute possibilité de mouvement de l'implant vers l'arrière. De plus, leur insertion dans l'os permet une mise en compression du greffon, ce dernier ayant, grâce au prélèvement direct, une largeur qui correspond parfaitement à la largeur maximale de l'implant, dents y compris. Cette mise en compression assure une parfaite application et une totale immobilisation du greffon par rapport aux vertèbres, ce qui est tout-à-fait favorable à la bonne croissance osseuse, et donc à l'obtention d'une parfaite fusion. La pénétration des dents à l'intérieur des vertèbres favorise également l'amorçage de la croissance osseuse venant réaliser la fusion.
Selon une forme de réalisation préférée de l'invention, la longueur des lames est inégale, afin de faciliter le prélèvement du greffon.
Les lames peuvent être rectangulaires, trapézoïdales, ou en forme de parallélogramme.
L'une au moins des deux lames peut comprendre une lumière latérale, pour permettre également la croissance osseuse selon cette direction latérale.
Avantageusement, le talon reliant les deux lames est percé d'un trou fileté permettant le montage de l'implant sur l'extrémité d'un outil d'impaction, pour le prélèvement du greffon puis pour la mise en place de l'implant dans son logement intervertébral.
De préférence, la distance séparant les lames est déterminée pour que la surface occupée par le greffon osseux au niveau des faces supérieures et inférieures de l'implant représente au moins 50 % de la surface totale de ces faces.
Pour sa bonne compréhension, l'invention est à nouveau décrite ci-dessous en référence au dessin schématique annexé représentant, à titre d'exemple non limitatif, une forme de réalisation préférée de l'implant intervertébral qu'elle concerne.
La figure 1 en est une vue en perspective ; la figure 2 en est une vue de côté, après prélèvement du greffon destiné à le garnir ; la figure 3 en est une vue de dessus ; la figure 4 en est une vue en bout, du côté postérieur ; la figure 5 est une vue postérieure de deux implants mis en place dans un espace intervertébral, et la figure 6 est une vue latérale de l'un des deux implants, après mise en place dans un espace intervertébral.
Les figures représentent, sous différents angles, un implant 2 permettant d'obtenir la fusion de deux vertèbres consécutives 3,4, au niveau d'un disque intervertébral 5.
Cet implant 2 présente une forme générale en U, c'est-à-dire est constitué par deux lames latérales rectangulaires 10, reliées l'une à l'autre, à une extrémité, par un talon 11. Les lames 10 ont une longueur inégale et comportent des arêtes tranchantes 12 à leur extrémité
libre, délimitées par leurs faces internes et par des faces d'extrémité en biseau.
Les lames 10 comprennent des dents 13 de type "harpon" ou "en sapin" sur leurs bords supérieurs et inférieurs, et des lumières latérales 14.
Le talon 11 reliant les deux lames 10 est percé d'un trou fileté 15 permettant le montage de l'implant 2 sur l'extrémité d'un outil d'impaction (non représenté).
L'implant 2, une fois monté sur cet outil, permet le prélèvement direct d'un greffon osseux monobloc 16 constitué par de l'os spongieux "de masse", provenant de préférence de la crête iliaque du patient.
La longueur inégale des lames 10 facilite le prélèvement du greffon 16. II apparaît aux figures 2 à 4 que le greffon 16 ainsi obtenu vient remplir totalement l'espace délimité par les lames 10 et le talon 11, et qu'il a une largeur correspondant à la largeur maximale de l'implant 2, dents 13 y compris. Le greffon 16 est parfaitement maintenu dans l'implant 2 et peut être retaillé si nécessaire.
En pratique, comme le montrent les figures 5 et 6, des logements intervertébraux sont forés dans les plateaux des vertèbres 3 et 4 à fusionner, de part et d'autre de l'axe du rachis, pour recevoir deux implants 2 munis d'un greffon 16.
Ces implants 2 sont impactés dans les logements au moyen de l'outil précité. Lorsqu'ils sont complètement introduits dans les logements, l'outil est retiré. Les dents 13 s'insèrent dans l'os spongieux des plateaux vertébraux, et empêchent toute possibilité de mouvement des implants 2 vers l'arrière.
Cette insertion provoque la mise en compression des greffons 16 sur une hauteur correspondant à celle des dents 13, soit environ 2 millimètres pour chaque rangée de dents.
Cette mise en compression permet une parfaite application et une totale immobilisation des greffons 16 par rapport aux vertèbres 3,4, ce qui est tout-à-fait favorable à l'obtention d'une bonne croissance osseuse, et donc d'une parfaite fusion.
En outre, la pénétration des dents 13 à l'intérieur des vertèbres favorise l'amorçage de la croissance osseuse venant réaliser la fusion.
La densité des greffons 16 correspond sensiblement à celle de l'os spongieux des vertèbres 3,4, et les greffons 16 sont maintenus en place latéralement par les lames 10 dans les logements intervertébraux.
Il apparaît sur les figures que la distance séparant les lames 10 est déterminée pour que la surface occupée par le greffon 16 au niveau des faces supérieures et inférieures de l'implant 2 représente au moins 50 % de la surface totale de ces faces. Les ouvertures supérieure et inférieure délimitées par ces lames 10 permettent ainsi de larges surfaces de contact du greffon 16 et de l'os spongieux des vertèbres 3,4.
Les lumières latérales permettent également la croissance osseuse selon cette direction latérale.
L'invention fournit ainsi un implant intervertébral permettant l'obtention d'une parfaite fusion des vertèbres, avec rehaussement adéquat du disque intervertébral et garantie de stabilité dans le temps, cet implant pouvant être mis en place par voie postérieure, selon une technique relativement simple et rapide de mise en oeuvre.
Claims
REVENDICATIONS
1 - Implant permettant la fusion de deux corps osseux adjacents, notamment de deux vertèbres consécutives, caractérisé en ce qu'il présente une forme générale en U, c'est-à-dire est constitué par deux lames latérales (10) reliées l'une à l'autre, à une extrémité, par un talon (11) , dont au moins une comporte une arête tranchante (12) à son extrémité libre, cet implant (2) étant conformé pour permettre lui-même le prélèvement d'un greffon osseux monobloc (16) .
2 - Implant selon la revendication 1, caractérisé en ce que les lames (10) comportent sur leurs bords supérieurs et/ou inférieurs des dents (13) de type "harpon" ou "en sapin". 3 - Implant selon la revendication 1 ou la revendication 2, caractérisé en ce que la longueur des lames (10) est inégale.
4 - Implant selon l'une des revendications 1 à 3, caractérisé en ce que les lames (10) peuvent être rectangulaires, trapézoïdales, ou en forme de parallélogramme.
5 - Implant selon l'une des revendications 1 à 4, caractérisé en ce que l'une au moins des lames (10) comprend une lumière latérale (14) . 6 - Implant selon l'une des revendications 1 à 5, caractérisé en ce que le talon reliant les lames (10) est percé d'un trou fileté (15) permettant le montage de l'implant sur l'extrémité d'un outil d'impaction.
7 - Implant selon l'une des revendications 1 à 6, caractérisé en ce que la distance séparant les lames (10) est déterminée pour que la surface occupée par le greffon osseux (16) au niveau des faces supérieures et inférieures de l'implant (2) représente au moins 50 % de la surface totale de ces faces.
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
FR9413685 | 1994-11-16 | ||
FR9413685A FR2726759B1 (fr) | 1994-11-16 | 1994-11-16 | Cage pour fusion de vertebres lombaires par interposition de greffons osseux |
PCT/FR1995/001507 WO1996014809A1 (fr) | 1994-11-16 | 1995-11-15 | Implant permettant la fusion de deux corps osseux adjacents, notamment de deux vertebres consecutives |
Publications (1)
Publication Number | Publication Date |
---|---|
EP0793463A1 true EP0793463A1 (fr) | 1997-09-10 |
Family
ID=9468826
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP95940320A Withdrawn EP0793463A1 (fr) | 1994-11-16 | 1995-11-15 | Implant permettant la fusion de deux corps osseux adjacents, notamment de deux vertebres consecutives |
Country Status (2)
Country | Link |
---|---|
EP (1) | EP0793463A1 (fr) |
WO (1) | WO1996014809A1 (fr) |
Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
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US9216096B2 (en) | 2010-03-16 | 2015-12-22 | Pinnacle Spine Group, Llc | Intervertebral implants and related tools |
US9380932B1 (en) | 2011-11-02 | 2016-07-05 | Pinnacle Spine Group, Llc | Retractor devices for minimally invasive access to the spine |
US10070970B2 (en) | 2013-03-14 | 2018-09-11 | Pinnacle Spine Group, Llc | Interbody implants and graft delivery systems |
Families Citing this family (13)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CA2287523C (fr) | 1997-04-25 | 2006-04-18 | Stryker France S.A. | Implants intersomatiques en deux parties |
US5865848A (en) * | 1997-09-12 | 1999-02-02 | Artifex, Ltd. | Dynamic intervertebral spacer and method of use |
FR2769827B1 (fr) * | 1997-10-17 | 2000-05-19 | Sdm | Implant pour arthrodese rachidienne inter-somatique |
DE19826619A1 (de) * | 1998-06-17 | 1999-12-30 | Ulrich Gmbh & Co Kg | Implantat zur Fusion zweier Wirbel |
US6193757B1 (en) | 1998-10-29 | 2001-02-27 | Sdgi Holdings, Inc. | Expandable intervertebral spacers |
FR2788686B1 (fr) * | 1999-01-26 | 2001-06-08 | Scient X | Implant intersomatique a introduction sagittale apte a un decalage lateral dans le plan frontal |
DE20117773U1 (de) * | 2001-10-31 | 2003-03-20 | Koenigsee Implantate & Instr | Implantat zur Stabilisierung der Vertebrae cervicales |
EP1585457B1 (fr) * | 2002-09-24 | 2010-03-31 | Bogomir Gorensek | Dispositif et procedes de stabilisation de disque intervertebral |
US8267939B2 (en) | 2008-02-28 | 2012-09-18 | Stryker Spine | Tool for implanting expandable intervertebral implant |
US9801732B2 (en) * | 2009-10-30 | 2017-10-31 | Spinefrontier, Inc | System and method for an intervertebral implant assembly |
AU2012296522B2 (en) | 2011-08-16 | 2016-12-22 | Stryker European Holdings I, Llc | Expandable implant |
US10342675B2 (en) | 2013-03-11 | 2019-07-09 | Stryker European Holdings I, Llc | Expandable implant |
US10828077B2 (en) | 2017-09-22 | 2020-11-10 | Howmedica Osteonics Corp. | Distal radius wedge screw |
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Publication number | Priority date | Publication date | Assignee | Title |
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US3848601A (en) * | 1972-06-14 | 1974-11-19 | G Ma | Method for interbody fusion of the spine |
US4834757A (en) * | 1987-01-22 | 1989-05-30 | Brantigan John W | Prosthetic implant |
AU683243B2 (en) * | 1993-02-10 | 1997-11-06 | Zimmer Spine, Inc. | Spinal stabilization surgical tool set |
FR2710519B1 (fr) * | 1993-09-29 | 1996-01-05 | Dominique Robine | Cage intersomatique lombaire (CH). |
DE9407806U1 (de) * | 1994-05-11 | 1994-07-14 | Aesculap AG & Co. KG, 78532 Tuttlingen | Zwischenwirbel-Implantat |
-
1995
- 1995-11-15 EP EP95940320A patent/EP0793463A1/fr not_active Withdrawn
- 1995-11-15 WO PCT/FR1995/001507 patent/WO1996014809A1/fr not_active Application Discontinuation
Non-Patent Citations (1)
Title |
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See references of WO9614809A1 * |
Cited By (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9216096B2 (en) | 2010-03-16 | 2015-12-22 | Pinnacle Spine Group, Llc | Intervertebral implants and related tools |
US9649203B2 (en) | 2010-03-16 | 2017-05-16 | Pinnacle Spine Group, Llc | Methods of post-filling an intervertebral implant |
US9788973B2 (en) | 2010-03-16 | 2017-10-17 | Pinnacle Spine Group, Llc | Spinal implant |
US9380932B1 (en) | 2011-11-02 | 2016-07-05 | Pinnacle Spine Group, Llc | Retractor devices for minimally invasive access to the spine |
US10070970B2 (en) | 2013-03-14 | 2018-09-11 | Pinnacle Spine Group, Llc | Interbody implants and graft delivery systems |
Also Published As
Publication number | Publication date |
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WO1996014809A1 (fr) | 1996-05-23 |
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