Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
  • A61B17/17—Guides or aligning means for drills, mills, pins or wires
  • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
  • A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
  • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
  • A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
  • A61B17/17—Guides or aligning means for drills, mills, pins or wires
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
  • A61B17/1613—Component parts
  • A61B17/1615—Drill bits, i.e. rotating tools extending from a handpiece to contact the worked material
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B2017/564—Methods for bone or joint treatment

Definitions

• the invention relates to an instrument and a method for processing a cervical vertebral body for receiving an intervertebral joint prosthesis in the intervertebral space.
• An instrumentation (WO 03/075774 A1) is already known for preparing an intervertebral space for receiving an intervertebral joint prosthesis in which the freedom of movement of a processing instrument is limited by guide surfaces of a fixing and guiding device.
• the fixing and guiding device With the aid of a jus animal instrument inserted between the vertebral bodies, the fixing and guiding device is brought into a position defined relative to the vertebrae and screwed tight to the vertebrae. After removing the adjustment instruments, the intervertebral space can be machined in the frame provided by the fixing and guiding device.
• a disadvantage of this instrumentation is that several preparation steps are required before it can be edited with his help the intervertebral space.
• the described instrument tray is not suitable for processing the ventral area of the vertebral body because the fixing and guiding device fastened to the vertebrae blocks access.
• the invention is based on the object of providing an instrument and a method for processing the ventral area of the vertebral body.
• the solution according to the invention lies in the features of An ⁇ claims.
• the basic idea of the method is that a guide element is positioned in the intervertebral space, which has a guide surface, and that the vertebrae body is machined by means of a processing instrument while it is guided on the guide surface.
• Instrumentation includes a guide element to be inserted into the intervertebral space and a processing instrument for machining at least one vertebral body, which have guide surfaces which act on each other.
• the vertebrae involved are first made accessible from the ventral side and the intervertebral space is freed from the disc. In the space created thereby the tenusseiement invention is used.
• the guide element In the inserted state, the guide element is in contact at various points with the vertebral body surfaces bounding the intervertebral space. Through this contact, the guide element automatically assumes a defined position within the intervertebral space. At the vertebral body areas adjacent surfaces of the guide element act as positioning.
• the guide element is in a position defined for both vertebrae and can be used as a fixed point for the guidance of the processing instrument, with which the vertebral body is processed.
• the guide element comprises guide surfaces which interact with guide surfaces of the processing instrument and on which the processing instrument is guided during the processing.
• the position of the vertebrae in relation to one another is determined in the healthy state by an interaction of the intervertebral disc with ligaments. After removing the intervertebral disc that previously held the vertebrae apart, the ligaments pull the vertebrae toward each other. Their tension holds the guide element located between two vertebrae fixed by clamping. The thickness of the guide element is dimensioned such that this clamping fixation takes place.
• the intervertebral space is made suitable for the outer shape of the prosthesis.
• the instrumentation according to the invention is used after the intervertebral space has been prepared in such a way, and the guide element has an outer shape that corresponds to the prosthesis insofar as both are introduced into the intervertebral space.
• the guide element has a ventro-dorsal depth which is normally not greater than the depth dimension of the part of the prosthesis lying behind the flanges. After the insertion of the guide element into the interproximal space, the guide surface is therefore recessed in the intervertebral space.
• the further processing of the vertebral bodies, carried out with the aid of the guide element can be matched exactly to the later position of the prosthesis. It is not absolutely necessary that the outer shape of the guide element within the intervertebral space completely coincides with the prosthesis shape. Rather, a partial match is sufficient such that the positioning surfaces of the guide element represent parts of the surface shape of the prosthesis.
• the guide surface of the processing instrument is movable relative to the guide surface of the guide element in the lateral direction. Fixed position is then only the position of the processing instrument in the cranio-caudal direction. Perpendicular to this, the machining tool can be moved freely. During the processing, the instrument is guided on the guide surface parallel to the surface to be produced by the machining.
• the guide surface of the processing instrument is preferably a guide pin.
• the processing tool is a roll milling cutter and the guide mandrel is rotatable relative to the guide surfaces of the guide element.
• the processing area of the milling cutter is then set on both sides of the guide surfaces of the guide element by the diameter of the milling cutter. This diameter is preferably between 5 and 10 mm.
• the processing instrument is a hand instrument, such as a cuvette or a rasp.
• the guide surface of the guide element is arranged centrally between the vertebral bodies. So, The vertebral bodies above and below the guide element are simultaneously processed in one operation. However, a one-sided processing is possible if the processing instrument extends only on one side of the guide surface or if the guide surface is arranged eccentrically.
• the instrument set preferably comprises an insertion element to which the handling of the guide element can be attacked.
• the insertion element is further preferably connected before insertion with the guide element and released after insertion of this again.
• the secure hold of the guide element in the intervertebral space is advantageously supported by the surface design of the positioning.
• projections for a mechanical engagement in the surface of the vertebral body can be provided on the positioning surfaces. They prevent a movement of the guide element relative to the vertebral bodies even when forces are exerted on the guide element during machining with the machining instrument.
• the protrusions may be formed, for example, as a toothing, the tooth tips of which are directed towards the vertebrae surfaces, or a roughness may be generated by regular or irregularly distributed smaller protrusions.
• FIG. 1 shows a perspective top view of an intervertebral joint prosthesis
• FIG. 2 shows a sagittal section through an intervertebral joint prosthesis inserted into the intervertebral space
• FIG. 4 shows a guide element according to the invention inserted into the space between the wires
• the intervertebral joint prosthesis 11 shown in FIG. 1 consists of end plates 12 and a prosthesis core 14 and forms a joint for replacing the intervertebral disc.
• Each or at least one end plate 12 has at the ventral edge a flange 13 which rises in the manner of a strip over the surface of the end plate 12 to be connected to the vertebral body.
• the prosthesis should, as shown in the sectional view of FIG. 2, be inserted into an intervertebral space 1 between vertebral bodies 2.
• the flanges 13 are buried in the vertebral bodies 2.
• the instrumentation according to the invention serves for the machining of the vertebral bodies 2 necessary for the countersinking.
• the intervertebral disc is removed.
• the surface of the vertebral bodies need not, but will usually be prepared for the reception of the prosthesis 11.
• the guide element 3 In order that the vertebrae 2 are positioned in the same relation to one another during the processing as is to be expected after insertion of the prosthesis, the guide element 3, as far as it comes into contact with the vertebral bodies 2 in the intervertebral space 3, has one with the prosthesis 11 consistent shape. It is not absolutely necessary that the shape of the guide element 3 corresponds overall to the shape of the prosthesis 11. Rather, it is sufficient if the positioning surfaces forming the surface of the guide element 3 represent corresponding parts of the prosthesis 11 or correspond to them.
• An insertion element 4 is connected for inserting the guide element 3 into the intervertebral space 1 in a suitable manner, not shown.
• the handling of the guiding element 3 connected to the inserting element 4 is attacked.
• the two vertebral bodies 2 are spread in a manner not shown against the tensile force of the ligaments, so that the intervertebral space 1 is sufficiently large for receiving the guide element 3.
• the guide element 3 it is also possible for the guide element 3 to be pressed into the intervertebral space by spreading the vertebral bodies 2. After insertion of the guide element 3 into the intervertebral space 1, the effect
• the secure hold of the guide element 3 is supported by projections 7 on the surface of the guide element, which engage in the surfaces of the vertebral body 2 delimiting the intervertebral space 1.
• the projections 7 can be be formed differently. It may be, for example, a toothing, or it may be generated by smaller Vor ⁇ cracks a roughness.
• the insertion element 4 is released from the guide element 3 located in clamping fixation.
• the guide element 3 is located in the manner shown in FIG. 4 in the intervertebral space 1. Accessible to the surgeon is only a front surface 8 with a groove forming the guide surface 5.
• the guide surface 9a of the milling cutter 10 is here the outer surface of a guide pin 9.
• the processing instrument and a hand instrument such as Rasp or cuvette with a corresponding guide pin 9 be.
• the roller cutter 10 has expediently a diameter between 5 and 10 mm, rotates together with the guide pin 9 and thereby carries material from the vertebral bodies 2 from.
• the guide surface 5 of the guide element 3 is arranged centrally between the vertebral bodies 2, so that both vertebrae 2 are processed simultaneously.
• the milling cutter 10 can be moved in the lateral direction within the guide surface 5, its position in cranio-caudal direction is predetermined by the guide surface 5. Its machining depth in the same direction is determined by its diameter. It is at least equal to the cranio-caudal prosthesis dimension in the flanges.
• Also predefined by the guide surface 5 is the penetration depth of the milling drum into the vertebral bodies 2 in a ventro-dorsal direction. The maximum penetration depth is reached when either the guide mandrel 9 abuts the bottom of the guide surface 5 or the Milling roller on the front surface 8 of the foundedsseiements 3 an ⁇ .
• the guide element 3 is removed again from the intervertebral space 1.
• the guide element 3 is connected to the insertion element 4 and pulled out of the intervertebral space 1.
• the prosthesis 11 can then be inserted.

Landscapes

• Health & Medical Sciences (AREA)
• Surgery (AREA)
• Life Sciences & Earth Sciences (AREA)
• Orthopedic Medicine & Surgery (AREA)
• Biomedical Technology (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Engineering & Computer Science (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Heart & Thoracic Surgery (AREA)
• Medical Informatics (AREA)
• Molecular Biology (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Dentistry (AREA)
• Oral & Maxillofacial Surgery (AREA)
• Prostheses (AREA)
• Surgical Instruments (AREA)

Applications Claiming Priority (2)

Publications (1)

Family

ID=34972276

Family Applications (1)

Country Status (14)

Families Citing this family (20)

Family Cites Families (10)

• 2004
  • 2004-07-23 US US10/897,404 patent/US20060106395A1/en not_active Abandoned
• 2005
  • 2005-07-05 JP JP2007521830A patent/JP2008507306A/ja active Pending
  • 2005-07-05 CN CNA200580024722XA patent/CN1988853A/zh active Pending
  • 2005-07-05 MX MX2007000905A patent/MX2007000905A/es unknown
  • 2005-07-05 WO PCT/EP2005/007253 patent/WO2006010444A1/de active Application Filing
  • 2005-07-05 RU RU2007104965/14A patent/RU2007104965A/ru not_active Application Discontinuation
  • 2005-07-05 EP EP05759147A patent/EP1771116A1/de not_active Withdrawn
  • 2005-07-05 CA CA002573121A patent/CA2573121A1/en not_active Abandoned
  • 2005-07-05 KR KR1020077001526A patent/KR20070046077A/ko not_active Application Discontinuation
  • 2005-07-05 AU AU2005266683A patent/AU2005266683A1/en not_active Abandoned
  • 2005-07-05 BR BRPI0513749-7A patent/BRPI0513749A/pt not_active Application Discontinuation
  • 2005-07-13 AR ARP050102911A patent/AR054670A1/es not_active Application Discontinuation
• 2006
  • 2006-12-26 IL IL180369A patent/IL180369A0/en unknown
• 2007
  • 2007-02-16 ZA ZA200701387A patent/ZA200701387B/en unknown

Non-Patent Citations (1)

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