FR2727003A1 - Lumbar-sacral vertebrae anterior stabiliser - Google Patents

Lumbar-sacral vertebrae anterior stabiliser Download PDF

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Publication number
FR2727003A1
FR2727003A1 FR9414067A FR9414067A FR2727003A1 FR 2727003 A1 FR2727003 A1 FR 2727003A1 FR 9414067 A FR9414067 A FR 9414067A FR 9414067 A FR9414067 A FR 9414067A FR 2727003 A1 FR2727003 A1 FR 2727003A1
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France
Prior art keywords
element
characterized
anterior
device according
lumbar
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Granted
Application number
FR9414067A
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French (fr)
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FR2727003B1 (en
Inventor
Philippe Tisserand
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Euros SA
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EUROS SA
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Publication of FR2727003B1 publication Critical patent/FR2727003B1/en
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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
    • A61F2/442Intervertebral 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
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    • 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
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86Threaded wires, pins or screws; Nuts therefor
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    • A61F2002/30782Apertures or holes, e.g. of circular cross section inclined obliquely
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    • A61F2310/00023Titanium or titanium-based alloys, e.g. Ti-Ni alloys

Abstract

The stabiliser consists of an insert designed to fit between two vertebrae (L1,L2) to maintain the spacing between them and receive spongy grafts, permitting their intersomatic fusion. The insert has holes (1g,1h) for fixings (2,3) which engage with the adjacent vertebrae and are angled at 90 deg to one another. The inset is three-dimensional and hollow, generally rectangular and shaped to conform to the anatomy of the adjacent vertebrae. It has a concave posterior surface (1c) and a rounded anterior surface (1d), with the anterior surface having a greater height than the posterior one to conform to the lumbar-sacral lordosis. Its upper and lower surfaces are grooved to ensure primary stability. The insert can be made from titanium or a polymer reinforced with carbon fibres.

Description

DlsltIf de stabilisation antérieure du rachis hmboe Mn anterior stabilization of the spine DlsltIf hmboe Mn
L'invention se rattache au secteur technique des implants rachidiens. The invention relates to the technical sector of spinal implants.

Le problème que se propose de résoudre rinvention, est de stabiliser les vertèbres lombaires et la charnière lombo-sacr8e, par voie antérieure. The problem is to solve rinvention, is to stabilize the lumbar and lumbosacral sacr8e hinge, anterior approach.

Pour assurer une telle stabilisation, il est connu crutiliser des implants sous forme de plateaux, destinés à être inserrés entre les corps vertébraux. To provide such stabilization, it is known crutiliser implants in the form of trays, to be inserrés between the vertebral bodies. Le plateau n'est pas fixé mais est simplement impacté entre les deux corps vertébraux. The tray is not fixed but is simply impacted between two vertebral bodies. Le plateau peut être conformé pour recevoir un greffon. The tray can be configured to receive a graft. Cette solution n'est cependant pas satisfaisante, étant donné qu'il peut y avoir des risques d'expulsion du greffon, en cas d'instabilité et de déplacement du plateau, qui n'est pas fixé. This solution is not satisfactory, as there may be risk of graft expulsion, in cases of instability and plate movement, which is not fixed.

L'invention s'est fixée pour but de remédier à ces inconvénients, de manière simple, sûre, efficace et rationnelle. The invention is set to remedy these drawbacks in a simple, safe, effective and rational.

Le problème que se propose de résoudre l'invention, est d'apporter une stabilité des vertèbres lombaires concernées, au moyen d'un ensemble prothétique, en évitant tout risque d'expulsion de cet ensemble prothétique, et en tenant compte du fait qu'au niveau lombaire, il peut y avoir des risques vasculaires, étant donné que les vertèbres sont relativement proches des vaisseaux. The problem to be solved by the invention is to provide stability of the lumbar vertebrae concerned, by means of a prosthetic assembly, avoiding any risk of expulsion of the prosthetic assembly, taking into account the fact that lumbar, there may be vascular risk, since the vertebrae are relatively close vessels.

Pour résoudre un tel problème, il a été conçu et mis au point un dispositif de stabilisation antérieure du rachis lombo-sacré, qui comprend un élément apte à maintenir l'écartement entre les corps vertébraux du rachis lombaire tout en étant agencé pour recevoir des greffons spongieux et permettre leur fusion intersomatique, ledit élément présentant des trous orientés pour le passage et l'intégration d'organes de fixation coopérant avec les corps vertébraux sus et sous jacents. To solve such a problem, it has been designed and developed an anterior stabilization device of the lumbosacral spine, which comprises a member adapted to maintain the spacing between the vertebral bodies of the lumbar spine while being arranged to receive the grafts spongy and allow them interbody fusion, said element having aligned holes for the passage and the incorporation of fastening members cooperating with the vertebral bodies above and underlying.

Pour résoudre le problème posé d'intégrer les organes de fixation et pour permettre auxdits organes d'être implantés dans l'os corffoo spongieux des corps vertébraux, les trous constituent des chambrais internes formés à partir de la face antérieure de l'élément, I'un des chambrages étant dirigés vers le bas tandis que rautre est dirigé vers le haut, en étant orienté l'un par rapport à l'autre, selon un angle d'environ 90". To resolve the problem of integrating the fixing members and to allow said members to be implanted in the cancellous bone of the vertebral bodies corffoo, holes are internal chambrais formed from the front face of the element, I one of chamberings being directed downwardly while Rother is directed upwards, being oriented with respect to each other, at an angle of about 90 ".

Pour résoudre le problème posé d'éviter l'écrasement, tout en ayant pour objectif de permettre la fusion intersomatique des greffons, To solve the problem of avoiding the crash, while aiming to allow interbody fusion graft,
I'élément est constitué par une structure volumétrique creuse de forme générale rectangulaire profilée pour correspondre à l'anatomie des corps vertébraux concernés. I'élément is constituted by a hollow profiled volumetric structure of generally rectangular shape to match the anatomy of the vertebral bodies involved. L'élément présente un bord postérieur concave en arrière et un bord antérieur arrondi pour épouser la face antérieure du corps vertébral. The element has a concave trailing edge back and a rounded leading edge to conform to the anterior surface of the vertebral body.

Pour résoudre le problème posé de respecter la lordose lombo-sacrée, la hauteur de la face antérieure est supérieure à la hauteur de la face postérieure pour respecter la lordose lombo-sacrée. To solve the problem to respect the lumbosacral lordosis, the anterior height is greater than the height of the posterior surface to meet the lumbosacral lordosis.

Les faces supérieure et inférieure de rélément sont crantées pour faciliter la stabilité primaire. The upper and lower faces of Relement are notched to facilitate primary stability.

L'invention est exposée, ci-après plus en détail à l'aide des dessins annexés, dans lesquels: The invention is explained below in more detail in the accompanying drawings, wherein:
La figure 1 est une vue en perspective du dispositif selon Figure 1 is a perspective view of the device according
I'invention. The invention.

La figure 2 est une we en plan du dispositif. Figure 2 is a plan view of the device we.

La figure 3 est une vue en coupe montrant la fixation du dispositif entre deux plateaux des vertèbres lombaires. Figure 3 is a sectional view showing the attachment of the device between two plates of lumbar vertebrae.

Comme le montre la figure 1, le dispositif comprend un élément (1) apte à maintenir l'écartement entre deux corps vertébraux (lui) et (L2) de la partie lombaire du rachis, y compris de la charnière lombosacrée. As shown in Figure 1, the device comprises an element (1) adapted to maintain the spacing between two vertebral bodies (it) and (L2) of the lumbar portion of the spine, including the lumbosacral junction. Cet élément (1) est agencé pour recevoir des greffons spongieux (G) et permettre leur fusion intersomatique. This element (1) is arranged to receive spongy grafts (G) and allow their intersomatic fusion. Les greffons sont avantageusement prélevés sur la crête iliaque ou dans l'extrémité supérieure du tibia The grafts are preferably harvested from the iliac crest or in the upper end of tibia
L'élément (1) est constitué par une structure volumétrique creuse de forme générale rectangulaire profilée, pour correspondre à l'anatomie des corps vertébraux (L1) (L2). The element (1) is constituted by a hollow profiled volumetric structure generally rectangular to match the anatomy of the vertebral bodies (L1) (L2). Notamment, l'élément (1) présente un bord postérieur (1c) concave en arrière et un bord antérieur arrondi (nid). In particular, the element (1) has a rear edge (1c) concave back and a rounded front edge (nest). La hauteur de la face antérieure est supérieure à la hauteur de la face postérieure. The height of the front face is greater than the height of the posterior surface.

En outre, I'élément (1) présente deux ouvertures débouchantes et séparées (1a) (il), recevant chacune les greffons spongieux. In addition, I'élément (1) has two lead-through and separate openings (1a) (ii), each receiving the cancellous grafts. On n'exclut pas de pratiquer dans l'épaisseur de l'élément (1), une seule ouverture débouchante, ou plus de deux ouvertures. We do not exclude in practice the thickness of the element (1), only one through opening, or more than two openings.

Suivant une caractéristique importante de l'invention, According to an important feature of the invention,
I'élément (1) présente des trous orientés (lg) (1h), pour le passage et l'intégration d'organes de fixation (2) et (3), coopérant avec les corps vertébraux (L1) et (L2) sus et sous jacents audit élément (1). I'élément (1) comprises oriented holes (lg) (1h) for the passage and integration of fasteners (2) and (3) cooperating with the vertebral body (L1) and (L2) plus and said underlying member (1). Comme le montre notamment la figure 3, les trous (lg) et (1h) constituent des chambrages internes établis à partir de la face antérieure (nid), à proximité des bords transversaux de l'élément (1). As shown in particular in Figure 3, the holes (lg) and (1h) are internal chamberings established from the anterior face (nest), near the transverse edges of the element (1). Le chambrage (lg) est orienté vers le haut, tandis que le chambrage (1h) est orienté vers le bas. The recess (lg) is oriented upwards, while the recess (1h) is oriented downwards. Les deux chambrages (lg) et (1h) sont décalés angulairement d'environ 90". Both chamberings (lg) and (1h) are offset angularly by about 90 ".

En conséquence, après introduction des vis (2) et (3), rune d'entre elles (2) sera dirigée vers le bas, tandis que l'autre (3) sera dirigée vers le haut. Accordingly, after introduction of the screw (2) and (3), rune of them (2) is directed downwardly, while the other (3) will be directed upwards. A noter que ces vis sont orientées d'un angle de très sensiblement 45 , pour s'implanter dans l'os coraco-spongieux. Note that these screws are oriented at an angle of significantly 45 for implanting in the coracohumeral cancellous bone. des corps vertébraux (L1) (L2). of the vertebral body (L1) (L2).

Les têtes (2a) et (3a) des vis (2) et (3) sont noyées dans le chambrage1 en appui dans le fond de ce dernier, et ne débordent pas de la face antXrieure (1d). The heads (2a) and (3a) of the screw (2) and (3) are embedded in the chambrage1 supported in the bottom of the latter, and do not exceed the antXrieure face (1d).

Les faces supérieure (1i) et inférieure (1j) sont crantées pour faciliter la stabilité primaire. The upper faces (1i) and lower (1j) are notched to facilitate primary stability. L'élément (1) est exécuté en titane ou polymère renforcé de fibre de carbonne. The element (1) is executed in titanium or polymer reinforced carbon fiber.

A noter que l'élément (1) est réalisé selon essentiellement trois tailles, à savoir: Note that the element (1) is formed on substantially three sizes, namely:
- une petite taille correspondant à une largeur de rordre de 20mm et à une longueur de l'ordre de 30mm, - a small size corresponding to a width of rordre 20mm and a length of about 30mm,
- une taille moyenne correspondant à une largeur de l'ordre de 25mm et à une bngueur de l'ordre de 35mm, - an average particle size corresponding to a 25 mm width and about a bngueur of the order of 35mm,
- une grande taille correspondant à une largeur de l'ordre de 30mm et à une longueur de rordre de 40mm. - a large size corresponding to a width of the order of 30mm and a length of 40mm rordre.

A noter également que ron distingue deux types d'éléments (1), selon qu'il concerne l'étage lombo-sacré L5-S1 ou les étages supérieures. Also note that ron two types of elements (1), as regards the lumbosacral floor L5-S1 or upper floors. A l'étage lombo-sacré, on utilise un élément dont robliquité est plus accentuée1 c'est-à-dire dont la hauteur de la face antérieure est nettement supérieure à celle de la face postérieure. At the lumbosacral floor is used an element which is more accentuée1 robliquité that is to say whose the front height is clearly greater than that of the posterior surface.

Trois types d'implants sont disponibles pour l'étage LiS1, dont les hauteurs antérieures sont respectivement de îOmm, 12mm et 14mm, tandis que les hauteurs postérieures 8mm, 10mm et 12mm. Three types of implants are available for Lis1 floor, whose previous heights are respectively îOmm, 12mm and 14mm, while the rear heights 8mm, 10mm and 12mm. Pour les étages supérieurs L4, L5 et suivants, les hauteurs antérieure sont respectivement de 9mm, 11mm et 13mm, tandis que les hauteurs postérieures sont de 8mm, îOmm et 12mm. For higher floors L4, L5 and following the earlier heights are respectively 9mm, 11mm and 13mm, while the rear heights are 8mm, 12mm and îOmm.

On indique ci-après, le mode opératoire de mise en place du dispositif selon l'invention. hereinafter it is indicated, the procedure of setting up the device according to the invention.

Après ablation du disque intervertébral réalisée par une vo(e antérieure, la distraction vertébrale permet de récupérer la hauteur intervertébrale souhaitée. Cette distraction peut être réalisée par une traction appliquée sur le crane et est permise par la résection la plus large possible de tout le tissu discal jusqu'au niveau du ligament vertébral postérieur qui peut être également réséqué. Un distracteur intersomatique peut compléter l'espacement intervertébral, la hauteur de l'élément (1) étant calculée d'après des fantômes et après essai de la bonne taille de l'élément. L'élément (1) est rempli de greffons spongieux et est disposé dans l'espace intervertébral considéré (L1) (L2) par exemple.L'élément (1) est ensuite solidarisé aux vertèbres sus et sous jacentes au moyen des vis (2) et (3), qui coopèrent dans l'os cortico-spongieux des corps vertébraux. After removal of the intervertebral disc conducted by a vo (anterior e, spinal distraction to retrieve intervertebral height desired. This distraction can be achieved by traction applied to the skull and is permitted by the wider resection can all tissue disc to the posterior longitudinal ligament may be resected. An interbody distractor can complete intervertebral spacing, the height of the element (1) being calculated from ghosts and after the test of the correct size of element. the element (1) is filled with cancellous bone and is disposed in the intervertebral space considered (L1) (L2) by exemple.L'élément (1) is then secured to the overlying and underlying vertebrae by means of screws (2) and (3), which cooperate in the cortico-cancellous bone of the vertebral bodies.

Un contrôle radioscopique per-opératoire est nécessaire pour s'assurer de la bonne position du dispositif. Intraoperative fluoroscopic control is necessary to ensure the correct position of the device.

Ce dispositif est particulièrement bien adapté pour stabiliser un segment mobile du rachis lombaire ou lombosacré et s'adresse essentillement sot à la charnière lombosacrée sot aux vertèbres sus jacentes, notamment au niveau des espaces LOL4 et L4-L5. This device is particularly well suited to stabilize a motion segment of the lumbar or lumbosacral spine and addresses essentillement fool to fool lumbosacral junction with underlying vertebrae above, particularly at LOL4 and L4-L5 space.

Les avantages ressortent bien de la description, en particulier on souligne et on rappelle que l'emploi des vis d'ostéosynthèse permet une stabilisation primaire, et permet d'éviter toute mobilisation des greffons spongieux, pendant le délai nécessaire à la repousse osseuse. The advantages are apparent from the description, in particular, emphasized and recalled that the use of bone screws allows primary stabilization, and avoids any mobilization of cancellous grafts during the period necessary for bone regrowth.

Claims (3)

    REVENDICATIONS
  1. -1- Dispositif de stabilisation antérieure du rachis lombosacrX, carArisX en ce qu'il comprend un élément (1) apte à maintenir récartement entre les corps vertébraux (L1) (L2) du rachis lombaire tout en étant agencé pour recevoir des greffons spongieux et permettre leur fusion intersomatique, ledit élément (1) présentant des trous orientés (1g) (1h) pour le passage d'organes de fixation (2) et (3) coopérant avec les corps vertébraux sus et sous jacents. -1- A anterior stabilization of the spine lombosacrX, carArisX in that it comprises an element (1) adapted to maintain récartement between the vertebral bodies (L1) (L2) of the lumbar spine while being arranged to receive spongy grafts and enable them interbody fusion, said element (1) having aligned holes (1g) (1h) for the passage of fasteners (2) and (3) cooperating with the vertebral bodies above and underlying.
  2. -2-Dispositif selon la revendication 1, caractérisé en ce que les trous (1g) (1h) constituent des chambrages intemes formés à partir de la face antérieure (nid) de l'élément (1), I'un des chambrages étant dirigé vers le bas tandis que l'autre est dirigé vers le haut, en étant orientés run par rapport à l'autre, selon un angle d'environ 90". -2-device according to claim 1, characterized in that the holes (1g) (1h) are intemal chamberings formed from the front face (nest) of the element (1) being directed I'un of chamberings downward while the other is directed upwards, being oriented run relative to each other, at an angle of about 90 ".
  3. -3- Dispositif selon la revendication 1, caractérisé en ce que rélément (1) est constitué par une structure volumétrique creuse de forme générale rectangulaire profilée pour correspondre à l'anatomie des corps vertébraux concemés. -3- The apparatus of Claim 1, characterized in that Relement (1) consists of a hollow volumetric structure of generally rectangular contoured to match the anatomy of the vertebral body concemed.
    + Dispositif selon la revendication 1, caractérisé en ce que l'élément présente un bord postérieur (tic) concave en arrière et un bord antérieur arrondi (Id) pour épouser la face antérieure du corps vertébral. + Device according to Claim 1, characterized in that the element has a rear edge (tic) concave back and a rounded front edge (Id) to conform to the anterior surface of the vertebral body.
    -5- Dispositif selon la revendication 1, caractérisé en ce que la hauteur de la face antérieure (Id) est supérieure à la hauteur de la face postérieure (lc) pour respecter la lordose lombosacrée. 5. Device according to claim 1, characterized in that the anterior face height (Id) is greater than the height of the posterior surface (lc) to meet the lumbosacral lordosis.
    -S Dispositif selon la revendication 1, caractérisé en ce que les faces supérieure (lui) et inférieure (1j) de l'élément (1) sont crantées pour faciliter la stabilité primaire. -S device according to claim 1, characterized in that the upper faces (him) and bottom (1d) of the element (1) is notched to facilitate the primary stability.
    -7- Dispositif selon la revendication 1, caractérisé en ce que I'élément (1) présente deux ouvertures débouchantes sépares (la) (lb) pour recevoir les greffons spongieux. -7 Apparatus according to claim 1, characterized in that I'élément (1) has two through openings SEPARATE (la) (lb) for receiving the cancellous grafts.
    -8- Dispositif selon la revendication 1, caractérisé en ce que l'élément (1) est réalisé en titane ou en polymère renforcé en fibres de carbone. -8 Apparatus according to claim 1, characterized in that the element (1) is made of titanium or polymer reinforced by carbon fibers.
FR9414067A 1994-11-18 1994-11-18 A stabilization of the anterior lumbosacral spine Expired - Fee Related FR2727003B1 (en)

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