ES2310255T3 - Implante de disco intervertebral. - Google Patents
Implante de disco intervertebral. Download PDFInfo
- Publication number
- ES2310255T3 ES2310255T3 ES03788497T ES03788497T ES2310255T3 ES 2310255 T3 ES2310255 T3 ES 2310255T3 ES 03788497 T ES03788497 T ES 03788497T ES 03788497 T ES03788497 T ES 03788497T ES 2310255 T3 ES2310255 T3 ES 2310255T3
- Authority
- ES
- Spain
- Prior art keywords
- intervertebral disc
- disc
- end plates
- membrane
- disk
- 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.)
- Expired - Lifetime
Links
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
-
- 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
- A61F2/441—Joints for the spine, e.g. vertebrae, spinal discs made of inflatable pockets or chambers filled with fluid, e.g. with hydrogel
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/08—Muscles; Tendons; Ligaments
-
- 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
- A61F2/28—Bones
-
- 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
- A61F2/30721—Accessories
- A61F2/30742—Bellows or hose-like seals; Sealing membranes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/3094—Designing or manufacturing processes
- A61F2/30965—Reinforcing the prosthesis by embedding particles or fibres during moulding or dipping
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
- A61F2/4611—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of spinal prostheses
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/28—Bones
- A61F2002/2835—Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
- A61F2002/30004—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
- A61F2002/30004—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis
- A61F2002/30014—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis differing in elasticity, stiffness or compressibility
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- 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
- A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
- A61F2002/3006—Properties of materials and coating materials
- A61F2002/30092—Properties of materials and coating materials using shape memory or superelastic materials, e.g. nitinol
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- A—HUMAN NECESSITIES
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30108—Shapes
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- A61F2002/30112—Rounded shapes, e.g. with rounded corners
- A61F2002/30113—Rounded shapes, e.g. with rounded corners circular
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- A—HUMAN NECESSITIES
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30108—Shapes
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
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- A61F2/02—Prostheses implantable into the body
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- A61F2002/30108—Shapes
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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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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- A61F2002/30317—The prosthesis having different structural features at different locations within the same prosthesis
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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
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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
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- A—HUMAN NECESSITIES
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- A—HUMAN NECESSITIES
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A—HUMAN NECESSITIES
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- A61F2002/30565—Special structural features of bone or joint prostheses not otherwise provided for having spring elements
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61F2002/30565—Special structural features of bone or joint prostheses not otherwise provided for having spring elements
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30581—Special structural features of bone or joint prostheses not otherwise provided for having a pocket filled with fluid, e.g. liquid
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- A61F2002/30581—Special structural features of bone or joint prostheses not otherwise provided for having a pocket filled with fluid, e.g. liquid
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- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30581—Special structural features of bone or joint prostheses not otherwise provided for having a pocket filled with fluid, e.g. liquid
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30581—Special structural features of bone or joint prostheses not otherwise provided for having a pocket filled with fluid, e.g. liquid
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- A—HUMAN NECESSITIES
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Landscapes
- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Neurology (AREA)
- Heart & Thoracic Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Cardiology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Veterinary Medicine (AREA)
- Vascular Medicine (AREA)
- Public Health (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Dispersion Chemistry (AREA)
- Chemical & Material Sciences (AREA)
- Prostheses (AREA)
- Polishing Bodies And Polishing Tools (AREA)
- Magnetic Treatment Devices (AREA)
- Electrochromic Elements, Electrophoresis, Or Variable Reflection Or Absorption Elements (AREA)
Abstract
Un disco intervertebral (10) para su ubicación entre la primera y segunda vértebra incluye: una placa terminal superior (12) con una primera superficie interna y una primera superficie externa, la primera superficie externa contacta a la primera vértebra; una placa terminal inferior (14) que tiene segunda superficie interna y una segunda superficie externa, la segunda superficie externa contacta a la segunda vértebra, una membrana (16) que se extiende desde la placa terminal superior (12) y la placa terminal inferior (14), un volumen interior (19) definido entre las placas terminales (12, 14) y la membrana elástica (16), una válvula (20) en comunicación con el volumen interior (19) llenando por lo menos parcialmente el volumen con un fluido (22), en donde una de las primeras y segundas superficies internas tiene un alvéolo (32) y la otra de la primera y segunda superficies interna tienen una protrusión (34), en donde la protrusión (34) se configura de manera convexa para articular dentro del alvéolo cóncavo (32), caracterizado porque el alvéolo (32) y la protrusión (34) están configurados y poseen las dimensiones para acoplarse o para que generalmente encastren entre si, y la membrana elástica (16) está configurada alrededor del alvéolo (32) y la protrusión (34), permitiendo flexión, extensión, curvatura lateral, rotación y traslación, en donde la traslación es un movimiento generalmente transverso al eje de la columna vertebral por lo que permite movimiento instantáneo de rotación del eje.
Description
Implante de disco intervertebral.
La presente invención se refiere a los
dispositivos y métodos para el tratamiento de los traumatismos y
enfermedades de la columna vertebral. Especialmente, a la invención
referida al cambio de los discos intervertebrales.
Una gran variedad de condiciones como la
espondilólisis, hernia de disco, compresión de los nervios
espinales, enfermedad degenerativa de disco, y traumatismo son
conocidos por causar malestar severo que requiere de atención
médica. Entre los procedimientos por lo general utilizados para
aliviar dichas condiciones se encuentra la fusión espinal, como la
intervertebral y la fusión posterolateral o artródesis. En estos
procedimientos, se fusionan juntos dos cuerpos vertebrales
adyacentes. Primero se extirpa el disco intervertebral afectado, y
se inserta un implante que acomoda el crecimiento del hueso entre
los dos cuerpos vertebrales para unir de manera efectiva la brecha
creada por la remoción del disco. Se han utilizado diferentes
materiales o diseños de implantes para la fusión resultando en
diferentes grados de éxito. Aunque la fusión intervertebral y la
posterolateral son ampliamente utilizadas, las desventajas que se
pueden observar incluyen un rango reducido de movilidad fisiológica
y otras complicaciones relacionadas a la fusión como la degeneración
de los discos adyacentes y desestabilización de la unidad funcional
espinal. Como resultado, se prefieren tratamientos alternativos que
presentan menores complicaciones pero que tienen una eficacia
similar para la fusión. Una de esas alternativas para la fusión
espinal es la artroplastia y el uso de disco prostésico o
artificial.
Por lo general, la artroplastia se utiliza para
el reemplazo de las articulaciones enfermas. La artroplastia
incluye un conjunto de procedimientos destinados a mantener la
movilidad de la articulación, es decir, preserva su integridad y
evita el deterioro de los segmentos adyacentes, como suele suceder
luego de la fusión. Dependiendo de la ubicación y de la condición
de la articulación afectada, se pueden utilizar procedimientos
específicos de artroplastia. Por ejemplo, cirugía de reconstrucción
interposicional, la cual reforma la articulación y agrega un disco
protésico entre los dos huesos formando la articulación y se utiliza
por lo general en las articulaciones del codo, hombro, tobillo y
dedos. El reemplazo total de la articulación, o la artroplastia
total, reemplaza a la totalidad de la articulación enferma por una
prótesis artificial y, en los últimos años se ha convertido en la
operación preferida para la mayoría de los problemas de rodilla y
cadera.
Los reemplazos de cadera y rodilla se han
extendido hasta alcanzar aproximadamente 300.000 reemplazos de
cadera casi igualando la cantidad de reemplazos de rodilla
realizados en los Estados Unidos durante el año 2001. Con respecto
a las cirugías de reemplazo de articulación de rodilla y cadera,
existen varios implantes o protésicos disponibles. Para el
protésico de cadera, de manera ejemplificadora, hay dos componentes,
uno es una bola metálica adjunta a un tallo metálico que se coloca
dentro del fémur, y el segundo es un alvéolo plástico que se
implanta en la pelvis. Las piezas metálicas por lo general se
encuentran formadas acero inoxidable, aleaciones de cobalto y
cromo, titanio, y aleaciones de titanio, las piezas plásticas por lo
general están formadas por polietileno de alta densidad. Para el
protésico de rodilla, en una incorporación ejemplificadora, se
utilizan nuevamente componentes de metal y plástico para reemplazar
las extremidades dañadas del hueso y el cartílago. Las piezas
metálicas por lo general se forman de acero inoxidable, aleaciones
de cobalto y cromo, titanio, y aleaciones de titanio; las piezas
plásticas por lo general están formadas de polietileno de alta
densidad. Para los protésicos de rodilla, en una incorporación
ejemplificadora, se utilizan también componentes metálicos y
plásticos para el reemplazo de las extremidades del hueso dañado y
del cartílago. Las piezas metálicas por lo general se encuentran
formadas por acero inoxidable, aleaciones de cobalto y cromo,
titanio, y aleaciones de titanio, las piezas plásticas se encuentran
formadas por polietileno de alta densidad.
Aunque la evolución de la artroplastia espinal y
el uso de los protésicos en la médula ha sido similar a la
evolución de las otras articulaciones del cuerpo, la evolución de la
fusión de la articulación al reemplazo de la articulación
funcional, el surgimiento de la artroplastia espinal, ha sido más
lento que la artroplastia en otras articulaciones mayores del
cuerpo. Algunas de las pocas razones posibles por las cuales la
artroplastia espinal se desarrolló más lentamente son que los
problemas espinales relacionados a la degeneración del disco son
difíciles de diagnosticar, los procedimientos espinales son
típicamente llevados a cabo luego de una crisis y como
consecuencias se aceptan soluciones conservadoras como la fusión, y
la anatomía espinal es compleja.
Durante los últimos 40 años, la tecnología sobre
artroplastia espinal ha estado en desarrollo y en los últimos 10
años, la artroplastia espinal ha ganado la atención de los
principales cirujanos y fabricantes de implantes. La evolución de
la artroplastia comenzó básicamente en la década de 1950 y uno de
los variados conceptos emergentes fue el concepto esférico de las
prótesis de disco. El concepto esférico se refiere simplemente la
colocación de la bola, en esencia una circunferencia, en la cavidad
del núcleo pulposo luego de realizar el procedimiento de
disectomia. El annulus se mantiene en su lugar y la bola sirve como
dispositivo núcleo de reemplazo. Se han experimentado materiales
diversos para el concepto esférico. Por ejemplo, en la década de
1960, se colocaron implantes con soporte para las bolas de silicona
en la región cervical de los pacientes, pero los resultados eran
inciertos. A mediados de la década de 1960 se implantaron prótesis
de acero inoxidable (soportes de bola) en los pacientes. Los
resultados de los procedimientos fueron al comienzo alentadores pero
con el transcurso del tiempo los espacios de los discos perdieron
altura debido al hundimiento de las bolas de acero dentro de los
cuerpos vertebrales. En la actualidad, el concepto de las prótesis
esféricas continúa siendo estudiado utilizando diferentes
materiales, el último de ellos es fibra de carbón modificado.
Otro concepto emergente es el de diseño
mecánico. El concepto de diseño mecánico es esencialmente el del
reemplazo total del disco con el fin de reparar la movilidad del
segmento vertebral. Estos dispositivos por lo general están hechos
de placas terminales fijas a los cuerpos vertebrales adyacentes
mediante el mecanismo de estabilización y su núcleo está formado de
polietileno u otros materiales poliméricos. Alternativamente, en
lugar de un núcleo, se pueden utilizar superficies de soporte con
materiales tales como cerámica sobre cerámica, metal sobre metal, o
metal sobre polietileno. El concepto de diseño mecánico se basa en
los mismos principios de los productos de reconstrucción de
articulación, como los reemplazos de rodilla y cadera, y se han
propuesto y aún se siguen proponiendo varios conceptos de prótesis
mecánicas.
Otro concepto es el fisiológico. El concepto
fisiológico utiliza un hidrogel, elastómero, o un núcleo de
poliuretano que se utiliza para restaurar la función del disco
mediante la absorción y la emisión de fluido entre las placas
terminales del paciente, mientras que también mantiene el shock
natural de las funciones de absorción y de efecto amortiguador del
disco. El concepto fisiológico de los dispositivos es por lo general
considerado sólo una solución parcial ya que estos son diseñados
para reemplazar sólo el núcleo o una porción del disco.
Todos los enfoques destinados al reemplazo del
disco tienen como objetivo algunos o todos de los siguientes:
alivio del dolor discogénico, restauración de la movilidad, la
mantención de la función natural de shock de absorción del disco,
restauración de la forma normal o altura del disco, y la
restauración de la cinemática fisiológica. Por lo general, se han
desarrollado ejemplos de discos artificiales intervertebrales para
el reemplazo de una parte o de todo el disco extirpado:
elastómero/llenado de fluido, discos, bola y alvéolos de discos
tipo, resorte de disco mecánico y discos híbridos.
Elastómero/discos llenos de fluido típicamente
incluyen un amortiguador de elastómero o una cámara llena de fluido
ubicada entre las placas terminales rígidas inferiores y superiores.
Los amortiguadores y cámaras de estos implantes funcionan de manera
ventajosa y mecánica, similar a un tejido de disco intervertebral
removido.
Los discos de tipo bola o alvéolos típicamente
incorporan dos placas miembro que tienen una bola de cooperación
interna y porciones de alvéolos que permiten el movimiento
articulatorio de los miembros durante los movimientos de la
columna.
Los resortes mecánicos típicamente incorporan
uno o más resortes graduables dispuestos entre placas terminales de
metal. Los resortes graduables definen un resorte acumulativo
constante que se diseña para que sea suficiente para mantener la
distribución del espacio de la vértebra adyacente mientras permite
el movimiento normal de las vértebras durante la flexión y
extensión de la espina en cualquier dirección.
El cuarto tipo de disco intervertebral
artificial, el disco híbrido, incorpora dos o más de los principios
de diseño antes mencionado. Por ejemplo, una de las distribuciones
conocidas de los discos híbridos incluye la bola y el alvéolo de la
articulación rodeada de un anillo de elastómero.
Mientras que cada una de las presentes prótesis
hace referencia a algunos de los problemas relacionados al
reemplazo de disco intervertebral, cada implante presenta
desventajas significativas. Por eso, existe la necesidad de un
implante intervertebral que acomode la anatomía y la geometría del
espacio intervertebral que se busca rellenar tan bien como la
anatomía y geometría de los extremos de los cuerpos vertebrales
adyacentes, y que además cuente con confiabilidad y simplicidad en
el diseño. En especial, existe la necesidad de un implante de disco
espinal que provea estabilidad para soportar las grandes cargas
aplicadas a las vértebras, que permita suficiente movilidad para
que el paciente puede aproximarse a un rango de movilidad normal, y
que brinde compresión axial entre las vértebras adyacentes, como
así también que cuente con habilidades de shock de absorción.
El documento
FRA-A1-2723841, Gauchet Fabien, da a
conocer un disco intervertebral para la ubicación entre la primera
y segunda vértebra que comprende placas terminales y una membrana
que se extiende entre las placas terminales y el volumen interior
definido entre las placas terminales y la membrana elástica. Un
movimiento horizontal de translación no es posible debido a la bola
7 en el tallo 6, es limitado por una cámara cilíndrica 8 que lo
rodea y que tiene como fin permitir el desplazamiento angular
relativo y la variación de distancia entre las placas. No muestra
alvéolos convexos o cóncavos ni protrusiones y tiene dimensiones que
encajan o corresponden generalmente con cada flexión, extensión,
curvatura lateral, rotación y translación por lo que permite un eje
de rotación de movimiento instantáneo.
El documento
US-B1-6375682, Fleischmann Lewis W,
et al., da a conocer un disco intervertebral para ser ubicado
entre la primera y segunda vértebra formando placas terminales y un
fuelle que se extiende entre las placas terminales y un volumen
interior definido entre las placas terminales y el fuelle elástico.
Descubre una unión de soporte para la rotación del fuelle entre las
placas terminales. Sin embargo, no se demuestra un alvéolo convexo
o cóncavo y protrusión que tengan las dimensiones que correspondan
por lo general entre si.
US-A-6113637,
Gilí Stevans S, et al., da a conocer un disco intervertebral
para la ubicación entre la primera y la segunda vértebra que forman
la placa terminal. Las placas terminales superior e inferior poseen
una protrusión o alvéolo que están directamente en contacto entre
si. Sin embargo no demuestra una membrana que se extiende entre las
placas terminales y que encierra un volumen interior definido entre
las placas terminales.
US-B1-6419704,
Ferree Bret, da a conocer un cuerpo con forma que tiene una medida
de volumen final y que consume al menos una porción del espacio de
disco intervertebral. El exterior del cuerpo del espacio
intervertebral se encuentra recubierto por una pieza flexible de
material 420 adjunto a las vértebras adyacentes o que retiene
miembros 422. Sin embargo no da a conocer placas terminales
superiores e inferiores ni alvéolos cóncavos o convexos y
protrución que tenga las dimensiones que correspondan generalmente
entre si.
US-A1-2002/045944,
Muhanna Nabil, L, et al., da a conocer espaciadores de
vértebra en cunea que tienen una superficie inferior y otra
superior. Sin embargo, no da a conocer una membrana que se extiende
entre las placas terminales que encierran a un volumen interior
definido entre las placas terminales.
La invención se refiere a un disco
intervertebral que es preferentemente diseñado para restaurar la
altura del disco y lordosis, permite el movimiento natural, absorbe
el shock y provee resistencia al movimiento y la compresión axial.
Además, el disco intervertebral puede utilizarse en las regiones
cervicales, torácicas, o lumbares de la columna.
El disco intervertebral incluye un cuerpo con
una huella que preferentemente se adapta en medida y forma con al
menos una porción de los extremos adyacentes de las vértebras. Las
formas de los discos intervertebrales son, pero no están limitadas
a, la forma circular, oval, elipsoide, en forma de alubia, anular,
en forma de C, en forma de D, etc.
El cuerpo de los discos intervertebrales incluye
una placa terminal superior, una placa terminal inferior, y una
membrana elástica dispuesta entre las placas terminales superior e
inferior. Alternativamente, la membrana elástica puede rodear y
encapsular a las placas terminales. La membrana elástica define un
interior que se encuentra al menos parcialmente lleno por un
fluido. Preferentemente, el fluido se selecciona de un grupo que
consiste en un gas, un liquido, un gel o cualquier combinación de
los mismos. Además, el fluido puede ser compresible, y puede ser
seleccionado de un grupo que consiste de, por ejemplo, gas, liquido,
o hidrogel, o puede ser incompresible, y se puede seleccionar del
grupo que consiste, por ejemplo, la solución salina.
El disco también incluye una válvula que permite
la inserción del fluido al interior del disco intervertebral. La
válvula puede ubicarse sobre una membrana elástica,
alternativamente, sin embargo, la válvula puede ubicarse en las
placas terminales superior o inferior del disco.
Las placas terminales superior e inferior son
preferentemente de metal, como el titanio, acero inoxidable,
aleaciones de titanio, aleaciones de cromo de cobalto, o aleaciones
amorfas. Alternativamente, sin embargo, las placas terminales
superior e inferior pueden estar formadas de cerámica, compuestos,
polímeros, como el polieteretercetona (por ejemplo, PEEK), o un
polietileno ultra liviano molecular (por ejemplo, ÜHMWPE), hueso,
que incluye, cortical, hueso esponjoso, aloinjerto, autoinjerto,
xenoinjerto, hueso desmineralizado o parcialmente desmineralizado,
o cualquier otro material que sirva como soporte de peso. Los
materiales elegidos para las placas terminales, en combinación con
el fluido deseado, son preferentemente seleccionados para reducir
el uso, y por consiguiente brindan una mayor vida a la
articulación.
La superficie externa de las placas terminales
superior e inferior puede ser sustancialmente plana, en forma de
cuña, etc. Las superficies exteriores de las placas terminales
superior e inferior pueden tener forma de cúpula con sus radios
definidos entre los planos sagital y coronal y que generalmente
coinciden con los extremos de la vértebra adyacente. La forma de
cúpula permite que las placas terminales superior e inferior se
adapten mejor a los extremos adyacentes de las vértebras para un
mejor encastre in situ.
El disco intervertebral además preferentemente
cuenta con la resistencia a la migración de estructuras provista
por la superficie externa de al menos una o ambas de las placas
terminales con el fin de impedir el movimiento, dislocación o
expulsión de las placas terminales dentro y desde los extremos de
las vértebras adyacentes. Las estructuras resistentes a la
migración incluyen, pero no están limitadas a: separadores, clavos,
dientes, placas, clavos desplazables, dientes desplazables, clavos
flexibles, dientes flexibles, alternativamente, dientes con forma,
placas insertables o expansibles, tornillos, ganchos, serraciones,
en forma de costilla, y superficies texturadas.
Además, las placas terminales superior e
inferior se encuentran recubiertas con un crecimiento óseo que
induce o conduce sustancia para promover el crecimiento interno del
hueso con el fin de asegurar de permanentemente el disco a las
vértebras adyacentes. Alternativamente, las placas terminales
superior e inferior pueden tener una superficie más rígida; una
superficie porosa, capas en las placas terminales tratadas con
láser; integrar un andamio osteoconductivo/osteoinductivo; o puede
ser provisto o estar hecho de un material integral osteoconductivo
y/o osteoinductivo para promover el crecimiento óseo. Las placas
terminales pueden también incluir una membrana y/o barrera para
limitar la cantidad y/o profundidad del crecimiento interno
óseo.
Las placas terminales superior e inferior pueden
contener un implante adjunto de instrumentación, y estructuras de
guía y retención. Por ejemplo, las placas terminales pueden tener
orificios, ranuras, hilos, o cola de milano para la implantación
del implante y/o para la distracción de las vértebras adyacentes.
Por ejemplo, el disco puede incluir una ranura formada de placas
terminal superior y/o inferior, la ranura está configurada para
recibir un inserción de instrumento de implante, o distraer, o
ambos.
Las placas terminales superior e inferior
incluyen superficies articuladas, lo que provee de mayor movilidad
al disco intervertebral. Las superficies articuladas preferentemente
incluyen una superficie lustrada o con un acabado similar al del
diamante, acabado TiNi, etc., con el fin de reducir el uso,
disminuir la generación de partículas, y lograr una mayor vida del
disco.
El disco intervertebral puede implantarse en
módulos, si es posible, o puede implantarse prearmado. Un enfoque
quirúrgico anterior, anteriolateral, o lateral puede utilizarse para
implantar el disco intervertebral. Además, dependiendo del disco
intervertebral que se implante, se puede utilizar un método
quirúrgico mínimamente invasivo o distracción simultánea e
implante. Además dependiendo del disco intervertebral que se
implante, se puede adjuntar un Ligamento Anterior Longitudinal al
disco o a los cuerpos vertebrales adyacentes. El Ligamento Anterior
Longitudinal puede estar formado por autoinjerto, aloinjerto, o
xenoinjerto parcialmente desmineralizado o desmineralizado.
Alternativamente, el Ligamento Anterior Longitudinal puede estar
formado por materiales biocomplatibles como los elastómeros, o por
polímeros trenzados. Con el fin de asistir al implante del disco
intervertebral, éste debe incluir marcadores de alineación.
Con el fin de facilitar la compresión y con el
propósito de ilustrar la presente invención, se demuestran
características ejemplificadoras y preferidas en los dibujos que
siguen, cabe entender, sin embargo, que la invención no se
encuentra limitada a los arreglos precisos e instrumentaciones
mostradas, en donde caracteres similares de referencia denotan
elementos similares mediante las distintas experiencias, y en
donde:
La Figura 1 es una vista en perspectiva de un
disco intervertebral.
La Figura 2 es una vista de sección cruzada del
disco artificial intervertebral de la Figura 1 a lo largo de la
línea A-A;
La Figura 2a es una vista de sección cruzada
alternativa del disco artificial intervertebral de la Figura 1 a lo
largo de la línea A-A;
La Figura 3a es una vista lateral de un clavo
desplazable según la presente invención.
La Figura 3b es una vista lateral de otro clavo
desplazable según la presente invención.
La Figura 3c es una vista lateral de un clavo
flexible según la presente invención.
La Figura 3d es una vista lateral de un diente
alternativamente modelado de acuerdo con la presente invención.
La Figura 3e es una vista lateral de soportes de
acuerdo con la presente invención.
Cualquiera de la amplia variedad de implantes
diferentes pueden prepararse de acuerdo con las enseñanzas
mostradas por los ejemplos ilustrativos de los discos
intervertebrales que aquí se muestran. Los discos intervertebrales
de la presente invención son preferentemente diseñados para
restaurar la lordosis espinal, la altura de disco, para permitir
movimientos naturales, absorber el shock y proveer resistencia al
movimiento y a la compresión axial.
Los discos intervertebrales cuentan con el
tamaño y la adaptación para el uso en las regiones cervical, tórax,
y lumbar de la espina. Además, los discos intervertebrales pueden
hacerse a la medida de cualquier paciente permitiendo por las
características del disco adecuarse a cada paciente individual. Por
ejemplo, el núcleo de disco puede incluir diferentes uniones,
diferente componentes, y/o distintos tipos de materiales para crear
las características deseadas para cada uno de los pacientes.
Además, los discos intervertebrales permiten
flexión, extensión, movimiento lateral, rotación, y traslación. La
flexión es un tipo de movimiento que hace que dos partes de la
articulación o cuerpo se vuelvan en una posición curvada; en la
espina, este es un movimiento en que ésta comienza en una posición
recta y luego se vuelve en una posición curva hacia adelante. La
extensión es un movimiento que hace que dos partes que se
encontraban separadas entre si se junten, en la espina, este es un
movimiento en el cual la espina comienza en una posición recta y
luego se vuelve en una posición curva hacia atrás. La inclinación
lateral es un movimiento en curva hacia un lateral; en la espina,
este movimiento generalmente incluye la curvatura (lateral) y la
rotación acoplada. La Rotación es un movimiento que hace que una
parte de la espina se retuerza, rote o doble con respecto a un eje
de la columna vertebral. La Traslación es un movimiento limitado que
por lo general es transversal a un eje de la columna vertebral.
Además, similares a los discos intervertebrales
naturales, los discos intervertebrales artificiales preferentemente
permiten el movimiento instantáneo del eje de rotación. A cada
instante de un cuerpo en un plano de movimiento existe una línea en
el cuerpo o una extensión hipotética de esta línea que no se mueve.
El eje instantáneo de rotación es esta línea. Un eje de movimiento
instantáneo de rotación se refiere a la habilidad del eje
instantáneo de rotación para moverse (por ejemplo, traslación), como
un resultado de diferentes condiciones de carga, en otras palabras,
la ubicación del eje instantáneo de rotación se mueve con respecto
al disco. La principal ubicación preferida del eje de movimiento
instantáneo de rotación para la región lumbar de la espina se
encuentra principalmente en la mitad posterior del espacio del disco
o próximo a la placa terminal adyacente, especialmente próximo a la
placa terminal inferior/caudal, la principal ubicación del
movimiento instantáneo del eje de rotación para la región torácica
de la espina se encuentra en la porción inferior del espacio del
disco o próximo al caudal del cuerpo vertebral que se extiende
posteriormente dentro del canal medular, y la principal ubicación
del movimiento instantáneo del eje de rotación de la región cervical
de la espina se encuentra preferentemente en la mitad posterior del
cuerpo del caudal vertebral.
También similar al disco intervertebral natural,
las características de respuesta del disco intervertebral
artificial son preferentemente no lineales. Por ejemplo, en
respuesta a la continua compresión del eje, el disco artificial
intervertebral preferentemente se somete a una gran cantidad inicial
de compresión seguida de una disminución no lineal de la
compresión.
En referencia a los dibujos adjuntos, las formas
de realización preferidas y las características del disco
intervertebral artificial son meramente ilustrativas. Se contempla
que una o más características o elementos de las distintas formas
de realización pueden ser combinadas o usadas singularmente, y que
las modificaciones o de las distintas formas de realización, tan
bien como, las otras formas de realización se contemplan y serán
evidentes en las personas detalladas en el articulo.
En referencia inicial a las Figuras 1 y 2, se
muestra una vista perspectiva de una forma de realización como
ejemplo de un disco artificial intervertebral 10. Como se observa,
el disco 10 tiene forma de alubia que incluye un lado anterior 11,
un lado posterior 13, y primero y segundo lado lateral 15, 17,
respectivamente. El lado anterior 11 y laterales 15, 17 son todos
sustancialmente convexos en forma mientras que el lado posterior 13
es sustancialmente cóncavo en forma. Sin embargo, el disco 10 puede
tomar otras formas que preferentemente concuerdan geométricamente y
anatómicamente con los cuerpos vertebrales adyacentes que incluye,
pero no está limitado a la forma circular, oval, elipsoide, anular,
en forma de D, en forma de C, etc.
Como se muestra, el disco intervertebral 10
incluye una placa terminal superior 12, una placa terminal inferior
14 y una membrana elástica 16, la membrana elástica 16 generalmente
se extiende desde la placa terminal superior 12 a la placa terminal
inferior 14 y está ubicada, preferentemente, próxima a la periferia
externa del disco 10. Alternativamente, la membrana elástica 16
puede rodear y/o encapsular las placas terminales superior e
inferior 12, 14. La membrana elástica 16 en combinación con las
placas terminales superior e inferior 12, 14 puede definir un
volumen interior que puede estar parcialmente lleno con un fluido
22. La membrana elástica 16 preferentemente está formada de un
elastómero como el poliuretano, silicona, un polímero trenzado, o
cualquier otro material elástico apropiado conocido en este
articulo. La membrana elástica puede no ser permeable.
Alternativamente la membrana elástica 16 puede ser permeable o
semipermeable para permitir que el fluido fluya dentro y fuera del
interior del disco (de la manera descripta más detalladamente
abajo). Preferentemente, la membrana elástica 16 puede resistir el
movimiento de traslación entre las placas terminales superior e
inferior 12, 14, y puede además evitar el crecimiento interno del
tejido blando entre las placas terminales 12, 14, tan bien como
contener cualquier tipo de partículas gastadas generadas dentro del
volumen interior. La membrana elástica 16 puede estar adjunta a las
placas terminales superior e inferior 12, 14 mediante cualquier
método de fijación conocido en este arte, que incluye, pero sin
limitación, a agentes de unión, soldadura ultrasónica, tornillo,
uñas, cuñas mecánicas y clavijas.
Alternativamente, la membrana elástica 16 puede
encontrarse en la forma de fuelle asumiendo la forma de
"acordeón", permitiendo la expansión y contracción según las
distintas condiciones de carga. El fuelle debe estar adjunto de
manera rígida a las placas terminales superior e inferior 12, 14 por
cualquier método conocido en este arte. Que incluye, pero no está
limitado a un surco circular formado en cada placa terminal 12, 14,
agentes de unión, soldadura ultrasónica, tornillos, uñas, cuñas
mecánicas y clavijas. Preferentemente, el fuelle está hecho de
metal, aunque cualquier otro material como elastómero o polímero
puede usarse.
El disco 10 también puede incluir un válvula 20,
la válvula 20 provee acceso al interior 19 del disco 10 para que el
fluido pueda ser inyectado dentro, o removido del interior 19 del
disco 10. La válvula 20 es preferentemente de un solo corredor,
como es sabido por los especialistas en este articulo, para que el
fluido, una vez inyectado, no pueda escapara desde el interior 19
del disco 10. Como se muestra en las Figuras 1 y 2, la válvula 20
preferentemente se ubica entre la membrana elástica 16, y
alternativamente, sin embargo, la válvula 20 puede estar ubicada
entre las placas terminales superior y/o inferior 12, 14 como se
muestra en la Figura 2a. Cuando se ubica la válvula sobre las
placas terminales superior y/o inferior 12, 14, se incluye
preferentemente un corredor 30 para interconectar la válvula 20 con
el interior 19 del disco 10.
El fluido 22 provisto en el volumen interior
puede ser un gas, un liquido, un gel, o la combinación de los
mismos. Cuando se provee un gas como medio de llenado para el
volumen interior, o cuando se provee la combinación de gas y
liquido, la última presión de gas dentro del volumen interior debe
ser seleccionada para proveer un shock de absorción adecuado
durante la compresión del eje del disco 10. El fluido también puede
permitir la articulación o movimiento limitado de la placa terminal
superior 12 y la placa terminal inferior 14 entre ellas.
Preferentemente, el fluido es un liquido incompresible, por ejemplo,
una solución salina. En el uso, el fluido 22 puede inyectarse
dentro del interior 19 del disco 10 antes de la inserción del disco
10 entre las vértebras adyacentes. Alternativamente, el fluido 22 se
puede inyectar in situ para facilitar la inserción del disco
10 y la subsecuente distracción entre las vértebras adyacentes. Las
capacidades de rigidez y distracción del disco 10 puede ser una
función de la cantidad de liquido de fluido 22 inyectado dentro del
interior 19 del disco 10 y/o la naturaleza elástica de la membrana
16. Generalmente, cuanto más fluido 22 se inyecte en el interior 19
del disco 10, más rígido será el disco 10, y tendrá mayor capacidad
de distracción. Además, la flexibilidad y la mayor articulación
pueden alcanzarse mediante el llenado de sólo una porción del
interior del volumen 19 del disco 10. Finalmente, el llenado
variable del interior 19 del disco 10 con fluido 22 permite la
totalidad altura H del disco 10 para que cambie según sea necesario
dependiendo de las necesidades individuales del paciente.
Según se muestra en la Figura 2a, la placa
terminal superior 12 posee una superficie interna provista de un
alvéolo arqueado 32, mientras que la placa termina inferior 14 posee
una superficie interna provista de una protrusión arqueada 34, o
viceversa. El alvéolo 32 y la protrusión 34 están configurados y
dimensionados para encastrar, o para corresponder generalmente
entre si. El tipo y cantidad de articulación deseada puede dictar
la curvatura del alvéolo 32, luego el disco 10 puede proveer mayor
soporte pero menor movimiento predeterminado. Alternativamente, si
el alvéolo 32 tiene un mayor radio que la profusión 34, el disco
contará con mayor articulación. Además, la profusión 34 y/o el
alvéolo 32 pueden también incorporar una porción plana que permita
el movimiento de translación de la placa terminal superior 12 con
respecto a la placa terminal inferior 14. Al permitir la
traslación, el disco 10 puede proveer un movimiento instantáneo del
eje de rotación de la manera en que fue explicado
anteriormente.
También es posible para el alvéolo 32 y la
profusión 34 adquirir contornos más allá de los descriptos más
arriba con el fin de lograr la articulación deseada. Además,
mientras el alvéolo 32 y la profusión 34 se muestran con contornos
que por lo general permiten unir sus superficies, es posible proveer
contornos que no se unan para que el alvéolo 32 y la protusión 34
adquieran la articulación deseada.
El uso de un volumen interior lleno de fluido 19
en combinación con una superficie de articulación puede permitir al
alvéolo 32 y la protrusión 34 que se traslade más fácilmente con
respecto a cada uno de ellos reduciendo la fricción entre las
superficies deslizantes.
Alternativamente, cuando el fluido es un gas
comprimido, las superficies de la articulación puede estar de
manera no constante comprometida, pero puedo sólo comprometerse
cuando la suficiente fuerza de compresión se ubica en el disco
mediante las vértebras adyacentes. Además, el disco de esta forma de
realización tendría un aspecto de desempeño dual, de acuerdo con un
escenario de carga que se desempeñe como disco lleno de fluido, y
según un segundo escenario que se desempeñe como un disco articulado
de protrusión/alvéolo.
Según la ubicación en la espina en donde se
implante, el disco 10 puede restaurar con preferencia la altura en
un rango que se extiende de aproximadamente 4 milímetros (mm) a
aproximadamente 2 6 mm. Además, el disco 10 con preferencia también
soluciona la lordosis en un rango que se extiende de aproximadamente
0º a aproximadamente 20º. El disco 10 con preferencia también puede
restaurar la rigidez en un rango que se extiende de aproximadamente
1 metro Newton por grado (Nm/gr) a aproximadamente 11 Nm/gr en
rotación axial, de aproximadamente 0 Nm/gr a aproximadamente 7
Nm/gr en flexión/extensión, y de aproximadamente 0 Nm/gr a
aproximadamente 5 Nm/gr en curvatura lateral. Además, el disco 10
provee con preferencia una rigidez de compresión de aproximadamente
100 N/mm a aproximadamente 5000 N/mm y una rigidez de tensión de
aproximadamente 50 N/mm a aproximadamente 1000 N/mm. Además, según
la ubicación de la espina donde se implante el disco 10, el disco
intervertebral 10 permite con preferencia un rango de movimiento de
aproximadamente 5º a aproximadamente 45º en la flexión/extensión,
de aproximadamente 3º a aproximadamente 33º en la curvatura lateral,
y de aproximadamente 1º a aproximadamente 60º en la rotación axial.
El disco intervertebral 10 también permite con preferencia la
compresión axial en un rango de aproximadamente 0,2 mm a
aproximadamente 2 mm.
Preferentemente las placas terminales superior e
inferior 12, 14 están formadas de metal, como el titanio, acero
inoxidable, aleaciones de titanio, aleaciones de
cromo-cobalto, aleaciones amorfas. Alternativamente,
sin embargo, las placas terminales superior e inferior 12, 14
pueden estar formadas por cerámica, compuestos, polímeros, como
PEEK o ÜHMWPE, hueso, que incluye hueso cortical, hueso esponjoso,
aloinjerto, autoinjerto, xenoinjerto, hueso desmineralizado o
parcialmente desmineralizado, o cualquier otro tipo de material
adecuado que sirva como soporte de la carga. Con mayor preferencia,
los materiales elegidos para las placas terminales, en combinación
con el fluido, pueden ser seleccionados para minimizar el uso.
Además, con preferencia, cualquier superficie de
articulación en los discos intervertebrales de la presente
invención incluye una superficie lustrada o de acabado similar al
acabo del diamante. Acabado tipo TiNi, etc., con el fin de
minimizar el uso, disminuir la generación de partículas, e
incrementar la vida del disco.
La superficie externa de las placas terminales
superior e inferior pueden ser sustancialmente planas, en forma de
cuña, etc. Las superficies externas de las placas terminales
superior e inferior 12, 14, además pueden tener forma de cúpula con
su radio definido en los planos sagital y coronal para que
generalmente coincida la forma del de los extremos de la vértebra
adyacente, por lo tanto provee un mejor encastre in situ.
Además, como se demuestra en las Figuras 1 a 2a,
el disco 10 puede incluir características de migración resistentes,
como por ejemplo, estructuras similares al clavo 18 sobre las
superficies externas de las placas terminales superior e inferior
12, 14. Las características de resistencia migratoria pueden
facilitar el compromiso del disco 10 con los extremos de las
vértebra adyacente mediante la provisión de un interbloqueo mecánico
como resultado de la penetración y/o deformación de las
extremidades de las vértebras adyacentes. El mecanismo de
estabilidad inicial logrado por los clavos 18, por ejemplo, minimiza
los riesgos de inestabilidad postoperatoria, movimiento,
dislocación o expulsión del disco 10. Otras características
resistentes a la migración pueden incluir, sin limitarse a,
separadores, dientes, dientes desplazables, clavos desplazables,
clavos flexibles, placas, placas insertables o expansibles,
soportes, tornillos, bordes, serraciones, u otras texturas similares
sobre las superficies externas de las placas terminales superior e
inferior 12, 14. Como se muestra en la Figura 3a, los clavos
desplazables 21 pueden ser provistos, y un mecanismo de leva 23 se
puede utilizar para desplazare los clavos 21. Alternativamente, y
como se muestra en la Figura 3b, un instrumento se puede utilizar
para desplazar a los clavos 21. Como se muestra en las Figuras 3c
hasta 3e, respectivamente, se muestran ejemplos de clavos flexibles
24, dientes en forma 25, y soportes 26. Alternativamente y además,
los agentes de unión como los cementos de fosfato de calcio, etc.,
pueden también utilizarse para asegurar el disco 10 de la vértebra
adyacente.
Además, las placas terminales superior e
inferior 12, 14 también pueden estar recubiertas por un crecimiento
óseo induciendo sustancia, como la hidroxiapatita, con el fin de
promover en crecimiento interno óseo para asegurar permanentemente
el disco 10 de las vértebras adyacentes. Alternativamente, las
placas terminales superior e inferior 12, 14 pueden tener una
superficie áspera o porosa que facilite el crecimiento interno
óseo. Alternativamente, las placas terminales superior e inferior
12, 14 pueden tener láminas de placas terminales tratadas con láser
para crear una estructura porosa, o pueden formar un puente
osteoconductor y/u osteoinductivo. Las placas terminales 12, 14
también pueden estar formadas por material osteoconductor y/u
osteoinductor para promover el crecimiento interno óseo. Las placas
terminales 12, 14 además incluyen una membrana y/o barrera que
limita la profundidad permitida del crecimiento interno óseo.
Las placas terminales 12, 14 también pueden
tener un implante adjunto de instrumentación, que guía y retiene
las estructuras. Por ejemplo, las placas terminales 12, 14 pueden
tener perforaciones, ranuras, hilos, o cola de milano con el fin de
permitir la utilización de la herramienta para realizar el implante
del disco 10 y/o para distraer las vértebras. Por ejemplo, el disco
puede incluir una ranura formada por las placas terminales superior
e inferior 12, 14, la ranura configurada para recibir el instrumento
de implante, un distractor o ambos.
Como resultado de los componentes materiales y
estructurales utilizados, el disco 10 puede permitir
flexión/exten-
sión, curvatura lateral, rotación axial, y translación, dependiendo de la carga impartida en el disco vertebral. Además, según las distintas condiciones de carga espinales que resultan de los movimientos espinales, el fluido 22 puede moverse dentro del volumen interior, ya sea por la compresión (en el caso de un gas), o por el movimiento radial hacia fuera a medida que la membrana se expande, permitiendo que las placas terminales se muevan entre si. Esta variación de movimiento o desplazamiento del fluido 22 provee un movimiento instantáneo del eje de rotación.
sión, curvatura lateral, rotación axial, y translación, dependiendo de la carga impartida en el disco vertebral. Además, según las distintas condiciones de carga espinales que resultan de los movimientos espinales, el fluido 22 puede moverse dentro del volumen interior, ya sea por la compresión (en el caso de un gas), o por el movimiento radial hacia fuera a medida que la membrana se expande, permitiendo que las placas terminales se muevan entre si. Esta variación de movimiento o desplazamiento del fluido 22 provee un movimiento instantáneo del eje de rotación.
La presente invención no se limita a las formas
de realización especificas descriptas en el presente.
Además, se debe comprender que el alcance de las
variaciones y modificaciones de esta invención puede ocurrir para
aquellos experimentados en el arte hacia los cuales esta invención
es dirigida. Por ejemplo, algunas porciones de implantes que se
muestran en el presente pueden estar formadas por hueso, como
aloinjerto, autoinjerto, y xenoinjerto, que pueden estar
parcialmente o totalmente desmineralizados. Además, algunos
implantes pueden incluir material óseo u otro tipo de crecimiento
óseo induciendo material en su interior o sobre/en las placas
terminales. Dichas sustancias en los interiores pueden interactuar
con la anatomía que las rodea, como canales u otro tipo de
orificios formados por paredes de implantes. Además, los marcadores
de alineación postoperación pueden utilizarse para asistir con el
implante de los discos vertebrales. También, los discos
intervertebrales pueden ser rígidos en situaciones donde es
necesaria una fusión. Los discos intervertebrales pueden ser
rígidos, por ejemplo, permitiendo la fusión entre las placas
terminales, insertando espaciadores entre las placas terminales, o
inyectando un líquido solidificado entre las placas terminales.
Según esto, todas las modificaciones convenientes que se encuentren
disponibles para aquellos experimentados en este arte mediante la
revelación que aquí se realiza y que se encuentran dentro del
alcance y el espíritu de la presente invención, deben ser incluidas
como formas de realización adicionales a la presente invención. El
alcance de la presente invención se encuentra debidamente definido
como es establecido en las reivindicaciones adjuntas.
Claims (20)
-
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1. Un disco intervertebral (10) para su ubicación entre la primera y segunda vértebra incluye:una placa terminal superior (12) con una primera superficie interna y una primera superficie externa, la primera superficie externa contacta a la primera vértebra;una placa terminal inferior (14) que tiene segunda superficie interna y una segunda superficie externa, la segunda superficie externa contacta a la segunda vértebra,una membrana (16) que se extiende desde la placa terminal superior (12) y la placa terminal inferior (14),un volumen interior (19) definido entre las placas terminales (12, 14) y la membrana elástica (16),una válvula (20) en comunicación con el volumen interior (19) llenando por lo menos parcialmente el volumen con un fluido (22), en dondeuna de las primeras y segundas superficies internas tiene un alvéolo (32) y la otra de la primera y segunda superficies interna tienen una protrusión (34), en donde la protrusión (34) se configura de manera convexa para articular dentro del alvéolo cóncavo (32), caracterizado porqueel alvéolo (32) y la protrusión (34) están configurados y poseen las dimensiones para acoplarse o para que generalmente encastren entre si, y la membrana elástica (16) está configurada alrededor del alvéolo (32) y la protrusión (34), permitiendo flexión, extensión, curvatura lateral, rotación y traslación,en donde la traslación es un movimiento generalmente transverso al eje de la columna vertebralpor lo que permite movimiento instantáneo de rotación del eje. - 2. Un disco intervertebral (10) de acuerdo con la reivindicación 1, en donde la protrusión (34) posee el mismo radio que el alvéolo (32) lo que provee de un mayor soporte pero de un movimiento más limitado.
- 3. Un disco intervertebral (10) de acuerdo con la reivindicación 1, en donde el alvéolo (32) tiene un radio mayor que la protrusión (34) que brinda una mayor articulación.
- 4. Un disco intervertebral (10) de acuerdo con la reivindicación 1, en donde la protrusión (34) y/o alvéolo (32) incorpora una porción plana que permite el movimiento de traslación de la placa terminal superior (12) con respecto a la placa terminal inferior (14).
- 5. Un disco intervertebral (10) de acuerdo con la reivindicación 1, en donde al menos una porción de la válvula (20) se coloca dentro de la membrana (16) .
- 6. Un disco intervertebral (10) de acuerdo con cualquiera de las reivindicaciones anteriores 1-2, en donde al menos una porción de membrana (16) se encuentra entre las placas superior e inferior (12, 14).
- 7. Un disco intervertebral (10) de acuerdo con cualquiera de las reivindicaciones anteriores 1-3, en donde la membrana (16) encapsula las placas terminales superior e inferior (12, 14).
- 8. Un disco intervertebral (10) de acuerdo con cualquiera de las reivindicaciones anteriores 1-4, en donde la membrana (16) está formada por material elastomérico.
- 9. Un disco intervertebral (10) de acuerdo con cualquiera de las reivindicaciones anteriores 1-5, en donde la membrana (16) forma un fuelle.
- 10. Un disco intervertebral (10) de acuerdo con cualquiera de las reivindicaciones anteriores 1-6 en donde el fluido (22) es incompresible.
- 11. Un disco intervertebral (10) de acuerdo con cualquiera de las reivindicaciones anteriores 1-7, en donde al menos una de las placas terminales (12, 14) está formada de material seleccionado de un grupo de metal consistente, polímero, cerámica o compuesto.
- 12. Un disco intervertebral (10) de acuerdo con cualquier de las reivindicaciones anteriores 1-8, en donde al menos una de las placas terminales (12, 14) está formada por material óseo seleccionado de un grupo cortical, hueso esponjoso, aloinjerto, xenoinjerto, hueso desmineralizado o parcialmente desmineralizado.
- 13. Un disco intervertebral (10) de acuerdo con cualquier de las reivindicaciones anteriores 1-9, que además comprende las estructuras resistentes a la migración dispuestas sobre al menos una de la primera o segunda superficie externa.
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- 14. Un disco intervertebral (10) de acuerdo con cualquier de las reivindicaciones anteriores 1-10, que además comprende los medios de fijación permanente dispuestos sobre al menos una de la primera o segunda superficie externa.
- 15. Un disco intervertebral (10) de acuerdo con cualquier de las reivindicaciones anteriores 1-11, que además comprende un adjunto de instrumento de implante, que guía o retiene las estructuras dispuestas sobre al menos una de la primera o segunda superficie externa.
- 16. Un disco intervertebral (10) de acuerdo con la reivindicación 1, en donde al menos una de las placas terminales (12, 14) posee una forma de cúpula con su radio que encastra con los extremos de la vértebra adyacente.
- 17. Un disco intervertebral (10) de acuerdo con la reivindicación 13, en donde las estructuras resistentes a la migración son clavos (18), clavos desplazables (21), clavos flexibles (24), dientes (25) o soportes en forma de estructuras (26).
- 18. Un disco intervertebral (10) de acuerdo con la reivindicación 17, en donde el mecanismo de leva (23) o un instrumento es utilizado para operar los clavos desplazables (21).
- 19. Un disco intervertebral (10) de acuerdo con la reivindicación 1, en donde el disco (10) tiene forma de alubia que incluye un lado anterior (11), un lado posterior (13) y el primer y segundo lado lateral (15, 17) son sustancialmente convexos en forma y el lado posterior (13) es sustancialmente cóncavo.
- 20. Un disco intervertebral (10) de acuerdo con la reivindicación 19, en donde el disco (10) posee una forma que se adapta geométrica y anatómicamente con los cuerpos de la vértebra adyacente y son circulares, ovales, elipsoides, anular, en forma de D, en forma de C.
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Cited By (1)
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WO2011098634A1 (es) | 2010-02-12 | 2011-08-18 | Alonso Abajo Antonio Magin | Dispositivo para el tratamiento de patología en la columna vertebral |
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US6558424B2 (en) * | 2001-06-28 | 2003-05-06 | Depuy Acromed | Modular anatomic fusion device |
WO2003002021A2 (en) * | 2001-06-29 | 2003-01-09 | The Regents Of The University Of California | Biodegradable/bioactive nucleus pulposus implant and method for treating degenerated intervertebral discs |
US6607558B2 (en) * | 2001-07-03 | 2003-08-19 | Axiomed Spine Corporation | Artificial disc |
DE10132588C2 (de) * | 2001-07-05 | 2003-05-22 | Fehling Instr Gmbh | Bandscheibenprothese |
US20030028251A1 (en) * | 2001-07-30 | 2003-02-06 | Mathews Hallett H. | Methods and devices for interbody spinal stabilization |
US6375682B1 (en) * | 2001-08-06 | 2002-04-23 | Lewis W. Fleischmann | Collapsible, rotatable and expandable spinal hydraulic prosthetic device |
US7066958B2 (en) * | 2002-05-10 | 2006-06-27 | Ferree Bret A | Prosthetic components with partially contained compressible resilient members |
US8388684B2 (en) * | 2002-05-23 | 2013-03-05 | Pioneer Signal Technology, Inc. | Artificial disc device |
US7166130B2 (en) * | 2002-06-27 | 2007-01-23 | Ferree Bret A | Artificial disc replacements with deployable fixation components |
US6733533B1 (en) * | 2002-11-19 | 2004-05-11 | Zimmer Technology, Inc. | Artificial spinal disc |
US6893465B2 (en) * | 2003-03-31 | 2005-05-17 | Shi, Tain-Yew | Vividly simulated prosthetic intervertebral disc |
US6984246B2 (en) * | 2003-06-06 | 2006-01-10 | Tain-Yew Shi | Artificial intervertebral disc flexibly oriented by spring-reinforced bellows |
KR100856977B1 (ko) * | 2004-11-11 | 2008-09-04 | 야마하 가부시키가이샤 | 반도체 장치, 반도체 웨이퍼, 칩 사이즈 패키지, 및 그제조 및 검사 방법 |
-
2003
- 2003-08-15 AT AT03788497T patent/ATE400237T1/de active
- 2003-08-15 KR KR1020057002537A patent/KR100984627B1/ko not_active IP Right Cessation
- 2003-08-15 ES ES03788497T patent/ES2310255T3/es not_active Expired - Lifetime
- 2003-08-15 DE DE20321571U patent/DE20321571U1/de not_active Expired - Lifetime
- 2003-08-15 BR BR0313502-0A patent/BR0313502A/pt not_active Application Discontinuation
- 2003-08-15 CA CA2495404A patent/CA2495404C/en not_active Expired - Fee Related
- 2003-08-15 WO PCT/US2003/025535 patent/WO2004016205A2/en active Application Filing
- 2003-08-15 DE DE60322066T patent/DE60322066D1/de not_active Expired - Lifetime
- 2003-08-15 EP EP03788497A patent/EP1531765B1/en not_active Expired - Lifetime
- 2003-08-15 JP JP2004529426A patent/JP4256345B2/ja not_active Expired - Fee Related
-
2005
- 2005-02-11 US US11/056,034 patent/US7563284B2/en active Active
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2011098634A1 (es) | 2010-02-12 | 2011-08-18 | Alonso Abajo Antonio Magin | Dispositivo para el tratamiento de patología en la columna vertebral |
Also Published As
Publication number | Publication date |
---|---|
EP1531765B1 (en) | 2008-07-09 |
DE20321571U1 (de) | 2008-02-14 |
JP2006514558A (ja) | 2006-05-11 |
DE60322066D1 (de) | 2008-08-21 |
EP1531765A2 (en) | 2005-05-25 |
US7563284B2 (en) | 2009-07-21 |
US20050197702A1 (en) | 2005-09-08 |
WO2004016205A9 (en) | 2004-07-08 |
JP4256345B2 (ja) | 2009-04-22 |
KR20060056264A (ko) | 2006-05-24 |
CA2495404C (en) | 2011-05-03 |
ATE400237T1 (de) | 2008-07-15 |
WO2004016205A3 (en) | 2004-05-27 |
KR100984627B1 (ko) | 2010-09-30 |
WO2004016205A2 (en) | 2004-02-26 |
CA2495404A1 (en) | 2004-02-26 |
BR0313502A (pt) | 2005-07-12 |
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