EP1651149A2 - Bandscheibenprothese - Google Patents

Bandscheibenprothese

Info

Publication number
EP1651149A2
EP1651149A2 EP04786253A EP04786253A EP1651149A2 EP 1651149 A2 EP1651149 A2 EP 1651149A2 EP 04786253 A EP04786253 A EP 04786253A EP 04786253 A EP04786253 A EP 04786253A EP 1651149 A2 EP1651149 A2 EP 1651149A2
Authority
EP
European Patent Office
Prior art keywords
prosthesis
face
cooperation
vertebrae
elements
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Withdrawn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
EP04786253A
Other languages
English (en)
French (fr)
Inventor
Karl Belliard
Régis Le Couedic
Jacques Senegas
Paolo Mangione
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.)
Zimmer Spine SAS
Original Assignee
Zimmer Spine SAS
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 Zimmer Spine SAS filed Critical Zimmer Spine SAS
Publication of EP1651149A2 publication Critical patent/EP1651149A2/de
Withdrawn legal-status Critical Current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
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442—Intervertebral or spinal discs, e.g. resilient
    • A61F2/4425—Intervertebral or spinal discs, e.g. resilient made of articulated components
    • 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
    • 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30383—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
    • 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
    • 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30383—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
    • A61F2002/30387—Dovetail connection
    • 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
    • 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30383—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
    • A61F2002/3039—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove with possibility of relative movement of the rib within the groove
    • 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
    • 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
    • A61F2002/30604—Special structural features of bone or joint prostheses not otherwise provided for modular
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30621—Features concerning the anatomical functioning or articulation of the prosthetic joint
    • A61F2002/30649—Ball-and-socket joints
    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30841—Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes
    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30884—Fins or wings, e.g. longitudinal wings for preventing rotation within the bone cavity
    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30891—Plurality of protrusions
    • A61F2002/30892—Plurality of protrusions parallel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442—Intervertebral or spinal discs, e.g. resilient
    • A61F2/4425—Intervertebral or spinal discs, e.g. resilient made of articulated components
    • A61F2002/443—Intervertebral or spinal discs, e.g. resilient made of articulated components having two transversal endplates and at least one intermediate component
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2002/448—Joints for the spine, e.g. vertebrae, spinal discs comprising multiple adjacent spinal implants within the same intervertebral space or within the same vertebra, e.g. comprising two adjacent spinal implants
    • 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
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements

Definitions

  • the present invention relates to an intervertebral disc prosthesis and a method of implanting said prosthesis.
  • one of the pathologies of the spine can consist of degeneration of the discs which are interposed between the vertebrae of the spine. This degeneration causes a decrease in the thickness of this disc and can cause very significant painful sensations.
  • the natural intervertebral disc When degeneration has reached an advanced stage, the natural intervertebral disc must be removed and replaced.
  • a system of intervertebral wedges or cages is put in place which maintains the spacing given between the vertebrae and which immobilizes the two vertebrae with respect to one another.
  • This technique has of course the disadvantage, if it concerns several vertebrae, of considerably limiting the possibilities of movement for the patient.
  • Another possible technique consists in replacing the natural intervertebral disc by an intervertebral disc prosthesis which will be mounted between the vertebrae and which, in the ideal case, will preserve to the patient all the possibilities of relative movement of the vertebrae or at least most of these possibilities of movement.
  • Another problem which arises in connection with intervertebral disc prostheses is the surgical technique of placing this prosthesis.
  • Two techniques can be envisaged: a technique known as an anterior approach, that is to say that the prosthesis is placed by the front face of the spine; or a so-called posterior technique in which the prosthesis is placed by the external face of the spine, that is to say the directly accessible face.
  • a first object of the present invention is to provide an intervertebral disc prosthesis which can be placed by the posterior route and which nevertheless ensures a large number of possibilities of relative movement for the vertebrae between which the prosthesis is placed.
  • the intervertebral disc prosthesis capable of being placed between two vertebrae by posterior or anterior route is characterized in that it comprises: - a first element of fixation comprising a first anchoring face in one of the vertebrae and a second cooperation face; - A second fastening element comprising a first anchoring face in the other vertebra and a second cooperation face; a first prosthesis element comprising a first active face and a second cooperation face, said cooperation faces of the first fixing element and of the first prosthesis element ensuring the joining of the two elements in a plane substantially orthogonal to the axis of the vertebrae ; and a second prosthesis element comprising a first active face and a second cooperation face, the cooperation faces of the second fixing element and of the second prosthesis element ensuring the joining of the two elements in a plane substantially orthogonal to the axis of the vertebrae; - Said active faces of the prosthesis elements each defining at least one portion of spherical
  • each prosthesis element can be put in place by the posterior route, in particular because the fixing element of each prosthesis element is constituted by a separate piece from the prosthesis element itself. .
  • the active faces in contact with each other of the two prosthesis elements have the shape of a spherical cap, which allows the physiological swiveling movements between the two vertebrae.
  • each prosthesis element comprises two separate parts, each active face of one of said parts defining a portion of spherical cap, the portions of spherical caps belonging to the same prosthesis element being arranged on the same spherical cap when the two parts are fixed on the vertebrae by said fixing element.
  • each prosthesis element is constituted by two separate parts, which facilitates the positioning of the prosthesis by the posterior route. However, when these two parts constituting the prosthesis element occupy their final position, they define an active surface in the form of a spherical cap.
  • each prosthesis element consists of a single piece, the active face of which consists of a substantially flat surface in which a single spherical cap is formed, said spherical caps being respectively concave and convex.
  • the intervertebral disc prosthesis capable of being placed between two vertebrae by the anterior or posterior route is characterized in that it comprises: - two prosthesis elements, each prosthesis element comprising two separate parts, each part having a first face intended to be fixed on a vertebra and a second active face in the form of a portion of a spherical cap; - The spherical cap portions forming the active faces of the two parts belonging to the same prosthesis element being disposed on the same spherical cap when said parts are fixed on the vertebra. It is understood that according to this aspect of the invention, each of the two prosthesis elements is constituted by two separate parts which can therefore be placed on either side of the spinal cord.
  • the two parts forming a prosthesis element when they occupy their final position, they together define a portion of a spherical cap, which makes it possible to obtain the desired swiveling movement.
  • the two parts forming a prosthesis element are fixed on the vertebrae and positioned suitably relative to each other to define the portion of spherical cap to using a fixing element which is separate from the two parts forming the prosthesis element. This arrangement makes it possible to reduce the size of the prosthesis elements and therefore to simplify the positioning by posterior route of the prosthesis of the intervertebral disc.
  • a second object of the invention is to provide a method of implantation by the posterior route of an intervertebral disc prosthesis of the type defined above, which is particularly suitable for this prosthesis.
  • This object is achieved by a process comprising the following steps: - providing a posterior access route to the intervertebral space in which one wishes to implant said prosthesis; - move aside the two vertebrae defining said space; - remove the natural intervertebral disc; and - implanting said prosthesis between the vertebrae by carrying out the following steps: a) introducing at least one fixing element between the vertebrae on one side of the dura mater; b) said fastening element is rotated to arrange it beyond the dura mater at its anchoring location; c) anchoring said fixing element in the vertebra; d) if necessary, steps a), b) and c) are repeated for the second fixing element; e) the prosthesis elements are introduced on at least one of the sides of the dura mater; and f) each prosthesis element is
  • a third object of the invention is to provide a method of implantation by the anterior route of an intervertebral disc prosthesis of the type defined above which specifically adapts to this prosthesis.
  • This object is achieved by a process comprising the following steps: - Provide an anterior access route to the intervertebral space in which we want to implant said prosthesis; - move aside the two vertebrae defining said space; - remove the natural intervertebral disc; and - implanting said prosthesis between the vertebrae by carrying out the following steps: a) introducing at least one fixing element between the vertebrae; b) anchoring said fixing element in the vertebra; c) if necessary, repeat steps a) and b) for the second fixing element; d) the prosthesis elements are introduced between the vertebrae; e) each prosthesis element is made to cooperate with a fixing element.
  • FIG. 1 is a simplified view in vertical section illustrating the first aspect of the invention
  • - Figure 2A is a simplified vertical sectional view illustrating the second aspect of the invention
  • - Figure 2B is a sectional view of Figure 2A along line BB
  • - Figure 3A is a front view of the fixing element of a first embodiment of the prosthesis
  • - Figure 3B is a side view of the fastener of Figure 3A
  • - Figure 4A is a front view of the two parts forming a prosthesis element of the first embodiment
  • - Figure 4B is a view of a prosthesis element according to arrow B in Figure 4A
  • - Figure 4C is a top view of the two parts constituting the prosthesis element
  • - Figure 5 is a perspective view showing the mounting of the prosthesis elements and the fixing elements
  • - Figure 6A is an elevational view of
  • FIG. 1 we will describe the intervertebral disc prosthesis in its first aspect.
  • FIG. 1 there is shown in a simplified manner a first vertebra VI and a second vertebra V2 between which the intervertebral disc prosthesis 10 must be put in place.
  • the prosthesis
  • the prosthesis element 10 consists of a first prosthesis element 12 and a second prosthesis element 14, as well as by a first fixing element 16 and a second fixing element 18.
  • the prosthesis element 12 comprises a cooperation face 12a and an active face 12b or friction or contact face. This face 12b has the shape of a convex spherical cap.
  • the prosthesis element 14 also has an active face or contact face 14b which has the shape of a concave spherical cap and which is of course intended to cooperate with the active surface 12b of the prosthesis element 12. As shown in FIG. 'will explain later in more detail, preferably the radii of curvature of the spherical caps 12b and 14b are not identical.
  • the prosthesis element 14 also has a cooperation face 14a.
  • the fixing element 16 has a cooperation face 16a and an anchoring face 16b.
  • the anchoring face 16b is provided with any suitable anchoring member 22 intended to fix the fixing element 12 on the plate of the vertebra VI.
  • the cooperation face 16a of the fastening element 16 is provided with fastening members which cooperate with conjugated bodies of the face 12a of the prosthesis element 12 to ensure the fastening of the prosthesis element on the element fixing at least in a horizontal plane.
  • the fastening element 18 comprises a face 18a for cooperation and an anchoring face 18b provided with anchoring member 24.
  • Each prosthesis element 12 'and 14' consists of two separate parts referenced 26 and 28 for the prosthesis element 12 ', and 30 and 32 for the prosthesis element 14'.
  • Each piece forming the prosthesis elements comprises a fixing face referenced a and an active face referenced b.
  • the attachment faces to parts 26 to 32 are provided with fastening members in the vertebrae VI and V2, these fastening members being able, as will be explained later, to be constituted by separate pieces as shown. in FIG. 1.
  • the active faces with parts constituting the prosthesis elements they are defined in such a way that they form portions of spherical caps, respectively concave and convex.
  • the parts 26 and 28 forming the prosthesis element 12 ′ are placed on the vertebra VI, their active faces a are placed on a concave spherical cap C.
  • the active faces have parts 30 and 32 forming the 'prosthesis element 14' are arranged on a spherical cap C.
  • the spherical caps C and C may have different radii of curvature. It is understood that, thanks to the fact that the two parts constituting the same prosthesis element reconstitute a friction or contact surface in the form of a spherical cap, the same possibilities of swiveling are obtained as for FIG. 1.
  • each prosthesis element consists of two separate parts, it is understood that the positioning of the prosthesis elements between the vertebrae is made easier for the surgeon.
  • FIGS. 3A and 3B a fixing element is shown which bears the reference 40.
  • the fixing element 40 consists of a plate 42, the anchoring face 42b of which is provided with two transverse ribs 44 and 46 constituting anchors in a vertebra.
  • the cooperation face 42a of the plate 42 is equipped with two locking members on the prosthesis element.
  • the locking members 48 and 50 each consist of a strip 54 which extends parallel to the ribs 44.
  • the cross section of the strips 54 has the general shape of a T, the strip comprising two wings 56 and 58 in its part the further from the plate 42. Furthermore, to allow a certain elastic deformation of the strips, the latter has a longitudinal slot 60.
  • a prosthesis element 62 is shown which is constituted by two separate parts 64 and 66.
  • the active faces b of the parts 64 and 66 constitute portions of a spherical cap. As already explained, when the parts 64 and 66 are fixed on the vertebra, the spherical cap portions b are arranged on the same spherical cap.
  • each piece 64 and 66 comprises over part of its length, an anchoring groove 68 whose cross section has the shape of a T and which is dimensioned so as to be able to receive the anchoring members 48 and 50.
  • the grooves 68 extend only over the length portion of the pieces 64 and 66 corresponding to the length of the anchoring pieces 48 and 50.
  • the cooperation faces has pieces 64 and 66 each have a countersink 70 and 72 such that when these parts are fixed to the vertebra, the plate 42 of the fixing element 40 completely penetrates this counterbore. As can be seen in FIG.
  • the grooves 68 open at their ends 68a into an end face of the parts 64 and 66 to allow the insertion of the locking members 48 and 50 of the fixing element 40.
  • the entire prosthesis comprises a second fixing part 40 'identical to the part 40 and a second prosthesis element 62' which is distinguished from the prosthesis element 62 only by the fact that its active surface b defines a concave spherical cap.
  • Figure 5 there is shown the two prosthesis elements consisting of parts 64 and 66 and two other similar parts mounted on the fastening elements 40 and 40 '.
  • the fixing elements 40 and 40 ′ have not only the function of ensuring the fixing of each prosthesis element on the corresponding vertebra but also of positioning the two parts constituting the same prosthesis element in such a way that their active surface constitutes a spherical cap.
  • Figure 11 shows a variant of the first embodiment of the intervertebral disc prosthesis which allows correction of scoliotic tendency. This variant is essentially characterized in that when the prosthesis elements 64 ′, 66 ′ and the fixing elements 40, 40 'are assembled, the plates 42 of the fastening elements form an angle between them.
  • each prosthesis element consists of a single piece and each prosthesis element is fixed to the corresponding vertebra by a separate fixing element.
  • FIGS. 6A and 6B show an embodiment of the fixing element 80.
  • the fixing element 80 is constituted by a preferably rectangular plate 82 relatively massive.
  • the anchoring face 82b of the plate 82 is provided with anchoring members in the vertebra which consist, for example, of two ribs 84 and 86 identical to those with which the fixing element 40 shown in FIGS. 3 is fitted. As will be explained later, other anchoring elements can be used.
  • the cooperation face 82a is provided with a locking groove 88.
  • This locking groove has a first insertion portion 90 which opens into a long side of the plate 82 and a portion of locking 92 which extends parallel to the great length of the plate 82.
  • the groove 88 has a T-shaped cross section.
  • the complete prosthesis naturally includes a second fixing element 80 ′.
  • the prosthesis element 100 is constituted by a solid piece whose cooperation face a has a shoulder 102 defining a recessed portion 104, the length of the recessed portion 104 corresponding to the width of the plate 82 of the fixing 80.
  • a locking member 106 projects from the withdrawal portion 104.
  • the shoulder 102 corresponds to the thickness of the plate 82.
  • This locking member which is preferably of revolution around the axis x, x 'is constituted by a head 108 and a body 110.
  • the diametral section of the locking device 108 has a shape which corresponds to that of the T-shaped groove 88 formed in the plate 82 of the fixing element 80.
  • the active or contact face b of the prosthesis element 100 comprises a substantially flat portion 112 and a portion 114 in the form of a concave spherical cap.
  • the second prosthesis element 120 is identical to the prosthesis element 100 with the exception that its active face b has a substantially planar portion 122 and a portion in the form of a convex spherical cap 124 capable of cooperating with the concave spherical cap. 114 of the prosthesis element 100.
  • the prosthesis elements 100 and 120 shown on the two fixing elements 80 and 80 ′ are shown. As best seen in this figure, in the mounted position, the prosthesis elements 100 and 120 are orthogonal to the fixing elements 80 and 80 '.
  • the anchoring element provided on the anchoring face of the fastening elements 80 or 40.
  • the anchoring element which bears the general reference 130 is constituted by two triangular projecting parts 132 and 134, one of the short sides of which is connected to that of the other triangle to form an edge 136, the triangles 132 and 137 forming an angle of less than 180 degrees between them.
  • This anchoring mode makes it possible to cancel any movement in the planes of the vertebral plates.
  • the anchoring element which consists in this particular case of four lugs 140 of generally cylindrical shape ending in a conical part.
  • FIG. 13A to 13G shows that, preferably, the locking members 48 and 50 of the fixing element 40 are further apart than the locking members 48 'and 50' of the fixing element 40 '.
  • the two fixing elements 40 and 40 ' can be arranged in the configuration shown in the figure.
  • the total thickness of the assembly constituted by the two fixing elements is thus reduced, which allows their simultaneous insertion between the two vertebrae.
  • Two embodiments of the intervertebral disc prosthesis according to the invention have been described previously, with their variants. As already indicated, one of the advantages of these prostheses is that they can be placed posteriorly. Referring first to Figures 13A to 13G, we will describe the method of positioning the posterior prosthesis shown in Figures 3, 4 and 5.
  • the surgeon must first of all, with conventional techniques used for the establishment of intervertebral cages by posterior way, to provide a posterior access way to the vertebrae between which the prosthesis must be placed: it must also separate the two vertebrae and proceed with the removal of the natural disc. Then, the surgeon most often performs certain resections of the parts of the two vertebrae on which the prosthesis is to be fixed. These resections which mainly concern the epiphysis and the facets of the vertebrae. Functionally, the most important resections are those which allow the anchoring of the fixation elements on the vertebrae if necessary. These resections made in the vertebral endplates have a shape adapted to the anchoring elements with which the fixing elements are fitted.
  • FIGS. 13A to 13G illustrate the installation of a vertebral disc prosthesis having the form shown in FIGS. 3 to 5.
  • the lower fixing element 40 ′ is inserted between the vertebrae VI and V2 by their posterior part ( Figure 13A) on one side or the other of the dura mater.
  • the fixing element 40 is pushed to bypass the spinal cord (dura mater) (FIG. 13B) by pivoting and arriving in position so that the anchoring ribs are in line with the slots FI and F2 (FIGS. 13C and 13D), then the anchoring ribs are pressed into the slots FI and F2 (FIG. 13E).
  • the upper fixing element 40 is put in place by the same process on the upper vertebra VI. As shown in Figure 10, it is also possible to simultaneously introduce the two fixing elements between the vertebrae then proceed to their separate placement in the resections. Still posteriorly, between the vertebrae is introduced between the right side of the dura mater the pieces 64 and 64 ′ constituting the right part of the prosthesis elements, bypassing the spinal cord.
  • FIG. 14A shows the insertion of the fixing elements in the case where they are produced in accordance with FIG. 10.
  • FIG. 14B illustrates the subsequent positioning of the prosthesis elements.
  • FIGS. 15A to 15C show the main stages of the positioning of the intervertebral disc prosthesis shown in FIG. 8.
  • FIG. 15A shows the positioning of the lower fixing element 80 ′ which is engaged posteriorly on one side of the dura, then this part is rotated to position it beyond the dura. It ends with the insertion of the anchoring ribs in the slots FI, F2.
  • FIG. 15A also shows "symbolically" the positioning of the upper fixing element 80.
  • FIG. 15B illustrates the initial phase of positioning the prosthesis elements 100 and 120. In this phase, the prosthesis elements are inserted between the vertebrae on the same side of the spinal cord according to the direction of their great length. The locking members 106 are presented at the entrance to the first portion 90 of the locking grooves 88 of the fastening elements until they reach the stop. Then (FIG.
  • FIG. 15C the surgeon pushes the prosthesis elements transversely so that the locking members 106 abut at the bottom of the second portion 92 of the locking groove 88.
  • the prosthesis elements are locked on the parts. fixing by the cooperation of the shoulder 102 with the edge of the fixing element.
  • an important advantage of the intervertebral disc prosthesis is the possibility of putting it in place posteriorly.
  • this prosthesis can of course also be placed by the anterior route.
  • Figures 16A to 16C illustrate the placement of the prosthesis shown in Figure 5 by the anterior route and Figures 17A and 17B that of the prosthesis shown in Figure 8.
  • FIG. 17A shows the positioning by anterior view of the fixing elements 80 and 80 ′
  • FIG. 17B illustrates the positioning of the prosthesis elements 100 and 120 on the fixing elements.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Neurology (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)
EP04786253A 2003-08-04 2004-08-03 Bandscheibenprothese Withdrawn EP1651149A2 (de)

Applications Claiming Priority (2)

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FR0309596A FR2858546B1 (fr) 2003-08-04 2003-08-04 Prothese de disque intervertebral
PCT/FR2004/002078 WO2005013862A2 (fr) 2003-08-04 2004-08-03 Prothese de disque intervertebral

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JP (1) JP2007501040A (de)
KR (1) KR20060063926A (de)
AU (1) AU2004262960A1 (de)
FR (1) FR2858546B1 (de)
WO (1) WO2005013862A2 (de)
ZA (1) ZA200601010B (de)

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US20110160863A1 (en) 2011-06-30
JP2007501040A (ja) 2007-01-25
KR20060063926A (ko) 2006-06-12
AU2004262960A1 (en) 2005-02-17
US7611538B2 (en) 2009-11-03
US20050033435A1 (en) 2005-02-10
FR2858546A1 (fr) 2005-02-11
WO2005013862A2 (fr) 2005-02-17
US8226721B2 (en) 2012-07-24
FR2858546B1 (fr) 2006-04-28
US20100121454A1 (en) 2010-05-13
US7896919B2 (en) 2011-03-01

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