EP1389962A2 - Instrument d'insertion - Google Patents

Instrument d'insertion

Info

Publication number
EP1389962A2
EP1389962A2 EP02766857A EP02766857A EP1389962A2 EP 1389962 A2 EP1389962 A2 EP 1389962A2 EP 02766857 A EP02766857 A EP 02766857A EP 02766857 A EP02766857 A EP 02766857A EP 1389962 A2 EP1389962 A2 EP 1389962A2
Authority
EP
European Patent Office
Prior art keywords
implant
tine
insertion apparatus
implant insertion
bone
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Withdrawn
Application number
EP02766857A
Other languages
German (de)
English (en)
Other versions
EP1389962A4 (fr
Inventor
David Nichols
John R. Pepper
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.)
Howmedica Osteonics Corp
Original Assignee
Howmedica Osteonics Corp
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
Application filed by Howmedica Osteonics Corp filed Critical Howmedica Osteonics Corp
Publication of EP1389962A2 publication Critical patent/EP1389962A2/fr
Publication of EP1389962A4 publication Critical patent/EP1389962A4/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • 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
    • A61F2/4603—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
    • A61F2/4611—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 of spinal prostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0206—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with antagonistic arms as supports for retractor elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • A61B2017/0256—Joint distractors for the spine

Definitions

  • the present invention generally relates to a device for use as a surgical instrument.
  • the present invention relates to a device that is adapted to hold a surgical implant, such as a bone graft, and is used to seat the surgical implant or bone graft into a designated vertebral disc space.
  • Some patents provide for an apparatus that has an outer and an inner sleeve arrangement.
  • the outer sleeve is positioned over the spinal distractor and has teeth at one end that are driven directly into the posterior surface of the adjacent vertebrae.
  • the inner sleeve is positioned within the outer sleeve and serves to guide instruments, such as a drill, used to form the implant receiving bore.
  • Other arrangements include the use of guide rods that are placed in pilot holes formed in the vertebral bodies. The guide rods guide a bore forming hollow drill into the intevertebral space.
  • an instrument for insertion of an implant which instrument preferably has two components removably connected together, with each component having a tine located at its distal end.
  • the two components when assembled, provide a fork-like front end with two prongs or tines.
  • Each of the two components removably connects to the other by a two- piece tumbuckle locking member that has a separate piece located on each component.
  • the fork-like front end can be withdrawn one tine at a time, so the implant stays in place while the instrument is removed.
  • the front end can hold a surgical implant on three sides, and keep the implant from rotating and from slipping laterally or vertically when positioning the implant into a designated vertebral disc space.
  • the first tine moves relative to the second or fixed tine.
  • One tine is released by turning the handle of the instrument preferably about ninety degrees in either a clockwise or counter-clockwise direction, thereby releasing the tumbuckle locking mechanism that serves to secure together and dissociate the two parts of the instrument.
  • the second tine is released only by removal of the instrument.
  • Fig. 1 is a perspective view of the insertion instrument of the present invention
  • Fig. 2 is an exploded plan view of the two components of the insertion instrument of Fig. 1 ;
  • Fig. 3 is a first plan view of the insertion instrument of Fig. 1 , with the instrument shown in the locked or insertion position;
  • Fig. 4 is a second plan view of the insertion instrument of Fig. 1 , with the instrument shown in the unlocked or retraction position, and with the handle rotated ninety degrees;
  • Fig. 5 is a perspective view of an alternative embodiment of the insertion instrument of the present invention.
  • Fig. 6 is a perspective view of one embodiment of an implant
  • Fig. 7 is a view of the tip of the insertion instrument of Fig. 1 with an implant positioned between the two tines;
  • Fig. 8 is an enlarged side view of the insertion instrument of Fig. 7;
  • Fig. 9 is a partial perspective view of the insertion instrument of Fig. 1 showing tines gripping an implant.
  • FIG. 1 there is shown an implant insertion instrument generally represented by reference numeral 10.
  • insertion instrument and associated method may be employed in a variety of instances, by way of example a preferred embodiment of the insertion instrument 10 is used with a bone fusion implant or allograft to insert an implant such as the one shown in Fig. 6 between vertebrae or bone sections to be fused.
  • the instrument and associated method could be applied in various surgical situations, including those requiring bone fusion or repair.
  • insertion instrument 10 is loaded with the implant to place the implant in a distracted intervertebral space between adjacent vertebrae.
  • proximal as is traditional, will refer to the portion of the structure that is closer to the operator, while the term “distal” will refer to the portion that is further from the operator.
  • Insertion instrument 10 is a two-piece instrument. Insertion instrument 10 has a partially hollow, elongated member 12 and an elongated member 30 that is at least partially receivable in the elongated member 12.
  • hollow elongated member 12 has a hollow cylindrical section 13 with an enlarged collar 14 at its proximal end, a protrusion 16 towards the distal end, and a first tine 18 adjacent the protrusion 16.
  • Hollow cylindrical member 13 is smaller in diameter than collar 14.
  • Protrusion 16 preferably is generally rectangular in shape.
  • first tine 18 that extends across and distally past the length of protrusion 16.
  • the first tine 18 resembles a fork-like tine element, and is positioned virtually or exactly perpendicular to the flat distal side of protrusion 16.
  • band 20 encircles first tine 18 and protrusion 16.
  • Band 20 is designed for stabilization of first tine 18.
  • there is an open space 22 (shown in phantom) present between the interior surface of band 20 and the outside surface of protrusion 16 that is furthest in distance from first tine 18.
  • first tine 18 preferably has a raised first implant engaging surface or structure 19.
  • Structure 19 is preferably positioned in the center of the inside surface of first tine 18, and extends longitudinally along the length of the first tine in the axial direction.
  • the inside surface of first tine 18 is the surface that comes into contact with the implant.
  • First implant engaging structure 19 is configured to engage a corresponding longitudinal recess or groove in the surface of the implant. First implant engaging structure 19 grips the implant and provides for improved movement and stabilization of the implant during implant insertion.
  • elongated member 30 has a body 31 , a handle
  • Handle 40 connected at the proximal end of the body, and a second tine 25 connected at the distal end of the body.
  • Handle 40 has a tumbuckle locking member 45.
  • the most proximal portion of tumbuckle member 45 has a larger diameter than body 31 and preferably forms a stop member 46.
  • Stop member 46 includes a tapered portion 48.
  • Elongated member 30 is preferably generally cylindrical in shape, and has an overall smaller diameter than hollow elongated member 12. Handle 40 rotates relative to body 31.
  • Elongated member 30 also has a cylindrical front member 33 that is larger in diameter than the remaining portion of body 31 of elongated member 30.
  • second tine 25 is located on cylindrical front member 33, preferably at the most distal end of elongated member 30.
  • handle 40 preferably is T-shaped.
  • second tine 25 has an inside surface with a second raised implant engaging structure 21 that is positioned in the center of the inside surface. Second implant engaging structure 21 extends longitudinally across the length of second tine 25 in the axial direction.
  • Elongated member 30 is designed to be removably inserted into hollow elongated member 12.
  • tumbuckle locking member 45 of elongated member 30 has one or more locking abutments 47.
  • Abutments 47 are designed to latch onto a corresponding area in collar 14.
  • Elongated member 30 can be inserted into hollow elongated member 12 through collar 14. As elongated member 30 is inserted into hollow elongated member 12, second tine 25 passes through hole 17 and then through open space 22 in band 20. Band 20 stabilizes second tine 25 and helps prevent unwanted outward movement. Elongated member 30 is inserted into hollow elongated member 12 until the distal end of stop member 46 contacts collar 14. Once elongated member 30 is fully inserted into hollow elongated member 12, insertion instrument 10 may be locked into operating position by rotating handle 40 preferably approximately ninety degrees in either the clockwise or counter-clockwise direction.
  • Fig. 3 shows insertion instrument 10 in the locked position
  • Fig. 4 shows the insertion instrument in an unlocked, partially separated position
  • elongated member 30 may be disengaged from hollow elongated member 12 by turning handle 40 preferably approximately ninety degrees in either the clockwise or counterclockwise direction.
  • insertion instrument 10 incorporates a ball detent mechanism to secure elongated member 12 to elongated member 30 and to disengage elongated member 12 from elongated member 30.
  • Fig. 5 is an alternative embodiment of insertion instrument 10 that lacks band 20.
  • first tine 18, second tine 25 and protrusion 16 are not encircled by a band.
  • the surgical implants used with the present invention are typically used in lumbar interbody fusion and other bone augmentation procedures.
  • the implants used with the present invention may be made from any suitable material, but preferably bone or allograft. ⁇
  • Fig. 6 shows an implant 100 that can be used with insertion instrument 10.
  • implant 100 has an anterior side 103, a posterior side 105, a lateral side 107 and a medial side 109.
  • Implant 100 has a groove 110 in the lateral side 107 and groove 115 in the medial side 109 for engaging first implant engaging structure 19 and second implant engaging structure 21 of insertion instrument 10.
  • Groove 110 can be of various configuration, but is preferably of semi-circular cross-section as shown in Fig. 6. The semi-circular section allows for instruments having various diameter shafts to engage and hold the implant 100 after insertion.
  • Implant 100 also has a top or superior surface 120 and an opposite or bottom or inferior surface 122.
  • implant 100 has in the top and bottom surfaces 120, 122, one or more series of grooves.
  • first or posterior series of grooves 132 there is a first or posterior series of grooves 132, and a second or anterior series of grooves 134 substantially perpendicular to the first series.
  • Implant 100 in this embodiment has a top and bottom grooved pattern that is primarily designed to prevent retropulsion of the implant from the intervertebral space.
  • top surface 120 has a planar angled surface 140 as shown.
  • Implants 100 are of various sizes designed to accommodate the ordinary and usual intervertebral space of patients of different dimensions.
  • the implants 100 are characterized by having a tapered or curved lateral end, which is advantageous to the contour of the body cavity of the intervertebral space.
  • the coronal fit design is a characteristic of implant 100.
  • second tine 25 when insertion instrument 10 is in a locked position, second tine 25 preferably is shorter in length distally than first tine 18. In this locked or operating position, first tine 18 and second tine 25 are located parallel to each other with their inside surfaces facing each other, so that their implant engaging structures 19, 21 , respectively, engage the implant therebetween. As shown in Figs. 7 to 9, once in the locked position, an implant or allograft is positioned between the two tines 18, 25 so that the tines hold the bone along the length of the graft. First implant engaging structure 19 and second implant engaging structure 21 are configured to engage corresponding longitudinal recesses or grooves 110 and 115 on the surface of the implant to better hold the implant and provide for improved movement stabilization of the implant during implant insertion. Preferably, distal ends of tines 18, 25 are chamfered or contoured to facilitate insertion into a narrow space and to allow for improved safety during such insertion.
  • the implant Prior to introduction of the implant, the intervertebral space has been previously prepared and the vertebrae distracted through the use of distractors and other instruments, as is known in the art.
  • the implant is loaded onto insertion instrument 10 so that the two tines 18, 25 are juxtaposed on opposing sides of the implant in a horizontal plane. Tines 18, 25, implant engaging structures 19, 21 and the front end of protrusion 16 together control lateral, vertical and backward motion and sliding as the implant is inserted into the intervertebral space.
  • the implant is secured laterally by the two tines and proximally by protrusion 16.
  • first implant engaging structure 19 and second implant engaging structure 21 Undesired vertical motion or sliding is restricted by first implant engaging structure 19 and second implant engaging structure 21.
  • handle 40 is rotated approximately ninety degrees so that tumbuckle locking member 45 is released and insertion instrument 10 is brought to an unlocked position.
  • elongated member 30 is released from hollow elongated member 12 and can be withdrawn away from the surgical area.
  • first tine 18 remains in contact with the implant. For this reason, hollow elongated member 12 can easily be moved away from the implant and can be retracted with virtually no disruption to the positioning of the implant. If required, additional instruments may subsequently be utilized to adjust the positioning of the implant or to further push the implant in the intervertebral space.
  • insertion instrument 10 holds an implant or allograft on two sides to hold the bone along the length of the graft.
  • the anterior to posterior holding allows enough force transmitted to reposition insertion instrument 10 intra-operatively.
  • the two thin tines 18, 25 allow enough room to get insertion instrument 10 in past the root and dura without excess distraction.
  • insertion instrument 10 is durable enough to be hammered in place. It is easy to hold. As set forth above, insertion instrument has a method of holding the implant or allograft. The release of tines 18, 25 will allow the instrument to be withdrawn leaving the implant or allograft in place. Tines 18, 25 can be of different lengths to facilitate closer fit to the annulus fibrous, which is curved where insertion instrument 10 will contact it. It is easy to assemble and clean which are important features of hospital equipment. The beveled anterior edge can be seen in Fig. 8.
  • Insertion instrument 10 is preferably made of biocompatible materials having sufficient strength to withstand the forces encountered during insertion and use. More preferably, insertion instrument 10 may be made of stainless steel, titanium, or aluminum. Since insertion instrument 10 is a two-piece design, it facilitates cleaning and sterilization of the instrument.

Abstract

L'invention concerne un instrument d'insertion ayant un premier élément allongé, partiellement creux et un second élément que l'on peut positionner par rapport au premier élément. Les deux éléments peuvent être verrouillés l'un à l'autre et dissociés l'un de l'autre par le biais d'un mécanisme de verrouillage à tendeur. Chaque élément est muni d'une butée saillant à son extrémité distale. Lorsque les deux éléments sont bloqués ensemble, les deux butées forment une extrémité avant du type fourche qui retient un implant durant son insertion. On peut escamoter une butée pour libérer l'implant dans la position voulue. L'invention concerne également un procédé permettant de retenir, de positionner avec précision et d'insérer l'implant dans un espace intervertébral entre des vertèbres contiguës. Elle concerne enfin un mécanisme et un procédé permettant de libérer l'implant entre des vertèbres contiguës et d'enlever en toute sécurité l'instrument d'insertion.
EP02766857A 2001-04-30 2002-04-30 Instrument d'insertion Withdrawn EP1389962A4 (fr)

Applications Claiming Priority (7)

Application Number Priority Date Filing Date Title
US28691301P 2001-04-30 2001-04-30
US35124702P 2002-01-24 2002-01-24
US35124602P 2002-01-24 2002-01-24
US351246P 2002-01-24
US351247P 2002-01-24
PCT/US2002/013472 WO2002087654A2 (fr) 2001-04-30 2002-04-30 Instrument d'insertion
US286913P 2009-12-16

Publications (2)

Publication Number Publication Date
EP1389962A2 true EP1389962A2 (fr) 2004-02-25
EP1389962A4 EP1389962A4 (fr) 2009-12-09

Family

ID=27403660

Family Applications (1)

Application Number Title Priority Date Filing Date
EP02766857A Withdrawn EP1389962A4 (fr) 2001-04-30 2002-04-30 Instrument d'insertion

Country Status (3)

Country Link
EP (1) EP1389962A4 (fr)
AU (2) AU2002303537A1 (fr)
WO (2) WO2002087654A2 (fr)

Families Citing this family (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CA2528154A1 (fr) * 2003-06-03 2005-01-06 Osteotech, Inc. Implant biologique a surfaces porteuses de charge comprenant des saillies disposees de maniere non uniforme
GB0519829D0 (en) 2005-09-30 2005-11-09 Depuy Int Ltd Distractor instrument
GB0519832D0 (en) 2005-09-30 2005-11-09 Depuy Int Ltd Instrument assembly for use in knee joint replacement surgery
GB201115411D0 (en) 2011-09-07 2011-10-19 Depuy Ireland Surgical instrument
WO2019115744A1 (fr) 2017-12-15 2019-06-20 Depuy Ireland Unlimited Company Instrument d'équilibrage de genou

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE19713416A1 (de) * 1996-04-01 1997-10-30 Asahi Optical Co Ltd Führungsvorrichtung für ein Zwischenwirbelimplantat
WO1999047083A1 (fr) * 1998-03-20 1999-09-23 Sulzer Spine-Tech Inc. Implant intervertebral a surface de contact reduite et procede
WO2000024327A2 (fr) * 1998-10-28 2000-05-04 Sdgi Holdings, Inc. Greffes de fusion osseuse et instrumentation

Family Cites Families (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4385628A (en) * 1980-04-21 1983-05-31 Straith Richard E Surgical instrument
US4545374A (en) * 1982-09-03 1985-10-08 Jacobson Robert E Method and instruments for performing a percutaneous lumbar diskectomy
US4554848A (en) * 1984-08-27 1985-11-26 Galletto Joseph L Internal pliers
DE3707097A1 (de) * 1986-12-05 1988-06-09 S & G Implants Gmbh Zange zum spreizen von wirbelsaeulenkoerpern
DE3809793A1 (de) * 1988-03-23 1989-10-05 Link Waldemar Gmbh Co Chirurgischer instrumentensatz
GB2306653B (en) * 1995-10-23 1999-12-15 Finsbury Surgical tool
US6197033B1 (en) * 1998-04-09 2001-03-06 Sdgi Holdings, Inc. Guide sleeve for offset vertebrae
EP1117335B1 (fr) * 1998-10-02 2009-03-25 Synthes GmbH Ecarteur de l'espace intervertebral

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE19713416A1 (de) * 1996-04-01 1997-10-30 Asahi Optical Co Ltd Führungsvorrichtung für ein Zwischenwirbelimplantat
WO1999047083A1 (fr) * 1998-03-20 1999-09-23 Sulzer Spine-Tech Inc. Implant intervertebral a surface de contact reduite et procede
WO2000024327A2 (fr) * 1998-10-28 2000-05-04 Sdgi Holdings, Inc. Greffes de fusion osseuse et instrumentation

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See also references of WO02087654A2 *

Also Published As

Publication number Publication date
WO2002087466A3 (fr) 2003-02-06
WO2002087654A9 (fr) 2004-12-16
WO2002087654A3 (fr) 2003-10-30
AU2002303537A1 (en) 2002-11-11
WO2002087654A2 (fr) 2002-11-07
AU2002338527A1 (en) 2002-11-11
EP1389962A4 (fr) 2009-12-09
WO2002087466A2 (fr) 2002-11-07

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