FR2694882A1 - Intervertebral disc prosthesis. - Google Patents

Intervertebral disc prosthesis. Download PDF

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Publication number
FR2694882A1
FR2694882A1 FR9210232A FR9210232A FR2694882A1 FR 2694882 A1 FR2694882 A1 FR 2694882A1 FR 9210232 A FR9210232 A FR 9210232A FR 9210232 A FR9210232 A FR 9210232A FR 2694882 A1 FR2694882 A1 FR 2694882A1
Authority
FR
France
Prior art keywords
plates
prosthesis
prosthesis according
pellet
conical
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.)
Granted
Application number
FR9210232A
Other languages
French (fr)
Other versions
FR2694882B1 (en
Inventor
Mazda Keyvan
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Societe de Fabrication de Material Orthopedique en Abrege SOFAMOR SNC
Original Assignee
Societe de Fabrication de Material Orthopedique en Abrege SOFAMOR SNC
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Societe de Fabrication de Material Orthopedique en Abrege SOFAMOR SNC filed Critical Societe de Fabrication de Material Orthopedique en Abrege SOFAMOR SNC
Priority to FR9210232A priority Critical patent/FR2694882B1/en
Priority to MX9305071A priority patent/MX9305071A/en
Priority to ZA936156A priority patent/ZA936156B/en
Priority to TR00730/93A priority patent/TR26927A/en
Priority to CN93118231A priority patent/CN1090485A/en
Priority to PCT/FR1993/000825 priority patent/WO1994004100A1/en
Priority to AU49645/93A priority patent/AU4964593A/en
Priority to TW082107636A priority patent/TW280767B/zh
Publication of FR2694882A1 publication Critical patent/FR2694882A1/en
Application granted granted Critical
Publication of FR2694882B1 publication Critical patent/FR2694882B1/en
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/02Inorganic materials
    • A61L27/10Ceramics or glasses
    • AHUMAN NECESSITIES
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    • A61F2/00Filters 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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    • A61F2/30771Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
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    • A61F2002/30024Material 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 coefficient of friction
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    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
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    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys
    • A61F2310/00017Iron- or Fe-based alloys, e.g. stainless steel
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys
    • A61F2310/00023Titanium or titanium-based alloys, e.g. Ti-Ni alloys
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00179Ceramics or ceramic-like structures
    • A61F2310/00185Ceramics or ceramic-like structures based on metal oxides
    • A61F2310/00203Ceramics or ceramic-like structures based on metal oxides containing alumina or aluminium oxide
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00179Ceramics or ceramic-like structures
    • A61F2310/00185Ceramics or ceramic-like structures based on metal oxides
    • A61F2310/00239Ceramics or ceramic-like structures based on metal oxides containing zirconia or zirconium oxide ZrO2
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2430/00Materials or treatment for tissue regeneration
    • A61L2430/38Materials or treatment for tissue regeneration for reconstruction of the spine, vertebrae or intervertebral discs

Abstract

Prosthesis comprising two plates (1, 2) secured to the corresponding vertebrae (L4, L5), and a ball joint linking the plates to one another, its centre of rotation (C), in an anterior-posterior plane (OX, OY) being offset rearwards in the posterior part of the plates. The ball joint with reference to a transversal plane (OX, OZ) is located substantially in the middle of the plates, and with reference to a vertical plane (OY, OZ) is located under the plate (1) of the lower vertebra (L5). The prosthesis also includes an elastic intercalary cushioning ring (10) having an opening (10a) for the passage of the joint (3) and being lodged in the space delimited between the plates and around the joint. This positioning of the centre of curvature (C) prevents straining of the articular apophyses during movements of the vertebrae, while the elastic ring (1) matches the prosthesis to the physiological lordosis of the vertebral column, cushioning the multiple stresses occurring during these movements.

Description

La présente invention a pour objet une prothèse
discale intervertébrale.
The present invention relates to a prosthesis
intervertebral disc.

Comme on le sait, un disque intervertébral se
présente sous la forme d'une lentille biconvexe attachée
par ses faces aux surfaces articulaires des corps verté
braux. Il est constitué d'une partie périphérique dure
(annulus), formée de lamelles fibreuses concentriques,
et d'une partie centrale (nucleus pulposus), gélatineuse
et molle, constitué de minces faisceaux fibreux séparés par des espaces remplis d'un tissu muqueux. Un disque
intervertébral est un élément déformable permettant tous
les mouvements relatifs possibles (6 degrés de liberté) mais qui limite les amplitudes de ces derniers, notamment en torsion, en association avec les ligaments ilz-
tervertébraux et les butoirs osseux. Le disque intervertébral est une structure viscoélastique d'amortissement, qui participe à la résistance et à la stabilité du rachis verticalisé en état de pesanteur.
As we know, an intervertebral disc is
present in the form of a biconvex lens attached
by its faces to the articular surfaces of the bodies verté
braux. It consists of a hard peripheral part
(annulus), formed of concentric fibrous lamellae,
and a central part (nucleus pulposus), gelatinous
and soft, consisting of thin fibrous bundles separated by spaces filled with mucous tissue. A disk
intervertebral is a deformable element allowing all
possible relative movements (6 degrees of freedom) but which limits the amplitudes of the latter, in particular in torsion, in association with the ligaments ilz-
tervertebral and bone bumpers. The intervertebral disc is a viscoelastic damping structure, which contributes to the resistance and stability of the verticalized spine in a state of gravity.

Un disque intervertébral peut subir des altérations pour diverses raisons, notamment vieillissement et dégénérescence, pouvant provoquer des hernies discales. An intervertebral disc may be damaged for a variety of reasons, including aging and degeneration, which may cause herniated discs.

La dégénérescence discale correspond à une destruction fonctionnelle puis anatomique du disque, qui semble résulter de l'effet des contraintes mécaniques sur un disque aux structures en voie de désorganisation. The disc degeneration corresponds to a functional and then anatomical destruction of the disc, which seems to result from the effect of the mechanical stresses on a disc with structures in the process of disorganization.

La dégénérescence discale modifie le comportement mécanique du disque et aboutit à une diminution de hauteur de l'espace intersomatique, laquelle entraîne une perturbation de l'ensemble fonctionnel disque--articulaires.Disc degeneration modifies the mechanical behavior of the disc and results in a decrease in the height of the intersomatic space, which causes a disruption of the disc-articular functional unit.

Il en résulte une instabilité susceptible de provoquer des conséquences cliniques gênantes, notamment des lombalgies. Ainsi l'instabilité segmentaire entraîne un fonctionnement anormal des articulaires, induisant une réaction arthrosique, source de douleurs et de processus ostéophytiques.This results in instability likely to cause uncomfortable clinical consequences, including low back pain. Segmental instability leads to abnormal functioning of the joints, inducing an osteoarthritic reaction, a source of pain and osteophytic processes.

On a donc proposé de remplacer le disque déficient par un disque artificiel, dont de nombreux types de réalisations ont été envisagés. Ainsi certaines prothèses comportent des articulations ne supprimant aucun degré de liberté, alors que d'autres au contraire négligent totalement certains mouvements et n'autorisent au maximum qu'un degré de liberté. Les auteurs des pre mières prothèses considèrent que le disque artificiel ne doit en aucune manière imposer un mouvement, que la stabilité de l'unité fonctionnelle est assurée par la rétention des freins ligamentaires restants et qu'une articulation non contrainte garantit une liaison os/prothèse durable. It has therefore been proposed to replace the deficient disk by an artificial disk, of which many types of embodiments have been envisaged. Thus some prostheses have articulations that do not suppress any degree of freedom, while others, on the contrary, completely neglect certain movements and allow only one degree of freedom. The authors of the first prostheses consider that the artificial disk must in no way impose a movement, that the stability of the functional unit is ensured by the retention of the remaining ligament brakes and that an unconstrained articulation guarantees a bone / prosthesis connection. sustainable.

Les auteurs du second type de prothèse estiment physiologiquement inutiles certains degrés de liberté, et rétablissent un degré de liberté considéré comme essentiel. Ainsi on connaît une prothèse formant charnière n'autorisant la rotation qu'autour d'un axe transversal. The authors of the second type of prosthesis consider physiologically useless certain degrees of freedom, and restore a degree of freedom considered essential. Thus, there is known a prosthesis forming a hinge permitting rotation only around a transverse axis.

Les prothèses articulées peuvent être extrêmement variées et comporter notamment des matériaux présentant une certaine souplesse, ou bien mettre en oeuvre des moyens mécaniques tels que des ressorts
Toutefois ces réalisations connues ne donnent pas entière satisfaction, par exemple parce que les frottements au niveau de l'articulation restent trop élevés (prothèse décrite dans le brevet FR 2 659 226), ou parce que l'on observe une instabilité de la prothèse en rotation. De plus, la prothèse décrite dans le brevet précité ne permet qu'une inclinaison et une flexion extension limitée à 10 degrés dans tous les plans, va leur faible en regard de la mobilité naturelle d'une vertèbre.
Articulated prostheses can be extremely varied and include in particular flexible materials, or implement mechanical means such as springs
However, these known embodiments are not entirely satisfactory, for example because the friction at the joint remains too high (prosthesis described in patent FR 2 659 226), or because there is observed instability of the prosthesis in rotation. In addition, the prosthesis described in the aforementioned patent only allows inclination and flexion extension limited to 10 degrees in all planes, their low compared to the natural mobility of a vertebra.

Il est encore actuellement relativement difficile de cerner les indications de l'arthroplastie discale, qui est proposée notamment pour le traitement des lombalgies et sciatalgies par instabilité, des lombosciatiques post-dissectomie, et des spondylolisthésis de grade I. It is still relatively difficult to define the indications for disc arthroplasty, which is proposed in particular for the treatment of low back pain and sciatica by instability, post-dissectomy lumbosciatica, and grade I spondylolisthesis.

En fait, le but de l'implant constitué par la prothèse discale visée par l'invention est triple a) Etre dimensionné pour pouvoir restaurer une hauteur normale de l'espace intersomatique. En effet, la dégénérescence discale, modifiant le comportement mécanique du disque et aboutissant à une diminution de hauteur de l'espace intersomatique, entraîne une perturbation de l'ensemble fonctionnel disque-articulaires. Cette diminution ide hauteur provoque une surcharge mécanique sur les facettes articulaires, arthrogène et source possible de lombalgie. Elle peut entraîner un déplacement vers le haut et en avant de l'articulaire supérieur de la vertèbre inférieure, aboutissant à un rétrécissement du trou de conjugaison, cause possible de sciatalgie.  In fact, the purpose of the implant consisting of the disc prosthesis targeted by the invention is threefold a) Being sized to restore a normal height of the intersomatic space. Indeed, disc degeneration, modifying the mechanical behavior of the disc and resulting in a decrease in height of the intersomatic space, causes a disruption of the disc-joint functional unit. This decrease in height causes mechanical overload on the facet joints, arthrosis and possible source of low back pain. It can cause upward and forward movement of the upper articular of the lower vertebra, resulting in narrowing of the foramen hole, a possible cause of sciatica.

b) Autoriser une mobilité physiologique entre les deux vertèbres instrumentées.b) Allow a physiological mobility between the two instrumented vertebrae.

L'instabilité peut être consécutive à la dégénérescence discale ou induite par la chirurgie. Les limites entre mobilité normale et anormale ne sont pas encore définies avec précision. L'instabilité segmentaire entraîne un fonctionnement anormal des articulaires, induisant comme déjà indiqué une réaction arthrosique.  Instability may be secondary to disc degeneration or surgery-induced degeneration. The boundaries between normal and abnormal mobility are not yet precisely defined. Segmental instability leads to abnormal functioning of the joints, inducing, as already indicated, an osteoarthritic reaction.

c) Posséder une stabilité intrinsèque et autoriser un mouvement intersomatique.(c) Possess intrinsic stability and allow interbody movement.

L'arthroplastie s'adresse à des cas où jusqu'à présent une arthrodèse est indiquée. Elle peut être une alternative intéressante à cette intervention, non dénuée de conséquences sur les étages adjacents. En effet, toutes les arthrodèses lombaires entraînent dans les segments adjacents une augmentation des contraintes et un déplacement des centres de rotation, pouvant conduire à une hypermobilité. The arthroplasty is intended for cases where until now arthrodesis is indicated. It can be an interesting alternative to this intervention, not without consequences on the adjacent floors. Indeed, all lumbar arthrodesis leads in adjacent segments to an increase in stress and a displacement of the centers of rotation, which can lead to hypermobility.

Le suivi à long terme des zones adjacentes aux arthrodèses montre un pincement discal constant à partir de la quinzième année, et surtout un glissement ou un déplacement angulaire dont la fréquence augmente avec le recul. On peut aussi observer une arthrose importante, une hernie discale ou une spondylolyse acquise de cette néocharnière. The long-term follow-up of the areas adjacent to the arthrodesis shows a constant disc nip from the fifteenth year, and especially a slip or angular displacement whose frequency increases with the decline. We can also observe significant osteoarthritis, herniated disc or spondylolysis acquired from this neocharnière.

La prothèse discale visée par l'invention comprend deux plaques équipées de moyens de fixation aux vertèbres correspondantes, ainsi qu'un dispositif d'articulation des plaques l'une sur l'autre.  The disc prosthesis targeted by the invention comprises two plates equipped with means for attachment to the corresponding vertebrae, as well as a device for articulating the plates one on the other.

Conformément à l'invention, le dispositif d'articulation est une rotule dont le centre de rotation, dans un plan antéro-postérieur est décalé vers l'arrière dans la partie postérieure des plaques et du corps vertébral, dans un plan transversal est situé sensiblement au milieu des plaques et du corps vertébral, et dans un plan vertical est situé juste sous la plaque de la vertèbre inférieure ; cette prothèse comporte de plus un anneau intercalaire d'amortissement, réalisé en une matière souple, percé d'une ouverture de passage de la rotule et dimensionné pour se loger dans l'espace délimité entre les plaques et autour de la rotule en épou sant sensiblement le contour des plaques. According to the invention, the hinge device is a ball joint whose center of rotation, in an anteroposterior plane is shifted rearwardly in the posterior part of the plates and the vertebral body, in a transverse plane is situated substantially in the middle of the plates and vertebral body, and in a vertical plane is located just under the plate of the lower vertebra; this prosthesis further comprises an intermediate damping ring, made of a flexible material, pierced with a passage opening of the ball and dimensioned to fit in the space defined between the plates and around the ball joint substantially the outline of the plates.

Le positionnement du centre de courbure de la rotule tel que défini selon l'invention présente l'avantage d'éviter de contraindre les apophyses articulaires, comme dans les vertèbres naturelles, ce qui n'avait pas été jusqu'à présent obtenu avec les prothèses connues. The positioning of the center of curvature of the patella as defined according to the invention has the advantage of avoiding constraining the articular processes, as in the natural vertebrae, which had not been obtained so far with the prostheses known.

De plus la prothèse selon l'invention possède tout à la fois la résistance mécanique nécessaire et des frottements réduits au niveau de l'articulation, grâce au dimensionnement approprié du système à rotule. En effet le centre de rotation n'est ni trop éloigné de l'articulation, ni trop proche de celle-ci, et permet ainsi de reproduire une mobilité proche de la mobilité naturelle. In addition, the prosthesis according to the invention has both the necessary mechanical strength and reduced friction at the joint, thanks to the appropriate sizing of the ball joint system. Indeed, the center of rotation is neither too far from the articulation, nor too close to it, and thus allows to reproduce a mobility close to the natural mobility.

D'autres particularités et avantages de l'invention apparaîtront au cours de la description qui va suivre, faite en référence aux dessins annexés qui en illustrent une forme de réalisation à titre d'exemple non limitatif. Other features and advantages of the invention will become apparent from the description which follows, with reference to the accompanying drawings which illustrate an embodiment by way of non-limiting example.

La figure I est une vue en perspective éclatée d'une paire de vertèbres équipées des éléments constitutifs d'une prothèse discale selon une forme de réalisation de l'invention. Figure 1 is an exploded perspective view of a pair of vertebrae equipped with the components of a disc prosthesis according to one embodiment of the invention.

La figure 2 est une vue de dessus de la plaque inférieure de la prothèse discale de la Fig.l
La figure 3 est une vue en coupe longitudinale suivant 3/3 de la Figea de la prothèse selon l'invention dans une position où les deux plaques sont parallèles.
FIG. 2 is a view from above of the lower plate of the disc prosthesis of FIG.
Figure 3 is a longitudinal sectional view 3/3 of Figea of the prosthesis according to the invention in a position where the two plates are parallel.

La figure 4 est une vue en élévation de la prothèse des Fig.l à 3 dans une position où les deux plaques sont inclinées l'une par rapport à l'autre. Figure 4 is an elevational view of the prosthesis of Figures 1 to 3 in a position where the two plates are inclined relative to each other.

On voit à la Fiv.1 deux vertèbres adjacentes, par exemple les vertèbres lombaires L5 et L4, pouvant être reliées par une prothèse discale. Cette prothèse comprend deux plaques 1 et 2, fixées respectivement à la vertèbre inférieure L5 et à la vertèbre supérieure L4, une articulation à rotule 3 des deux plaques 1 et 3 l'une sur l'autre, et un anneau souple 10 d'amortissement intercalé entre les deux plaques 1 et 2 et traversé par la rotule 3. Fiv.1 shows two adjacent vertebrae, for example the lumbar vertebrae L5 and L4, which can be connected by a disc prosthesis. This prosthesis comprises two plates 1 and 2, respectively fixed to the lower vertebra L5 and to the upper vertebra L4, a ball joint 3 of the two plates 1 and 3 on top of each other, and a soft ring 10 damping interposed between the two plates 1 and 2 and crossed by the patella 3.

Les plaques 1, 2 sont similaires, ont des dimensions sensiblement égales à celles des vertèbres L5, L4
(ces vertèbres pouvant être situées à d'autres étages que L5-L4, y compris des étages non lombaires) et épousent approximativement le contour des surfaces articulaires associées. Chaque plaque 1, 2 présente ainsi un bord curviligne 4, sensiblement elliptique, et un bord rectiligne 5 reliant les deux extrémités tronquées de l'ellipse 4. D'autre part chaque plaque 1, 2 est percée, dans sa partie centrale, d'un trou traversant 6 dans lequel est insérée une pastille 7, 8 respective, ayant un corps dimensionné pour pouvoir s'engager dans le trou 6 correspondant.Ce dernier peut être avantageusement conique, de même que les bases complémentaires des pastilles 7, 8, qui peuvent ainsi être solidarisées de manière amovible avec les plaques ou plateaux correspondant 1, 2
Les pastilles 7, 8 constituent ensemble l'articulation 3 à rotule. La première pastille 7, insérer dans la plaque inférieure 1, présente une surface sphérique convexe 9, située en saillie par rapport à la face correspondante de la plaque 1, tandis que sa surface opposée 11, plane, affleure la face opposée, tournée vers l'extérieur de la plaque 1. La pastille 8 de la plaque supérieure 2 fait également saillie de sa face tournée vers la plaque 1, et présente une surface sphé rique concave 12. Le rayon de courbure de cette dernière est égal à celui (r) de la surface sphérique 9, afin de pouvoir glisser sur celle-ci en formant une articulation à rotule.La face opposée 13 de la pastille 8 est plane et affleure la face extérieure de la plaque 2.
The plates 1, 2 are similar, have dimensions substantially equal to those of the vertebrae L5, L4
(These vertebrae may be located at other floors than L5-L4, including non-lumbar floors) and approximate the contour of the associated joint surfaces. Each plate 1, 2 thus has a curvilinear edge 4, substantially elliptical, and a straight edge 5 connecting the two truncated ends of the ellipse 4. On the other hand, each plate 1, 2 is pierced, in its central part, with a through-hole 6 in which is inserted a respective pellet 7, 8, having a body sized to be able to engage in the corresponding hole 6.The latter can be advantageously conical, as well as the complementary bases of the pellets 7, 8, which can thus be secured in a removable manner with the corresponding plates or trays 1, 2
The pellets 7, 8 together constitute the ball joint 3. The first wafer 7, inserted in the lower plate 1, has a convex spherical surface 9, projecting from the corresponding face of the plate 1, while its opposite flat surface 11 is flush with the opposite face, facing the The outside of the plate 1. The pellet 8 of the upper plate 2 also projects from its face facing the plate 1, and has a concave spherical surface 12. The radius of curvature of the latter is equal to that (r) of the spherical surface 9, in order to slide on it by forming a ball joint.The opposite face 13 of the pellet 8 is flat and is flush with the outer face of the plate 2.

Le centre de courbure ou de rotation C de la rotule 3, distant des surfaces 9 et 12 du rayon de courbure r, est localisé de la manière suivante
- ce centre C est, dans un plan antéro-postérieur (OX, OY), décalé vers l'arrière dans la partie postérieure des plaques 1, 2 et des corps vertébraux;
- dans un plan transversal (OX, OZ), le centre de rotation C est situé sensiblement au milieu des plaques 1, 2 et des corps vertébraux;
- et dans un plan vertical (OY, OZ), le centre C est situé juste sous la plaque 1 recouvrant la face supérieure de la vertèbre inférieure, par exemple L5 dans l'exemple illustré à la Fig.1.
The center of curvature or rotation C of the ball 3, distant from the surfaces 9 and 12 of the radius of curvature r, is located as follows
- This center C is, in an anteroposterior plane (OX, OY), shifted rearward in the posterior part of the plates 1, 2 and vertebral bodies;
- In a transverse plane (OX, OZ), the center of rotation C is located substantially in the middle of the plates 1, 2 and vertebral bodies;
and in a vertical plane (OY, OZ), the center C is situated just under the plate 1 covering the upper face of the lower vertebra, for example L5 in the example illustrated in FIG.

Ce positionnement du centre C correspond à un rayon de courbure r compris approximativement entre la hauteur de la prothèse quand les plaques 1, 2 sont parallèles, et la moitié de cette hauteur. This positioning of the center C corresponds to a radius of curvature r approximately between the height of the prosthesis when the plates 1, 2 are parallel, and half of this height.

La prothèse comporte de plus un anneau intercalaire d'amortissement 10, réalisé en une matière souple appropriée, percé d'une ouverture 10a de passage de la rotule 3. L'anneau souple 10 est dimensionné pour pouvoir être logé dans l'espace intercalaire délimité entre les plaques 1, 2 et autour de la rotule 3, en épousant sensiblement le contour des plaques. The prosthesis further comprises an intermediate damping ring 10, made of a suitable flexible material, pierced with an opening 10a for passage of the ball 3. The flexible ring 10 is dimensioned so that it can be accommodated in the interspaced space between the plates 1, 2 and around the ball 3, substantially marrying the outline of the plates.

A l'état libre non comprimé (fiv.1), l'anneau souple 10 a une épaisseur variable de sa partie antérieure à sa partie postérieure. Sa partie antérieure a une épaisseur maximum H, qui décroît régulièrement, de part et d'autre du centre du bord de cette partie antérieure, jusqu'à la partie postérieure de l'anneau 10, dont l'épaisseur h est ainsi nettement inférieure à H. In the uncompressed free state (fiv.1), the flexible ring 10 has a variable thickness from its anterior portion to its posterior portion. Its anterior part has a maximum thickness H, which decreases regularly, on either side of the center of the edge of this anterior part, as far as the posterior part of the ring 10, whose thickness h is thus well below H.

L'anneau 10 se présente donc sous la forme d'une- pièce asymétrique dont les faces opposées sont inclinées l'une par rapport à l'autre, en se rapprochant vers la partie antérieure
Chaque plaque 1, 2 comporte, sur sa face de laquelle fait saillie la pastille correspondante 7, 8, une surépaisseur annulaire centrale 14, 15. Cette dernière est contiguë à la pastille associée 7, 8 qu'elle entoure en formant un renfort, venu de matière avec le reste de la plaque De préférence, comme représenté, les renforts 14 et 15 ont une surface conique, dont l'épaisseur décroît à partir de la pastille 7, 8.
The ring 10 is therefore in the form of an asymmetric part whose opposite faces are inclined relative to each other, moving towards the front part.
Each plate 1, 2 comprises, on its face which projects the corresponding pellet 7, 8, a central annular extra thickness 14, 15. The latter is contiguous to the associated pellet 7, 8 which it surrounds forming a reinforcement, come of material with the rest of the plate Preferably, as shown, the reinforcements 14 and 15 have a conical surface, the thickness of which decreases from the pellet 7, 8.

Dans chaque plaque 1, 2 sont ménagés un ensemble de trous 16, convenablement répartis le long des bords de la plaque. Ces trous 16 sont agencés pour recevoir des picots 17, fixés dans la plaque 1, 2 par tout moyen convenable, tel que vissage de leur base cylindrique 17a. Leurs pointes 17b, impactées dans l'os sous-cho- dral des plateaux vertébraux, assurent la fixation des plaques 1, 2 aux vertèbres telles que L5 L4, L5.  In each plate 1, 2 are formed a set of holes 16, suitably distributed along the edges of the plate. These holes 16 are arranged to receive pins 17, fixed in the plate 1, 2 by any suitable means, such as screwing their cylindrical base 17a. Their spikes 17b, impacted in the subchromal bone of the vertebral endplates, secure the plates 1, 2 to the vertebrae such as L5 L4, L5.

Les pastilles 7, 8 formant l'articulation en rotule 3 sont de faibles dimensions par rapport à celles des plaques 1, 2, et sont de manière générale choisies en un matériau présentant les meilleures caractéristiques tribologiques possibles (caractéristiques mécaniques : statiques, dynamiques et résistance à I'usure), et bien entendu biostable. Leur coefficient de frottement doit être faible et leur durée de vie, ainsi que celle des plaques 1, 2, très élevée (par exemple 40 ans).  The pellets 7, 8 forming the ball joint 3 are of small dimensions compared to those of the plates 1, 2, and are generally selected from a material having the best possible tribological characteristics (mechanical characteristics: static, dynamic and resistance to wear), and of course biostable. Their coefficient of friction must be low and their lifetime, as well as that of plates 1, 2, very high (for example 40 years).

Ces pastilles 7, 8 peuvent être réalisées en un matériau approprié tel qu'une céramique notamment un oxyde fritté tel qu'alumine ou zircone, une pierre de synthèse, un alliage métallique avec traitement de surface (dépôt de diamant etc)
L'anneau souple 10 d'amortissement est avantageusement constitué en un élastomère, notamment un silicone de dureté shore A.
These pellets 7, 8 may be made of a suitable material such as a ceramic including a sintered oxide such as alumina or zirconia, a synthetic stone, a metal alloy with surface treatment (diamond deposition etc.)
The flexible damping ring 10 is advantageously made of an elastomer, in particular a Shore A hardness silicone.

Les plateaux 1, 2 sont prévus en nombre standard, adaptés à tous les morphotypes possibles des corps vertébraux. Les rotules 3 sont par contre en nombre supérieur, adaptées à la morphologie de chaque individu et de chaque étage vertébral. On peut ainsi réaliser une gamme de pièces (plaques 1, 2, rotules 3, anneaux souples 10) adaptées à toutes les hauteurs discales des patients et permettant des combinaisons en nombre infini, adaptées à chaque cas particulier. The trays 1, 2 are provided in standard number, adapted to all possible morphotypes of the vertebral bodies. The patella 3 are in contrast in greater number, adapted to the morphology of each individual and each vertebral stage. It is thus possible to produce a range of parts (plates 1, 2, ball joints 3, flexible rings 10) adapted to all the disc height of the patients and allowing combinations in infinite number, adapted to each particular case.

Outre les avantages techniques déjà mentionnés, la prothèse discale selon l'invention présente les avantages suivants
Grâce au dimensionnement approprié de la rotule 3 et à la position de son centre d'articulation C, définis ci-dessus, les surfaces en frottement sont réduites et le frottement provoqué par le basculement des plaques 1, 2 l'une par rapport à l'autre (Fig.4) reste faible.
In addition to the technical advantages already mentioned, the disc prosthesis according to the invention has the following advantages:
Thanks to the appropriate dimensioning of the ball 3 and the position of its articulation center C, defined above, the friction surfaces are reduced and the friction caused by the tilting of the plates 1, 2 relative to the other (Fig.4) remains weak.

Il en résulte une usure réduite des pastilles 7, 8. Par ailleurs les surfaces 9, 12 de l'articulation ont cependant un rayon de courbure suffisant pour ne pas centrale ner une instabilité excessive de la prothèse, tout en lui assurant une mobilité tridimensionnelle convenable, pratiquement identique à celle des vertèbres naturelles
Durant les mouvements tridimensionnels des plaques 1, 2 et des vertèbre correspondantes, l'anneau souple 10 assure une fonction d'amortissement des contraintes multiples qui limite les mouvements, les faces opposées de l'anneau 10 restant toujours en contact avec les faces correspondantes des plaques 1.La variation de la hauteur, ou de l'épaisseur de l'anneau 10 de l'avant vers l'arrière présente l'avantage de l'adapter à la lordose physiologique du rachis lombaire Le rapport Hfh s adapte ainsi à la statique rachidienne de profil, en fonction de l'étage discal concerné. L'inclinaison des faces de l'anneau 10 l'une sur l'autre peut varier en fonction de l'étage et de la morphologie du patient. A titre d'exemple elle peut atteindre 150 en L5/S1.
This results in reduced wear of the pellets 7, 8. Moreover, the surfaces 9, 12 of the joint have however a radius of curvature sufficient not to centralize excessive instability of the prosthesis, while ensuring adequate three-dimensional mobility , virtually identical to that of natural vertebrae
During the three-dimensional movements of the plates 1, 2 and the corresponding vertebrae, the flexible ring 10 provides a multi-stress damping function which limits the movements, the opposite faces of the ring 10 still remaining in contact with the corresponding faces of the plates 1.The variation of the height, or the thickness of the ring 10 from front to back has the advantage of adapting it to the physiological lordosis of the lumbar spine The Hfh ratio thus adapts to the Spinal static profile, depending on the disc floor concerned. The inclination of the faces of the ring 10 one on the other may vary depending on the stage and the morphology of the patient. For example, it can reach 150 in L5 / S1.

Il convient par ailleurs d'observer que le fait que l'épaisseur de la partie antérieure de l'anneau 10 soit supérieure à celle de sa partie postérieure permet une mise en jeu plus précoce du matériau souple constitutif de cet anneau. Ceci entraîne donc la production d'un effet amortisseur dès l'apparition d'un mouvement des corps vertébraux associés à la prothèse. D'autre part, le choix convenable d'un matériau souple pour l'anneau 10, permet l'obtention d'une raideur optimale pour reproduire les pentes des rotations d'un disque sain dans les diverses sollicitations. Finalement, la prothèse selon l'invention permet d'obtenir une raideur et un amortissement très proches ou même identiques à ceux d'un disque naturel. It should also be observed that the fact that the thickness of the anterior part of the ring 10 is greater than that of its posterior part allows earlier play of the flexible material constituting this ring. This therefore leads to the production of a damping effect as soon as a movement of the vertebral bodies associated with the prosthesis occurs. On the other hand, the appropriate choice of a flexible material for the ring 10, allows obtaining an optimal stiffness to reproduce the rotational slopes of a healthy disk in the various stresses. Finally, the prosthesis according to the invention makes it possible to obtain stiffness and damping very close to or even identical to those of a natural disk.

La mise en place par le chirurgien de la prothèse qui vient d'être décrite se fait que la manière suivante. The setting up by the surgeon of the prosthesis which has just been described is as follows.

Tout d'abord le chirurgien place sur la vertèbre inférieure, par exemple L5, la plaque correspondante I, la centre convenablement par rapport au corps vertébral, et la fixe par enfoncement des picots 17 dans la vertè bre. First of all the surgeon places on the lower vertebra, for example L5, the corresponding plate I, the center suitably with respect to the vertebral body, and fixes it by driving the pins 17 into the vertebra.

Ensuite le chirurgien met en place sur la vertèbre supérieure, par exemple L4, la plaque supérieure 2, en la positionnant convenablement par rapport à la plaque inférieure 1. Then the surgeon places on the upper vertebra, for example L4, the upper plate 2, positioning it properly with respect to the lower plate 1.

Le chirurgien dispose ensuite entre les plaques 1, 2 un "sandwich" composite constitué par l'assemblage de l'anneau souple 10 et de la rotule 3, formée par les pastilles 7, 8. Il place cet assemblage dans la zone centrale entre les plaques 1, 2, avec les pastilles 7, 8 en regard des trous coniques 6, puis relâche la distraction imposée jusque là aux corps vertébraux recevant les plaques 1, 2. Il en résulte une impaction qui provoque l'entrée des bases coniques des pastilles 7, 8 dans les trous 6, et leur solidarisation à force avec les plaques 1, 2. The surgeon then has between the plates 1, 2 a composite "sandwich" constituted by the assembly of the flexible ring 10 and the ball 3, formed by the pellets 7, 8. He places this assembly in the central zone between the plates 1, 2, with the pellets 7, 8 next to the conical holes 6, then relaxes the distraction imposed so far on the vertebral bodies receiving the plates 1, 2. This results in an impaction which causes the entry of the conical bases pellets 7, 8 in the holes 6, and their integral force with the plates 1, 2.

Les valeurs des amplitudes angulaires des mouvements possibles avec la prothèse selon l'invention sont proches des amplitudes ci-dessous d'un disque sain
L4/L5 L5/S1 - Flexion/extension 240 180 - Inclinaison 140 < 140 - Rotation axiale 40 40
La prothèse selon l'invention garantit par sa solidité la restauration de l'espace intersomatique de hauteur H, tout en présentant une stabilité intrinsèque, c est-à-dire n'autorisant pas une mobilité non physiologique, surtout en translation.
The values of the angular amplitudes of the possible movements with the prosthesis according to the invention are close to the amplitudes below of a healthy disc.
L4 / L5 L5 / S1 - bending / extension 240 180 - inclination 140 <140 - axial rotation 40 40
The prosthesis according to the invention guarantees by its solidity the restoration of the intersomatic space of height H, while having an intrinsic stability, that is to say not allowing non-physiological mobility, especially in translation.

Les matériaux susceptibles d'être utilisés pour la constitution de la prothèse sont bien entendu biocompatibles et doivent être biologiquement neutres, c'est à-dire non toxiques, insensibles à la corrosion. De plus ils ne doivent pas être pro-inflammatoires > leurs qualités mécaniques et biologiques ne devant pas être altérées par le mode de stérilisation choisi. A titre d'exemple les plaques 1, 2 peuvent être en acier inoxydable, stelliteftitane ou alliage de titane. The materials that can be used for the constitution of the prosthesis are of course biocompatible and must be biologically neutral, that is to say non-toxic, insensitive to corrosion. In addition they must not be pro-inflammatory> their mechanical and biological qualities should not be altered by the sterilization mode chosen. By way of example, the plates 1, 2 can be made of stainless steel, stellite-titanium or titanium alloy.

L'alliage de titane présente l'avantage de posséder des caractéristiques radiologiques et magnétiques avantageuses pour le suivi iconographique de la pathologie rachidienne, ainsi qu'une excellente biotolérance et des caractéristiques mécaniques élevées. The titanium alloy has the advantage of possessing advantageous radiological and magnetic characteristics for the iconographic follow-up of the spinal pathology, as well as an excellent biotolerance and high mechanical characteristics.

Bien entendu l'invention est susceptible de diverses variantes d'exécution. Ainsi les picots 17 de fixation aux vertèbres peuvent être remplacés par tous autres éléments équivalents, tels que vis, plots... En revanche la fixation par ciment (méthylméthacrylate) n est pas envisageable, compte tenu de la proximité des éléments nerveux et du dégagement de chaleur lors de la polymérisation. Le nombre et l'emplacement des trous filetés 16 recevant les picots coniques 17 peut varier. Naturally, the invention is capable of various alternative embodiments. Thus the pins 17 for attachment to the vertebrae can be replaced by any other equivalent elements, such as screws, pads ... However cement fixation (methylmethacrylate) is not possible, given the proximity of the nerve elements and clearance of heat during the polymerization. The number and location of the threaded holes 16 receiving the conical pins 17 may vary.

Pour des étages non lombaires, l'anneau souple 10 peut ne pas présenter l'asymétrie décrite et donc avoir une épaisseur uniforme
Il convient d'observer que la prothèse discale selon l'invention ne comporte pas de pièce libre, contrairement à certaines prothèses discales connues. Ceci présente l'avantage d'éliminer tout risque d'éjection d'une telle pièce libre contre l'aorte ou vers le canal rachidien
For non-lumbar stages, the flexible ring 10 may not have the asymmetry described and therefore have an even thickness
It should be noted that the disc prosthesis according to the invention does not comprise a free piece, unlike some known disc prostheses. This has the advantage of eliminating any risk of ejection of such a free piece against the aorta or to the spinal canal

Claims (10)

REVENDICATIONS 1. Prothèse discale intervertébrale, comprenant deux plaques (1, 2) équipées de moyens de fixation aux vertèbres correspondantes (L4, L5), et un dispositif (7, 8) d'articulation des plaques l'une sur l'autre, caractérisée en ce que le dispositif d'articulation est une rotule (3) dont le centre de rotation (C), dans un plan antéro-postérieur (OX, OY) est décalé vers l'arrière dans la partie postérieure des plaques et du corps vertébral, dans un plan transversal (OX, OZ) est situé sensiblement au milieu des plaques et du corps vertébral, et dans un plan vertical (OY,OZ) est situé juste sous la plaque (1) de la vertèbre inférieure (L5), et en ce que cette prothèse comporte de plus un anneau intercalaire d'amortissement (10), réalisé en une matière souple, percé d'une ouverture (10a) de passage de la rotule (3) et dimensionné pour se loger dans l'espace délimité entre les plaques et autour de la rotule en épousant sensiblement le contour des plaques. 1. Intervertebral disc prosthesis, comprising two plates (1, 2) equipped with means for attachment to the corresponding vertebrae (L4, L5), and a device (7, 8) for articulating the plates one on the other, characterized in that the articulation device is a ball joint (3) whose center of rotation (C) in an anteroposterior plane (OX, OY) is offset rearwardly in the posterior part of the plates and the vertebral body in a transverse plane (OX, OZ) is located substantially in the middle of the plates and the vertebral body, and in a vertical plane (OY, OZ) is located just under the plate (1) of the lower vertebra (L5), and in that this prosthesis further comprises an interposed damping ring (10), made of a flexible material, pierced with an opening (10a) for the passage of the ball (3) and dimensioned to fit in the defined space between the plates and around the patella by substantially marrying the outline of the plates. 2. Prothèse selon la revendication 1, caractérisée en ce que l'articulation à rotule (3) est constituée par une première pastille (7) à surface sphérique convexe (9) et une seconde pastille (8) à surface sphérique concave (12) recevant la surface sphérique convexe, ces deux surfaces sphériques ayant le même rayon de courbure (r) et les pastilles étant solidaires des parties centrales des plaques respectives (1, 2), sur les faces en vis-à-vis desquelles elles font saillie. 2. Prosthesis according to claim 1, characterized in that the ball joint (3) is constituted by a first pellet (7) with a convex spherical surface (9) and a second pellet (8) with a concave spherical surface (12). receiving the convex spherical surface, these two spherical surfaces having the same radius of curvature (r) and the pellets being integral with the central portions of the respective plates (1, 2), on the faces vis-à-vis which they project. 3. Prothèse selon la revendication 2, caractérisée en ce que chaque plaque (1, 2) comporte, sur la face de laquelle fait saillie la pastille (7, 8), une surépaisseur annulaire centrale (14, 15), contiguë à la pastille qu'elle entoure en formant renfort  3. Prosthesis according to claim 2, characterized in that each plate (1, 2) comprises, on the face of which protrudes the pellet (7, 8), a central annular extra thickness (14, 15) contiguous to the pellet. that it surrounds by forming reinforcement 4. Prothèse selon la revendication 3, caractérisée en ce que le renfort (14, 15) a une surface conique, dont l'épaisseur décroît à partir de la pastille (7, 8). 4. Prosthesis according to claim 3, characterized in that the reinforcement (14, 15) has a conical surface, the thickness of which decreases from the pellet (7, 8). 5. Prothèse selon l'une des revendications 2 à 4, caractérisée en ce que les pastilles (7, 8) ont une base conique adaptée à des trous coniques conjugués ménagés dans les plaques (1, 2). 5. Prosthesis according to one of claims 2 to 4, characterized in that the pellets (7, 8) have a conical base adapted to conical conical holes formed in the plates (1, 2). 6. Prothèse selon l'une des revendications 1 à 5, caractérisée en ce que les moyens de fixation des plaques (1, 2) aux vertèbres (L5, L4) comprennent des picots coniques (17) vissés dans des trous (16) formés dans les plaques et convenablement répartis sur cellesci. 6. Prosthesis according to one of claims 1 to 5, characterized in that the means for fixing the plates (1, 2) to the vertebrae (L5, L4) comprise conical pins (17) screwed into holes (16) formed in the plates and properly distributed on these. 7. Prothèse selon l'une des revendications 1 à 6, caractérisée en ce que les plaques ont des dimensions identiques et sensiblement égales à celles d'une vertèbre, notamment lombaire 7. Prosthesis according to one of claims 1 to 6, characterized in that the plates have identical dimensions and substantially equal to those of a vertebra, including lumbar 8. Prothèse selon l'une des revendications 1 à 7, caractérisée en ce que l'anneau souple (10) d'amortissement a une partie antérieure d'épaisseur maximum (H), supérieure à celle (h) de sa partie postérieure, ladite épaisseur (H) décroissant régulièrement du centre du bord de la partie antérieure à la partie postérieure, et les faces opposées de l'anneau (10), à l'état non comprimé, sont corrélativement inclinées l'une par rapport à l'autre. 8. Prosthesis according to one of claims 1 to 7, characterized in that the flexible ring (10) of damping has an anterior portion of maximum thickness (H), greater than that (h) of its posterior part, said thickness (H) decreasing regularly from the center of the edge of the anterior portion to the posterior portion, and the opposite faces of the annulus (10), in the uncompressed state, are correlatively inclined relative to the other. 9 Prothèse selon l'une des revendications 1 à 8, caractérisée en ce que les pastilles (7, 8) de la rotule (3) sont réalisées en l'un des matériaux suivants: céramique notamment oxyde fritté tel qu'alumine ou zircone, pierre de synthèse, alliage métallique avec traitement de surface. 9 prosthesis according to one of claims 1 to 8, characterized in that the pellets (7, 8) of the ball joint (3) are made of one of the following materials: ceramics including sintered oxide such as alumina or zirconia, synthetic stone, metal alloy with surface treatment. 10 Prothèse selon l'une des revendications 1 à 9, caractérisée en ce que l'anneau souple (10) est en élastomère, notamment un silicone de dureté shore A.  Prosthesis according to one of Claims 1 to 9, characterized in that the flexible ring (10) is made of elastomer, in particular a Shore A hardness silicone.
FR9210232A 1992-08-24 1992-08-24 Intervertebral disc prosthesis. Expired - Fee Related FR2694882B1 (en)

Priority Applications (8)

Application Number Priority Date Filing Date Title
FR9210232A FR2694882B1 (en) 1992-08-24 1992-08-24 Intervertebral disc prosthesis.
MX9305071A MX9305071A (en) 1992-08-24 1993-08-20 INTERVERTEBRAL DISC PROSTHESIS.
ZA936156A ZA936156B (en) 1992-08-24 1993-08-23 Intervertebral disc prosthesis
CN93118231A CN1090485A (en) 1992-08-24 1993-08-24 Intervertebral disk prosthesis
TR00730/93A TR26927A (en) 1992-08-24 1993-08-24 Intervetrebral disc prosthesis.
PCT/FR1993/000825 WO1994004100A1 (en) 1992-08-24 1993-08-24 Intervertebral disk prosthesis
AU49645/93A AU4964593A (en) 1992-08-24 1993-08-24 Intervertebral disk prosthesis
TW082107636A TW280767B (en) 1992-08-24 1993-09-17

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FR2694882B1 FR2694882B1 (en) 1994-10-21

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AU (1) AU4964593A (en)
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CN1090485A (en) 1994-08-10
TW280767B (en) 1996-07-11

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