FR2615095A1 - Osteosynthesis instrumentation for the correction of lumbar scoliosis through the posterior - Google Patents

Osteosynthesis instrumentation for the correction of lumbar scoliosis through the posterior Download PDF

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Publication number
FR2615095A1
FR2615095A1 FR8706864A FR8706864A FR2615095A1 FR 2615095 A1 FR2615095 A1 FR 2615095A1 FR 8706864 A FR8706864 A FR 8706864A FR 8706864 A FR8706864 A FR 8706864A FR 2615095 A1 FR2615095 A1 FR 2615095A1
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vertebra
plate
instrumentation
characterized
screw
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FR8706864A
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French (fr)
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FR2615095B1 (en )
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Daniel Chopin
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FABRICATION MATERIEL ORTHOPEDIQU
FABRICATION MATERIEL ORTHOPEDI
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FABRICATION MATERIEL ORTHOPEDIQU
FABRICATION MATERIEL ORTHOPEDI
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7044Screws or hooks combined with longitudinal elements which do not contact vertebrae also having plates, staples or washers bearing on the vertebrae
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002Longitudinal elements, e.g. rods
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7041Screws or hooks combined with longitudinal elements which do not contact vertebrae with single longitudinal rod offset laterally from single row of screws or hooks
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7049Connectors, not bearing on the vertebrae, for linking longitudinal elements together

Abstract

This instrumentation comprises, for each lumbar vertebra 1b, two pedicle screws 2, 3, with a double thread 4, 5 and two rods 8, 9, associated respectively with one screw 2, 3 and solidly attached therewith with corresponding clamps 11, 12; it comprises, for each vertebra, a plate 13 passed through by the said screws 2, 3 and adapted to hold the latter transversally. The presence of the transverse holding plate 13 ensures very solid vertical holding, making it possible to act on the vertebra in all directions and distribute the stresses over the whole of the latter between the pedicle screws 2, 3 and this joining plate 13, which prevents any risk of breakage or tearing of the vertebra. <IMAGE>

Description

La présente invention a pour objet une instrumentation d'ostéosynthèse pour la correction de scolioses lombaires par voie postérieure, du type comprenant pour chaque vertèbre lombaire, deux vis pédiculaires à double filetage et deux tiges associées respectivement à une vis et solidarisées avec cellesci par des pinces correspondantes. The present invention relates to an osteosynthesis instrumentation for the correction of scoliosis by lumbar posterior approach, of the type comprising for each lumbar vertebra, two pedicular screws double thread and two rods associated respectively with a screw and secured by clamps with cellesci corresponding.

On sait que le traitement chirurgical des scolioses a pour objectif de corriger la déformation rachidienne dans les trois plans de l'espace. We know that the surgical treatment of scoliosis aims to correct spinal deformity in three planes of space. A cette fin, ce traitement réalise une compression entre tous les éléments anatomiques structurels qui s'opposent à la correction (disques, articulaires, ligaments, etc..) et ce au moyen d'une instrumentation dont les points d'application et les directions des forces développées doivent aller dans le sens de la correction. To this end, this treatment realizes compression between all structural anatomical elements that oppose to the correction (discs, joints, ligaments, etc. ..) and this by means of an instrumentation whose points of application and the directions the developed forces must move in the direction of correction.

Pour satisfaire à ces impératifs, les instrumentations les plus récentes connues réalisent une prise segmentaire intéressant plusieurs vertèbres de la déformation To meet these requirements, the latest instrumentation known realize an interesting segmental taken several vertebrae deformation
- soit toutes les vertèbres, avec prise sur, les corps vertébraux ou sur les arcs postérieurs; - or all vertebrae that takes over the vertebral body or on the posterior arches;
- soit certaines vertèbres dites stratégiques, par une instrumentation située au niveau de la colonne postérieure. - or some called strategic vertebrae by instrumentation located at the posterior column.

Les différences entre ces dispositifs résident dans leur mode d'action et dans le type de "pri- se" vertébrale, les instrumentations antérieures connues permettant une excellente prise vertébrale au moyen de vis corporéales transversales. The differences between these devices reside in their mode of action and in the type of "plug" spine, the anterior instrumentation known for excellent vertebral engagement by means of screws transverse corporeal.

Par ailleurs, l'excision discale nécessaire à la greffe, et que permet l'abord direct des corps vertébraux, permet une correction importante de l'in clinaison latérale et de la rotation en raccourcissant la colonne antérieure. Moreover, disc excision required for grafting, and that allows direct first vertebral body, allows a significant correction in the lateral clinaison and rotation by shortening the anterior column. Elle présente toutefois l'inconvénient lié à la nature de sa voie elle-mème, en raison de la proximité d'organes nobles. However, it has the disadvantage of the nature of the track box itself, due to the proximity of vital organs. Mais surtout, si cette instrumentation antérieure a un effet "décyphosant", elle n'a pas un effet réel lordosant du fait de son mode d'action en.compression antéro-latérale. More importantly, if this prior instrumentation has an effect "décyphosant" she does not have a real effect lordosing because of its mode of action en.compression anterolateral.

Or, la restitution d'une lordose est particulièrement importante au niveau thoraco-lombaire et surtout lombaire pour l'équilibre sagittal du patient. But the return of a lordosis is particularly important at the thoracolumbar level and above lumbar sagittal balance for the patient.

Les instrumentations postérieures prévues sur les arcs postérieurs ou au niveau de la colonne postérieure avec des crochets, permettent une bonne correction frontale, saggitale au niveau lombaire, mais malheureusement ne procurent pratiquement aucune efficacité dans le plan horizontal, c'est-à-dire que pratiquement aucun effet de dérotation vertébrale n'est obtenu. Posterior instrumentation provided on the posterior arches or the posterior column with hooks, enable good front correction saggitale at the lumbar level, but unfortunately practically provide no efficacy in the horizontal plane, that is to say virtually no spinal derotation effect is obtained.

Cette lacune est liée en grande partie au mode de la prise vertébrale. This shortcoming is largely related to the mode of the vertebral engagement. En effet, au niveau lombaire considéré ici, les articulaires ne sont pas utilisables du fait de leur orientation, et les transverses sont trop fragiles pour permettre une prise solide. Indeed, lumbar considered here, the joint can not be used because of their orientation, and the cross are too fragile to allow a solid grip. Par ailleurs, c'est essentiellement sur les lames que sont appuyées les instrumentations, soit par l'intermédiaire de fils (Luque), soit par l'intermédiaire de crochets (Cotrel-Dubousset). Moreover, it is essentially on the blades that are supported the instrumentation or via son (Luque) or by means of hooks (Cotrel-Dubousset). Or, ces prises lamaires présentent l'inconvénient de ne pas assurer une prise vertébrale parfaite autorisant une petite mobilité de la vertèbre par rapport à l'intrumentation. However, these laminae taken have the drawback of not ensuring perfect vertebral engagement allowing a small mobility of the vertebrae relative to the intrumentation. Par ailleurs, elles sont très mal placées mécaniquement pour permettre une dérotation vertébrale, car elles sont trop proches de l'axe de rotation. Moreover, they are very badly placed mechanically to allow a spinal derotation because they are too close to the axis of rotation.

Il s'ensuit notamment lors de la rotation de la tige en lordose avec l'instrumentation Cotrel It follows in particular during rotation of the rod in lordosis with Cotrel instrumentation
Dubousset, une perte de la correction potentielle avec absence de dérotation vertébrale réelle -qui persiste par rapport à l'instrumentation- et lordotisation moins importante de la colonne par rapport à la tige. Dubousset, loss of potential Correction lack of real vertebral derotation -which persists with respect to the instrumentation- and less lordotisation of the column relative to the rod.

En d'autres termes, il est relativement difficile de déplacer la vertèbre dans -les trois directions de l'espace au moyen de cette instrumentation. In other words, it is relatively difficult to move the vertebra in -the three directions in space by means of the instrumentation.

L'invention a pour but de réaliser une instrumentation d'ostéosynthèse pour la correction de scolioses lombaires par voi# postérieure ne présentant pas ces inconvénients. The invention is intended to perform osteosynthesis instrumentation for the correction of lumbar scoliosis by posterior voi # does not have these disadvantages.

Suivant l'invention, l'instrumentation comporte, pour chaque vertèbre, une plaque traversée par les vis pédiculaires et adaptée pour maintenir celles-ci transversalement. According to the invention, the instrumentation comprises for each vertebra, a passage plate and the pedicular screws adapted to hold the latter transversely.

La présence de cette plaque de liaison et de maintien transversal des vis associées permet une correction tridimensionnelle effective par voie postérieure, grâce à une prise vertébrale solide. The presence of this connecting plate and transverse holding of the associated screw allows an effective three-dimensional correction posterior approach, through a solid vertebral engagement. De plus, la plaque supporte une partie de l'effort exercé sur la vertèbre, ce qui évite des risques de cassure ou d'arrachement-de cette dernière. In addition, the plate supports a portion of the force exerted on the vertebra, which avoids the risk of breakage or tearing, of the latter.

Suivant un mode de réalisation de l'invention, la plaque est profilée en V largement ouvert et dont la concavité est dirigée vers un canal médulaire de la vertèbre, et les extrémités de ladite plaque sont traversées par les vis correspondantes, grâce à des trous de préférence tronconiques ménagés dans lesdites extrémités. According to one embodiment of the invention, the plate is shaped in widely open V and whose concavity is directed towards a medullary canal of the vertebra, and the ends of said plate are traversed by the corresponding screws through holes preferably frustoconical provided in said ends.

Grâce à ce profil tronconique, il est possible de positionner les vis pédiculaires avec un débattement angulaire important, par exemple de l'ordre de 20*. With this tapered profile, it is possible to position the pedicle screws with a large angular displacement, for example of the order of 20 °.

D'autres particularités et avantages de l'invention apparaitront au cours de la description qui va suivre, faite en référence aux dessins annexés qui en illustrent un mode de réalisation à titre d'exemple non limitatif Other features and advantages of the invention appear from the following description with reference to the accompanying drawings which illustrate an embodiment by way of example
- la Figure 1 est une vue en élévation en traits continus d'une vertèbre lombaire d'une colonne vertébrale affectée d'une scoliose et, en traits plus fins, de la même vertèbre positionnée après correction; - Figure 1 is an elevation in solid lines to a lumbar vertebra of a spinal column affected scoliosis and in finer features of the same vertebra positioned after correction;
- la Figure 2 est une vue en perspective éclatée d'un mode de réalisation de l'instrumentation d'ostéosynthèse selon 1 ' invention; - Figure 2 is an exploded perspective view of an embodiment of instrumentation for osteosynthesis according to one invention;
- la Figure 3 est une vue de dessus de l'instrumentation de la Figure 2 positionnée sur une vertèbre lombaire redressée; - Figure 3 is a top view of the instrumentation of Figure 2 positioned on a rectified lumbar vertebra;
- la Figure 4 est une vue mi-coupe, mi-élévation partielle à échelle agrandie, de l'instrumentation de la Figure 3;; - Figure 4 is a mid-sectional view, partial mid-elevation on an enlarged scale, of the instrumentation of Figure 3 ;;
- la Figure 5 est une vue en élévation de l'ensemble d'une instrumentation conforme aux Figures 2 à 4 disposée sur des vertèbres lombaires. - Figure 5 is an elevational view of the set of instrumentation in accordance with Figures 2-4 arranged on the lumbar vertebrae.

On voit à la Figure 1 une vertèbre lombaire la d'une colonne vertébrale affectée par une scoliose lombaire, et en traits fins cette même vertèbre 1b positionnée après correction au moyen de l'instrumen- tation visée par l'invention. Seen in Figure 1 a lumbar vertebra of a vertebral column affected by scoliosis lumbar, and in thin lines the same vertebra 1b positioned after correction by means of the instru- mentation intended by the invention.

Comme le montrent les trois séries de flèches F, G, H, cette déviation de la position de la vertèbre la est tridimensionnelle, de sorte que la correction de son positionnement doit pouvoir être réalisée dans les trois plans de l'espace, au moyen notamment d'une dérotation latérale indiquée par l'angle A. As shown the three sets of arrows F, G, H, this deviation of the position of the vertebra is the three-dimensional, so that the correction of its positioning must be carried out in the three spatial planes, in particular by means a side rotator indicated by the angle A.

L'instrumentation d'ostéosynthèse visée par l'invention est donc destinée à permettre cette correction de scolioses par voie postérieure. The osteosynthesis instrumentation intended by the invention is therefore designed to allow the correction of scoliosis by posterior approach. Cette instrumentation comprend (Figures 2 à 4), pour chaque vertèbre lombaire, deux vis pédiculaires 2, 3 à double filetage 4, 5 séparés par un corps 6 et par une partie tronconique 7. La partie 2a extérieure à la vertèbre porte un filetage 4 à faible pas de vis, tandis que la partie 2b de la vis 2, 3 porte un filetage 5 à pas important et est destinée à s'enfoncer dans le corps vertébral. This instrumentation comprises (Figures 2 to 4), for each lumbar vertebra, two pedicular screws 2, 3 hanger 4, 5 separated by a body 6 and a frustoconical portion 7. The outer portion 2a to the vertebra carries a thread 4 low thread pitch, whereas the part 2b of the screw 2, 3 has a screw thread 5 not important and is intended to sink into the vertebral body. Ces vis sont dites du type à spondylolisthèsis. These screws are called type spondylolisthesis.

L'instrumentation comporte également deux tiges moletées 8, 9 à pointes de diamant, associées respectivement à une vis pédiculaire 2, 3 et solidarisées avec celles-ci par des pinces correspondantes 11, 12 ainsi que, pour chaque vertèbre, une plaque 13 traversée par la partie 2b des vis 2, 3 portant le filetage 5 et adaptée pour maintenir celle-ci transversalement. The instrumentation also includes two knurled rods 8, 9 to diamond points, respectively associated with a pedicular screw 2, 3 and joined to the latter by corresponding clamps 11, 12 and, for each vertebra, a plate 13 through which the portion 2b of the screws 2, 3 bearing the thread 5 and adapted to keep it transversely.

La plaque 13 est profilée en V largement ouvert et dont la concavité est dirigée vers un canal médulaire 14 (Figure 3) de la vertèbre lb. The plate 13 is shaped in widely open V and whose concavity is directed towards a medullary canal 14 (Figure 3) of the vertebra lb. Les extrémités 15 de la plaque ou barrette 13 sont rabattues dans un même plan par rapport aux deux branches du V, et percées de trous tronconiques 16 adaptés pour recevoir la partie filetée 2b des vis 2, 3. The ends 15 of the plate or bar 13 are bent in the same plane relative to the two branches of the V, and pierced with frustoconical holes 16 adapted to receive the threaded portion 2b of the screws 2, 3.

La plaque 13 est pourvue, dans sa partie médiane, de moyens de préhension par un outil non représenté tel qu'un davier, afin de permettre de déplacer la vertèbre dans les directions souhaitées. The plate 13 is provided in its middle part, gripping means by a not shown tool such as a forceps, to enable to move the vertebra in the desired directions.

Dans l'exemple d'exécution représenté, ces moyens de préhension consistent en un bossage 17 saillant vers l'extérieur du V, c'est-à-dire dans la direction opposée au canal médulaire 14, et dans lequel est ménagé un trou taraudé 18 destiné à recevoir l'extrémité correspondante de l'outil. In the embodiment shown, the gripping means consist of a boss 17 projecting outwardly of the V, that is to say in the direction opposite to the medullary canal 14, and in which is formed a threaded hole 18 for receiving the corresponding end of the tool.

Bien entendu, chaque plaque de maintien transversal 13 peut être réalisée suivant différentes longueurs, de manière à pouvoir s'ajuster à toutes les morphologies des vertèbres. Of course, each transverse holding plate 13 can be carried out according to different lengths, so as to adjust to all the morphologies of vertebrae.

Chaque pince 11, 12 de liaison entre la tige moletée 8, 9 et la vis 2, 3 associée est constituée de deux demi-crochets ou hémi-crochets 19, 21 présentant chacun à une extrémité une ouverture semi-circulaire 22, 23. Les demi-crochets 19, 21 sont disposés l'un par rapport à l'autre de manière que les ouvertures 22, 23 se complètent pour recevoir la tige correspondante 8 ou 9. Chaque demi-crochet 19, 21 est percé d'un trou 24, 25 de passage de la partie filetée 2a de la vis 2 (ou 3) portant le filetage 4. Chaque trou 24, 25 présente un évasement tronconique 24a, 25a adapté pour recevoir respectivement un écrou 26 de serrage des deux demi-crochets 19, 21 sur la tige 8 (ou 9), et la partie tronconique 7 de la vis (Figure 4). Each clamp 11, 12 connecting between the knurled rod 8, 9 and the screw 2, 3 associated consists of two half-brackets or hemi-hooks 19, 21 each having at one end a semi-circular aperture 22, 23. The half-brackets 19, 21 are arranged relative to each other so that the openings 22, 23 complement each other to receive the corresponding rod 8 or 9. Each half-hook 19, 21 is a hole 24 , 25 for passage of the threaded portion 2a of the screw 2 (or 3) carrying the thread 4. Each hole 24, 25 has a frustoconical flare 24a, 25a respectively adapted to receive a nut 26 for clamping the two half-brackets 19, 21 of the rod 8 (or 9), and the tapered portion 7 of the screw (Figure 4).

La mise en oeuvre de l'instrumentation qui vient d'être décrite est la suivante. The implementation of instrumentation which has just been described is as follows.

Tout d'abord, on monte chaque plaque transversale 13 sur les deux vis pédiculaires correspondantes 2, 3 dont les parties filetées 2b sont enfoncées dans les corps vertébraux. First, it mounts each transverse plate 13 of the two screws corresponding pedicle 2, 3 including the threaded portions 2b are driven into the vertebral bodies. Puis on enfile chaque tige moletée 8, 9 préalablement galbée à la courbure voulue dans deux crochets extrêmes 27 et 28 (Figure 5) pédiculaire et lamaire. Then puts each knurled rod 8, 9 previously curved to the desired curvature in two end hooks 27 and 28 (Figure 5) pedicle and lamina. (Les crochets 27 et 28 sont connus en soi et ne nécessitent donc pas de description particulière). (The hooks 27 and 28 are known per se and therefore do not require any particular description).

On monte ensuite sur la partie filetée 2a de chaque vis 2, 3 les demi-crochets 19, 21, à une hauteur déterminée par la déformation de la vertèbre, de telle façon que la tige 8, 9 soit emprisonnée dans les ouvertures 22, 23 entre les demi-crochets 19, 21. Ces derniers prennent donc appui sur la tige 8 ou 9 bloquée par ses extrémités dans une position fixe, les vis 2, 3 étant d'autre part bloquées dans la vertèbre. Is then mounted on the threaded portion 2a of each screw 2, 3 half-brackets 19, 21 at a height determined by the deformation of the vertebra, so that the rod 8, 9 is trapped in the openings 22, 23 between the half-brackets 19, 21. the latter therefore are supported on the shaft 8 or 9 blocked by its ends in a fixed position, the screws 2, 3 are on the other hand blocked in the vertebra.

On visse alors l'écrou 26 sur le filetage 4 jusqu'à ce qu'il s'enfonce dans l'évasement tronconique 24a (l évasement tronconique 25a recevant la partie tronconique 7). then the nut 26 is screwed onto the thread 4 until it sinks into the frustoconical flare 24a (the frustoconical flare 25a receiving the frustoconical portion 7). Le demi-crochet supérieur 19 étant en appui sur la tige fixe 8 ou 9, ce serrage de l'écrou 26 élève la vertèbre jusqu'à ce que la tige 8 (ou 9) vienne en contact avec le demi-crochet inférieur 21, qui lui-#mème se trouve en contact avec le cône supérieur 7. On achève le serrage de l'écrou 26 et la vertèbre est alors redressée. The upper half-hook 19 bearing on the fixed rod 8 or 9, the tightening of the nut 26 increases the vertebra until the rod 8 (or 9) comes into contact with the lower half-hook 21, which itself # meme is in contact with the upper cone 7. completes the tightening of the nut 26 and the vertebra is then rectified.

On a ainsi réalisé un ensemble monobloc comprenant la prise de la tige 8 ou 9 par les deux demi-crochets 19t 21 bloqués par la partie conique 7 et par l'écrou 26, la vis 2 ou 3 étant elle-même prise par la vertèbre. a one-piece assembly has thus been produced comprising the taking of the rod 8 or 9 by the two half-brackets 21 19t blocked by the tapered portion 7 and by the nut 26, the screw 2 or 3 itself being taken by the vertebra .

On effectue ce mouvement de "dérotation", qui permet de donner une tension aux vertèbres lombaires V1, V2, V3 (Figure 5) pour chacune de celles-ci successivement. This is accomplished motion "derotation", which allows to give a voltage to the lumbar vertebrae V1, V2, V3 (Figure 5) for each of them successively. Chacune de ces opérations successives est facilitée par la présence de la plaque de liaison 13 préalablement enfilée sur la partie filetée 2b puis sur le corps 6 de la vis avant vissage de celle-ci dans le corps vertébral. Each of these successive operations is facilitated by the presence of the connection plate 13 previously fitted on the threaded portion 2b and the body 6 of the screw before screwing thereof into the vertebral body.

La présence des plaques 13, ancrées sur l'une des vis 2, 3 enfoncées dans la vertèbre, permet de serrer l'écrou 26 sur l'autre vis (3 ou 2) et de forcer sur le filetage 4 en évitant tout risque de cassure ou d'arrachage de la vertèbre. The presence of plates 13, anchored on one of the screws 2, 3 driven into the vertebra, allows to tighten the nut 26 on the other screw (3 or 2) and force the thread 4 while avoiding any risk of break or tear of the vertebra. En effet, chaque plaque 13 reçoit une partie de l'effort exercé sur la vertèbre. Indeed, each plate 13 receives a portion of the force exerted on the vertebra.

Une fois la première série de demi-crochets 19, 21 ainsi mise en place sur les vis et la tige correspondante 8 ou 9, on recommence avec la deuxième série de demi-crochets 19, 21 sur la deuxième tige 9 ou 8. Comme dans la séquence précédente, l'appui fixe fourni par les prises extrêmes des crochets pédiculaire 27 et lamaire 28 permet, en vissant et en serrant les écrous 26, de compléter le redressement des vertèbres dans les trois dimensions de l'espace, pour les repositionner correctement (Figure 1). Once the first series of half-brackets 19, 21 and placed on the screws and the corresponding rod 8 or 9 is repeated with the second half-series of hooks 19, 21 on the second rod 9 or 8. As in the above sequence, the fixed support provided by the extreme catch pedicle 27 and laminar hooks 28 allows, by screwing and tightening the nuts 26, to complete the recovery of the vertebrae in the three dimensions of space, to reposition properly (Figure 1).

On voit à la Figure 5 l'ensemble de l'instrumentation obtenue après mise en place successive des divers éléments de celle-ci selon les séquences décrites ci-dessus, sur trois vertèbres lombaires V1, Seen in Figure 5 the whole of the instrumentation obtained after successive setting up of the various components thereof according to the sequences described above, three lumbar vertebrae V1,
V2, V3. V2, V3.

En plus des avantages techniques précédemment mentionnés, l'instrumentation selon l'invention présente les autres avantages ci-dessous. In addition to the technical advantages mentioned above, the instrumentation of the invention has other advantages below.

La plaque interpédiculaire 13 solidarisant les vis correspondantes 2, 3 constitue une "prise bipédiculaire" vertébrale très solide permettant d'agir sur la vertèbre dans toutes les directions, les contraintes étant réparties sur l'ensemble de la vertèbre entre les vis 2, 3 convergentes vers le corps vertébral et leur liaison par la plaque 13. Interpedicular plate 13 interconnecting the corresponding screws 2, 3 constitute a "bipédiculaire taken" very strong spinal for acting on the vertebra in all directions, the stresses are distributed over the entire vertebra between the screws 2, 3 converging to the vertebral body and their connection plate 13.

La préhension de cette dernière en cours de séquence de montage est rendue possible par le bossage 17 percé du trou fileté 18 de réception d'un davier, qui permet au chirurgien de déplacer et d'orienter correctement les vertèbres au cours des séquences décrites ci-dessus. The gripping of the latter during assembly sequence is made possible by the boss 17 of the threaded drilled hole 18 for receiving a davit which allows the surgeon to move and correctly orient the vertebrae during the sequences described above above. Les trous tronconiques 16 permettent de positionner les plaques 13 sur les corps 6 des vis avec un large débattement angulaire, par exemple de l'ordre de 20 (Figure 3) en fonction de la géométrie des trous coniques 16. Le positionnement des plaques 13 est ainsi adapté à la morphologie de chaque vertèbre. The tapered holes 16 are used to position plates 13 of the body 6 of the screw with a wide angular range, for example of the order of 20 (Figure 3) depending on the geometry of the tapered holes 16. The positioning plate 13 is thus adapted to the morphology of each vertebra.

Par ailleurs, le fait de remplacer les crochets simples des instrumentations antérieures par deux demi-crochets ou hémi-crochets 19, 21 complémentaires améliore notablement la stabilité de la tige moletée 8, 9, qui en effet n'est plus logée dans une mâchoire ouverte et ne risque donc plus de glisser dans celle-ci. Furthermore, the fact of replacing the single brackets prior instrumentations by two half-brackets or hemi-hooks 19, 21 further significantly improves the stability of the knurled rod 8, 9, which in effect is no longer housed in an open jaw and therefore more likely to slip into it. Du côté convexe, la tige 8 ou 9 pousse en lordose sur les hémi-crochets antérieurs 19, la stabilisation étant favorisée par le serrage des hémi-crochets postérieurs 21. Le pédicule convexe est ainsi poussé vers l'avant. The convex side, the shaft 8 or 9 pushes lordosis on the previous half-brackets 19, the stabilization being favored by the clamping of the posterior half-brackets 21. The convex pedicle is thus pushed forwards. Du côté concave inversement, les hémi-crochets postérieurs 21 permettent par vissage progressif, d'augmenter la dérotation par rappel postérieur du pédicule concave. The concave side conversely, hemi-post hooks 21 allow progressive by screwing, to increase the derotation by posterior point of the concave pedicle. L'ensemble-des deux hémi-crochets 19, 21 incomplètement vérrouillés permet d'exercer des forces de traction et de compression. All-the two half-brackets 19, 21 incompletely locked possible to exert tensile and compressive forces.

il convient également de noter que la structure articulaire postérieure a été préalablement au maximum diminuée par une excision articulaire large en d'autres termes, les ligaments et les muscles de maintien de la vertèbre ont été réduits par le chirurgien afin de faciliter le déplacement de celle-ci. it should also be noted that the facet joint structure was previously maximally decreased by a large joint excision in other words, ligaments and keeping the vertebra were reduced by the surgeon muscles to facilitate its movement -this.

Enfin, comme déjà indiqué, la partie médiane en V des plaques ou barrettes 13 permet, grâce à son trou fileté 18, la prise de la plaque par un instrument permettant d'agir sur celle-ci. Finally, as already indicated, the middle portion V of the plates or strips 13 allows, through its threaded hole 18, the engagement of the plate by an instrument to act thereon.

De nombreuses variantes peuvent être apportées à l'invention dans les cadre des revendications ci-après. Many variations may be made to the invention within the scope of the claims below.

Claims (6)

    REVENDICATIONS
  1. 1 - instrumentation d'ostéosynthèse pour la correction de scolioses lombaires par voie postérieure comprenant, pour chaque vertèbre lombaire (V1, V2, V3), deux vis pédiculaires (2, 3) à double filetage (4, 5) et deux tiges (8, 9) associées respectivement à une vis (2, 3) et solidarisées avec celles-ci par des pinces correspondantes (11, 12), caractérisée en ce qu'elle comporte, pour chaque vertèbre, une plaque (13) traversée par lesdites vis (2, 3) et adaptée pour maintenir celles-ci transversalement. 1 - osteosynthesis instrumentation for the correction of scoliosis by posterior lumbar comprising, for each lumbar vertebra (V1, V2, V3), two pedicular screws (2, 3) double-threaded (4, 5) and two rods (8 , 9) respectively associated with a screw (2, 3) and made integral therewith by corresponding clamps (11, 12), characterized in that it comprises, for each vertebra, a plate (13) traversed by said screw (2, 3) and adapted to maintain the latter transversely.
  2. 2 - instrumentation selon la revendication 1, caractérisée en ce que la plaque (13) est profilée en V largement ouvert et dont la concavité est dirigée vers un canal médulaire (~4) de la vertèbre, et les extrémités (15) de ladite plaque (13) sont traversées par les vis correspondantes (2, 3). 2 - instrumentation according to claim 1, characterized in that the plate (13) is profiled in widely open V and whose concavity is directed towards a medullary canal (~ 4) of the vertebra, and the ends (15) of said plate (13) are traversed by the corresponding screws (2, 3).
  3. 3 - instrumentation selon l'une des revendications 1 et 2, caractérisée en ce que la plaque (13) est pourvue, dans sa partie médiane, de moyens de préhension par un outil tel qu'un davier, afin de permettre de déplacer la vertèbre dans les. 3 - instrumentation according to one of claims 1 and 2, characterized in that the plate (13) is provided in its middle part, with means of handling by a tool such as a forceps, to enable to move the vertebra in the. directions souhaitées. desired directions.
  4. 4 - instrumentation selon la revendication 3, caractérisée en- ce que les moyens de préhension comprennent un bossage (17) saillant vers l'extérieur du V et dans lequel est ménagé un trou taraudé (18). 4 - instrumentation according to claim 3, characterized in- that the gripping means comprises a boss (17) projecting outwardly from V and wherein is formed a tapped hole (18).
  5. 5 - instrumentation selon l'une des revendications 2 à 4, caractérisée en ce que les extrémités (15) de la plaque (13) sont percées de trous tronconiques (16). 5 - instrumentation according to one of claims 2 to 4, characterized in that the ends (15) of the plate (13) are pierced with tapered holes (16).
  6. 6 - instrumentation selon l'une des revendications 1 à 5, caractérisée en ce que chaque pince (11, 12) de liaison entre la tige (8, 9) et la vis associée (2, 3) est constituée de deux demi-crochets (19, 21) complémentaires, présentant chacun une ouverture semi-circulaire (22, 23), la tige (8, 9) pou van t être reçue et bloquée dans lesdites ouvertures grâce à un écrou (26) de serrage des demi-crochets (19, 21) dont la vis (2, 3) est pourvue. 6 - instrumentation according to one of claims 1 to 5, characterized in that each clamp (11, 12) between the rod (8, 9) and the associated screw (2, 3) consists of two half-brackets (19, 21) further each having a semi-circular opening (22, 23), the rod (8, 9) louse van t be received and locked in said openings with a nut (26) for clamping the half-brackets (19, 21), the screw (2, 3) is provided.
FR8706864A 1987-05-15 1987-05-15 Osteosynthesis instrumentation for the correction of scoliosis by posterior lumbar path Expired FR2615095B1 (en)

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EP0384001A1 (en) * 1989-02-08 1990-08-29 Acromed Corporation Connector for attaching a corrective device to vertebrae
US4957495A (en) * 1987-04-01 1990-09-18 Patrick Kluger Device for setting the spinal column
FR2645427A1 (en) * 1989-04-11 1990-10-12 Cotrel Yves Transverse fixing bar for spinal osteosynthesis device
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FR2656214A1 (en) * 1989-12-26 1991-06-28 Baulny Dominique Dynamic frame for spinal osteosynthesis
FR2657775A1 (en) * 1990-02-08 1991-08-09 Henry Patrick multifunctional spinal instrumentation rod or plate.
US5047029A (en) * 1988-06-10 1991-09-10 Synthes (U.S.A.) Clamp and system for internal fixation
EP0487830A1 (en) * 1990-11-29 1992-06-03 Howmedica GmbH Implant for correction of the humain spinal column
US5147360A (en) * 1990-02-19 1992-09-15 Societe De Fabrication De Materiel Orthopedique Osteosynthesis device for the correction of spinal curvatures
FR2687561A1 (en) * 1992-02-20 1993-08-27 Jbs Sa Device for straightening, fixing, compressing and elongating cervical vertebrae
EP0567423A1 (en) * 1992-04-24 1993-10-27 Bilbao Ortiz de Zarate, José Ramon Transpedicular vertebral attachment systems and device for the practice thereof
US5261913A (en) * 1989-07-26 1993-11-16 J.B.S. Limited Company Device for straightening, securing, compressing and elongating the spinal column
FR2692471A1 (en) * 1992-06-19 1993-12-24 Roussouly Pierre An apparatus for treating the spine.
US5290288A (en) * 1990-02-08 1994-03-01 Vignaud Jean Louis Multi-function device for the osteosynthesis of rachis
EP0593321A1 (en) * 1992-09-15 1994-04-20 Rémi Cavagna Device for spinal osteosynthesis
ES2050073A1 (en) * 1992-04-24 1994-05-01 Alacreu Jose Vicente Barbera Transpedicular vertebral attachment system
FR2701833A1 (en) * 1993-02-24 1994-09-02 Garin Christophe Fixator for lumbosacral osteosynthesis
FR2702361A1 (en) * 1993-02-24 1994-09-16 Soprane Sa Fixator for lumbosacral osteosyntheses
US5360429A (en) * 1992-02-20 1994-11-01 Jbs Societe Anonyme Device for straightening, fixing, compressing, and elongating cervical vertebrae
FR2704420A1 (en) * 1993-04-27 1994-11-04 Innovations Technologiques Ste Clamp for spinal fixation device
FR2709057A1 (en) * 1993-08-20 1995-02-24 Cdo Medical Spinal osteosynthesis instrumentation comprising a multiplicity of connection elements
ES2072831A1 (en) * 1993-01-04 1995-07-16 Levante Ind Quirurgicas Spinal fastening system
FR2718945A1 (en) * 1994-04-25 1995-10-27 Soprane Sa Device for retaining a connecting rod to a spine fixator on a pedicle screw.
US5474555A (en) * 1990-04-26 1995-12-12 Cross Medical Products Spinal implant system
US5487744A (en) * 1993-04-08 1996-01-30 Advanced Spine Fixation Systems, Inc. Closed connector for spinal fixation systems
WO1996013219A1 (en) * 1994-10-27 1996-05-09 Comptoir De Diffusion Orthopedique Medical-C.D.O Medical (Sa) Spinal osteosynthesis device having multiple linking members
US5520687A (en) * 1992-09-02 1996-05-28 Advanced Spine Fixation Systems, Inc. Low profile spine fixation system
WO1996028106A1 (en) * 1992-08-11 1996-09-19 Gelbard Steven D Spinal stabilization implant system
US5562661A (en) * 1995-03-16 1996-10-08 Alphatec Manufacturing Incorporated Top tightening bone fixation apparatus
FR2736258A1 (en) * 1995-07-07 1997-01-10 Eurosurgical Bone screw fastener for spinal rod - has screw made with conical head having upper end thread to engage with rod fixing ring
EP0809974A2 (en) * 1996-05-31 1997-12-03 Acromed Corporation An apparatus for retaining bone portions in a desired spatial relationship
US5743907A (en) * 1990-07-24 1998-04-28 Acromed Corporation Spinal column retaining method and apparatus
US5810817A (en) * 1992-06-19 1998-09-22 Roussouly; Pierre Spinal therapy apparatus
FR2761256A1 (en) * 1997-04-01 1998-10-02 Daniel Chopin Spinal osteosynthesis instrumentation has link connector between a vertebral rod and bone anchoring bodies
US6379357B1 (en) 1994-10-25 2002-04-30 Sdgi Holdings, Inc. Modular spinal system
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EP1252865A1 (en) * 2001-04-24 2002-10-30 Co-Ligne AG Instrumentation for stabilizing certain vertebrae of the spine
US6736817B2 (en) 1999-12-17 2004-05-18 Thomas N. Troxell Transconnector for coupling spinal rods
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US4957495A (en) * 1987-04-01 1990-09-18 Patrick Kluger Device for setting the spinal column
US5000166A (en) * 1988-04-27 1991-03-19 Sulzer Brothers Limited Implant kit for stabilizing regions of a spine
US5047029A (en) * 1988-06-10 1991-09-10 Synthes (U.S.A.) Clamp and system for internal fixation
WO1990002527A1 (en) * 1988-09-09 1990-03-22 Australian Defence Industries Pty. Limited Spinal distractor
EP0384001A1 (en) * 1989-02-08 1990-08-29 Acromed Corporation Connector for attaching a corrective device to vertebrae
US5024213A (en) * 1989-02-08 1991-06-18 Acromed Corporation Connector for a corrective device
FR2645427A1 (en) * 1989-04-11 1990-10-12 Cotrel Yves Transverse fixing bar for spinal osteosynthesis device
US5000165A (en) * 1989-05-15 1991-03-19 Watanabe Robert S Lumbar spine rod fixation system
US5084048A (en) * 1989-07-12 1992-01-28 Sulzer Brothers Limited Implant for vertebrae with spinal stabilizer
EP0408489A1 (en) * 1989-07-12 1991-01-16 SULZER Medizinaltechnik AG Implant for the fixation of two vertebrae
WO1991001691A1 (en) * 1989-07-26 1991-02-21 J.B.S. S.A. Device for straightening, securing, compressing and elongating the spinal column
FR2650173A1 (en) * 1989-07-26 1991-02-01 Jbs Sa Method and rectifying device, fixation, compression, elongation of the spine
US5261913A (en) * 1989-07-26 1993-11-16 J.B.S. Limited Company Device for straightening, securing, compressing and elongating the spinal column
EP0425783A1 (en) * 1989-10-30 1991-05-08 Synthes AG, Chur Pedicle screw clamp
FR2656214A1 (en) * 1989-12-26 1991-06-28 Baulny Dominique Dynamic frame for spinal osteosynthesis
EP0441084A1 (en) * 1990-02-08 1991-08-14 STRYKER CORPORATION (a Michigan corporation) Multifunctional spinal osteosynthesis device
WO1991011967A1 (en) * 1990-02-08 1991-08-22 Vignaud Jean Louis Multifunctional rachis osteosynthesis device
FR2657775A1 (en) * 1990-02-08 1991-08-09 Henry Patrick multifunctional spinal instrumentation rod or plate.
US5290288A (en) * 1990-02-08 1994-03-01 Vignaud Jean Louis Multi-function device for the osteosynthesis of rachis
US5147360A (en) * 1990-02-19 1992-09-15 Societe De Fabrication De Materiel Orthopedique Osteosynthesis device for the correction of spinal curvatures
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US5474555A (en) * 1990-04-26 1995-12-12 Cross Medical Products Spinal implant system
US5743907A (en) * 1990-07-24 1998-04-28 Acromed Corporation Spinal column retaining method and apparatus
US6080156A (en) * 1990-07-24 2000-06-27 Depuy Acromed, Inc. Spinal column retaining method and apparatus
EP0487830A1 (en) * 1990-11-29 1992-06-03 Howmedica GmbH Implant for correction of the humain spinal column
US5360429A (en) * 1992-02-20 1994-11-01 Jbs Societe Anonyme Device for straightening, fixing, compressing, and elongating cervical vertebrae
FR2687561A1 (en) * 1992-02-20 1993-08-27 Jbs Sa Device for straightening, fixing, compressing and elongating cervical vertebrae
EP0567423A1 (en) * 1992-04-24 1993-10-27 Bilbao Ortiz de Zarate, José Ramon Transpedicular vertebral attachment systems and device for the practice thereof
ES2050073A1 (en) * 1992-04-24 1994-05-01 Alacreu Jose Vicente Barbera Transpedicular vertebral attachment system
FR2692471A1 (en) * 1992-06-19 1993-12-24 Roussouly Pierre An apparatus for treating the spine.
US5810817A (en) * 1992-06-19 1998-09-22 Roussouly; Pierre Spinal therapy apparatus
WO1994000062A1 (en) * 1992-06-19 1994-01-06 Pierre Roussouly Spinal therapy apparatus
WO1996028106A1 (en) * 1992-08-11 1996-09-19 Gelbard Steven D Spinal stabilization implant system
US5776134A (en) * 1992-09-02 1998-07-07 Advanced Spine Fixation Systems, Inc. Low-profile spinal fixation system
US5520687A (en) * 1992-09-02 1996-05-28 Advanced Spine Fixation Systems, Inc. Low profile spine fixation system
EP0593321A1 (en) * 1992-09-15 1994-04-20 Rémi Cavagna Device for spinal osteosynthesis
US5571102A (en) * 1992-09-15 1996-11-05 Cavagna; Remi System for spinal osteosynthesis
ES2072831A1 (en) * 1993-01-04 1995-07-16 Levante Ind Quirurgicas Spinal fastening system
FR2701833A1 (en) * 1993-02-24 1994-09-02 Garin Christophe Fixator for lumbosacral osteosynthesis
FR2702361A1 (en) * 1993-02-24 1994-09-16 Soprane Sa Fixator for lumbosacral osteosyntheses
US5487744A (en) * 1993-04-08 1996-01-30 Advanced Spine Fixation Systems, Inc. Closed connector for spinal fixation systems
FR2704420A1 (en) * 1993-04-27 1994-11-04 Innovations Technologiques Ste Clamp for spinal fixation device
FR2709057A1 (en) * 1993-08-20 1995-02-24 Cdo Medical Spinal osteosynthesis instrumentation comprising a multiplicity of connection elements
EP0679369A1 (en) * 1994-04-25 1995-11-02 Societe De Fabrication De Materiel Orthopedique Sofamor Device for attaching a spinal fixation rod to a pedicular screw
FR2718945A1 (en) * 1994-04-25 1995-10-27 Soprane Sa Device for retaining a connecting rod to a spine fixator on a pedicle screw.
US6379357B1 (en) 1994-10-25 2002-04-30 Sdgi Holdings, Inc. Modular spinal system
WO1996013219A1 (en) * 1994-10-27 1996-05-09 Comptoir De Diffusion Orthopedique Medical-C.D.O Medical (Sa) Spinal osteosynthesis device having multiple linking members
US5562661A (en) * 1995-03-16 1996-10-08 Alphatec Manufacturing Incorporated Top tightening bone fixation apparatus
FR2736258A1 (en) * 1995-07-07 1997-01-10 Eurosurgical Bone screw fastener for spinal rod - has screw made with conical head having upper end thread to engage with rod fixing ring
EP0809974A2 (en) * 1996-05-31 1997-12-03 Acromed Corporation An apparatus for retaining bone portions in a desired spatial relationship
EP0809974A3 (en) * 1996-05-31 1998-04-15 Acromed Corporation An apparatus for retaining bone portions in a desired spatial relationship
FR2761256A1 (en) * 1997-04-01 1998-10-02 Daniel Chopin Spinal osteosynthesis instrumentation has link connector between a vertebral rod and bone anchoring bodies
WO1998043551A1 (en) * 1997-04-01 1998-10-08 Daniel Chopin Apparatus for osteosynthesis comprising a connector of the spinal pin and the anchoring elements
US6248104B1 (en) 1997-04-01 2001-06-19 Daniel Chopin Apparatus for osteosynthesis comprising a connector of the spinal pin and the anchoring elements
US6736817B2 (en) 1999-12-17 2004-05-18 Thomas N. Troxell Transconnector for coupling spinal rods
US6432108B1 (en) 2000-01-24 2002-08-13 Depuy Orthopaedics, Inc. Transverse connector
EP1252865A1 (en) * 2001-04-24 2002-10-30 Co-Ligne AG Instrumentation for stabilizing certain vertebrae of the spine
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