EP3200729A1 - Zwischenwirbelfusionskäfig mit verstellbarem deckel und zugehöriges herstellungsverfahren - Google Patents

Zwischenwirbelfusionskäfig mit verstellbarem deckel und zugehöriges herstellungsverfahren

Info

Publication number
EP3200729A1
EP3200729A1 EP15784079.4A EP15784079A EP3200729A1 EP 3200729 A1 EP3200729 A1 EP 3200729A1 EP 15784079 A EP15784079 A EP 15784079A EP 3200729 A1 EP3200729 A1 EP 3200729A1
Authority
EP
European Patent Office
Prior art keywords
cage
expansion cover
inclination
axis
vertebral body
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Withdrawn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
EP15784079.4A
Other languages
English (en)
French (fr)
Inventor
Pierre Dominique RICHERME
Christophe TAMBURINI
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.)
Yellowsteps
Original Assignee
Yellowsteps
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 Yellowsteps filed Critical Yellowsteps
Publication of EP3200729A1 publication Critical patent/EP3200729A1/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Withdrawn legal-status Critical Current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
    • 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
    • A—HUMAN NECESSITIES
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    • 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
    • A61F2/3094—Designing or manufacturing processes
    • 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
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30261—Three-dimensional shapes parallelepipedal
    • A61F2002/30266—Three-dimensional shapes parallelepipedal wedge-shaped parallelepipeds
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30405—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves
    • 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
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    • 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
    • A61F2002/30405—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves
    • A61F2002/30411—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves having two threaded end parts connected by a threaded central part with opposite threads at its opposite ends, i.e. for adjusting the distance between both end parts by rotating the central part
    • A—HUMAN NECESSITIES
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    • 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
    • A61F2002/30471—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements connected by a hinged linkage mechanism, e.g. of the single-bar or multi-bar linkage type
    • 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
    • A61F2002/30476—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
    • A61F2002/30515—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism using a locking wedge or block
    • 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
    • A61F2002/30537—Special structural features of bone or joint prostheses not otherwise provided for adjustable
    • A61F2002/30538—Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting angular orientation
    • A—HUMAN NECESSITIES
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    • 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
    • A61F2002/30579—Special structural features of bone or joint prostheses not otherwise provided for with mechanically expandable devices, e.g. fixation devices
    • 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
    • A61F2002/30593—Special structural features of bone or joint prostheses not otherwise provided for hollow
    • 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
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A—HUMAN NECESSITIES
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    • 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
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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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    • A61F2002/3093—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth for promoting ingrowth of bone tissue
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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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    • 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 the technical field of surgical implants intended to be implanted in the body of a patient, and in particular in one of the intersomatic spaces of the spine.
  • a cage body comprising a bearing surface intended to be positioned in abutment with the first vertebral body
  • a means for controlling the inclination of the expansion cover capable of holding the expansion cover in a desired inclination of the inclination stroke.
  • the present invention also relates to a method of manufacturing an expandable interbody cage for implantation between a first vertebral body and a second vertebral body of a patient, the method comprising a step in which:
  • a cage body comprising a bearing surface intended to be positioned in abutment against the first vertebral body, an expansion cover is made comprising a bearing element against the second vertebral body,
  • the expansion cover is mounted on the cage body via a connecting element, so that the expansion cover can rotate in a tilting stroke around a tilting axis. relative to the support surface, a means is provided for controlling the inclination of the expansion cover capable of holding the expansion cover in a desired inclination of the inclination stroke.
  • intersomatic cages These are hollow implants intended to accommodate an osteoinductive material, such as a bone graft.
  • Such cages are intended to be implanted surgically in the vertebral intersomatic space of a patient, after an adequate preparation of the latter, for example to restore an unbalanced disc height for the correction of a lordosis which suffers the patient.
  • Another object assigned to the invention is to propose a new interbody cage and a new method of manufacturing an interbody cage, the placement of which in the body of a patient is weakly invasive.
  • an expansion cover comprising a support element against the second vertebral body, and mounted on the cage body via a connecting element so as to be able to pivot in a tilting stroke around an axis of inclination with respect to the bearing surface,
  • said cage being characterized in that said cage body comprises at least one orifice of fixation forming an oblique well adapted to receive and guide from outside said cage means for fixing the cage to the first vertebral body and / or the second vertebral body.
  • a cage body comprising a bearing surface intended to be positioned in abutment against the first vertebral body, an expansion cover is made comprising a bearing element against the second vertebral body,
  • the expansion cover is mounted on the cage body via a connecting element, so that the expansion cover can rotate in a tilting stroke around a tilting axis. relative to the support surface,
  • a means for controlling the inclination of the expansion cover adapted to hold the expansion cover in a desired inclination of the inclination stroke, said method being characterized in that it also comprises a step during said cage body is provided with at least one fastening aperture forming an oblique well adapted to receive and guide from the outside of said cage a means for fixing the cage to the first vertebral body and / or to the second vertebral body.
  • FIG. 4 illustrates, in an exploded perspective view, the intersomatic cage of Figures 1 and 2 and various elements that it comprises.
  • FIG. 7 illustrates, in a perspective view, the cage body of FIGS. 5 and 6, according to an embodiment in which the support walls and facades and a lateral wall are provided with a plurality of pores and or windows.
  • FIGS. 13 and 14 illustrate, in a perspective view, the cage of FIGS. 11 and 12, respectively in position of minimum inclination (FIG. 13) and maximum position (FIG. 14), so as to particularly highlight the configuration of the secondary fixing hole allowing passage of a fastening means through the expansion cover.
  • expandable interbody cage 1 Examples of expandable interbody cage 1 according to the invention are shown in Figures 1 to 14.
  • said cage 1 When said cage 1 is implanted in the body of a patient at the spine of the latter, it allows in particular to treat different types of pathologies related for example to an incorrect vertebral body orientation of the spine relative to each other, such pathologies being of the genus lordosis, scoliosis, kyphosis, or vertebral compression.
  • the patient designated by the invention is preferably a human being, it being understood that nothing prevents the introduction and fixation of said cage of the invention in the body of an animal to treat similar veterinary pathologies. to the human pathologies described above.
  • the expandable interbody cage 1 of the invention is intended to be implanted between a first vertebral body 4 and a second vertebral body 5, and in particular between the vertebral end plates of the latter, so that said cage 1 occupies all or part of the intersomatic space separating said vertebral bodies.
  • the first vertebral body 4 and the second vertebral body 5 thus being separated by the cage 1, the latter advantageously makes it possible to position them relative to each other, or at least to orient them relative to each other. another, one of said vertebral bodies resting on the other through said cage 1, which forms a wedge.
  • the first vertebral body 4 and the second vertebral body 5 may for example form vertebrae, lumbar, and / or cervical, that is to say, advantageously, bone and / or cartilaginous bodies of the patient's spine.
  • the cage 1 is preferably implantable inside the body of the patient, between the first vertebral body 4 and the second vertebral body 5, during a surgical operation, performed for example under anesthesia.
  • the intersomatic space intended to accommodate the cage 1 is advantageously prepared accordingly, certain body elements, such as for example the intervertebral disk, being for example removed.
  • the intersomatic cage 1 is intended to be inserted and placed inside the body of the patient by the lateral route, that is to say by the side of the patient, its shape and the disposition of its components being adapted to such an insertion mode.
  • An insertion of the cage 1 laterally, advantageously in a direction of insertion substantially orthogonal to the plane of extension of the spinous processes 4A, 5A, which corresponds substantially to the anatomical sagittal plane, as is particularly visible in Figures 15 and 16 advantageously makes it possible to position said cage 1 between the first vertebral body 4 and the second vertebral body 5 by making an incision of particularly small size in the tissues of said patient, while avoiding conflicts with the nerves and the vessels attached to said vertebral bodies.
  • the approach is at the level of the psoas.
  • the placement of the cage in the body of the patient is preferably carried out using a dilatator tube and / or a distractor in minimally invasive surgery.
  • a dilatator tube and / or a distractor in minimally invasive surgery.
  • other methods of setting up the cage 1 may be considered, the shape and design of said cage 1 being adapted in consequence without departing from the scope of the invention.
  • the cage 1 can be introduced into the body of the patient by first anterior or posterior.
  • the cage 1 of the invention comprises three main parts described above. after, namely a cage body 2, an expansion cover 3 or adjustable pivotally mounted on the cage body 2, and a control means 16 of the inclination of the expansion cover 3 relative to the cage body 2 ,
  • the cage body 2 constitutes the element of the cage 1 through which said cage 1 is intended to rest on the first vertebral body 4, and in particular against the vertebral plate thereof.
  • the cage body 2 forms a lower part of the cage 1, the first vertebral body 4 being placed below the second vertebral body 5, as illustrated in FIGS. 1, 2 and 16.
  • the first vertebral body 4 may instead be placed above the second vertebral body 5 (which is not illustrated).
  • the cage body 2 is placed so as to form the lower part of the cage 1.
  • said cage body 2 comprises, as introduced above, a bottom plate 6, the latter being provided with at least one primary through hole 44 through which said means fixation 43 introduced by the fixing orifice 41 may open so as to fix, or at least to contribute to fix, said cage body 2 to the first vertebral body 4. You! illustrated in particular in FIGS.
  • said oblique wells 42 and primary through hole 44 are advantageously designed, oriented and positioned relative to each other, so that said fastening means 43 is inserted from the outside of the cage 1 in said oblique well 42 of the fixing orifice 41, the primary through hole 44 is on the natural trajectory, that is to say that induced by the conformation and the inclination of the inner wall of said oblique well 42, of said fastening means 43.
  • the latter preferably of wing screw type, will advantageously be chosen of a length sufficient for its head 46 being housed in oblique well 42, a portion of its length opens out of the through hole primary 44 formed in bottom plate 6 of the cage body 2 so as to be anchored by screwing in the first vertebral body 4, for example in the cortex or in the spongy bone of this vertebral body 4.
  • Lesdi Said fixing orifices 41 and / or fixing means 43 can moreover be advantageously shaped or designed to be self-retentive in order to guarantee the durability of the holding of the cage 1 in the intersomatic space.
  • Such a fixing of the cage body 2 thus contributes to ensuring the good stability of the cage 1 between the vertebrae.
  • the fixing orifice 41 is optionally adapted to allow the connection of a means of introduction and delivery of osteoinductive material, through said fixing orifice 41, inside the cage 1. , the surgeon may, as desired, successively use said fixing orifice 41 to introduce osteoinductive material in cage 1 and then to guide a fixing means 43, or to use the fixing hole 41 only for the introduction of osteoinductive material, without implementing fixing means 43 or, conversely, solely to guide a fixing means 43.
  • FIG. 3 represents a first example of an expansion cover 3 according to the invention, and belonging to the cage 1 of FIGS. 1, 2 and 4.
  • FIGS. 9 to 14 show a second example of embodiment, in connection with and with the cage 1 of Figures 5 to 8.
  • the extension cover 3 is preferably in the form of a single piece. H could, however, perfectly understand several separate extension cover members 3.
  • the expansion cover 3 is mounted on the cage body 2 by means of a connecting element 12, 13, so as to be able to pivot in a tilting stroke about an axis d inclination XX 'with respect to the bearing surface 6A.
  • the expansion lid 3 is thus preferably rotatably mounted on the cage body 2 opposite the bearing surface 6A and the bottom plate 6, in a swinging manner about the axis of inclination X- X ', in particular for closing the access opening 8 in the manner of a swinging door.
  • the connecting element 12, 13 advantageously forms a pivot connection around the X-X 'inclination axis, connecting the expansion lid to the cage body 2.
  • the expansion lid 3 forms preferentially the upper part of the cage 1, which can be oriented around the inclination axis XX 'continuously.
  • the expansion cover 3 forms a cover plate of generally rectangular shape and defined by a cover edge 40.
  • the lid edge 40 comprises in particular on the one hand a first edge connected to the cage body 2 by means of the connecting element 12, 13 so as to be able to pivot, preferably freely, and a free edge flapping opposite said connected edge.
  • the connecting element 12, 13 thus preferably extends along said lid edge 40, but could alternatively extend in a middle portion of the lid (not shown) without departing from the scope of the invention.
  • the cage body 2, and in particular the outer casing 7, advantageously comprises a longitudinal support wall 9, that is to say extending in the longitudinal direction of the outer casing 7 of generally parallelepipedal shape, and which advantageously forms one of the aforementioned walls 9, 10, 11, said longitudinal support wall 9 protruding from the bottom plate 6 to a support edge 14, the expansion cover 3 being mounted on said support wall 9 of the cage body 2 via the connecting element 12, 13, in the vicinity of the support edge 14.
  • the support wall 9 preferably forms a substantially flat wall, for example substantially perpendicular to the bottom plate 6, and preferably extending from the bottom plate 6 to the inclination axis X-X ', along which the support edge 14 and the element extends. 12, 13.
  • the expansion cover 3 of the invention comprises a bearing element 3A against the second vertebral body 5, that is to say that the second vertebral body 5 is intended to rest on said lid 3 via the support element 3A.
  • the support element 3A is for example formed by an upper surface 3A of the cover plate forming the expansion cover 3.
  • the support element 3A can, however, be formed for example by an edge of the expansion cover 3, or by an additional non-illustrated part attached to the cover 3 without departing from the scope of the invention.
  • the outer casing 7 also forms at least a first transverse wall 11 connecting the front wall 10 to the support wall 9, and projecting from the bottom plate 6.
  • the outer casing 7 may also comprise a second wall transverse 1 1 disposed opposite the first transverse wall 1 1, for example parallel to the latter.
  • the hollow space E is formed between the first transverse wall 11, the front wall 10, the support wall 9 and the bottom plate 6, and optionally the second transverse wall 11.
  • Figures 1-2, 9-10, 11-12 and 13-14 show examples of different inclinations that can be adopted by the expansion cover 3.
  • the cage 1 is thus more or less extended, which allows in particular to influence the relative positioning, and / or relative orientation, of the first vertebral body 4 relative to the second vertebral body 5 which are supported one on the other via said cage 1.
  • the inclination stroke of the expansion cover 3 relative to the bearing surface 6A extends between:
  • a minimum inclination of said expansion cover 3 (as illustrated for example in FIG. 1) in which the support element 3A, and in particular the expansion cover 3, is at a distance minimum of the bearing surface 6A
  • a maximum inclination of said expansion cover 3 (as illustrated for example in FIG. 2) in which the support element 3A is at a maximum distance from the bearing surface 6A
  • the expansion cover 3 In its minimum inclination, the expansion cover 3, and in particular its free edge, is as close as possible to the cage body 2, and in particular to the bearing surface 6A.
  • the space occupied by the cage 1 in this situation is thus minimal, so that said cage 1 is in a compact configuration allowing it, for example, to be introduced with ease into the body of the patient, and in particular into the intersomatic space referred.
  • the minimum inclination of the expansion cover 3 corresponds to a situation in which said expansion cover, and / or the support element 3A, extends in a plane substantially parallel to the bearing surface 6A, and or at the bottom plate 6, as is the case in the example of FIG. 1.
  • the minimum inclination may correspond to a situation in which said expansion cover, and / or the support element 3A, are not parallel to the bearing surface 6A, and / or to the support plate. 6.
  • the correction of the relative position of said vertebral bodies provided by said cage 1 is also minimal.
  • the expansion cover 3 abuts against the abutment edge 15 of the front wall 0 when it is in its minimum inclination so that the inclination stroke of the expansion cover 3 is limited by the abutment edge 15.
  • the abutment edge 15 advantageously makes it possible to form a limit of the inclination of the expansion cap 3.
  • the expansion cap 3 thus preferably comes, in this situation, to close and cover all or part of the access opening 8.
  • the expansion cover 3 is preferably folded, or even retracted, against the cage body 2.
  • the inclination end of the expansion cover 3 can alternatively, of course, be intrinsically formed in the connecting element 12, 13, or by other walls 9, 10, 11, or other elements of the cage body 2.
  • the expansion cover 3 can also be opened, preferably substantially freely, to its maximum inclination, so that said expansion cover 3, and / or the support member 3A can be tilted at an angle d inclination ranged from about 0 ° (minimum inclination) to 30 ° (maximum inclination) with respect to the surface 6A support or the bottom plate 6, around Tilt Tax X-X '.
  • the expansion cover 3 is thus at a maximum distance from the bearing surface 6A and / or the bottom plate 6, so that the cage 1 is in an extended configuration, and has a bulk maximum.
  • the orientation and / or the positioning of the first vertebral body 4 vis-à-vis the second vertebral body 5 is modified relatively importantly, which allows to create, or on the contrary to mitigate, lordosis, kyphosis or scoliosis of the patient's spine.
  • said vertebral bodies 4, 5, and in particular their respective vertebral trays rest on the support surface 6A and on the support element 3A, so that they adopt the imposed inclination by the cage 1, and in particular that of its expansion cover 3.
  • said expansion cover 3 is, like the bottom plate 6 described above, provided with at least one secondary through hole 45 through which a fixing means 43 introduced by a fixing hole 41 the cage body 2 can open in such a way as to fix, or at least to contribute to fixing, said cage body 2 to the second vertebral body 5.
  • This secondary through hole 45 is advantageously configured so as to allow the passage of said fixing means 43 irrespective of the angle of inclination of the expansion cover 3 with respect to the bearing surface 6A.
  • said oblique wells 42 and secondary through hole 45 are advantageously designed, oriented and positioned relative to each other, so that said fastening means 43 is inserted from outside the cage 1 into said oblique well 42 of the fixing hole 41, the secondary through hole 45 is in the natural trajectory, that is to say the one induced by the conformation and the inclination of the inner wall of said oblique well 42, of said fixing means 43.
  • said secondary through hole 45 of circular or oblong shape, for example, is shaped and dimensioned so that the fixing means 43 can pass through secondary through hole 45 without interfering with the expansion cover 3, and this whatever the inclination of the latter.
  • the secondary through hole 45 is advantageously oblong and extends longitudinally along a length L, parallel to the axis of inclination X-X ' t and transversely to a width I.
  • These dimensions I and L are advantageously chosen in accordance with the above, so that the secondary through hole 45 is maintained on the path of said means of 43 and that the latter can be implemented through the secondary through hole 45 regardless of the angle of inclination chosen by the surgeon of the expansion cover 3 relative to the bearing surface 6A.
  • said cage body 2 comprises at least two fixing orifices 41 respectively forming an oblique well 42, one of said fixing orifices 41 being intended to receive and guide from outside said cage 1 a fixing means 43, for example a screw, from the cage 1 to the first vertebral body 4 through the primary through hole 44 which is provided with the bottom plate 6, and the other orifice fixing means 41 being for its part intended to receive and guide from the outside of said cage 1 a fixing means 43 of the cage 1 to the second vertebral body 5 through the secondary through hole 45 which is provided with the cover of 3.
  • a fixing means 43 for example a screw
  • the intersomatic cage 1 also comprises a control means 16 for the inclination of the expansion cover 3 adapted to maintain the expansion cover 3 in a desired inclination of the inclination stroke, an exemplary embodiment of which is particularly visible in FIG. 4, in an exploded view.
  • the control means 16 allows both:
  • the control means 16 is preferably accessible to the surgeon when the cage 1 is in place in the intersomatic space, so that the latter can adjust the inclination of the expansion cover 3 after placement.
  • the control means 16 comprises an interaction head with a tool 47, of the screw head type 18, which appears in an orifice formed in the first transverse wall 11 of the cage 1, said transverse wall 11 facing the surgeon when said cage 1 is in place in the body of the patient.
  • the cage 1 when the cage 1 is implanted between the first vertebral body 4 and the second vertebral body 5, it undergoes from the latter forces counteracting compressive forces, which are received by upper and lower ends of said cage, formed in this case by the bearing surface 6A and by the support element 3A, and transmitted to the walls 9, 10, 1 1, and the control means 16, which absorb said compressive antagonistic forces so as to maintain said vertebral bodies 4 and 5 in position.
  • the control means 16 for adjusting the inclination of the expansion cover 3, the cage 1 allows a setting up of the cage accurately, reliably, and modifiable to treat a pathology satisfactorily.
  • the cage 1 is introduced into the body of the patient by the surgeon at minimum inclination, and is placed in the intersomatic space in this configuration.
  • the surgeon can then advantageously vary the inclination of the expansion cover 3 through the control means 16 in order to apply to the patient's spine the desired angular correction, or the desired positional correction.
  • control means 16 which could, as such, be protected.
  • the control means 16 advantageously comprises at least a first control screw 17 of the inclination of the expansion cover 3 actuable by a surgeon, and having a screwing axis YY ! clean.
  • the first screw of control 17 is advantageously provided with a screw head 18 through which said screw 17 can be rotated about its screw axis YY 'by the surgeon from outside the cage 1.
  • the control means 16 can be produced according to two main variants, one in which the screw head 18 is preferably accessible from one of the walls 9, 10, 1 1 of the cage body 2 (as illustrated, for example in Figures 1 and 2), and the other in which the screw head 18 is accessible from the edge of the lid 3 (not shown). Consequently, the first control screw 17 is preferably rotatably mounted about its screw axis YY 'either on the cage body 2 or on the expansion cover 3.
  • the first control screw 17 is mounted with free rotation on the cage body 2 by means of rotation orifices 19 passing through the first transverse wall 1 and / or the second transverse wall 11, so that at least one of said transverse walls 1 supports the first
  • the control screw 7 advantageously comprises one or more non-threaded portions through which it is mounted in the rotation orifices 19, so that said first control screw 17 does not advance along its length.
  • the cage body 2 or the expansion cover 3 may comprise an intermediate support cradle 23 of the first rotation control screw 17, making it possible to hold said first control screw 17 on a portion intermediate or central of the latter, while allowing its rotation.
  • the first control screw 17 preferably comprises at least a first thread 20 around the screw axis YY 'so that the rotation of the screw 17 about its axis YY' causes a forward movement of the first thread. 20 with respect to the cage body 2 if said first control screw 17 is mounted on the latter, or with respect to the expansion cover 3 if said first control screw 17 is mounted on the latter.
  • the control means 16 also preferably comprises a first transmission means for transforming the advance movement of the first thread 20 in a tilting movement of the expansion cover 3 with respect to the cage body 2.
  • a first transmission means for transforming the advance movement of the first thread 20 in a tilting movement of the expansion cover 3 with respect to the cage body 2.
  • the first transmission means comprises at least a first mobile 24 which comprises a threaded orifice 26 through which it is mounted on the first control screw 1.
  • the first thread 20 thus cooperates preferably with the threaded orifice 26 so as to transmit its advance movement to the first mobile 24 along the screw axis YY '.
  • the first mobile 24 evolves within the hollow space E.
  • the first transmission means also preferably comprises a first rotational locking means around the screw axis YY 'of the first mobile 24, so that the latter moves along the screw axis YY' under the action the rotation of the first control screw 17 around the latter.
  • the locking means will block the rotation around the screw axis YY 'of the first mobile 24 relative to said cage body 2.
  • the locking means is advantageously formed by an inner guide rail of the hollow space E, formed for example by the front wall 10, and / or a central rib 27, and / or the bottom plate 6 (in the case shown in Figure 4, as well as in Figure 8).
  • another of the walls 9, 10, 11 may also or alternatively contribute to form the guide rail.
  • the biocage means will block the rotation about the screw axis YY 'of the first mobile 24 relative to said expansion cover 3.
  • the blocking means will for example be formed by a window 30 of the cover whose edges form a guide rail and rotational locking of the first mobile 24.
  • the first mobile 24 is preferably in contact respectively:
  • the rotation of the first control screw 17 advantageously drives the displacement of the first mobile 24 according to the forward movement of the first thread 20, so that said first mobile 24 comes:
  • the first mobile 24 being mounted on the first thread 20, i! can advantageously be displaced by compression of the expansion cover 3 against the cage body 2, so that the control means 16 holds the expansion cover 3 in its inclination against the compression forces exerted by the vertebral bodies 4 , 5.
  • the first mobile 24 comprises a first deflection surface 31, for example inclined with respect to the screw axis Y-Y ', the first transmission means comprising at least one first deflection element 28, for example inclined with respect to the inclination axis XX 'at a close or reciprocal angle to that of the deflection surface 31.
  • the first deflection element 28 is preferably solidary respectively: either of the expansion cover 3, in the preferred case where the first control screw 17 is mounted on the cage body 2,
  • the first control screw 17 drives the inclination of the expansion cover 3, the first deflection member 28 and the first deflection surface 31 mutually in sliding contact, so that said first deflection element 28 is driven by the first deflection surface 31, during the translation of the first mobile 24, in a displacement having at least one non-zero displacement component along an axis ZZ 'oriented so circular, that is to say ortho-radial, relative to the screw axis YY '.
  • the complementary and reciprocal forms of the first deflection element 28 and of the deflection surface 31 advantageously make it possible to convert the orientation of the advance movement of the first mobile 24 into a movement of opening of the cover expansion 3, that is to say increasing its inclination.
  • the first deflection element 28 has a component of displacement zero along the screw axis YY ', so that substantially all the advance movement of the first threading 20 is advantageously returned radially with respect to the axis YY 'to allow opening of the expansion cover 3 with maximum mechanical efficiency.
  • the conformation of the first deflection element 28 and the first deflection surface 31 will be adapted accordingly, in particular according to the arrangement of the inclination axis X-X 'with respect to the screw axis Y-Y'.
  • the first control screw 17 is rotatably mounted on the transverse wall 1 1 of the cage body 2.
  • said first screw 17, irrespective of its place of assembly, is mounted so that the screw axis YY 'is substantially parallel to the inclination axis XX' of the expansion cover 3, which allows the access to the screw head 18 from the side of the cage 1, preferably through one of the rotation orifices 19, so that the latter is accessible by the surgeon during a insertion by lateral approach, the cage 1 is thus particularly easy to implement and adjust.
  • said at least one fixing orifice 41 is, as illustrated in the figures, preferentially formed in said transverse wall 1 of the cage body 2, so as to be also accessible by the surgeon during insertion by means of a lateral approach so that the latter can insert a means of attachment 43 of the cage 1 to the first vertebral body 4 and / or the second vertebral body 5.
  • the first control screw 17 comprises a second thread 21 around the screw axis Y-Y ', the pitch of which is preferentially inverted with respect to the first thread 20, the rotation of the first control screw 17 around its screw axis YY 'causing an advance movement of the second thread 21.
  • this advance movement can thus s' perform, according to the direction of the pitch, in a direction opposite to that of the first thread 20.
  • control means 16 comprises a second transmission means making it possible to transform the advance movement of the second thread 21 into a tilting movement of the expansion cover 3 with respect to the cage body 2, by intermediate of a second mobile 25, so that the first thread 20 and the second thread 21 contribute in pair to the control of the inclination of the expansion cover 3 during the rotation of the first control screw 17.
  • the action of the second mobile 25 on the inclination of the expansion lid 3 is preferably similar to that of the first mobile 24, and is advantageously reciprocal in the advantageous case where the pitch of the second thread 21 is reversed compared to that of the first 20.
  • a second deflection element 29 and a second deflection surface 32 are provided accordingly, and of similar design respectively to the first deflection element 28 and to the first deflection surface 31.
  • the first deflection element 28 and the second deflection element 29 are arranged head to tail on an inner face 33 of the expansion cover 3, so as to project from the latter, said inner face 33 being turned towards the the hollow space E.
  • the first deflection surface 31 and the second deflection surface 32 are arranged head-to-tail along the first control screw 17. This head-to-tail assembly advantageously makes it possible to cancel the forces in the direction of the screwing pin YY 'communicated by the mobiles 24, 25 to the expansion cover 3 (or respectively to the cage body 2).
  • a second control screw may be provided, preferably rotatably mounted via rotation orifices 9 of the cage body 2, and arranged for example so that its screw axis is parallel to the screw axis YY 'of the first control screw 17.
  • a second or similar transmission means will then advantageously be provided for transforming the rotation of the second screw into an inclination of the expansion cover 3.
  • FIGS. 1 to 14 The description will now relate in more detail to the connecting element 12, 3, which may also be protected as such.
  • the details of an exemplary embodiment of a link 12, 13 according to the invention appear in FIGS. 1 to 14.
  • the cage 1 comprises a hinge forming the connecting element 12, 13, and through which the expansion cover 3 is pivotally mounted about the inclination axis XX 'on the body of the cage 2.
  • the hinge is advantageously formed on the one hand by a first hinge element 12, which optionally is made of material with the cage body 2, and on the other hand by a second hinge element 13, which optionally comes of material
  • the first hinge element 12 and the second hinge element 13 are designed to cooperate with one another in order to form the hinge, and in particular to be rotatable. relative to one another around the inclination axis X-X ', while ensuring the solidarity of the expansion cover 3 and the cage body 2.
  • first hinge element 12 and the second hinge element 13 form to they alone said hinge, without it being necessary to implement a blocking element, for example of hinge type, of said first and second hinge elements 12, 13.
  • the connecting element 12, 13 may alternatively be formed by an independent part, such as a metal or plastic axis, which is an insert and which provides the connecting and pivoting the expansion cover 3 with the cage body 2.
  • the first hinge element 12 comprises a rectilinear groove 34 formed in the cage body 2 and extending along the axis of inclination X-X ', the rectilinear groove 34 comprising a retaining rim 35 extending along the axis of inclination XX 'over at least a portion of the length of the straight groove 34, preferably over its entire length.
  • the rectilinear groove 34 and its retaining rim 35 thus form an inner chamber of preferentially cylindrical shape, along which is formed a longitudinal opening defined by the retaining flange 35, the longitudinal opening being thinner than the diameter of said chamber cylindrical.
  • the longitudinal opening, as well as optionally the retaining flange 35 extends over substantially the entire length of said rectilinear groove 34, or at least the majority of the latter.
  • the second hinge element 13 comprises a rotation rod 36 having a proper longitudinal axis, which is preferably substantially cylindrical over at least a majority of its circumference.
  • the rotation rod 36 is engaged in the rectilinear groove 34 so that said proper longitudinal axis of the rotation rod 36 is substantially coaxial with the axis of inclination X -X '.
  • the rectilinear groove 34 is preferably shaped so that the rotation rod 36 can rotate about said inclination axis XX 'with respect to the first hinge element 12, the retaining rim 35 making it possible to retain the rod of FIG. rotation 36 within the rectilinear groove 34.
  • the respective shapes of the rotation rod 36 and the straight groove 34 allow the rod to be trapped in the straight groove 34 while being rotatable about the axis of inclination X-X ', which advantageously makes it possible to avoid any translation of the expansion cover 3 relative to the cage body 2 along the axis of inclination X-X', for example, under the effect of vibrations or stresses mechanical forces related to the compression force exerted on the cage 1 by the first and second vertebral bodies 4, 5.
  • the second hinge element 13 comprises an attachment lug 37 of the rotation rod 36 to the expansion lid 3, said fixing lug 37 extending from the expansion lid 3 to the rod of rotation 36 over at least the majority of the length of the rotating rod 36.
  • the fixing lug 37 is thus designed to secure and maintain at a distance the rotation rod 36 of the expansion lid 3.
  • the fixing lug 37 connects the edge of the expansion cover 3 to the rotation rod 36.
  • the upper surface 3A of the cover is advantageously extended by the bracket 37 as is particularly visible in Figure 3.
  • the upper surface 3A of the cage 1 is thus advantageously devoid of protruding ridge and therefore adapts particularly well to the shape of the second vertebral body 5.
  • the fixing lug 37 is preferably of a thickness less than the width of the longitudinal opening of the rectilinear groove 34.
  • the fixing lug 37 preferably circulates from one edge to the other of the longitudinal opening of the throat rectilinear 34 depending on the inclination adopted by the expansion cover 3 relative to the cage body 2.
  • the straight groove 34 and the fixing lug 37 extend substantially over the entire length of the hinge, from one end to the other of the latter.
  • the fixing lug 37 may possibly abut against the retaining flange 35 in order to define the maximum and / or minimum inclination of the expansion lid 3.
  • the expansion lid 3 preferably comprises at least one window 30, or more, formed in the latter so as to pass through from one side to the other, so as to allow the introduction of osteoinductive material (for example a bone graft ) through said window 30, inside the cage 1, and in particular in the hollow space E.
  • the window or windows 30 may for example be oblong. As described above, such windows 30 may also advantageously participate in forming the control means 16 of the opening of the expansion cover 3, serving in particular as means for guiding in translation of movables 24, 25 placed inside. hollow space E.
  • the mobiles 24, 25 may advantageously make it possible to compress or tamp the osteoinductive material within the hollow space E.
  • said window 30, or one of these windows 30, may advantageously be merged with the secondary through hole 45 through which said fixing means 43 introduced by the fixing orifice 41 can unclogging so as to fix said expansion cover 3 to the second vertebral body 5.
  • it may of course be completely separate from the secondary through hole 45 without departing from the scope of the invention.
  • the bottom plate 6 and / or one and / or the other of the walls 9, 10, 1 1 comprise a plurality of pores 48 which pass right through them, the passage section of said pores presenting a characteristic quantity of between 0.01 mm and 5 mm.
  • the characteristic size of the passage section forms, for example, its diameter, its smallest width, or its largest width.
  • Such pores 48 may advantageously be produced by an additive manufacturing method, for example a three-dimensional printing, or a laser melting, and preferably measure between 0.05 and 0.03 mm.
  • conventional machining means may be used for the production of said pores 48, which will therefore be wider, and will measure for example between 0.5 and 5 mm.
  • the pores 48 may advantageously form through channels, for example honeycomb.
  • said bottom plate 6 and / or the support wall 9 and / or the front wall 10 and / or transverse wall! 1 1 may also be provided, in addition to said pores 48 and for the same purposes, through windows 30 ( Figures 5 to 7, 9 and 10) or only be provided with said windows 30, excluding said pores 48 ( Figures 8, 13 and 14).
  • the bottom plate 6 preferably comprises an inner surface 38 opposite to the bearing surface 6A, an osteoinductive material being intended to be mounted in the hollow space E on said inner surface 38, so that a bone fusion between the first vertebral body 4 and the osteoinductive material via the pores 48 of the said bottom plate 6.
  • the cage body 2 can be fixed to the first vertebral body 4 by means of the osteoinductive material. , which is less invasive, for example a fastening by screwing.
  • pores 48 may be formed in the expansion cover 3 so that it can be similarly fixed to the second vertebral body 5 via osteoinductive material.
  • the upper surface 3A and the support surface 6A may advantageously be rough to allow retention of the cage 1 by roughness adhesion, under the effect in particular of the compressive forces of the vertebral bodies 4, 5 against the cage 1.
  • the cage body 2 and the expansion lid 3 are each made in one piece, for example by machining blanks, or by additive manufacturing processes.
  • the expansion cover 3 and, optionally, the cage body 2 may alternatively be each made of several parts.
  • an opening of the body of the patient is effected by lateral approach leading to the intersomatic space between the first vertebral body 4 and the second vertebral body 5,
  • the intersomatic space is prepared to receive the cage 1,
  • an osteoinductive material is introduced into the hollow space of the cage 1 via the windows 30 and / or the fixing orifice 41,
  • the cage 1 is introduced into the intersomatic space, the expansion lid 3 of the latter being in its minimum inclination, preferentially by the lateral route, and even more preferably so that the inclination axis XX 'of the expansion cover 3 with respect to the bearing surface 6A is orthogonal to the plane of extension of the spinous processes 4A, 5A of the first and second vertebral bodies 4, 5, which plane substantially corresponds to the anatomical sagittal plane,
  • Gage 1 is fixed by means of at least one attachment means 43 inserted from outside of said cage 1 into a fixing orifice 40, so as to fix the cage 1 to the first vertebral body 4 and / or the second vertebral body 5, as illustrated for example in FIG.
  • the surgeon operates, for example, the preceding steps in reverse.
  • the invention relates as te! a method of manufacturing an expandable interbody cage 1 intended to be implanted between a first vertebral body 4 and a second vertebral body 5 of a patient, said cage 1 preferably being in accordance with the foregoing description.
  • the method of the invention comprises a step during which a cage body 2 is produced, comprising a bearing surface 6A intended to be positioned in abutment against the first vertebral body 4, and a step during which one carries out an expansion cover 3 comprising a support element 3A against the second vertebral body 5.
  • the method of the invention also comprises a step during which the expansion cover 3 is mounted on the cage body 2 by means of a connecting element 12, 13, so that the cover 3 can pivot in a tilt stroke about a tilt axis XX 'with respect to the bearing surface 6A, the tilt stroke preferably extending between:
  • the connecting element 12, 13 is in accordance with that described above.
  • the method advantageously comprises, preferably prior to the assembly of the expansion cover 3 on the cage body 2, the following steps: on the one hand, a first hinge element 12 made of material with the cage body 2 is produced, the first hinge element 12 advantageously comprising a rectilinear groove 34 formed in the cage body 2 and extending along the tilting axis XX ⁇ the rectilinear groove 34 extending between two groove ends 39 at least one of which is open.
  • a second hinge element 13 is made from material with the expansion cover 3, the second hinge element 13 advantageously comprising a rotation rod 36 having a proper longitudinal axis.
  • the step of assembling the expansion cover 3 with the cage body 2 may preferably be carried out by assembling the first hinge element 12 with the second hinge element 13 in order to form a hinge forming the connecting element 12 13.
  • the second hinge element 13 is preferably engaged on the first hinge element 12 by threading the rotation rod 36 into the straight groove 34 via the opening groove end 39 and making sliding said rotation rod 36 along said rectilinear groove 34 along the axis of inclination X-X ', to the other end of groove 39, so that the entire length of the rotation rod 36 is preferably between the two groove ends 39.
  • the straight groove 34 and the rotation rod 36 are shaped so that the sliding of one in the other must be made in force.
  • a control means 16 for the inclination of the expansion cover 3 adapted to hold the expansion cover 3 in a desired inclination of the inclination stroke.
  • the control means 16 is in accordance with the foregoing description.
  • the control means 16 is assembled to the expansion cover 3 and / or to the cage body 2 prior to the step of assembling said expansion cover with the cage body 2.
  • said manufacturing method also comprises a step during which said cage body 2 is provided, for example by drilling after completion of the cage body 2 or by omission of material being produced from the cage body 2, at least one fixing orifice 40 forming an oblique well 41 adapted to receive and guide from outside said cage 1 a fixing means 43 of the cage 1 to the first vertebral body 4 and / or the second vertebral body 5.
  • this fixing hole 41 is also in accordance with the description who is before.
  • At least the step of producing the cage body 2 is carried out by means of an additive manufacturing process, preferably a melting process. Conventional machining can also be envisaged.
  • the cage 1, and in particular the expansion cover 3 and the cage body 2 may be made of biocompatible material of the PEEK, PEKK or titanium type. Also, these elements may preferably be made of SLS, or of laser melting titanium if this method of manufacture is retained.
  • the invention finds its industrial application in the design, construction and implementation of expandable interbody cage intended to be implanted between a first vertebral body and a second vertebral body of a patient.

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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)
EP15784079.4A 2014-09-30 2015-09-30 Zwischenwirbelfusionskäfig mit verstellbarem deckel und zugehöriges herstellungsverfahren Withdrawn EP3200729A1 (de)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR1459304A FR3026294A1 (fr) 2014-09-30 2014-09-30 Cage intersomatique a couvercle ajustable et procede de fabrication afferent
PCT/FR2015/052624 WO2016051095A1 (fr) 2014-09-30 2015-09-30 Cage intersomatique a couvercle ajustable et procede de fabrication afferent

Publications (1)

Publication Number Publication Date
EP3200729A1 true EP3200729A1 (de) 2017-08-09

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Country Status (4)

Country Link
US (1) US20170296352A1 (de)
EP (1) EP3200729A1 (de)
FR (1) FR3026294A1 (de)
WO (1) WO2016051095A1 (de)

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US20170296352A1 (en) 2017-10-19
FR3026294A1 (fr) 2016-04-01

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