FR2717068A1 - Intersomatic cage insertable between two vertebral bodies - Google Patents

Intersomatic cage insertable between two vertebral bodies Download PDF

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Publication number
FR2717068A1
FR2717068A1 FR9403036A FR9403036A FR2717068A1 FR 2717068 A1 FR2717068 A1 FR 2717068A1 FR 9403036 A FR9403036 A FR 9403036A FR 9403036 A FR9403036 A FR 9403036A FR 2717068 A1 FR2717068 A1 FR 2717068A1
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FR
France
Prior art keywords
cage
characterized
branches
legs
12a
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
FR9403036A
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French (fr)
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FR2717068B1 (en
Inventor
Lahille Michel
Lemaire Jean-Philippe
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.)
Biomat SARL
Original Assignee
Biomat SARL
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Filing date
Publication date
Application filed by Biomat SARL filed Critical Biomat SARL
Priority to FR9403036A priority Critical patent/FR2717068B1/en
Publication of FR2717068A1 publication Critical patent/FR2717068A1/en
Application granted granted Critical
Publication of FR2717068B1 publication Critical patent/FR2717068B1/en
Anticipated expiration legal-status Critical
Application status is Expired - Fee Related legal-status Critical

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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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    • A61F2/442Intervertebral or spinal discs, e.g. resilient
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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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    • A61F2002/30383Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
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    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surfaces, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surfaces, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30904Special external or bone-contacting surfaces, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves serrated profile, i.e. saw-toothed
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    • 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
    • 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
    • A61F2/02Prostheses implantable into the body
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    • A61F2/3094Designing or manufacturing processes
    • A61F2002/30975Designing or manufacturing processes made of two halves
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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
    • A61F2/02Prostheses implantable into the body
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    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2002/4475Joints for the spine, e.g. vertebrae, spinal discs hollow
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    • 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
    • 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4625Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use
    • A61F2002/4627Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
    • AHUMAN NECESSITIES
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    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
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    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
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    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0017Angular shapes
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    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063Three-dimensional shapes
    • A61F2230/0082Three-dimensional shapes parallelepipedal
    • AHUMAN NECESSITIES
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    • 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
    • A61F2250/00Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0004Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
    • A61F2250/0006Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting angular orientation
    • 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
    • A61F2250/00Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0004Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
    • A61F2250/0009Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting thickness
    • AHUMAN NECESSITIES
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    • 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

Abstract

The intersomatic cage (1a) for fitting between two adjacent vertebrae consists of two parallel branches (11a,12a) and a bridge (13a) between the rear ends (131a,132a,134a) of the branches, with a movable component (15a,16a) which can adjust the spacing between the forward ends (141a,144a) of the two branches once the cage is in position. The inner faces of the branches have thrust surfaces forming the sides of a V which points towards the bridge and which are in sliding contact with the spacer (15a), which is adjusted by a screw (16a).

Description

cage intersomatique vertébrale Vertebral intersomatic cage
La présente invention a trait a une cage intersomatique destinée à etre insérée entre les corps vertébraux de deux vertebres notamment lombaires, ainsi qu'à du matériel ancillaire pour l'implantation de la cage. The present invention relates to an intervertebral cage for insertion between vertebral bodies including two lumbar vertebrae and to the ancillary equipment for implantation of the cage. Une telle cage permet la fusion des corps vertébraux après discectomie tout en conservant la distance intervertebrale. Such cage allows the fusion of the vertebral bodies after discectomy while preserving INTERVERTEBRAL distance.

Une cage intersomatique lombaire selon la technique antérieure comprend un corps cylindrique creux terminé par une extrémité hémisphérique antérieure et fermé par un bouchon postérieur vissé. A lumbar intervertebral cage according to the prior art comprises a hollow cylindrical body ending in a hemispherical front end and closed by a screwed plug posterior. Des fenêtres longilignes sont en outre ménagées longitudinalement dans le corps cylindrique. Of elongate windows are also formed longitudinally in the cylindrical body. Le corps est préalablement rempli de "greffons" osseux, dits "allogreffe", et le bouchon est vissé et bloqué sur le corps. The body is previously filled with "grafts" bone, known as "allograft", and the cap is screwed and locked to the body. Au moins une telle cage est introduite entre deux corps vertébraux à l'aide d'un matériel ancillaire approprié. At least one such cage is introduced between two vertebral bodies with an appropriate ancillary equipment.

Les dimensions de la cage sont généralement sélectionnées parmi un choix de quelques tailles pour s'adapter aux conditions anatomiques du patient. the cage dimensions are generally selected from a choice of several sizes to fit the patient's anatomical conditions.

Cependant, la cage une fois choisie a des dimensions fixes. However, once chosen cage has fixed dimensions. Or, il est généralement souhaitable au cours de l'intervention chirurgicale de régler la position relative des deux vertèbres qui vont être "réunies" par fusion des corps vertébraux à travers les greffons, notamment leur position angulaire dans le plan antéropostérieur ou angle de lordose. However, it is generally desirable during surgery to adjust the relative position of the two vertebrae which are to be "combined" by fusion of the vertebral bodies through the grafts, including their angular position in the anteroposterior plane or angle of lordosis. Ce réglage peropératoire n'est pas réalisable avec une telle cage intersomatique. This intraoperative setting is not feasible with such interbody cage.

En outre, si la plupart des interventions chirurgicales pour mettre en place une telle cage sont effectuées par voie postérieure, il existe des cas où une intervention par voie antérieure est préférable. Also, though most surgical procedures to implement such a cage is made posteriorly, there are cases where an anterior approach procedure is preferable.

La présente invention vise à fournir une cage intersomatique vertébrale qui permet de régler de manière peropératoire la position angulaire relative de deux vertebres notamment lombaires dans le plan antéropostérieur, c'est-à-dire qui contribue à imposer un angle de lordose déterminé, tout en étant adaptée pour être insérée par voie antérieure entre les corps vertébraux de deux vertèbres. The present invention aims to provide a spinal interbody cage which adjusts intraoperatively the relative angular position of two particular lumbar vertebrae in the anteroposterior plane, that is to say, contributes to impose a determined angle of lordosis, while being adapted to be inserted through an anterior approach between the vertebral bodies of two vertebrae.

A cette fin, une cage intersomatique destinée à être insérée entre deux corps vertébraux est caractérisée en ce qu'elle comprend deux branches sensiblement parallèles pour être introduites entre lesdits corps vertébraux, un pont reliant des extrémités postérieures des branches, et un moyen manoeuvrable depuis des extrémités antérieures des branches pour écarter angulairement les extrémités antérieures des branches apres insertion de la cage entre les corps vertébraux. To this end, an intervertebral cage for insertion between two vertebral bodies is characterized in that it comprises two substantially parallel legs to be introduced between said vertebral bodies, a bridge connecting the rear ends of branches, and means operable from the front ends of the legs to angularly deviate the front ends of branches after insertion of the cage between the vertebral bodies.

En pratique, le pont comprend une articulation en chape. In practice, the bridge comprises an articulation clevis. L'écartement angulaire des extrémités antérieures des branches permet au chirurgien de choisir l'angle de lordose le plus approprié aux besoins anatomophysiologiques du patient. The angular spacing of the front ends of the branches allows the surgeon to choose the angle of lordosis most suitable for anatomophysiological needs of the patient.

Une coopération entre le moyen pour écarter et les branches a été recherchée de manière à commander l'écartement souhaité par l'extrémité antérieure de la cage, seule accessible après implantation de la cage par voie antérieure. Cooperation between the mean and to spread the branches has been sought so as to control the spacing desired by the front end of the cage, only accessible after implantation of the cage through an anterior approach. Les caractéristiques suivantes contribuent à cet objectif. The following characteristics contribute to this goal.

Les faces internes des branches ont des surfaces d'appui en regard qui forment les côtés d'un vé dont le sommet est orienté vers le pont et qui sont en contact glissant avec le moyen pour écarter. The internal faces of the branches of the support facing surfaces which form the sides of a V whose apex is oriented toward the bridge and which are in sliding contact with the medium for deviate.

De manière à imposer un angle de lordose prédéterminé, l'écartement angulaire des branches peut être limité d'une part par butée des extrémités antérieures des branches l'une contre l'autre, d'autre part par butée des extrémités postérieures des branches l'une contre l'autre. So as to impose a predetermined lordosis angle, the angular spacing of the branches may be limited on the one hand by abutment of the front ends of the branches against each other, on the other hand by abutment of the rear ends of the branches one against the other.

Selon une réalisation préférée, le moyen pour écarter comprend une vis vissée dans l'extrémité antérieure de l'une des branches et s'étendant entre les branches, et une pièce d'écartement en contact avec des surfaces d'appui en regard de faces internes des branches et solidaire au moins en direction axiale avec une extrémité postérieure de la vis. In a preferred embodiment, the means for rule comprises a screw screwed into the front end of one of the legs and extending between the legs, and a spacer in contact with bearing surfaces opposite faces internal branches and connected at least in axial direction with a rear end of the screw. Pour cette réalisation préférée, un angle de lordose prédéterminé peut être imposé grâce & des butées de fin de course pour la pièce d'écartement constituées par des extrémités antérieure et postérieure saillantes de l'une des branches. For this preferred embodiment, a predetermined angle of lordosis may be imposed by the & limit stops for the spacer formed by protruding the front and rear ends of one of the branches. Plus précisément, ces butées de fin de course peuvent être des cotés d'au moins un décrochement ménagé parallèlement à la vis dans la branche où pénètre la vis pour guider la pièce d'écartement. More specifically, the limit stops can be listed at least one recess arranged parallel to the screw in the branch where the screw penetrates to guide the spacer.

De préférence, une extrémité postérieure de la vis comprend un moyen d'arrêt, tel que anneau, rondelle ou collet, pour immobiliser axialement la pièce d'écartement autour de la vis et ainsi autoriser la rotation libre de la tige filetée de la vis dans la pièce d'écartement tout en évitant un démontage indésirable de la vis et de la piece d'écartement. Preferably, a rear end of the screw comprises a stop means such as ring, collar or washer to axially immobilize the spacer around the screw and thus allow free rotation of the threaded rod of the screw in the spacer while avoiding undesired disassembly of the screw and the spacer.

La vis est sans tête et comprend par exemple une fente ou une croix, ou six pans creux pour permettre la manoeuvre de la vis par un tournevis approprié. The screw is headless and includes for example a slot or a cross, or hexagon socket to allow operation of the screw with a suitable screwdriver.

D'autre part, la cage est sensiblement parallélépipédique et offre ainsi des surfaces d'appui planes sur les corps vertébraux. On the other hand, the cage is substantially rectangular and thus offers planar bearing surfaces on the vertebral bodies.

Ces surfaces d'appui sont des faces externes des branches comprenant des moyens d'ancrage transversaux pour ancrer les branches dans les corps vertébraux avec lesquels les faces externes sont en contact intime. These bearing surfaces are outer surfaces of the limbs comprising transverse anchoring means for anchoring the legs into the vertebral body with which the outer surfaces are in intimate contact. De préférence, les moyens d'ancrage sont des dentures. Preferably, the anchoring means are teeth.

Au moins l'une des branches comprend au moins une lumière pour remplir la cage avec des fragments osseux pour une bonne reprise osseuse entre les corps vertébraux. At least one of the branches comprises at least one lumen to fill the cage with bone fragments for proper recovery bone between the vertebral bodies.

Selon une variante de réalisation, la cage a des côtés latéraux sensiblement cylindriques pour une bonne adaptation anatomique. According to a variant, the cage has substantially cylindrical sides for good anatomical fit.

L'invention concerne également un porte-cage pour liaison amovible avec une cage selon l'invention. The invention also relates to a cage holder for detachable connection with a cage according to the invention. Une face de l'extrémité antérieure d'au moins l'une des branches comprend un moyen de liaison avec le portecage, de préférence un tenon en queue d'aronde ou en té et le porte-cage comprend une rainure à largeur variable pour pincer le moyen de liaison, tel que tenon, de la cage. One side of the front end of at least one of the branches comprises a connecting means with the portecage, preferably a dovetail tenon or tee and portecage comprises a variable width groove to pinch the connecting means, such as pin, the cage. Le chirurgien règle la largeur de la rainure par un moyen, tel que tête de manoeuvre, pour lier la cage et le porte-cage afin d'insérer la cage entre les corps vertébraux, puis pour séparer la cage et le porte-cage lorsque la cage est bien positionnée entre les corps vertébraux. The surgeon adjusts the groove width by a means such as operating head, to bind the cage and the cage holder to insert the cage between the vertebral bodies, and then to separate the cage and the cage door when the cage is positioned between the vertebral bodies.

Selon une réalisation préférée, le porte-cage comprend According to a preferred embodiment, the cage door comprises
un corps cylindrique creux, a hollow cylindrical body,
une tige montée à coulissement dans un conduit traversier du corps et rappelée élastiquement vers une extrémité postérieure évasée du conduit, a rod mounted slidably in a ferry body and resiliently biased towards a conduit flared rear end of the duct,
une tête de manoeuvre vissée à une extrémité filetée antérieure de la tige et rappelée élastiquement contre une extrémité antérieure du corps, et an operating head screwed to a front threaded end of the shaft and resiliently biased against a front end of the body, and
deux mâchoires contenant ladite rainure & largeur variable bloquées en translation axiale autour d'une extrémité postérieure de la tige et appliquées élastiquement en opposition transversale et à glissement contre l'extrémité postérieure évasée du conduit. two jaws containing said groove & variable width blocked in axial translation around a rear end of the rod and applied elastically in transverse opposition and sliding against the rear end of the tapered conduit.

D'autres caractéristiques et avantages de la présente invention apparaîtront plus clairement à la lecture de la description suivante de plusieurs réalisations préférées de l'invention en référence aux dessins annexés correspondants dans lesquels Other features and advantages of the present invention will become apparent from reading the following description of several preferred embodiments of the invention in the corresponding accompanying drawings
- la figure 1 est une vue en perspective d'une cage selon une première réalisation de l'invention ; - Figure 1 is a perspective view of a cage according to a first embodiment of the invention;
- la figure 2 est une vue en perspective éclatée de la cage selon la première réalisation ; - Figure 2 is an exploded perspective view of the cage according to the first embodiment;
- la figure 3 est une vue longitudinale de dessus de la cage selon la première réalisation ; - Figure 3 is a longitudinal plan view of the cage according to the first embodiment;
- la figure 4 est une première vue en coupe longitudinale antéro-postérieure de la cage selon la première réalisation ; - Figure 4 is a first perspective anteroposterior longitudinal section of the cage according to the first embodiment;
- la figure 5 est une seconde vue en coupe longitudinale antéro-postérieure de la cage selon la première réalisation, avec des branches écartées ; - Figure 5 is a second perspective anteroposterior longitudinal section of the cage according to the first embodiment, with legs apart;
- la figure 6 est une vue en perspective d'une cage selon une seconde réalisation de l'invention ; - Figure 6 is a perspective view of a cage according to a second embodiment of the invention;
- la figure 7 est une vue en perspective éclatée de la cage selon la seconde réalisation ; - Figure 7 is an exploded perspective view of the cage according to the second embodiment;
- la figure 8 est une vue de face antérieure de la cage selon la seconde réalisation ; - Figure 8 is a plan view of front side of the cage according to the second embodiment;
- la figure 9 est une vue de dessus en coupe partielle de la cage selon la seconde réalisation - Figure 9 is a top view in partial section of the cage according to the second embodiment
- la figure 10 est une première vue longitudinale antéro-postérieure de la cage selon la seconde réalisation ; - Figure 10 is a first anteroposterior longitudinal view of the cage according to the second embodiment;
- la figure 11 est une seconde vue longitudinale antéro-postérieure de la cage selon la seconde réalisation, avec des branches écartées ; - Figure 11 is a second anteroposterior longitudinal view of the cage according to the second embodiment, with legs apart;
- la figure 12 est une vue longitudinale partiellement en coupe axiale d'un porte-cage selon l'invention - Figure 12 is a longitudinal view partially in axial section of a cage holder according to the invention
- la figure 13 est une vue en coupe transversale du porte-cage, selon la ligne XIII-XIII à la figure 12 ; - Figure 13 is a cross-sectional view of the carrier cage, according to line XIII-XIII in Figure 12;
- la figure 14 est une vue longitudinale d'une mâchoire du porte-cage ; - Figure 14 is a longitudinal view of a jaw holder cage; et and
- la figure 15 est une vue longitudinale du portecage lié à la cage selon la seconde réalisation. - Figure 15 is a longitudinal view of portecage bound to the cage according to the second embodiment.

La cage intersomatique et l'outil porte-cage selon l'invention sont réalisés en un matériau biocompatible, par exemple titane ou alliage à base de titane. The intersomatic cage and the tool holder cage according to the invention are made of a biocompatible material, for example titanium or titanium based alloy.

En référence aux figures 1 à 5, une cage intervertébrale 1 selon une première réalisation de l'invention est de forme sensiblement parallélépipédique et est symétrique par rapport à un plan longitudinal antéro-postérieur de trace AP et perpendiculaire à la figure 3. Referring to Figures 1-5, an intervertebral cage 1 according to a first embodiment of the invention is of substantially parallelepipedal shape and is symmetrical with respect to an anteroposterior longitudinal plane of trace AP and perpendicular to the Figure 3.

Deux branches longitudinales 11 et 12 de la cage sont reliées par un pont de liaison postérieur 13 transversal à l'axe AP. Two longitudinal arms 11 and 12 of the cage are connected by a rear connecting bridge 13 transverse to the axis AP. Le pont de liaison comprend une articulation cylindrique en chape. The connecting bridge comprises a cylindrical articulation clevis. Deux branches de chape 131 et 132 sont dressées parallèlement au plan antéro-postérieur à l'extrémité postérieure de la branche 12 et sont traversées par des perçages cylindriques coaxiaux 133 perpendiculaires à l'axe AP. Two fork portions 131 and 132 are laid out parallel to the antero-posterior plane at the rear end of the arm 12 and are traversed by coaxial cylindrical bores 133 perpendicular to the axis AP.

Les branches de chape 131 et 132 forment entr'elles une rainure longitudinale 133f transversale au perçage 133 et propre à recevoir à glissement un tenon complémentaire 134 saillant à l'extrémité postérieure de l'autre branche 11. Le tenon 134 présente un perçage cylindrique 135 ayant un diamètre sensiblement supérieur à celui du perçage 133. Un pivot cylindrique de rotation 136 est inséré sensiblement à force dans les perçages 133 et librement dans le perçage central 135 pour lier les branches 11 et 12 tout en permettant une libre rotation de la branche 11 autour du pivot 136. The branches of clevis 131 and 132 form between them a longitudinal groove 133f transverse to the bore 133 and suitable for slidably receiving a complementary pin 134 projecting at the rear end of the other leg 11. The pin 134 has a cylindrical bore 135 having a diameter substantially greater than that of the bore 133. a cylindrical rotation pivot 136 is inserted substantially forced into the bores 133 and freely within the central bore 135 to link arms 11 and 12 while permitting free rotation of the arm 11 about pivot 136.

Lors de la fabrication de la cage, après assemblage de l'articulation, le pivot 136 peut être bloqué en translation par un procédé classique non représenté, tel que écrasement ou soudage ou vissage au moins d'une extrémité du pivot 136 à l'une des branches de chape 131 et 132. During the manufacture of the cage, after assembly of the joint, the pivot 136 can be blocked in translation by a not shown conventional method such as grinding or welding or screwing at least one end of the pivot 136 to one the fork portions 131 and 132.

Toutefois, selon une autre variante, le pivot 136 tourne librement dans les perçages 133 qui sont alors plus larges que le perçage 135, et est lié centralement au perçage 135 dans le tenon 134 par rondelle d'arrêt, collerette, soudure, filetage ou moyen analogue. However, according to another variant, the pivot 136 rotates freely in the bores 133 which are then larger than the bore 135, and is centrally connected to the bore 135 in the pin 134 by lock washer, collar, welding, threading or means similar.

Le débattement des branches 11 et 12 est limité entre des première et seconde positions extremes par rotation de la branche 11 autour du pivot 136. La première position extrême est une position "fermée" représentée aux figures 1 et 4 dans laquelle des faces externes 111 et 121 des branches 11 et 12 sont sensiblement parallèles. The deflection of the legs 11 and 12 is limited between first and second extreme positions by rotation of the arm 11 about the pivot 136. The first end position is a "closed" position shown in Figures 1 and 4 wherein the outer faces 111 and 121 branches 11 and 12 are substantially parallel. La seconde position extrême est une position ouverte" représentée à la figure 5, dans laquelle les faces 111 et 121 forment un angle AN de quelques degrés. The second extreme position is an open position "shown in Figure 5, in which the faces 111 and 121 form an angle AN of a few degrees.

L'extrémité antérieure de la cage est un pont antérieur 14 transversal à l'axe AP. The front end of the cage is an anterior bridge 14 transverse to the axis AP. Le pont 14 comprend des première et seconde parties 141 et 144 séparées et en regard. The bridge 14 comprises first and second portions 141 and 144 separate and opposite.

La première partie de pont 141 est monolithique avec l'extrémité antérieure de la branche 12 et s'etend sur environ les trois quarts de la hauteur du pont 14. The first bridge portion 141 is monolithic with the front end of the arm 12 and extends over approximately three quarters of the height of the bridge 14.

La partie de pont 141 est terminée à l'opposé de la branche 12 par une surface d'appui 142 parallèle à la face 121. Un perçage taraudé longitudinal 143 est ménagé dans la partie 141 et centré sur l'axe AP. The bridge portion 141 is closed opposite to the arm 12 by a bearing surface 142 parallel to the face 121. A longitudinal threaded bore 143 is formed in the portion 141 and centered on the axis AP.

La seconde partie de pont 144 est monolithique avec l'extrémité antérieure de la branche 11. La partie 144 comprend une surface d'appui 145 en regard de la surface d'appui 142 et analogue à cette dernière. The second bridge portion 144 is monolithic with the front end of the arm 11. The part 144 includes a support surface 145 facing the bearing surface 142 and the like thereto. Lorsque la cage 1 est en position fermée selon la figure 4, les surfaces 142 et 145 sont en appui l'une contre l'autre. When the cage 1 is in the closed position according to Figure 4, the surfaces 142 and 145 abut against each other.

Lorsque la cage 1 est en position complètement ouverte, des épaulements 11e de la branche 11 situés de part et d'autre du tenon 134 butent contre des coins supérieurs 12e des branches de chape 131 et 132, et les surfaces d'appui 142 et 145 sont éloignées l'une de l'autre. When the cage 1 is in the fully open position, shoulder 11 of the leg 11 situated on either side of the pin 134 abut against the upper corners 12 of the fork portions 131 and 132 and bearing surfaces 142 and 145 are distant from one another.

La face externe en bout du pont 14 comprend un moyen de liaison démontable avec un outil porte-cage 2 détaillé dans la suite. The outer end face of the bridge 14 includes a removable connecting means with a tool-holder shaft 2 described in detail below. Le moyen de liaison est un tenon en queue d'aronde 146 formé de manière continue dans les parties 141 et 144 du pont antérieur 14. En variante, le tenon est formé uniquement sur la partie de pont la plus haute 141, ou est remplacé par un logement en queue d'aronde. The connecting means is a tang dovetail 146 continuously formed in the portions 141 and 144 of the anterior bridge 14. Alternatively, the pin is formed only on the bridge portion Highest 141, or is replaced by a housing dovetail. Selon d'autres variantes, le moyen de liaison démontable est du type tenon ou logement à section en te, In other embodiments, the removable connection means is of the tenon or type flat section you,
Un galet d'écartement 15 a la forme d'un cylindre coupé par deux plans orthogonaux entre eux et parallèles à l'axe du cylindre pour former deux méplats longitudinaux 150 et 151. Le méplat 151 et la surface cylindrique 152 du galet sont des surfaces d'appui coopérant respectivement avec les faces internes 122 et 112 des branches 12 et 11. Le galet 15 comprend en outre au milieu du méplat 150 un trou lisse transversal 153 qui reçoit l'extrémité postérieure plate d'une vis à six pans creux sans tête 16. La vis 16 est vissée dans le trou 143 de la branche 12 et traverse celui-ci. A spacer roller 15 has the shape of a cylinder cut by two planes orthogonal to each other and parallel to the cylinder axis to form two longitudinal flats 150 and 151. The flat portion 151 and the cylindrical surface of the roller 152 are surfaces bearing cooperating respectively with the inner faces 122 and 112 of the branches 12 and 11. the roller 15 further comprises in the middle of flattened portion 150 a transverse smooth bore 153 which receives the rear flat end of a screw with hexagon socket without head 16. the screw 16 is screwed into the hole 143 of the arm 12 and passes through the latter.

L'extrémité postérieure de la vis tourne librement dans le trou 153 du galet 15. La vis 16 est immobilisee en translation dans le trou de galet 153 par un anneau torique élastique interne encastré à force dans deux gorges correspondantes respectivement pratiquées dans le trou et l'extremite postérieure de la vis, ou par deux collerettes ou rondelles d'arrêt 162 et 163 soudées à l'argon autour de la vis 16 de part et d'autre du galet 15 après insertion de la vis 16 dans le trou 153. The rear end of the screw rotates freely in the hole 153 of the roller 15. The screw 16 is immobilized in translation in the roller hole 153 by a recessed inner resilient O-ring force in two corresponding grooves provided respectively in the hole and rear end of the screw, or by two stop collars or rings 162 and 163 welded to the argon around the screw 16 on either side of the roller 15 after inserting the screw 16 into the hole 153.

Les faces internes 112 et 122 des branches 11 et 12 s'étendent entre les ponts postérieur et antérieur 13 et 14 et forment un chemin de glissement pour le galet 15. The inner faces 112 and 122 of the legs 11 and 12 extend between the posterior and anterior bridges 13 and 14 and form a sliding path for the roller 15.

La face interne 122 de la branche 12 est plane et parallèle à la face externe 121. Dans l'autre branche 11, la face 112 est inclinée d'un angle AF par rapport à la surface externe 111 dans le plan antéro-postérieur. The inner face 122 of the arm 12 is flat and parallel to the outer face 121. In the other branch 11, the side 112 is inclined at an angle AF with respect to the outer surface 111 in the anterior-posterior plane.

Ainsi, l'extrémité de la face interne 122 proche du pont postérieur 13 est en permanence à une distance plus faible de la face en regard 112 que ne l'est l'extrémité de la face 122 proche du pont antérieur 14, quelle que soit la position fermée ou ouverte des branches Il et 12. Thus, the end of the inner side 122 close to the rear axle 13 is constantly at a lower distance from the facing surface 112 than is the end of the face 122 near the anterior bridge 14, regardless of the closed or open position of the branches 12 and He.

Le vissage de la vis 16 dans le trou 143 du pont 14 positionne le galet 15 sur son chemin de glissement et ainsi impose un angle AN entre les faces externes 111 et 121 des branches 11 et 12. La longueur du tronçon fileté de la vis 16 situé à l'extérieur du galet 15 et vissé dans le perçage taraudé 143 de la branche 12, et la longueur de ce perçage taraudé 143 sont supérieures à la course de glissement CG du galet dont les limites correspondent aux positions ouverte et fermée de la cage. Screwing the screw 16 into the hole 143 of the bridge 14 positions the roller 15 on its sliding track and thus imposes an AN angle between the outer faces 111 and 121 of the branches 11 and 12. The length of the threaded portion of the screw 16 located outside the roller 15 and screwed in the threaded bore 143 of the arm 12, and the length of the threaded bore 143 are greater than the sliding stroke of the roller CG whose boundaries correspond to the open and closed positions of the cage . En position fermée de cage, le méplat diamétral 150 du galet bute sensiblement contre la face interne de la partie de pont 141, comme montré à la figure 4 ; Closed cage position, the flat diametrical 150 of the roller substantially abuts against the inner face of the bridge portion 141, as shown in Figure 4; la tete de vis 161 affleure sensiblement la face antérieure de la partie de pont 141, si bien que la vis 16 est toujours comprise dans la cage et n'agresse pas le milieu environnant. the screw head 161 is substantially flush with the anterior face of the bridge portion 141, so that the screw 16 is always within the cage and does not attack the surrounding environment. En position ouverte maximale de cage, le galet est localisé sensiblement à mi-distance entre la chape 131-132 et la partie de pont 141, comme montré à la figure 5. In maximum open position of cage, the roller is located substantially midway between 131-132 yoke and the bridge portion 141, as shown in Figure 5.

Les faces externes 111 et 121 comprennent des moyens d'ancrage dans des corps vertébraux CV1 et CV2 montrés schématiquement à la figure 5. Les moyens d'ancrage sont des dentures transversales sur toute la surface des faces 111 et 121. En variante, les moyens d'ancrage sont des picots. The outer faces 111 and 121 include means for anchoring in the vertebral bodies CV1 and CV2 shown schematically in figure 5. The anchoring means are transverse teeth over the entire surface of the faces 111 and 121. Alternatively, the means anchor are pimples.

Les faces postérieures des branches de chape 131 et 132 et du tenon 134 sont arrondies afin de faciliter la pénétration de la cage entre deux corps vertébraux par voie antérieure. The backside of the fork portions 131 and 132 and the stud 134 are rounded to facilitate penetration of the cage between two vertebral bodies through an anterior approach.

Chacune des deux branches 11 et 12 est en outre percée par une lumière rectantulaire ou oblongue 113, 123 pour alléger la cage et, le cas échéant, remplir la cage par des greffons osseux. Each of the two branches 11 and 12 is also pierced by a rectantulaire or oblong slot 113, 123 to reduce the cage and, where applicable, fill the cage with bone grafts.

En pratique, deux cages 1 sont juxtaposées dans un même espace intervertébral ; In practice, two cages 1 are juxtaposed in the same intervertebral space; les cages sont à une distance moyenne de 10 à 15 mm environ l'une de l'autre, et convergent sensiblement de 10 à 150 environ vers la direction antérieure. the cages are at an average distance of 10 to 15 mm from each other, and converge substantially from 10 to 150 approximately towards the anterior direction.

En référence aux figures 6 à 11, une seconde réalisation de cage intervertébrale la selon l'invention se différencie de la cage 1 principalement par sa forme. Referring to Figures 6-11, a second embodiment intervertebral cage according to the invention differs from the cage 1 mainly by its shape.

La cage la est sensiblement parallélépipédique et symétrique par rapport à un plan longitudinal à l'axe antéro-postérieur de trace AP et perpendiculaire à la figure 9. La cage la a sensiblement la même longueur que la cage 1 selon l'axe AP et la même hauteur que la cage 1, mais a une largeur supérieure à celle de la cage 1 dans le plan frontal, typiquement supérieure au double de la largeur de la cage 1. La largeur de la cage la correspond sensiblement à la largeur d'un disque vertébral à remplacer. The cage is substantially rectangular and symmetrical about a longitudinal plane at the anterior-posterior axis AP track and perpendicular to the Figure 9. The cage has the substantially the same length as the housing 1 along axis AP and same height as the cage 1, but has a width greater than that of the cage 1 in the frontal plane, typically greater than twice the width of the cage 1. the width of the cage substantially corresponds to the width of a disc vertebral replacement. En pratique, le chirurgien implante une seule cage la dans un espace intervertébral. In practice, the surgeon implants a single cage in the intervertebral space.

Comme la cage 1, la cage la comprend deux branches lla et 12a réunies par un pont postérieur de liaison 13a. As the cage 1, the cage comprises two legs lla and 12a joined by a posterior bridge 13a bond. Le pont 13a comprend une articulation cylindrique postérieure en chape ayant deux branches de chape 131a et 132a saillant de la branche 12a et encadrant un tenon 134a de l'autre branche lia, et un pivot cylindrique de rotation 136a traversant librement un trou 135a du tenon 134a et à force dans deux trous 133a des branches de chape. Bridge 13a includes a rear cylindrical articulation fork having two fork portions 131a and 132a projecting from the branch 12a and surrounding a pin 134a of the other leg lla, and a cylindrical rotation pivot 136a passing freely through a hole 135a of the tenon 134a and force in two holes 133a of the fork branches.

La cage la comprend également un pont antérieur 14a en deux parties 141a et 144a, un moyen de liaison 146a avec l'outil porte-cage 2 et un moyen d'écartement des branches comprenant une vis 16a et un galet 15a. The cage also includes an anterior bridge 14a into two parts 141a and 144a, 146a a connection means with the tool-holder shaft 2 and a spacer means of the branches comprising a screw 16a and a roller 15a.

Perpendiculairement à la face interne 122a de la branche la plus haute 12a sont ménagées deux décrochements en dièdre droit rectangulaires en regard 124a compris entre le pont postérieur 13a et la partie de pont antérieur l4la de la branche 12a. Perpendicularly to the inner face 122a of the uppermost part 12a are formed two rectangular recesses in right dihedral 124a eye between the posterior bridge 13a and bridge portion prior l4la 12a branch. Les décrochements 124a ont des grands côtés postérieur et antérieur encadrant longitudinalement le galet 15a et un fond constituant un chemin de glissement pour le méplat 151a du galet 15a. The recesses 124a have large posterior and anterior sides framing longitudinally roller 15a and a bottom constituting a sliding path for the flat 151a of the roller 15a. Le fond des décrochements 124a assure le guidage rectiligne du galet 15a qui demeure ainsi bien perpendiculaire à l'axe AP. The bottom of the recesses 124a assures the rectilinear guidance of the roller 15a which is thus kept well perpendicular to the axis AP.

La longueur Ca du fond des décrochements 124a peut définir la course de glissement CGa du galet 15a, bien que cette course est en pratique déterminée par le débattement de la branche pivotante lla autour du pivot 136a, entre une position fermée (figure 10) à laquelle des surfaces d'appui 142a et 145a butent l'une contre l'autre, et une position ouverte (figure 11) à laquelle les surfaces 142a et 145a sont éloignées et des épaulements ilea de la branche 11 encadrant le tenon 134a butent contre des bords 12ea des branches de chape 131a et 132a. Ca length 124a recesses of the bottom may define the sliding stroke CGa the roller 15a, although this race is in practice determined by the movement of the pivoting leg lla around 136a pivot between a closed position (Figure 10) to which bearing surfaces 142a and 145a abut against each other, and an open position (Figure 11) to which the surfaces 142a and 145a are remote and shoulders ilea of ​​the leg 11 surrounding the tenon 134a abut against the edges 12EA fork portions 131a and 132a.

La branche la moins haute lia présente deux lumières sensiblement oblongues identiques 113a de part et d'autre de l'axe AP et ouvertes en direction postérieure selon la réalisation illustrée. The least high IIa arm has two essentially identical oblong slots 113a on either side of the axis AP and open in the posterior direction in the illustrated embodiment. La branche la plus haute 12a présente deux lumieres sensiblement oblongues identiques 123a situées de part et d'autre de l'axe AP, selon la réalisation illustrée. Highest 12a limb has two lights substantially identical oblong 123a located on either side of the axis AP, according to the illustrated embodiment. La cage peut être remplie de greffons osseux à travers les lumières 113a et 123a. The cage may be filled with bone grafts through the lights 113a and 123a. En variante, les branches lia et 12a comprennent une seule lumière oblongue transversale à l'axe AP. Alternatively, the branches 12a and IIa include a single transverse oblong hole to the axis AP.

Les surfaces de côtés latéraux 18a et l9a de la cage la sont convexes cylindriques autour d'un axe vertical pour une bonne adaptation anatomique et faciliter la pénétration de la cage entre deux corps vertébraux. The surfaces of the lateral sides 18a and L9A of the cage are convex cylindrical about a vertical axis for good anatomical adaptation and facilitate penetration of the cage between two vertebral bodies.

Comme montré plus particulièrement aux figures 10 et 11, le vissage de la vis 16a dans le trou taraudé 143a du pont 14a positionne le long galet lSa sur son chemin de glissement CGa entre les branches lia et 12a. As shown more particularly in Figures 10 and 11, the screwing of the screw 16a into the threaded hole 143a of the bridge 14a positioned along LSA roller on its sliding track CGa between the limbs Ila and 12a.

Le méplat l5la et la surface cylindrique 152a du galet sont en contact glissant respectivement contre le fond des décrochements 124a et la face interne 112a des branches. The flat l5la 152a and the cylindrical surface of the roller are in sliding contact respectively against the bottom of the recesses 124a and the inner face 112a of the branches. La face interne 112a de la branche la moins haute lla forme un angle AFa avec la face externe alla. The inner face 112a of the least high branch lla forms an AFa angle with the outer face left.

Ainsi l'angle ANa entre la face externe lîla de la branche lia et la face externe 121a de la branche 12a est réglé par rotation de la vis 16a dans le trou taraudé 143a. Thus ANa angle between the outer face of the branch lîla IIa and the outer face 121a of the branch 12a is adjusted by rotation of the screw 16a into the threaded hole 143a. Quelle que soit la position fermée (figure 10) ou ouverte (figure 11) de la cage la, la vis 16a est toujours noyée dans la cage. Whatever the closed position (Figure 10) or open (Figure 11) of the cage, the screw 16a is still embedded in the cage.

En référence aux figures 12 à 14, un porte-cage 2 comprend un corps longiligne 20 longitudinal à l'axe antéro-postérieur AP. Referring to Figures 12 to 14, a shaft holder 2 comprises an elongated longitudinal body 20 to the anterior-posterior axis AP. Le porte-cage comprend à l'une de ses extrémités, dite extrémité antérieure distale, une tête de manoeuvre 21 et à son autre extrémité, dite extrémité postérieure proximale, un moyen de liaison 22 avec la cage 1,la. The cage door comprises at one of its ends, said distal front end, an operating head 21 and at its other end, said proximal rear end, a connecting means 22 with the cage 1, the. Le porte-cage 2 est symétrique par rapport à un plan longitudinal de trace AP et perpendiculaire à la figure 12. La longueur L du portecage 2 est d'environ 20 à 30 centimètres. The portecage 2 is symmetrical with respect to an AP trace longitudinal plane of and perpendicular to the Figure 12. The length L of portecage 2 is about 20 to 30 centimeters.

Le corps 20 est percé longitudinalement par un conduit long cylindrique traversier 201. Le conduit 201 débouche à l'extrémité antérieure distale par un trou lisse 202 de diamètre inférieur au conduit 201 et forme avec ce trou 202 un épaulement interne 203. A l'extrémité postérieure proximale, le conduit 201 débouche par un évasement conique 204 ayant un angle au sommet de quelques degrés. The body 20 is pierced longitudinally by a long cylindrical conduit ferry 201. The conduit 201 opens to the distal front end by a smooth hole 202 of smaller diameter than the conduit 201 and forms with the hole 202 an inner shoulder 203. At the end proximal posterior, the conduit 201 opens via a conical extension 204 having an apex angle of a few degrees.

Deux ergots de positionnement filetés du type vispointeau sans tête & six pans 23 et 24 sont vissés dans deux trous taraudés 205 et 206 radiaux et axés dans un plan diamétral commun au corps 20. Les trous taraudés sont sensiblement situés au milieu du corps 20 selon l'axe AP et sont espacés d'environ 1 centimètre. Two threaded locating pegs of type vispointeau headless & hexagon 23 and 24 are screwed in two threaded holes 205 and radial 206 oriented and in a common diametral plane of the body 20. The threaded holes are substantially located in the middle of the body 20 according to AP axis and are spaced approximately 1 centimeter. Une fois vissés dans les trous, les ergots 23 et 24 affleurent la surface externe cylindrique du corps 20 et saillent radialement dans le conduit 201 sur une longueur de 1 à 2 millimètres. Once screwed into the holes, the pins 23 and 24 are flush with the cylindrical outer surface of the body 20 and protrude radially into the duct 201 of a length of 1 to 2 millimeters.

La surface extérieure du corps 20 comprend des gorges et couronnes cylindriques alternées 207 et 208 depuis l'extrémité antérieure jusqu'à environ le milieu du corps 20 selon l'axe AP. The outer surface of the body 20 comprises alternating grooves and cylindrical rings 207 and 208 from the front end to about the middle of body 20 along axis AP. Les gorges et couronnes favorisent une bonne préhension du porte-cage 2. The gorges and crowns promote good grip on the cage door 2.

Une tige interne 25 à plusieurs tronçons cylindriques est montée à coulissement dans le conduit 201. Depuis l'extrémité antérieure, la tige 25 comprend un tronçon d'extrémité antérieur fileté 251, un long tronçon intermédiaire lisse 252, un court tronçon large lisse rainuré 253, un second long tronçon intermédiaire lisse 255, un court tronçon large lisse 256, et un tronçon d'extrémité postérieur mince 257. An internal rod 25 to a plurality of cylindrical sections is slidably mounted in the conduit 201. Since the front end, the rod 25 comprises a threaded front end portion 251 along a smooth intermediate section 252, a short smooth wide groove portion 253 a second long smooth intermediate section 255, a short stretch wide smooth 256, and a thin rear end portion 257.

Le tronçon d'extrémité fileté 251 traverse b glissement le trou 202 du corps 20 et saille longitudinalement du corps 20. Le tronçon intermédiaire lisse 252 s'étend depuis le tronçon 251 sur environ un tiers de la longueur de la tige 25. Le tronçon 252 a sensiblement le même diamètre que le tronçon fileté 251 et l'autre tronçon intermédiaire 255. The threaded end portion 251 b passes through the sliding hole 202 of the body 20 and protrudes longitudinally from the body 20. The smooth intermediate section 252 extends from section 251 of about one third of the length of the rod 25. The section 252 has substantially the same diameter as the threaded section 251 and the other intermediate section 255.

A partir du tronçon 252 et en regard des ergots de positionnement 23 et 24, le tronçon lisse 253 présente un diamètre plus grand que les deux tronçons 251 et 252 et correspondant sensiblement au diamètre du conduit 201. Dans le tronçon 253 est pratiquée une rainure longitudinale 254 propre à recevoir les extrémités saillantes des ergots de positionnement 23 et 24. La distance radiale entre l'axe AP et le fond de la rainure 254 est au moins égale au diamètre des tronçons 251, 252 et 255. From the section 252 and opposite locating pins 23 and 24, the smooth portion 253 has a larger diameter than the two sections 251 and 252 and substantially corresponding to the diameter of the conduit 201. In the section 253 is performed a longitudinal groove 254 adapted to receive the projecting ends of the positioning pins 23 and 24. the radial distance between the axis AP and the bottom of the groove 254 is at least equal to the diameter of sections 251, 252 and 255.

Après le second tronçon intermédiaire lisse 255, le court tronçon lisse 256 a environ deux centimetres de long et un diamètre correspondant sensiblement au diamètre du conduit 201. After the second smooth intermediate section 255, the short smooth portion 256 of about two centimeters long and a diameter substantially corresponding to the diameter of the conduit 201.

A l'extrémité postérieure de la tige, le tronçon cylindrique 257 de faible diamètre comprend transversalement un tenon sensiblement parallélépipédique 258 ayant des cotés cylindriques 258c montés à glissement dans le conduit 201, comme montré aux figures 12 et 13, pour bloquer en translation et en rotation le moyen de liaison 22 qui est maintenant décrit. At the rear end of the rod, the cylindrical portion 257 of smaller diameter comprises a substantially rectangular transverse tenon 258 having cylindrical sides 258c slidably mounted in the conduit 201, as shown in Figures 12 and 13, for locking in translation and in rotating the connecting means 22 which is now described.

Le moyen de liaison 22 est sous la forme d'une pince de révolution ayant deux mâchoires identiques 221 qui sont symétriques par rapport au plan de trace AP dans la figure 12. Comme montré à la figure 14, chaque mâchoire 221 comprend une portion sensiblement hémicylindrique 222 dans laquelle est ménagé un logement en croix ayant une grande branche axiale 257b pour recevoir longitudinalement environ la moitié du mince tronçon cylindrique 257 et une petite branche diamétrale à section rectangulaire 258b pour recevoir environ la moitié du tenon 258. A partir de la portion 222 et au moins partiellement en contact avec l'évasement conique 204 du conduit 201, chaque mâchoire 221 comprend une première portion hémi-conique 223 de dimensions correspondant à l'évasement 204. La mâchoire est terminée par une seconde portion hémi-conique 224 dont la grande base est commune avec celle de la première portion 223. The connecting means 22 is in the form of a revolution clip having two identical jaws 221 which are symmetrical with respect to the AP plane of the line in Figure 12. As shown in Figure 14, each jaw 221 includes a substantially semi-cylindrical portion 222 in which is provided a housing having a large cross axial leg 257b for receiving longitudinally about half of the thin cylindrical portion 257 and a small diameter branch 258b to rectangular section to receive about half of the pin 258. from the portion 222 and at least partially in contact with the tapered sides 204 of the conduit 201, each jaw 221 includes a first semi-conical portion 223 of dimensions corresponding to the flare 204. the jaw is closed by a second semi-conical portion 224 whose large base is common with that of the first portion 223.

Sensiblement à l'aplomb de la grande base des portions 223 et 224, la mâchoire 221 comprend un trou cylindrique transversal borgne 225 propre à recevoir un ressort d'écartement de mâchoires 226. Substantially in line with the large base portions 223 and 224, jaw 221 includes a blind transverse cylindrical hole 225 adapted to receive one of the jaws 226 of spring spacing.

L'extrémité proximale de chaque mâchoire 221 comprend une demi-rainure en queue d'aronde transversale pour former avec la demi-rainure dans l'autre mâchoire une rainure en queue d'aronde 227 de largeur variable lorsque les mâchoires sont rapprochées ou éloignées. The proximal end of each jaw 221 comprises a half-groove transverse dovetail to form with the half-groove in the other jaw a dovetail groove 227 of varying width when the jaws are moved towards or away.

Enfin, la tête 21 comprend un trou taraude 211 qui est vissé sur le tronçon 251 saillant du corps 20 par le trou 202. Un ressort hélicoïdal 26 enfilé autour du tronçon intermédiaire 252 est en appui entre l'épaulement 203 et le tronçon 253 dans le conduit 201. Finally, the head 21 includes a threaded hole 211 which is screwed onto the projecting portion 251 of the body 20 through the hole 202. A coil spring 26 fitted around the intermediate portion 252 is in abutment between the shoulder 203 and the portion 253 in the 201 leads.

Le ressort 26 applique en permanence la tete de manoeuvre 21 contre l'extrémité plate antérieure distale du corps 20 et pousse la tige 25 suivant la direction postérieure lorsque la tête est dévissée. The spring 26 applies continuously the operating head 21 against the distal anterior flat end of the body 20 and pushes the rod 25 along the posterior direction when the head is unscrewed.

En vissant la tête 21 sur le tronçon 251, la tige 25 coulisse longitudinalement vers l'extrémité antérieure et le ressort 26 est comprimé. By screwing the head 21 on the section 251, the rod 25 slides longitudinally towards the front end and the spring 26 is compressed. Les mâchoires 221 sont alors rapprochées l'une de l'autre à l'encontre du ressort 226 en raison de la conicité des portions 223 qui "rentrent" dans l'évasement 204 du conduit 201, ce qui a pour effet de diminuer la largeur de la rainure en queue d'aronde 227. The jaws 221 are then moved towards each other against the spring 226 due to the taper portions 223 which "fall" in the flaring 204 of the conduit 201, which has the effect of reducing the width of the groove dovetail 227.

Ainsi, en dévissant tout d'abord légèrement la tête 21, le chirurgien donne à la rainure en queue d'aronde 227 la largeur suffisante pour y insérer le tenon en queue d'aronde 146, 146a de la cage 1, la. Thus, unscrewing initially slightly the head 21, the surgeon gives the dovetail groove 227 of sufficient width to insert the tenon of dovetail 146, 146a of the cage 1, the. Puis en vissant à nouveau la tête 21, le chirurgien rétrécit la rainure 227 pour pincer le tenon de la cage. Then screwing again the head 21, the surgeon narrows the groove 227 to clamp the pin of the cage. La cage 1, la est alors liée au porte-cage 2 et les axes longitudinaux AP de la cage et du porte-cage sont confondus. The cage 1, the door is then connected to the cage 2 and the longitudinal axis AP of the cage and the cage carrier coincide. De préférence, la cage 1, la est fermée, c'est-à-dire les branches 11 et 12, ila et 12a sont sensiblement parallèles. Preferably, the cage 1, the is closed, that is to say the branches 11 and 12, ila and 12a are substantially parallel.

Après discectomie par voie anterieure pour ôter un disque déficient entre deux corps vertébraux CV1 et CV2 et râpage de 1'espace intervertébral entre ces corps vertébraux au moyen d'outils appropriés afin de former un logement de dimensions analogues à la cage, le chirurgien implante alors la cage 1, la par la voie antérieure ainsi accessible entre les corps vertébraux After discectomy through an anterior approach to remove a defective disc between two vertebral bodies CV1 and CV2 and buffing 1'espace intervertebral between vertebral bodies by means of suitable tools to form a housing similar dimensions to the cage, the surgeon then implants the cage 1 by the anterior route and accessible between the vertebral bodies
CV1 et Cv2 en maintenant et positionnant la cage grâce au porte-cage, comme montré à la figure 15. CV1 and Cv2 maintaining and positioning the cage through the cage door, as shown in Figure 15.

Lorsque la cage 1, la dans le logement intervertébral est à l'emplacement souhaité par le chirurgien, après avoir frappé sur la tête de manoeuvre 21 le cas echéant, celui-ci dévisse la tête 21 pour élargir la rainure 227 afin de dissocier le porte-cage et la cage puis retirer le porte-cage. When the cage 1, in the intervertebral-disc compartment is at the desired location by the surgeon, after hitting on the operating head 21 if applicable, one unscrews the head 21 to expand the groove 227 in order to separate the door -cage cage and then remove the cage door.

Ensuite, un embout à six pans d'un tournevis est introduit dans la tête à six pans creux 161, 161a de la vis 16, 16a pour visser la vis dans le perçage taraudé 143, 143a et déplacer le galet 15, 15a afin d'écarter les branches 11 et 12, lia et 12a d'un angle AN, ANa souhaité comme illustré aux figures 1, 6 par les flèches 30 et 31, 30a et 3la. Then, a tip Allen screwdriver is inserted into the head with hexagon socket 161, 161a of the screws 16, 16a for screwing the screw into the threaded bore 143, 143a and move the roller 15, 15a in order to aside the branches 11 and 12, lia and 12a an angle aN, ANa desired as illustrated in figures 1, 6 by the arrows 30 and 31, 30a and 3la.

Bien que 1invention ait été décrite en référence à deux réalisations préférées de cage, celles-ci peuvent subir des modifications en restant dans le cadre de 1'invention. Although 1invention has been described with reference to two preferred embodiments of cage, they may undergo modifications within the scope of 1'invention. Par exemple, à la place d'un pont postérieur 13, 13a à articulation à pivot 136, 136a, peut être prévu un moyen à charnière "flexibles qui lie de manière monolithique les extrémités postérieures des branches 11 et 12, îla et 12a, l'avance du galet 15, 15a suivant la direction postérieure provoquant des fléchissements opposés des branches 11 et 12, lîa et 12a. For example, instead of a rear axle 13, 13a to pivot joint 136, 136a may be provided a hinge means "flexible linking monolithically the rear ends of branches 11 and 12, Ila and 12a, the advance of the roller 15, 15a according to posterior direction opposite deflections causing the branches 11 and 12, lia and 12a.

Claims (17)

REVENDICATION8 REVENDICATION8
1 - Cage intersomatique (1 ; la) à insérer entre deux corps vertébraux (CV1, CV2), caractérisée en ce qu'elle comprend deux branches sensiblement parallèles (Il, 12 ; lia, 12a) pour être introduites entre lesdits corps vertébraux, un pont (13 ; 13a) reliant des extrémités postérieures (131, 132, 134 ; 131a, 132a, 134a) des branches, et un moyen (15, 16 ; 15a, 16a) manoeuvrable depuis des extrémités antérieures (141, 144 ; 141a, 144a) des branches pour écarter angulairement les extrémités antérieures des branches après insertion de la cage entre les corps vertébraux. 1 - intersomatic cage (1; la) to be inserted between two vertebral bodies (CV1, CV2), characterized in that it comprises two substantially parallel branches (II, 12; lla, 12a) to be introduced between said vertebral bodies, a bridge (13; 13a) connecting the posterior ends (131, 132, 134; 131a, 132a, 134a) of the legs, and means (15, 16; 15a, 16a) operable from the front ends (141, 144; 141a, 144a) of the legs to angularly deviate the front ends of branches after insertion of the cage between the vertebral bodies.
2 - Cage conforme à la revendication 1, caractérisée en ce que le pont (13, 13a) comprend une articulation en chape (131, 132, 134 ; 131a, 132a, 134a). 2 - Cage according to claim 1, characterized in that the bridge (13, 13a) comprises a universal joint yoke (131, 132, 134; 131a, 132a, 134a).
3 - Cage conforme à la revendication 1 ou 2, caractérisée en ce que les faces internes des branches (11, 12 ; pila, 12a) ont des surfaces d'appui en regard (112, 122 ; 112a, 122a) qui forment les côtés d'un vé dont le sommet est orienté vers le pont (13, 13a) et qui sont en contact glissant avec le moyen pour écarter (15, 16 ; 15a, 16a). 3 - Cage according to claim 1 or 2, characterized in that the inner faces of the limbs (11, 12; pila, 12a) have bearing surfaces facing (112, 122; 112a, 122a) which form the sides a vee whose apex is oriented toward the bridge (13, 13a) and which are in sliding contact with the medium to spread (15, 16; 15a, 16a).
4 - Cage conforme à l'une quelconque des revendications 1 à 3, dans laquelle un écartement angulaire des branches est limité d'une part par butée (142, 145 ; 142a, 145a) des extrémités antérieures (141, 144 ; 141a, 144a) des branches l'une contre l'autre, d'autre part par butée (île, 12e, ilea, 12ea) des extrémités postérieures (131, 132, 134 ; 131a, 132a, 134a) des branches l'une contre l'autre. 4 - Cage according to any one of claims 1 to 3, wherein an angular spacing of the branches is limited on one hand by stop (142, 145; 142a, 145a) of the front ends (141, 144; 141a, 144a ) of the legs one against the other, on the other hand by stop (island, 12e, ilea, 12EA) posterior ends (131, 132, 134; 131a, 132a, 134a) of the legs one against the other.
5 - Cage conforme a l'une quelconque des revendications 1 à 4, caractérisée en ce que le moyen pour écarter comprend 5 - Cage according to any one of claims 1 to 4, characterized in that the means to spread comprises
une vis (16 ; 16a) vissée dans l'extrémité antérieure (141 ; 141a) de l'une (12 ; 12a) des branches et s'étendant entre les branches (11, 12 ; lia, 12a), et a screw (16; 16a) screwed into the front end (141; 141a) of one (12; 12a) of the legs and extending between the legs (11, 12; lla, 12a), and
une pièce d'écartement (15 ; 15a) en contact avec des surfaces d'appui en regard (112, 122 ; 112a, 122a) de faces internes des branches et solidaire au moins en direction axiale avec une extrémité postérieure de la vis. a spacer (15; 15a) in contact with bearing surfaces facing (112, 122; 112a, 122a) of the inner faces of the branches and connected at least in axial direction with a rear end of the screw.
6 - Cage conforme à la revendication 5, comprenant des butées de fin de course pour la pièce d'écartement (15 ; 15a) constituées par des extrémités antérieure et postérieure saillantes (141, 132, 133 ; 141a, 132a, 133a) de l'une (12 ; 12a) des branches. 6 - Cage according to claim 5, comprising limit stops for the spacer (15; 15a) formed by projecting front and rear ends (141, 132, 133; 141a, 132a, 133a) of one (12; 12a) of the legs.
7 - Cage conforme à la revendication 5 ou 6, comprenant un décrochement (124a) ménagé parallèlement à ladite vis (16a) dans ladite une (12a) des branches pour guider la pièce d'écartement (15a). 7 - Cage according to claim 5 or 6, comprising a step (124a) arranged parallel to said screw (16a) in said one (12a) of the legs to guide the spacer (15a).
8 - Cage conforme 1'une quelconque des revendications 5 à 7, caractérisée en ce qu'une extrémite postérieure de la vis (16) comprend un moyen d'arrêt (162, 163) pour immobiliser axialement la pièce d'écartement (15) autour de la vis. 8 - Cage accordance 1'une any of claims 5 to 7, characterized in that one end of the posterior screw (16) comprises a stop means (162, 163) to axially immobilize the spacer (15) around the screw.
9 - Cage conforme à l'une quelconque des revendications 1 à 8, caractérisée en ce qu'elle est sensiblement parallélépipédique, 9 - Cage according to any one of claims 1 to 8, characterized in that it is substantially parallelepipedic,
10 - Cage conforme à 1'une quelconque des revendications 1 à 9, caractérisée en ce qu'elle a des côtés latéraux sensiblement cylindriques (18a, l9a). 10 - Cage according to 1'une any of claims 1 to 9, characterized in that it has substantially cylindrical sides (18a, L9A).
11 - Cage conforme à l'une quelconque des revendications 1 à 10, caractérisée en ce que des faces externes (111, 121 ; villa, 121a) des branches comprennent des moyens d'ancrage transversaux, de préférence des dentures. 11 - Cage according to any one of claims 1 to 10, characterized in that external faces (111, 121; Villa, 121a) of the legs comprise transverse anchoring means, preferably gears.
12 - Cage conforme à 1'une quelconque des revendications 1 à 11, caractérisée en ce qu'au moins l'une des branches comprend au moins une lumière (113, 123 ; 113a, 123a). 12 - Cage according to 1'une any of claims 1 to 11, characterized in that at least one of the branches comprises at least one lumen (113, 123; 113a, 123a).
13 - Cage conforme à 1'une quelconque des revendications 1 à 12, caractérisée en ce qu'une face de I'extrémité antérieure (141 ; 141a) d'au moins l'une (12 12a) des branches comprend un moyen de liaison (146 ; 146a) avec un porte-cage (2). 13 - Cage according to 1'une any of claims 1 to 12, characterized in that one side of front I'extrémité (141; 141a) of at least one (12 12a) of the branches comprises a connecting means (146; 146a) with a cage door (2).
14 - Cage conforme à la revendication 13, caractérisée en ce que le moyen de liaison est un tenon en queue d'aronde (146 ; 146jazz 14 - Cage according to claim 13, characterized in that the connecting means is a dovetail tenon (146; 146jazz
15 - Porte-cage (2) pour liaison amovible avec la cage conforme à la revendication 13 ou 14, caractérisé en ce qu'il comprend une rainure à largeur variable (227) pour pincer le moyen de liaison (146 ; 146a) de la cage (1, la). 15 - holder cage (2) for releasable connection to the cage according to claim 13 or 14, characterized in that it comprises a variable-width groove (227) for clamping the connecting means (146; 146a) of the cage (1, la).
16 - Porte-cage (2) conforme à la revendication 15, caractérisé en ce qu'il comprend un moyen (21) pour modifier la largeur de la rainure (227). 16 - holder cage (2) according to claim 15, characterized in that it comprises means (21) for changing the width of the groove (227).
17 - Porte-cage (2) conforme à la revendication 15 ou 16, comprenant 17 - holder cage (2) according to claim 15 or 16, comprising
un corps cylindrique creux (20), a hollow cylindrical body (20),
une tige (25) montée à coulissement dans un conduit traversier (201) du corps et rappelée élastiquement vers une extrémité postérieure évasée (204) du conduit, a rod (25) slidably mounted in a conduit ferry (201) of the body and resiliently biased towards a flared rear end (204) of the conduit,
une tête de manoeuvre (21) vissée à une extrémité filetée antérieure (251) de la tige et rappelée élastiquement contre une extrémité antérieure du corps, et an operating head (21) screwed in a front threaded end (251) of the shaft and resiliently biased against a front end of the body, and
deux mâchoires (221) contenant ladite rainure à largeur variable (227) bloquées en translation axiale autour d'une extrémité postérieure (257, 258) de la tige et appliquées élastiquement en opposition transversale et à glissement contre l'extrémité postérieure évasée (204) du conduit (201). two jaws (221) containing said variable-width groove (227) blocked in axial translation around a rear end (257, 258) of the rod and applied elastically in transverse opposition and sliding against the flared rear end (204) the duct (201).
FR9403036A 1994-03-14 1994-03-14 Vertebral intersomatic cage. Expired - Fee Related FR2717068B1 (en)

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