FR2722679A1 - Expansible arthrodesis implant for insertion between vertebrae - Google Patents

Expansible arthrodesis implant for insertion between vertebrae Download PDF

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Publication number
FR2722679A1
FR2722679A1 FR9409389A FR9409389A FR2722679A1 FR 2722679 A1 FR2722679 A1 FR 2722679A1 FR 9409389 A FR9409389 A FR 9409389A FR 9409389 A FR9409389 A FR 9409389A FR 2722679 A1 FR2722679 A1 FR 2722679A1
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Prior art keywords
implant
cylinder
zes
appendages
projections
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FR9409389A
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French (fr)
Inventor
Daniel Felman
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CORMALINE SA
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CORMALINE SA
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    • 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
    • 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
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/4455Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • 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
    • 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
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442Intervertebral or spinal discs, e.g. resilient
    • 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
    • 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
    • A61F2/4611Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of spinal prostheses
    • 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
    • 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
    • A61F2/28Bones
    • A61F2002/2835Bone graft implants for filling a bony defect or an endoprosthesis cavity
    • 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
    • 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
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30003Material related properties of the prosthesis or of a coating on the prosthesis
    • A61F2002/3006Properties of materials and coating materials
    • A61F2002/30092Properties of materials and coating materials using shape memory or superelastic materials, e.g. nitinol
    • A61F2002/30093Properties of materials and coating materials using shape memory or superelastic materials, e.g. nitinol operated at only one temperature whilst inside or touching the human body, e.g. constrained in a non-operative shape during surgery, another temperature only occurring before the operation
    • 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
    • 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
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108Shapes
    • A61F2002/30199Three-dimensional shapes
    • A61F2002/30224Three-dimensional shapes cylindrical
    • 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
    • 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
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30579Special structural features of bone or joint prostheses not otherwise provided for with mechanically expandable devices, e.g. fixation devices
    • 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
    • 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
    • A61F2/30767Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes, grooves
    • A61F2002/30772Apertures or holes, e.g. of circular cross section
    • 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
    • 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
    • A61F2/30767Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes, grooves
    • A61F2002/30841Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes
    • 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
    • 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
    • A61F2002/4635Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor using minimally invasive surgery
    • 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
    • A61F2210/00Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0014Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol
    • A61F2210/0019Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol operated at only one temperature whilst inside or touching the human body, e.g. constrained in a non-operative shape during surgery, another temperature only occurring before the operation
    • 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
    • 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
    • A61F2230/0069Three-dimensional shapes cylindrical
    • 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

Abstract

The implant is dimensioned to fit between a pair of adjacent vertebrae, and has a composite cylindrical structure including a rigid external shell with a series of perforations through which retractable projections may extend. The projections are supported by a ring of shape-memory material which is ductile when refrigerated. The ring is initially cooled to allow insertion into the cylinder with the projections in a retracted position. When the ring is allowed to reach the temperature of the human body, it changes shape to allow the projections to extend through the perforations into the intervertebral space. The cylinder may be associated with one or more special surgical instruments designed to simplify its implantation.

Description

Le dispositif objet du présent brevet vise à arthrodéser deux vertèbree The object of the present patent system is designed to be fused two vertebrate

consécutives, en les fixant entre elles, au niveau des corps vertébraux, consecutive, fixing them to the vertebral body,

au moyen d'un implant expansif. by means of an expanding implant.

Lee indications d'arthrodèse de la colonne vertébraZe sont nombreuses, soit pour remédier à des instabilit4s d'origine traumwnatique ou dégénérative, soit pour redresser une colonne uert4braZe déviée par une scoliose ou une cyphose. Lee indications of arthrodesis of the vertébraZe column are many, either to remedy original instabilit4s traumwnatique or degenerative, or to straighten a deviated uert4braZe column by scoliosis or kyphosis. Le siège de choix de l'arthrodèse entre les vertébres se situe au niveau des corps vert4brauz qui représentent le centre de rotation des mouvemente The seat selection arthrodesis between the vertebrae is at the level of vert4brauz body representing the center of rotation of the eventful

o0 de la colonne vertébrale. o0 of the spine.

On a propos6 de fizer les corps vert4braux entre eux au moyen de vis, fixées dans les corps vert4braux et ré4unies entre elles par des tiges, dee plaques ou des cables, mais l'abord antérieur nécessaire pour la mise en place du matériel est extrémement délabrant pour la paroi abdominaZe ou thoracique et la tenue du matériel d'osté.osynthèse à l'intériesur des corps Was propos6 of fizer vert4braux the body between them by means of screws fixed in the body and vert4braux ré4unies together by rods, plates or dee cables, but the anterior approach necessary for the implementation of the hardware is extremely decaying for abdominaZe or chest wall and holding the material of the osté.osynthèse intériesur bodies

vertébraux, dans l 'os spongieux est aléatoire. vertebral, in the cancellous bone is random.

On. We. a propos4 ds mettre en place des implants, de forme diverses, cylindriques, coniques ou prismatiques dans Z 'espace intercorporéal, séparant deu= corps vertébrauz consécutifs et occupés, chez le sujet sain, par le has propos4 ds introduce implants of various shape, cylindrical, conical or prismatic in Z 'intercorporéal space separating deu = consecutive vertébrauz body and occupied, in healthy subjects, for the

disque intervertébral. intervertebral disc.

Ces implants posent deuz problmes: A) le choix de la voie d'abord: - soit antérieure avec tous les dangers de la traversée des plane superficiels et des viscères thoraciques ou abdominaux; These implants pose deuz problems: A) the choice of the way first - either earlier with all the dangers of crossing the superficial flat and thoracic and abdominal viscera;

- soit post4rieure avec- le danger de 1éser le système nerveux et Za dure- - either post4rieure with- 1éser the danger of the nervous system and Za dura

mère. mother. B) la stabilité du montage peut être réalisé: - soit par vis6aqe de l'implant dans ut orifice préalabZlement fraisé et taraudé, mais il s'agit ld de manoeuvres dangereuses à proximité du névraze en arrière et des viscères en avant, - soit en pZaçant l'implant entre les corps vertébraux préaZabZlement écartés par uo dispositif quelZconque, mais cette manoeuvre d'écartement obZige d B) the stability of the assembly can be carried out: - either by vis6aqe of the implant in ut préalabZlement milled and threaded hole, but it is ld dangerous maneuvers near the névraze back and the viscera in front, - or pZaçant the implant between the vertebral bodies separated by préaZabZlement uo quelZconque device, but this obZige spacer maneuver

agrandir encore Za voie d'abord. Za even larger way first.

rtL nous a donc paru judicieux de proposer un implant inter-corporéaZ- RTL therefore thought it wise to propose an inter-implant corporéaZ-

vertébral à expansion, permettant de restaurer un espace inter- vertébral vertebral expansion, to restore vertebral space inter-

normal et de fixer solidement deux corps vertébraux conseécutifs. normal and firmly secure two vertebral bodies conseécutifs.

Comme cet implant se présente sous forme rétractée Zors de la mise en place, il peut etre posé par tne voie d'abord réduite, de préférence par zme voie d'abord laparoscopiie, transpéritonéale, sous péritonéaZe ou As the implant is in the retracted Zors form of the establishment, it may be asked by tne way first reduced, preferably by way zme first laparoscopiie, transperitoneal, or under péritonéaZe

pleuroscopique. thoracoscopic.

lBAD ORIGINAL L'imptplant objet du préeent brevet est composite en ceZa que sa structure comprend une coque externe rigide, pouvant etre réalisée soit en métaZ, de préférence Ze titane, ou un autre matériel biocomnpatibZe, résistant et amagnetique et des parties internes destinées, en position activée, à faire S saillie dans des orifices de la coque, prévus à cet effet et plaçés lBAD ORIGINAL imptplant The object of the patent is préeent composite Ceza that its structure comprises a rigid outer shell which can be performed either in Metaz, Ze preferably titanium or another material biocomnpatibZe resistant and non-magnetic internal parts intended, in activated position S to protrude into openings of the shell, provided for this purpose and placed

perpendicuZairement à l 'axe de la coque. perpendicuZairement to the axis of the shell.

Les parties internes sont des appendices rétractiles destinés d faire 6saillie dans Z'espace inter-corporéal Zorsque l'implant est définitivemmnt The internal parts are retractable appendices intended to make 6saillie in Z'espace inter-corporeal Zorsque the implant is définitivemmnt

placé entre deux corps vertébraux. placed between two vertebral bodies.

Au conti-ire lors de ta mise en place de Z'implant, ils sont rétractés l2 'intérieur de la coque ce qui permet une mise en place faciZe et atraumatique. In conti-ire during your installation of Z'implant they are retracted l2 inside the hull which allows implementation faciZe and atraumatic. Le dispositif objet du présente brevet présente deux parties a décrire: A) La coque réalisée en titane ou en tout autre matériZel amagnétique et résistant, a la forme préférentielle d'un cylindre creux dont Ze diametre The object of the present patent device has two parts to describe: A) shell made of titanium or any other nonmagnetic matériZel and resistant, in the preferred form of a hollow cylinder whose diameter Ze

correspond à '4paiseeur du disque intervertébral que l'on désire appareiller. matches' 4paiseeur intervertebral disc which is desired sail.

Des longueurs progressives sont d prévoir suivant la taille des différentes vertbre--s cervicales, dorsales ou lonbaires et suivant la morphologie des Progressive lengths of providing according to the size of the different vertbre - s cervical, dorsal or lonbaires and following the morphology of

différents individus. different individuals.

Des longueurs de 1 cm d 3 cm environ sont prévues de 5 mm en 5 mn. Lengths of 1 cm 3 cm are provided 5mm 5 minutes.

Le diamètre du culindre doit correspondre exactement à Za hauteur d'un disque intervertébral normal à t'étage à inetrumenter et peut être caZlcuZé avec The culindre diameter must match exactly Za height of a normal intervertebral disc floor to you and can be inetrumenter with caZlcuZé

précision sur les radiographies pré-opératoires. accuracy of preoperative radiographs.

1l faut prévoir des diametres successifs s 'étendant approximativement de 1l is necessary to provide successive diameters extending approximately

5 à d15 mm. 5 to d15 mm.

l,'épaisseur du cylindre creux doit permettre une bonne résistance de Z'implont l, the thickness of the hollow cylinder should allow good resistance Z'implont

à la pression. with pressure.

Au moins quatre orifices perpendiculaires d tl'axe du cylindre sont prévu sur la coque, diaro'tralZement opposées deux par deux et située a proximités At least four ports tl'axe perpendicular to the cylinder are provided on the hull, diaro'tralZement two opposite pairs and located in vicinities

des deux extrémités du cylindre. both ends of the cylinder.

Chacun de ces orifices de forme quadranguZaire incurvée a une longueur caZlculée de manière d représenter un tiers de la circonférence du cyZindre et un8 largeur suffisante pour admettre le passage à frottement doux de 'appendice Each of these curved shape quadranguZaire caZlculée orifices has a length so as to represent one-third of the circumference of cyZindre un8 and width sufficient to admit the snug passage of Appendix

expansible ou aiZette une fois que ce dernier sera en position déployée. expandable or Alzette once the latter is in the deployed position.

Au deux extrémités du cylindre creux sont fixés: - une cone dont la base, fixée sur la base du cyZindre a la mdme circonférence que ce dernier et dont Z'extrémité émoussée est destindée à facilZiter la pénétration de 'impZant dans 1 'espace inter-vertébral, sans danger de At both ends of the hollow cylinder are attached: - a cone whose base, set on the basis of cyZindre has MDME circumference as the latter and which is blunt Z'extrémité destindée to facilZiter penetration 'impZant in 1' inter- space vertebral without danger

traumatisme sur les parties molles péri-vertébralZes. trauma to soft tissue peri-vertébralZes.

2 SAD ORIGINAL 2 SAD ORIGINAL

- ur. - ur. pas de vis est ménagé d Z 'autre extrémité du cylindre permettant Za fixation de l'impZant sur une tiae introductrice fiZetée, pour la mise en no screw is made of Z other end of the cylinder for fastening the Za impZant on a tiae introducer fiZetée, for carrying

place et la manipulation de l'impZant. up and handling the impZant.

- un repère est fixé sur la tige introductrice de manière à contrôler la rotation de l 'implant. - a marker is attached to the introducer rod so as to control the rotation of the implant. En effet, les orifices situés sur le cylindre doivent se situer, Zorsque Z 'implant est en place, en regard des plateaux vertébraux de manière d ce que, Zors de 'activation des ailettes distractrices et stabilisatrices, ces dernières viennent s'appliquer avec force contre les plateaux vertébraux Indeed, the holes in the cylinder shall be situated Zorsque Z implant is in place, facing the vertebral plates so as to that of Zors activation distractor and stabilizer fins, the latter are applied with force against the endplates

adjacents et fixer Zl'implant. adjacent and fix Zl'implant.

B) le6 parties rétractiles de Z'implant sont formées par quatre ailettes, ou appendices, disposées deux d deu-x sur Za circonférence d'un anneau de n"taZ B) LE6 retractile Z'implant portions are formed by four fins or protrusions arranged two to two on Za circumference of a ring n "TAZ

o mémoire de foime". o foime memory. "

Il faut rappeler que les "métaux à mémoire de forme", en principe des alliages de titane et d'autres métaux, présentent la caractéristique It should be remembered that the "shape memory metals", in principle, titanium alloys and other metals, have the characteristic

particulière d'tre maZlléables après refroidissement. particular of being maZlléables after cooling.

Ceci permet de leur donner une forme facilitant leur mise en place. This will give them a form facilitating their implementation.

Le matériau à mémoire de forme reprend sa géométrie initialement déterminée The shape memory material returns to its geometry initially determined

dès qu'il est d la température du corps humain. as soon as it is to the human body temperature.

Les ailettes ont une forme parallépipédique, prévue pour pouvoir couZiseer librement dans lee orifices de la coque cylindrique de manière àd faire saillie d'un à quelques millimètres en position -expansée et à se retirer compZétement The fins have a parallelepiped shape, provided to be freely couZiseer in lee openings of the cylindrical shell so as to protrude TBD of a few millimeters -expansée position and withdraw compZétement

dans le cylindre en position rétractée. in the cylinder in the retracted position.

Ces ailettes sont orientées perpendicuZairement à l'axe du cylindre. These fins are oriented perpendicuZairement to the cylinder axis.

Une gorge cylindrique incurvée déstinée à recevoir de manière rétentive un anneau de matériau à mémoire de forme est prévue eur la base axiale de chaque appendice. A curved cylindrical groove for receiving a manner retentive shape memory material ring is provided eur the axial base of each appendage.

Deu= anneaux de ce mat4riau eont prévus pour chaque implant. Deu = rings that mat4riau eont provided for each implant.

Les ailettes sont impZantées deux par deux, de manière diamétraZement opposée The fins are impZantées two by two, so diamétraZement opposite

sur chacun des anneaux. on each of the rings.

A Za température ordinaire du corps humain, Z'implant ee présente comme un cZulindre avec un ex-trémité conique et une extrémité fiZetée avec quatre ailZettes diamétralement opposées deux par deux et eituées esymétriquement par rapport au milZieu de l'axe du cylindre. A Za ordinary human body temperature, Z'implant ee present as a cZulindre with a conical end and a fiZetée end with four diametrically opposed pairs and ailZettes eituées esymétriquement milZieu relative to the axis of the cylinder. Ces ailettee font eaiZZie de These are eaiZZie of finned

un à queZques millimètres à la surface du cylindre. a queZques millimeters at the surface of the cylinder.

D'autre dispositions de ces ailettes peuvent être envisagées pour répondre On the other provisions of these fins may be envisaged to meet

à dee déformatione particuZières de la colonne vertébrale. to dee déformatione particuZières spine.

3 BAD ORIGINAL 3 BAD ORIGINAL

Aprss refroidissement de 'impZant, soit par congélation dans un appareiZ de refroidissement, soit par simpZle emploi d'une bombe cryogénique, Z'anneau de matériau à m4moire se rétracte, permettant ds faire rentrer Zes ailettes à Z'int4rieur du cylindre creux de manière à ce que t'implant présente une surface externe lisse pour Zl'introduction dans Z 'espace inter-vertébraZ. Aprss cooling 'impZant or by freezing in a cooling appareiZ or by use of a cryogenic simpZle bomb Z'anneau material m4moire retracts, allowing ds to return Zes finned Z'int4rieur of the hollow cylinder so that this implant you a smooth outer surface for Zl'introduction in Z 'inter-vertébraZ space. Une fois Z 'implant introduit sous sa forme cylindrique Zisse dans Z 'espace intervertébral, Z'anneau de matériau à mémoire reprend sa forme primitive en quelques minutes, sous l'effet de la température du corps hwumain et Zes aiZettes fixées symétriquement sur son pourtour, font issue par les orifices prévus à cet effet dans le cylindre et viennent s'appliquer avec force contre Once Z implant introduced in its cylindrical shape Zisse Z in the intervertebral space, memory material Z'anneau resumes its original shape in a few minutes under the effect of the temperature of the body and hwumain Zes aiZettes fixed symmetrically on its periphery , are end through the orifices provided for this purpose in the cylinder and are applied forcefully against

le plateau vertébral correspondant. the corresponding vertebral plate.

On obtient ainsi un écartement des deux vertébres adjacentes, restaurant Thus, a distance between the two adjacent vertebrae, restaurant

un espace intervertébral normal et une fixation soZide de t'implant. intervertebral space and normal soZide fixation you implant.

L'implant, sous sa forme refroidie, peut 4tre mis en place par une voie d'abord minime, par laparoscopie, ou par thoracoscopie, ou par abord rétropz4ritonéat. The implant, in its chilled form, can 4tre set up by minimal surgical approach, laparoscopic, or thoracoscopic, or first rétropz4ritonéat. L'implant peut présenter, outre les quatres orifices destinés à la saiZlie des appendices rétractiZes, d'autres orifices destinées d rempZir te cyZindre The implant may present, in addition to the four ports for the saiZlie rétractiZes of appendages of other orifices for rempZir cyZindre you

creux avec des greffons osseux pour obtenir une arthrodèse intervertébraZe. hollow with bone grafts for arthrodesis intervertébraZe.

Le procédé de mise en pZace est le suivant: - Le disque intervertébral est abordé par la voie d'abord choisi par The setting pZace method is as follows: - The intervertebral disc is addressed by the channel initially selected by

Z'op4rateur, de préférence sous contrôle radioZogique extemporand. Z'op4rateur, preferably under control radioZogique extemporand.

- Le disque intervertébral est excisé au moyen de pinces, de curettes, d'appareils rotatifs, d'aspirateurs, Z'espace ainsi créé est nettoyé de tous fragments libres qui pourraient faire issue dans e canalZ vertébral Iors - The intervertebral disc is excised using forceps, curettes, rotary machines, vacuum cleaners, Z'espace created is cleaned of all free fragments that could result in an CanalZ vertebral IORS

de Zl'introduction de l'implant. Zl'introduction of the implant.

- la hauteur de Z'espace intervertébral est mesurée au moyen de gabarits - the height of the intervertebral Z'espace is measured by means of jigs

de diaintres successifs. successive diaintres.

- Au cours de ces manoeuvres, les plateaux vertébraux ne doivent pae Otre lsées car iZs représentent la partie résistante du corps vertébraZ sur laquelle - During these maneuvers, the endplates must pae Otre LSees because izs represent the strongest part of the body on which vertébraZ

viendront s'appuyer les appendices expansibles. will build expandable appendages.

- Le diamètre de l'implant est choisi semblable au diametre du plus gros - The diameter of the implant is chosen similar to the larger diameter

gabarit pouvant être introduit à frottement doux. template can be inserted with gentle friction.

- La Zongueur ds l'impltant a été calculé en fonction de la taiZZle du corpe - The Zongueur impltant ds was calculated according to the taiZZle of Corpe

vertébral sur les clichés pré-opératoires. vertebral on preoperative images.

- L'implant choisi, préalablement refroidi, est introduit. - The implant selected, previously cooled, is introduced. Sa position est Its position is

contrôlée radiologiquement. controlled radiographically.

àAD ORIGiNAL - g'anneau de matériau à mémoire reprend sa forme primitive, sous Z'effet de Za chaleur du corps humain et Zes aiZettes r4tractiZes font eaiZllie a Aad original - g'anneau memory material returns to its original form under Z'effet Za body heat and Zes aiZettes r4tractiZes are eaiZllie has

la surface de Z'impZant. surface Z'impZant.

- L 'importance de la distraction peut stre choisie en faisant uarier ta taillZZe des aiZettes et lee caractérietiques mécaniques de Z'anneau de matériau à mémoire. - The importance of distraction can stre chosen by uarier your taillZZe of aiZettes and lee caractérietiques mechanical memory material of Z'anneau. - Si Z 'op4rateur souhaite réaliser une arthrodèse compZlémentaire, iZ convient de rempZir, par Zes orifices prévus à cet effet, Ze cytindre creux d l'aide - If Z 'op4rateur would perform arthrodesis compZlémentaire, iZ be rempZir by Zes orifices provided for this purpose, Ze cytindre hollow of using

de greffons d'os epongieux prélevés sur la crète iZiaque du patient. bone grafts taken from the crest epongieux iZiaque patient.

- Suiuant le pZan pré-opératoire u. - Suiuant the pZan preoperative u. ou plusieurs impZante peuvent étre mie or more can be impZante crumb

en place. in place.

BAD ORIGiNAL BAD oRIGINAL

Claims (4)

    REVENDúCATTONS REVENDúCATTONS
  1. 1) ImpZant destiné à étre placé entre Zes corps vertébraux de deux vertébres adjacentes et caractéris6 par une structure composite comnportant une coque rigide externe perforée d'orifices et des appendices rétractiles internes destinés à faire saillZZie dans Z'espace intervertébral lorequ'ils sont ezpansé6. 1) ImpZant intended to be placed between Zes vertebral bodies of two adjacent vertebrae and caractéris6 by a composite structure comnportant a rigid perforated outer shell of orifices and internal retractable appendices intended to saillZZie in Z'espace intervertebral lorequ'ils are ezpansé6.
  2. 2) Dispositif selon Za revendication 1, caractérisé en ce que tee appendices rétractiZes sont disposés sur un anneau de matériau à mémoire, ayant la propriété de devenir ductiZle Zorsqu'iZ est refroidi, permettant de rentrer Zes appendices à Z 'intérieur du cylindre en poeition d'introwduction et de reprendre sa forme et ses qualités mécaniquee Zorsqu'il est d la température du corps uhwain, provoquant ainsi la saillZZie des appendices dans 2) Device according Za claim 1, characterized in that tee rétractiZes appendages are arranged on a ring memory material having the property of becoming ductiZle Zorsqu'iZ is cooled, to return Zes appendages Z within the cylinder poeition of introwduction and resume its shape and qualities Mechanical, Zorsqu'il is to the temperature of uhwain body, thus causing the appendages in saillZZie
    Z 'espace intervertébraZ. Z space intervertébraZ.
  3. 3) Dispositif selon Zes revendications 1 et 2 combinant une coque externe 3) Device according to claims 1 and 2 Zes combining an outer shell
    rigide, de quelques forme et matériau qu'eZZe soit et une ou des parties rigid, some form and qu'eZZe material is and one or more parts
    internes exzpansibles sous Z'action d'un matériau à mémoire de forme. internal exzpansibles under Z'action of a shape memory material.
  4. 4) Dispositifs suivant les revendications 1, 2 et 3 permettant de mettre 4) Devices according to Claims 1, 2 and 3 for carrying
    en place chirurgicaZement Z'implant, teZs que gabarits, tubes introducteurs, up chirurgicaZement Z'implant, teZs as jigs, introducer tubes,
    tiges d'introduction et d'orientation de Z 'implant. insertion rods and Z orientation of the implant.
    BAD ORmGièL ADB ORmGièL
FR9409389A 1994-07-25 1994-07-25 Expansible arthrodesis implant for insertion between vertebrae Withdrawn FR2722679A1 (en)

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WO1998055051A1 (en) * 1995-12-05 1998-12-10 Metagen, Llc Modular prosthesis
WO2000044319A1 (en) * 1999-01-27 2000-08-03 Disc-O-Tech Medical Technologies, Ltd. Expandable intervertebral spacer
US8066713B2 (en) 2003-03-31 2011-11-29 Depuy Spine, Inc. Remotely-activated vertebroplasty injection device
US8360629B2 (en) 2005-11-22 2013-01-29 Depuy Spine, Inc. Mixing apparatus having central and planetary mixing elements
US8361078B2 (en) 2003-06-17 2013-01-29 Depuy Spine, Inc. Methods, materials and apparatus for treating bone and other tissue
US8415407B2 (en) 2004-03-21 2013-04-09 Depuy Spine, Inc. Methods, materials, and apparatus for treating bone and other tissue
US8556949B2 (en) 2007-11-14 2013-10-15 DePuy Synthes Products, LLC Hybrid bone fixation element and methods of using the same
US8950929B2 (en) 2006-10-19 2015-02-10 DePuy Synthes Products, LLC Fluid delivery system
US8992541B2 (en) 2003-03-14 2015-03-31 DePuy Synthes Products, LLC Hydraulic device for the injection of bone cement in percutaneous vertebroplasty
US9155578B2 (en) 2012-02-28 2015-10-13 DePuy Synthes Products, Inc. Expandable fastener
US9381024B2 (en) 2005-07-31 2016-07-05 DePuy Synthes Products, Inc. Marked tools
US9642932B2 (en) 2006-09-14 2017-05-09 DePuy Synthes Products, Inc. Bone cement and methods of use thereof
US9693876B1 (en) 2012-03-30 2017-07-04 Ali H. MESIWALA Spinal fusion implant and related methods
US9918767B2 (en) 2005-08-01 2018-03-20 DePuy Synthes Products, Inc. Temperature control system
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WO1998055051A1 (en) * 1995-12-05 1998-12-10 Metagen, Llc Modular prosthesis
US5858020A (en) * 1995-12-05 1999-01-12 Metagen, Llc Modular prosthesis
WO1998017207A1 (en) * 1996-10-21 1998-04-30 Synthes Ag Chur Surgical prosthetic device
US6019793A (en) * 1996-10-21 2000-02-01 Synthes Surgical prosthetic device
WO2000044319A1 (en) * 1999-01-27 2000-08-03 Disc-O-Tech Medical Technologies, Ltd. Expandable intervertebral spacer
EP1552797A2 (en) * 1999-01-27 2005-07-13 Disc-O-Tech Medical Technologies, Ltd. Expandable intervertebral spacer
US7097648B1 (en) 1999-01-27 2006-08-29 Disc-O-Tech Medical Technologies Ltd. Expandable element delivery system
EP1552797A3 (en) * 1999-01-27 2007-02-07 Disc-O-Tech Medical Technologies, Ltd. Expandable intervertebral spacer
US8728160B2 (en) 1999-01-27 2014-05-20 Warsaw Orthopedic, Inc. Expandable intervertebral spacer
US9186194B2 (en) 2003-03-14 2015-11-17 DePuy Synthes Products, Inc. Hydraulic device for the injection of bone cement in percutaneous vertebroplasty
US8992541B2 (en) 2003-03-14 2015-03-31 DePuy Synthes Products, LLC Hydraulic device for the injection of bone cement in percutaneous vertebroplasty
US8333773B2 (en) 2003-03-31 2012-12-18 Depuy Spine, Inc. Remotely-activated vertebroplasty injection device
US8066713B2 (en) 2003-03-31 2011-11-29 Depuy Spine, Inc. Remotely-activated vertebroplasty injection device
US9839460B2 (en) 2003-03-31 2017-12-12 DePuy Synthes Products, Inc. Remotely-activated vertebroplasty injection device
US10039585B2 (en) 2003-06-17 2018-08-07 DePuy Synthes Products, Inc. Methods, materials and apparatus for treating bone and other tissue
US8540722B2 (en) 2003-06-17 2013-09-24 DePuy Synthes Products, LLC Methods, materials and apparatus for treating bone and other tissue
US8361078B2 (en) 2003-06-17 2013-01-29 Depuy Spine, Inc. Methods, materials and apparatus for treating bone and other tissue
US8956368B2 (en) 2003-06-17 2015-02-17 DePuy Synthes Products, LLC Methods, materials and apparatus for treating bone and other tissue
US9504508B2 (en) 2003-06-17 2016-11-29 DePuy Synthes Products, Inc. Methods, materials and apparatus for treating bone and other tissue
US9750840B2 (en) 2004-03-21 2017-09-05 DePuy Synthes Products, Inc. Methods, materials and apparatus for treating bone and other tissue
US8415407B2 (en) 2004-03-21 2013-04-09 Depuy Spine, Inc. Methods, materials, and apparatus for treating bone and other tissue
US8809418B2 (en) 2004-03-21 2014-08-19 DePuy Synthes Products, LLC Methods, materials and apparatus for treating bone and other tissue
US9381024B2 (en) 2005-07-31 2016-07-05 DePuy Synthes Products, Inc. Marked tools
US9918767B2 (en) 2005-08-01 2018-03-20 DePuy Synthes Products, Inc. Temperature control system
US9259696B2 (en) 2005-11-22 2016-02-16 DePuy Synthes Products, Inc. Mixing apparatus having central and planetary mixing elements
US8360629B2 (en) 2005-11-22 2013-01-29 Depuy Spine, Inc. Mixing apparatus having central and planetary mixing elements
US9642932B2 (en) 2006-09-14 2017-05-09 DePuy Synthes Products, Inc. Bone cement and methods of use thereof
US8950929B2 (en) 2006-10-19 2015-02-10 DePuy Synthes Products, LLC Fluid delivery system
US8556949B2 (en) 2007-11-14 2013-10-15 DePuy Synthes Products, LLC Hybrid bone fixation element and methods of using the same
US9510877B2 (en) 2007-11-14 2016-12-06 DePuy Synthes Products, Inc. Hybrid bone fixation element and methods of using the same
US9155578B2 (en) 2012-02-28 2015-10-13 DePuy Synthes Products, Inc. Expandable fastener
US9693876B1 (en) 2012-03-30 2017-07-04 Ali H. MESIWALA Spinal fusion implant and related methods
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