FR2801782A1 - Intervertebral stabiliser comprises implant between adjacent vertebrae and movement damper to rear of spine - Google Patents

Intervertebral stabiliser comprises implant between adjacent vertebrae and movement damper to rear of spine Download PDF

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Publication number
FR2801782A1
FR2801782A1 FR9915160A FR9915160A FR2801782A1 FR 2801782 A1 FR2801782 A1 FR 2801782A1 FR 9915160 A FR9915160 A FR 9915160A FR 9915160 A FR9915160 A FR 9915160A FR 2801782 A1 FR2801782 A1 FR 2801782A1
Authority
FR
France
Prior art keywords
sep
implant
intervertebral
extra
vertebral
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
FR9915160A
Other languages
French (fr)
Other versions
FR2801782B3 (en
Inventor
Henry Graf
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.)
Individual
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority to FR9915160A priority Critical patent/FR2801782B3/en
Application filed by Individual filed Critical Individual
Priority to DE60030313T priority patent/DE60030313T2/en
Priority to EP00985390A priority patent/EP1233711B1/en
Priority to AU21824/01A priority patent/AU778410B2/en
Priority to AT00985390T priority patent/ATE336952T1/en
Priority to US10/148,693 priority patent/US7291150B2/en
Priority to JP2001541414A priority patent/JP4294901B2/en
Priority to CA002392868A priority patent/CA2392868C/en
Priority to PCT/FR2000/003368 priority patent/WO2001039678A1/en
Priority to ES00985390T priority patent/ES2270888T3/en
Publication of FR2801782A1 publication Critical patent/FR2801782A1/en
Application granted granted Critical
Publication of FR2801782B3 publication Critical patent/FR2801782B3/en
Anticipated expiration legal-status Critical
Priority to US11/982,761 priority patent/US8172880B2/en
Expired - Fee Related legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—Filters 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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442—Intervertebral or spinal discs, e.g. resilient
    • A61F2/4425—Intervertebral or spinal discs, e.g. resilient made of articulated components
    • A—HUMAN NECESSITIES
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7004—Longitudinal elements, e.g. rods with a cross-section which varies along its length
    • A61B17/7005—Parts of the longitudinal elements, e.g. their ends, being specially adapted to fit in the screw or hook heads
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    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
    • A61B17/7031—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other made wholly or partly of flexible material
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    • A61F2/4405—Joints for the spine, e.g. vertebrae, spinal discs for apophyseal or facet joints, i.e. between adjacent spinous or transverse processes
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    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
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    • A—HUMAN NECESSITIES
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    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7049—Connectors, not bearing on the vertebrae, for linking longitudinal elements together
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters 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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    • A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—Filters 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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30621—Features concerning the anatomical functioning or articulation of the prosthetic joint
    • A61F2002/30639—Features concerning the anatomical functioning or articulation of the prosthetic joint having rolling elements between both articulating surfaces
    • A61F2002/30642—Features concerning the anatomical functioning or articulation of the prosthetic joint having rolling elements between both articulating surfaces having a single rolling (or sliding) ball articulating between two cups
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—Filters 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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442—Intervertebral or spinal discs, e.g. resilient
    • A61F2/4425—Intervertebral or spinal discs, e.g. resilient made of articulated components
    • A61F2002/443—Intervertebral or spinal discs, e.g. resilient made of articulated components having two transversal endplates and at least one intermediate component
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—Filters 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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442—Intervertebral or spinal discs, e.g. resilient
    • A61F2002/444—Intervertebral or spinal discs, e.g. resilient for replacing the nucleus pulposus
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/005—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using adhesives
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0065—Three-dimensional shapes toroidal, e.g. ring-shaped, doughnut-shaped
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0071—Three-dimensional shapes spherical
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005—The prosthesis being constructed from a particular material
    • A61F2310/00011—Metals or alloys
    • A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni alloys

Abstract

The stabiliser consists of an implant (18) inserted at least partially between two adjacent vertebrae (2, 2') and permitting at least one degree of rotational freedom, and at least one extra-discal component (20) situated to the rear of the intervertebral space and designed to damp any movement between the vertebrae, especially in the direction of flexion. The damper is connected to the two vertebrae by pedicular screws (22, 22'), and the implant has an elastic core, partially covered by a rigid material to for a partial disc prosthesis.

Description

présente invention concerne un dispositif de stabili sation intervertébral. The present invention relates to an intervertebral stabilization device.

manière habituelle, un tel dispositif destiné<B>à</B> remplacer tout ou partie d'un disque intervertébral, lorsque ce dernier a été détruit par la chirurgie ou maladie. usually, such a device for <B> to replace all or part of an intervertebral disc, when the latter was destroyed by surgery or disease.

L'invention se propose de réaliser un dispositif de stabilisation qui, tout en assurant une liberté de mouvement satisfaisante entre les vertèbres qui lui sont adjacentes, induise seulement de faibles sollicitations mécaniques au niveau de l'ensemble de la chaîne vertébrale. The invention proposes to provide a stabilization device which, while ensuring a satisfactory freedom of movement between the vertebrae adjacent thereto, induces only low mechanical stresses at the level of the entire vertebral chain.

cet effet, elle a pour objet un disposit' stabili sation intervertébral destiné<B>à</B> relier deux vertèbres voisines, caractérisé en ce qu'il comprend un implant destiné <B>à</B> être inséré au moins partiellement entre les corps verté braux des deux vertèbres voisines, ledit implant étant apte <B>à</B> conférer auxdits deux corps vertébraux voisins au moins un degré liberté mutuel, ledit dispositif comprenant également au moins un organe extra-discal, disposé<B>à</B> arrière de l'espace intervertébral, propre<B>à</B> amortir un déplacement entre lesdites vertèbres, au moins dans le sens la<B>f</B> lexion intervertébrale. For this purpose, it relates to an intervertebral stabilization device intended to connect two neighboring vertebrae, characterized in that it comprises an implant intended to be inserted at least partially. between the green-braille bodies of the two neighboring vertebrae, said implant being able to confer on said two adjacent vertebral bodies at least one degree of mutual freedom, said device also comprising at least one extra-discal organ disposed <B rearward of the intervertebral space, clean to dampen a displacement between said vertebrae, at least in the direction of the intervertebral exonition.

Dans le cas où les deux vertèbres voisines possèdent un unique degré de liberté, il s'agit d'un degré liberté en rotation, autour d'un axe transversal du patient correspon dant aux mouvements de flexion et d'extension de ce patient. Le ou chaque organe extra-discal est propre<B>à</B> amortir un déplacement entre ces vertèbres voisines au moins dans le sens de flexion intervertébrale, dans laquelle patient se penche vers l'avant. Cette flexion intervertébrale correspond <B>à 1</B> extension de chaque organe extra-discal, -à-dire <B>à</B> son longement selon sa direction principale qui est sensiblement la direction principale de la chaîne vertébrale, soit verticale lorsque le patient est debout. In the case where the two neighboring vertebrae have a single degree of freedom, it is a degree of freedom in rotation about a transverse axis of the patient corresponding to the flexion and extension movements of this patient. The or each extra-discal organ is clean <B> to </ B> cushion a movement between these neighboring vertebrae at least in the direction of intervertebral flexion, in which patient leans forward. This intervertebral flexion corresponds to <B> to 1 </ B> extension of each extra-discal organ, ie to <B> to </ B> its length along its main direction which is substantially the main direction of the vertebral chain, is vertical when the patient is standing.

Selon d'autres caractéristiques de l'invention <B>-</B> l'implant est apte<B>à</B> conférer aux deux corps vertébraux au moins un degré de liberté en rotation, autour d'un pivot fixe dudit implant<B>;</B> <B>-</B> le pivot fixe est disposé vers la partie posté- rieure de l'implant, dans la position anatomique verticale repos<B>;</B> <B>-</B> il est prévu des moyens supplémentaires d'amortis sement au moins dans le sens de la flexion intervertébrale disposés vers la partie antérieure dudit implant<B>;</B> <B>-</B> l'implant est apte<B>à</B> conférer aux deux corps vertébraux au moins un degré de liberté en rotation, autour d'un pivot mobile dudit implant<B>;</B> <B>-</B> l'implant comprend une âme élastique, notamment réalisée en un polymère de silicone ou un élastomère partiellement recouverte par un enrobage réalisé en un matériau rigide<B>;</B> <B>-</B> l'implant comprend une bille rigide entourée par un anneau élastique dont les extrémités latérales sont disposées au voisinage des corps vertébraux<B>;</B> <B>-</B> implant comprend une enveloppe contenant un hydrophile<B>;</B> <B>-</B> dimension verticale dudit implant posé augmente vers sa partie antérieure, dans la position anatomique verticale repos<B>;</B> <B>-</B> l'implant possède deux régions de contact avec lesdits deux corps vertébraux voisins, ces deux régions contact étant solidaires desdits corps vertébraux<B>;</B> <B>-</B> il est prévu deux organes d'amortissement extra- discaux disposés de part et d'autre d'un axe principal de la chaîne vertébrale<B>;</B> <B>-</B> il est prévu en outre des moyens de solidarisation des organes d'amortissement entre eux, au moins selon une direction verticale<B>;</B> <B>-</B> l'implant comprend au moins une prothèse partielle de disque, ou cage intersomatique <B>;</B> <B>-</B> l'implant inter-vertébral comprend une unique cage intersomatique, associée<B>à</B> un unique organe d'amortissement extra-discal, tous deux étant décalés d'un même côté par rapport<B>à</B> l'axe principal de la chaîne vertébrale<B>;</B> <B>-</B> l'implant intervertébral comprend deux cages intersomatiques disposées de part et d'autre dudit axe principal, ainsi que deux organes d'amortissement extra-

Figure img00030001
According to other characteristics of the invention, the implant is capable of conferring on the two vertebral bodies at least one degree of freedom in rotation, around a fixed pivot. of said implant <B>;</B><B> - </ B> the fixed pivot is arranged towards the posterior part of the implant, in the vertical resting anatomical position <B>;</B><B Additional damping means are provided at least in the direction of the intervertebral flexion disposed towards the anterior part of said implant; <b><b></b> implant is adapted to provide both vertebral bodies with at least one degree of rotational freedom about a movable pivot of said implant; <b><b> - </ b> implant comprises an elastic core, in particular made of a silicone polymer or an elastomer partially covered by a coating made of a rigid material <B>;</B><B> - </ B> the implant comprises a rigid ball surrounded by an elastic ring whose lateral ends are disposed in the vicinity of the vertebral bodies <B>;</B><B> - </ B> implant comprises an envelope containing a hydrophilic <B>;</B><B> - </ B> vertical dimension of said implant posed increases towards its anterior part, in the vertical anatomical rest position <B>;</B><B> - </ B> the implant has two regions of contact with said two adjacent vertebral bodies, these two contact regions being joined together of said vertebral bodies <B>;</B><B> - </ B> two extra-discarding damping members are provided on each side of a main axis of the vertebral chain <B>;</B><B> - </ B> it is further provided means for securing the damping members to each other, at least in a vertical direction <B>;</B><B> - </ B> the implant comprises at least one partial disc prosthesis, or intersomatic cage, the intervertebral implant comprises a single intersomatic cage, associated with <B><B><B><B><B><B> / B> a unique extra-discard damping device, both of which are staggered on the same side with respect to the main axis of the vertebral chain <B><B> - </ B></ B on both sides of said main axis, as well as two extra damping devices
Figure img00030001

discaux <SEP> disposés <SEP> de <SEP> part <SEP> et <SEP> d'autre <SEP> dudit <SEP> axe <SEP> <B>-</B>
<tb> <B>-</B> <SEP> les <SEP> cages <SEP> intersomatiques <SEP> ont <SEP> hauteurs
<tb> différentes.
<tb> L'invention <SEP> va <SEP> être <SEP> décrite <SEP> ci-dessous, <SEP> en <SEP> ref <SEP> érence <SEP> aux
<tb> dessins <SEP> annexés, <SEP> donnés <SEP> uniquement <SEP> <B>à</B> <SEP> titre <SEP> d'exemples <SEP> non
<tb> limitatifs <SEP> et <SEP> dans <SEP> lesquels <SEP> <B>:</B>
<tb> <B>-</B> <SEP> la <SEP> figure <SEP> <B>1</B> <SEP> est <SEP> une <SEP> vue <SEP> schématique <SEP> de <SEP> côté,
<tb> illustrant <SEP> deux <SEP> vertèbres <SEP> voisines <SEP> entre <SEP> lesquel <SEP> est <SEP> placé
<tb> un <SEP> dispositif <SEP> de <SEP> stabilisation <SEP> conforme <SEP> <B>à</B> <SEP> l'invention <SEP> <B>;</B>
<tb> <B>-</B> <SEP> la <SEP> <B>f</B> <SEP> igure <SEP> 2 <SEP> est <SEP> une <SEP> vue <SEP> de <SEP> côté, <SEP> <B>'</B> <SEP> plus <SEP> grande
<tb> échelle <SEP> illustrant <SEP> un <SEP> implant <SEP> appartenant <SEP> au <SEP> dispositif <SEP> de
<tb> stabilisation <SEP> de <SEP> la <SEP> figure <SEP> <B>1 <SEP> ;</B>
<tb> <B>-</B> <SEP> les <SEP> <B>f</B> <SEP> igures <SEP> <B>3 <SEP> à <SEP> 6</B> <SEP> sont <SEP> des <SEP> vues <SEP> analogues <SEP> <B>à</B> <SEP> la
<tb> figure <SEP> illustrant <SEP> des <SEP> variantes <SEP> de <SEP> réalisat' <SEP> de <SEP> l'implant
<tb> appartenant <SEP> au <SEP> dispositif <SEP> de <SEP> stabilisation <SEP> de <SEP> la <SEP> figure <SEP> <B>1 <SEP> ;</B>
<tb> <B>-</B> <SEP> la <SEP> figure <SEP> <B>7</B> <SEP> est <SEP> une <SEP> vue <SEP> de <SEP> dessus, <SEP> illustrant <SEP> une
<tb> variante <SEP> supplémentaire <SEP> de <SEP> l'invention <SEP> <B>;</B> <SEP> et
<tb> <B>-</B> <SEP> la <SEP> figure <SEP> <B>8</B> <SEP> est <SEP> une <SEP> vue <SEP> de <SEP> derrière, <SEP> illustrant
<tb> les <SEP> deux <SEP> organes <SEP> d'amortissement <SEP> appartenant <SEP> au <SEP> dispositif <SEP> de
<tb> stabilisation <SEP> de <SEP> la <SEP> figure <SEP> <B>7.</B>
<tb> La <SEP> figure <SEP> <B>1</B> <SEP> représente <SEP> deux <SEP> vertèbres <SEP> respectivement
<tb> supérieure <SEP> 2 <SEP> et <SEP> inférieure <SEP> 21 <SEP> qui <SEP> sont <SEP> reliées <SEP> l'intermé diaire <SEP> d'un <SEP> dispositif <SEP> de <SEP> stabilisation <SEP> conforme <SEP> <B>à</B> <SEP> l'inven tion. <SEP> Chaque <SEP> vertèbre <SEP> comprend <SEP> un <SEP> corps <SEP> vertébral <SEP> 4, <SEP> 41
<tb> prolongé <SEP> par <SEP> un <SEP> pédicule <SEP> <B>6, <SEP> 61,</B> <SEP> une <SEP> articulaire <SEP> supérieure <SEP> <B>8,</B>
<tb> <B>81</B> <SEP> et <SEP> une <SEP> articulaire <SEP> inférieure <SEP> <B>10, <SEP> 101.</B> <SEP> On <SEP> désigne <SEP> par <SEP> 12
<tb> l'espace <SEP> intervertébral, <SEP> par <SEP> 14 <SEP> et <SEP> 14' <SEP> les <SEP> facettes <SEP> articulai res <SEP> en <SEP> regard <SEP> et <SEP> par <SEP> <B>16</B> <SEP> et <SEP> <B>16'</B> <SEP> les <SEP> capsules <SEP> articulaires.
<tb> Les <SEP> deux <SEP> vertèbres <SEP> 2, <SEP> 21 <SEP> sont <SEP> reliées <SEP> mutuellement <SEP> par
<tb> l'intermédiaire <SEP> d'un <SEP> dispositif <SEP> de <SEP> stabilisation, <SEP> comprenant
<tb> un <SEP> implant <SEP> intersomatique <SEP> <B>18,</B> <SEP> logé <SEP> dans <SEP> l'espace <SEP> interverté bral <SEP> 12, <SEP> ainsi <SEP> qu'un <SEP> organe <SEP> d'amortissement, <SEP> désigné <SEP> dans <SEP> son
<tb> ensemble <SEP> par <SEP> la <SEP> référence <SEP> 20, <SEP> dont <SEP> les <SEP> deux <SEP> extrémités <SEP> sont
<tb> fixées <SEP> sur <SEP> les <SEP> vertèbres <SEP> correspondantes <SEP> par <SEP> l'intermédiaire
<tb> de <SEP> vis <SEP> pédiculaires <SEP> 22, <SEP> 22'.
<tb> L'organe <SEP> d'amortissement <SEP> est <SEP> par <SEP> exemple <SEP> conforme <SEP> <B>à</B>
<tb> l'enseignement <SEP> de <SEP> FR-A-2 <SEP> <B>676 <SEP> 911,</B> <SEP> ou <SEP> bien <SEP> encore <SEP> <B>à</B> <SEP> celui <SEP> de
<tb> FR-A-2 <SEP> <B>751</B> <SEP> 864. <SEP> Il <SEP> peut <SEP> également <SEP> comprendre <SEP> un <SEP> ligament,

Figure img00040001
<SEP> disks arranged <SEP> of <SEP> shares <SEP> and <SEP> of other <SEP> of said <SEP> axis <SEP><B> - </ B>
<tb><B> - <SEP><SEP> intersomatic <SEP> cages <SEP> have <SEP> heights
<tb> different.
<tb> The invention <SEP> is <SEP> be <SEP> described <SEP> below, <SEP> in <SEP> ref <SEP> erence <SEP> in
<tb> drawings <SEP> appended, <SEP> given <SEP> only <SEP><B> to </ B><SEP><SEP> title of examples <SEP> no
<tb> limiting <SEP> and <SEP> in <SEP> which <SEP><B>:</B>
<tb><B> - <SEP><SEP> Figure <SEP><B> 1 </ B><SEP> is <SEP> a <SEP><SEP> schematic view <SEP> of <SEP> side,
<tb> illustrating <SEP> two <SEP> neighboring <SEP> vertebrae <SEP> where <SEP> is <SEP> placed
<tb> a <SEP> device <SEP> of <SEP> Stabilization <SEP> compliant <SEP><B> to </ B><SEP> the invention <SEP><B>;</B>
<tb><B> - <SEP><SEP><B> f </ B><SEP> igure <SEP> 2 <SEP> is <SEP> a <SEP><SEP> view of <SEP> side, <SEP><B>'</B><SEP> more <SEP> big
<tb> scale <SEP> illustrating <SEP> a <SEP> implant <SEP> belonging <SEP> to the <SEP> device <SEP> of
<tb> Stabilization <SEP> of <SEP><SEP> Figure <SEP><B> 1 <SEP>;</B>
<tb><B> - <SEP><SEP><B> f </ B><SEP> igures <SEP><B> 3 <SEP> to <SEP> 6 </ B><SEP> are <SEP><SEP> views <SEP> analogues <SEP><B> to </ B><SEP>
<tb> figure <SEP> illustrating <SEP> of <SEP><SEP> variants of <SEP> realizing <SEP> of <SEP> the implant
<tb> owned <SEP> at the <SEP> device <SEP> of <SEP> Stabilization <SEP> of <SEP><SEP> Figure <SEP><B> 1 <SEP>;</B>
<tb><B> - <SEP><SEP> Figure <SEP><B> 7 </ B><SEP> is <SEP> a <SEP><SEP> view of <SEP> above , <SEP> illustrating <SEP> one
<tb> additional <SEP> variant <SEP> of <SEP> the invention <SEP><B>;</B><SEP> and
<tb><B> - <SEP> The <SEP> figure <SEP><B> 8 </ B><SEP> is <SEP> a <SEP><SEP> view of <SEP> behind , <SEP> illustrating
<tb> the <SEP> two <SEP> bodies <SEP> depreciation <SEP> belonging <SEP> to the <SEP> device <SEP> of
<tb> Stabilization <SEP> of <SEP><SEP> Figure <SEP><B> 7. </ B>
<tb> The <SEP> figure <SEP><B> 1 </ B><SEP> represents <SEP> two <SEP> vertebrae <SEP> respectively
<tb> upper <SEP> 2 <SEP> and <SEP> lower <SEP> 21 <SEP> which <SEP> are <SEP> connected <SEP> the intermediate <SEP> of a <SEP> device <SEP> from <SEP> Stabilization <SEP> compliant <SEP><B> to </ B><SEP> the invention. <SEP> Each <SEP> vertebra <SEP> includes <SEP> one <SEP> body <SEP> vertebral <SEP> 4, <SEP> 41
<tb> prolonged <SEP> with <SEP> one <SEP> pedicle <SEP><B> 6, <SEP> 61, <SEP> one <SEP> joint <SEP> upper <SEP><B> 8, </ B>
<tb><B> 81 </ B><SEP> and <SEP> a <SEP> joint <SEP> lower <SEP><B> 10, <SEP> 101. </ B><SEP> On <SEP > designates <SEP> by <SEP> 12
<tb> intervertebral <SEP> space, <SEP> by <SEP> 14 <SEP> and <SEP> 14 '<SEP><SEP> facets <SEP> articular <SEP> in <SEP> look <SEP> and <SEP> with <SEP><B> 16 </ B><SEP> and <SEP><B> 16 '<SEP> joint <SEP> capsules <SEP>.
<tb><SEP> two <SEP> vertebrae <SEP> 2, <SEP> 21 <SEP> are <SEP> connected <SEP> mutually <SEP> by
<tb> the <SEP> intermediate of a <SEP><SEP><SEP> device, including <SEP>
<tb> an <SEP> intersomatic <SEP> implant <SEP><B> 18, </ B><SEP> housed <SEP> in <SEP><SEP> space inverted bral <SEP> 12, <SEP > thus <SEP> that a <SEP> organ <SEP> of amortization, <SEP> designated <SEP> in <SEP> its
<tb> set <SEP> by <SEP> the <SEP> reference <SEP> 20, <SEP> where <SEP><SEP> two <SEP> ends <SEP> are
<tb> set <SEP> on <SEP><SEP> corresponding <SEP> vertebrae <SEP> by <SEP> intermediate
<tb> of <SEP> screws <SEP> pedicles <SEP> 22, <SEP> 22 '.
<tb> The <SEP> depreciation <SEP> is <SEP> by <SEP> example <SEP> compliant <SEP><B> to </ B>
<tb> teaching <SEP> of <SEP> FR-A-2 <SEP><B> 676 <SEP> 911, </ B><SEP> or <SEP> well <SEP> still <SEP><B> to </ B><SEP> that <SEP> from
<tb> FR-A-2 <SEP><B> 751 <SE> 864. <SEP> It <SEP> can <SEP> also <SEP> understand <SEP> a <SEP> ligament,
Figure img00040001

conformément <SEP> par <SEP> exemple <SEP> l'enseignement <SEP> de <SEP> FR-A-2 <SEP> 694 <SEP> <B>182.</B>
<tb> L'implant <SEP> <B>18</B> <SEP> est <SEP> représenté <SEP> de <SEP> façon <SEP> plus <SEP> précise <SEP> sur <SEP> la
<tb> <B>f</B> <SEP> igure <SEP> 2. <SEP> Sur <SEP> cette <SEP> dernière, <SEP> comme <SEP> sur <SEP> les <SEP> <B>f</B>igures <SEP> suivantes,
<tb> le <SEP> côté <SEP> droit <SEP> correspond <SEP> la <SEP> partie <SEP> postérieure <SEP> de <SEP> l'espace
<tb> intervertébral <SEP> 12, <SEP> le <SEP> côte <SEP> gauche <SEP> correspondant <SEP> <B>à</B> <SEP> la <SEP> partie
<tb> antérieure.
<tb> L'implant <SEP> <B>18</B> <SEP> comprend <SEP> des <SEP> éléments <SEP> respectivement
<tb> supérieur <SEP> 24 <SEP> et <SEP> inférieur <SEP> <B>26,</B> <SEP> entrant <SEP> en <SEP> contact <SEP> avec <SEP> les
<tb> corps <SEP> vertébraux <SEP> 4, <SEP> 41, <SEP> des <SEP> surfaces <SEP> de <SEP> contact <SEP> 24', <SEP> <B>261</B>
<tb> respectives, <SEP> qui <SEP> sont <SEP> planes. <SEP> Les <SEP> éléments <SEP> 24, <SEP> <B>26</B> <SEP> comportent
<tb> des <SEP> chapes <SEP> respectives <SEP> 24'', <SEP> <B>26'',</B> <SEP> qui <SEP> sont <SEP> articulées <SEP> au
<tb> moyen <SEP> d'un <SEP> axe <SEP> <B>28</B> <SEP> s'étendant <SEP> transversalement. <SEP> Cet <SEP> axe <SEP> <B>28,</B> <SEP> qui
<tb> est <SEP> disposé <SEP> du <SEP> côté <SEP> postérieur <SEP> de <SEP> l'espace <SEP> intervertébral <SEP> 12,
<tb> confère <SEP> un <SEP> degré <SEP> de <SEP> liberté <SEP> entre <SEP> les <SEP> surfaces <SEP> 24' <SEP> et <SEP> <B>261,</B> <SEP> et
<tb> donc <SEP> entre <SEP> les <SEP> corps <SEP> vertébraux <SEP> 4, <SEP> 4' <SEP> <B>.</B> <SEP> Ce <SEP> degré <SEP> de <SEP> liberté
<tb> unique <SEP> est <SEP> une <SEP> rotation <SEP> autour <SEP> de <SEP> l'axe <SEP> <B>28</B> <SEP> transversal, <SEP> ou
<tb> sagittal, <SEP> ou <SEP> <B>à</B> <SEP> une <SEP> extension <SEP> ce <SEP> qui <SEP> correspond <SEP> ainsi <SEP> <B>à</B> <SEP> une
<tb> flexion <SEP> du <SEP> patient <SEP> vers <SEP> l'avant <SEP> de <SEP> celui-ci <SEP> vers <SEP> l'arrière.
<tb> Un <SEP> ressort <SEP> <B>30,</B> <SEP> travaillant <SEP> en <SEP> compression, <SEP> est <SEP> fixé <SEP> aux
<tb> éléments <SEP> 24, <SEP> <B>26,</B> <SEP> du <SEP> côté <SEP> antérieur <SEP> de <SEP> l'espace <SEP> intervertébral
<tb> 12. <SEP> Ce <SEP> ressort <SEP> peut <SEP> être <SEP> remplacé <SEP> par <SEP> un <SEP> bloc <SEP> résilient,
<tb> réalisé <SEP> par <SEP> exemple <SEP> en <SEP> élastomère, <SEP> notamment <SEP> en <SEP> caoutchouc.
<tb> La <SEP> figure <SEP> <B>3</B> <SEP> illustre <SEP> un <SEP> second <SEP> mode <SEP> de <SEP> réalisation <SEP> de
<tb> l'implant <SEP> intervertébral, <SEP> désigné <SEP> par <SEP> la <SEP> référence <SEP> <B>68.</B> <SEP> Ce
<tb> dernier <SEP> comprend <SEP> deux <SEP> éléments <SEP> respectivement <SEP> supérieur <SEP> 74 <SEP> et
<tb> inférieur <SEP> <B>76,</B> <SEP> entrant <SEP> en <SEP> contact <SEP> avec <SEP> les <SEP> corps <SEP> vertébraux <SEP> 4,
<tb> 41 <SEP> par <SEP> <B>1</B> <SEP> intermédiaire <SEP> de <SEP> surfaces <SEP> de <SEP> contact <SEP> planes <SEP> 741, <SEP> <B>761 <SEP> .</B>
<tb> L'un <SEP> de <SEP> ces <SEP> éléments, <SEP> en <SEP> l'occurrence <SEP> l'élément <SEP> supé rieur, <SEP> est <SEP> pourvu <SEP> d'un <SEP> logement <SEP> sphérique <SEP> 7411, <SEP> formant
<tb> cupule, <SEP> disposé <SEP> vers <SEP> la <SEP> partie <SEP> postérieure <SEP> de <SEP> l'espace
<tb> intervertébral <SEP> 12. <SEP> Ce <SEP> logement <SEP> 7411 <SEP> coopère <SEP> avec <SEP> une <SEP> saillie
<tb> sphérique <SEP> <B>76''</B> <SEP> de <SEP> l'autre <SEP> élément, <SEP> <B>à</B> <SEP> savoir <SEP> l'élément
<tb> inférieur <SEP> <B>76.</B>
<tb> Etant <SEP> donné <SEP> que <SEP> les <SEP> rayons <SEP> du <SEP> logement <SEP> 7411 <SEP> et <SEP> de <SEP> la
<tb> saillie <SEP> <B>7611</B> <SEP> sont <SEP> sensiblement <SEP> identiques, <SEP> leur <SEP> coopération
<tb> assure <SEP> trois <SEP> degrés <SEP> de <SEP> liberté <SEP> en <SEP> rotation, <SEP> autour <SEP> du <SEP> centre
<tb> fixe <SEP> <B>78</B> <SEP> de <SEP> la <SEP> saillie <SEP> sphérique <SEP> <B>76'',</B> <SEP> des <SEP> surfaces <SEP> de <SEP> contact
<tb> 741, <SEP> <B>76'</B> <SEP> et <SEP> donc <SEP> des <SEP> corps <SEP> vertébraux <SEP> 4, <SEP> 4'. Il est possible de munir cet implant<B>68</B> d'un ou plusieurs ressorts, analogues<B>à</B> celui<B>30,</B> ou d'un bloc résilient, s'étendant entre les éléments supérieur et inférieur par exemple du côté antérieur de l'espace intervertébral. in accordance with <SEP> by <SEP> example <SEP> teaching <SEP> of <SEP> FR-A-2 <SEP> 694 <SEP><B> 182. </ B>
<tb> The implant <SEP><B> 18 </ B><SEP> is <SEP> represented <SEP> of <SEP> way <SEP> more <SEP> accurate <SEP> on <SEP> la
<tb><B> f </ B><SEP> igure <SEP> 2. <SEP> On <SEP> this <SEP> last, <SEP> as <SEP> on <SEP><SEP><B> f </ B> igures <SEP> next,
<tb><SEP> side <SEP> right <SEP> matches <SEP> the <SEP> part <SEP> posterior <SEP> of <SEP> space
<tb> intervertebral <SEP> 12, <SEP><SEP> side <SEP> left <SEP> corresponding <SEP><B> to </ B><SEP> the <SEP> part
<tb> earlier.
<tb> The <SEP><B> 18 <SEP> implant includes <SEP> of <SEP><SEP> elements respectively
<tb> higher <SEP> 24 <SEP> and <SEP> lower <SEP><B> 26, </ B><SEP> incoming <SEP> in <SEP><SEP> contact with <SEP>
<tb> body <SEP> vertebral <SEP> 4, <SEP> 41, <SEP> of <SEP> surfaces <SEP> of <SEP> contact <SEP> 24 ', <SEP><B> 261 </ B >
<tb> respective, <SEP> which <SEP> are <SEP> planes. <SEP> The <SEP> elements <SEP> 24, <SEP><B> 26 </ B><SEP> include
<tb><SEP> respective <SEP> screeds <SEP> 24 '', <SEP><B> 26 '', <SEP> which <SEP> are <SEP> articulated <SEP> with
<tb> average <SEP> of a <SEP> axis <SEP><B> 28 </ B><SEP> extending <SEP> transversely. <SEP> This <SEP> axis <SEP><B> 28, </ B><SEP> which
<tb> is <SEP> willing <SEP> of <SEP> side <SEP> posterior <SEP> of <SEP> space <SEP> intervertebral <SEP> 12,
<tb> confers <SEP> a <SEP> degree <SEP> of <SEP> freedom <SEP> between <SEP><SEP> surfaces <SEP> 24 '<SEP> and <SEP><B> 261, < / B><SEP> and
<tb> therefore <SEP> between <SEP><SEP> bodies <SEP> vertebral <SEP> 4, <SEP> 4 '<SEP><B>.</SEP><SEP> This <SEP> degree <SEP> of <SEP> freedom
<tb> single <SEP> is <SEP> one <SEP> rotation <SEP> around <SEP> of <SEP> the <SEP><B> 28 </ B><SEP> cross axis, <SEP> or
<tb> sagittal, <SEP> or <SEP><B><SEP> a <SEP> extension <SEP> this <SEP> which <SEP> matches <SEP> thus <SEP><B> to </ B><SEP> one
<tb> bending <SEP> of the <SEP> patient <SEP> to <SEP> the <SEP> front of <SEP> this <SEP> to the <SEP> back.
<tb> A <SEP> spring <SEP><B> 30, </ B><SEP> working <SEP> in <SEP> compression, <SEP> is <SEP> set <SEP> to
<tb> elements <SEP> 24, <SEP><B> 26, </ B><SEP> of the <SEP><SEP> side <SEP> of <SEP> intervertebral <SEP> space
<tb> 12. <SEP> This <SEP> spring <SEP> can <SEP> be <SEP> replaced <SEP> with <SEP> a <SEP> resilient <SEP> block,
<tb> realized <SEP> by <SEP> example <SEP> in <SEP> elastomer, <SEP> in particular <SEP> in <SEP> rubber.
<tb> The <SEP> figure <SEP><B> 3 <SEP> illustrates <SEP> a <SEP> second <SEP><SEP> mode of <SEP><SEP> realization of
<tb> intervertebral <SEP> implant, <SEP> designated <SEP> by <SEP><SEP> reference <SEP><B> 68. </ p><SEP> Ce
<tb> last <SEP> includes <SEP> two <SEP> elements <SEP> respectively <SEP> higher <SEP> 74 <SEP> and
<tb> inferior <SEP><B> 76, <SEP> incoming <SEP> in <SEP> contact <SEP> with <SEP> the <SEP> body <SEP> vertebral <SEP> 4,
<tb> 41 <SEP> with <SEP><B> 1 </ B><SEP> intermediate <SEP> of <SEP> surfaces <SEP> of <SEP> contact <SEP> planes <SEP> 741, <SEP ><B> 761 <SEP>. </ B>
<tb> One <SEP> of <SEP> these <SEP> elements, <SEP> in <SEP> the <SEP> instance the <SEP> superior, <SEP> is <SEP> provided <SEP> of a <SEP> housing <SEP> spherical <SEP> 7411, <SEP> forming
<tb> cup, <SEP> arranged <SEP> to <SEP> the <SEP> part <SEP> posterior <SEP> of <SEP> space
<tb> intervertebral <SEP> 12. <SEP> This <SEP> slot <SEP> 7411 <SEP> cooperates <SEP> with <SEP> a <SEP> projection
<tb> spherical <SEP><B> 76 ''<SEP> of <SEP> the other <SEP> element, <SEP><B> to </ B><SEP> know <SEP> the element
<tb> lower <SEP><B> 76. </ B>
<tb> Given <SEP> given <SEP> that <SEP><SEP> departments <SEP> of <SEP> slot <SEP> 7411 <SEP> and <SEP> of <SEP>
<tb> protruding <SEP><B> 7611 </ B><SEP> are <SEP> substantially <SEP> identical, <SEP> their <SEP> cooperation
<tb> provides <SEP> three <SEP> degrees <SEP> of <SEP> freedom <SEP> in <SEP> rotation, <SEP> around <SEP> of <SEP> center
<tb> fixed <SEP><B> 78 </ B><SEP> of <SEP> the <SEP> protrusion <SEP> spherical <SEP><B> 76 '', </ B><SEP><SEP> surfaces <SEP> of <SEP> contact
<tb> 741, <SEP><B> 76 '<SEP> and <SEP> thus <SEP><SEP> bodies <SEP> vertebral <SEP> 4, <SEP>4'. It is possible to provide this implant <B> 68 </ B> with one or more springs, similar <B> to </ B> 30, </ B> or a resilient block, s' extending between the upper and lower elements for example on the anterior side of the intervertebral space.

La figure 4 illustre un troisième mode de réalisation de l'implant intervertébral, qui est désigné dans son ensemble par la référence<B>118.</B> Cet implant comprend deux éléments supérieur 124 et inférieur<B>126,</B> formant plateaux. Chacun de ces plateaux, qui prend appui contre un corps vertébral respectif par l'intermédiaire d'une surface plane 1241, <B>1261,</B> est pourvu d'un renfoncement sphérique 124<B>' ' , 126 ' ' .</B> Une bille <B>128</B> qui possède un rayon de courbure sensiblement inférieur <B>à</B> celui des renfoncements 12411, 126'', est intercalée entre les plateaux 124,<B>126.</B> Figure 4 illustrates a third embodiment of the intervertebral implant, which is designated as a whole by the reference 118. This implant comprises two upper elements 124 and lower 126, <B> > forming trays. Each of these trays, which bears against a respective vertebral body via a flat surface 1241, <B> 1261, </ B> is provided with a spherical recess 124 <B> '', 126 '' . </ B> A ball <B> 128 </ B> which has a radius of curvature significantly lower <B> than </ B> that of recesses 12411, 126 '', is interposed between trays 124, <B> 126. </ B>

Cette bille<B>128</B> est libre de se déplacer au voisinage de la surface adjacente des plateaux 124,<B>126,</B> ce qui confère trois degrés de liberté en rotation, aux deux corps vertébraux 4, 41 autour d'un point mobile, ainsi que deux degres de liberté en translation autorisés par les glissements des plateaux sur cette bille. Cette dernière peut être remplacée par un organe non sphérique, par exemple ovale ou cylindrique, prenant appui contre les plateaux 124,<B>126</B> par l'intermédiaire d'une surface de contact dont le rayon de courbure est inférieur celui des renfoncements 1241<B>126, 1</B> précités, afin de permettre un déplacement mutuel de cet organe par rapport au plateau. This ball <B> 128 </ B> is free to move in the vicinity of the adjacent surface of the trays 124, <B> 126, </ B> which gives three degrees of freedom in rotation to the two vertebral bodies 4, 41 around a movable point, as well as two degrees of freedom in translation allowed by the slides of the trays on this ball. The latter can be replaced by a non-spherical member, for example oval or cylindrical, bearing against the trays 124, <B> 126 </ B> via a contact surface whose radius of curvature is less than the 1241 <B> 126, 1 </ B> recesses, to allow a mutual displacement of this body relative to the plate.

La figure<B>5</B> représente une quatrième variante de réalisa tion de l'implant intervertébral, désigné dans son ensemble par la réference <B>168.</B> Ce dernier comprend un enrobage, formé par deux plateaux rigides 74,<B>176,</B> entre lesquels est intercalée une âme élastique<B>178.</B> Les plateaux 174<B>176</B> recouvrent partiellement l'âme<B>178,</B> en ce sens qu'ils sont disposés sur les bords de cette âme adjacents aux corps vertébraux. Les plateaux sont par exemple réalisés en titane alors que l'âme, qui est par exemple collée au plateau, est réalisée par exemple en silicone ou en élastomère, notamment en caoutchouc. Figure <B> 5 </ B> represents a fourth embodiment of the intervertebral implant, designated as a whole by the reference <B> 168. </ B> The latter comprises a coating, formed by two rigid plates 74, <B> 176, </ B> between which is interposed an elastic soul <B> 178. </ B> The trays 174 <B> 176 </ B> partially cover the soul <B> 178, </ B> in that they are arranged on the edges of this soul adjacent to the vertebral bodies. The plates are for example made of titanium while the core, which is for example glued to the plate, is made for example of silicone or elastomer, especially rubber.

Les plateaux 174,<B>176</B> entrent en contact avec les corps vertébraux 4, 41 par l'intermédiaire de surfaces planes 174' <B>176' .</B> Cet implant est inséré dans l'espace intervertébral impaction, comme les implants<B>18, 68</B> et<B>118.</B> Il est également envisageable que la distance séparant les surfaces de contact 1741,<B>1761</B> qui correspond<B>à</B> la dimension verticale de l'implant posé, augmente vers sa partie antérieure, dans position anatomique verticale du repos du patient. The trays 174, <B> 176 </ B> come into contact with the vertebral bodies 4, 41 via flat surfaces 174 '<B> 176'. </ B> This implant is inserted into the intervertebral space impaction, like the implants <B> 18, 68 </ B> and <B> 118. </ B> It is also conceivable that the distance between the contact surfaces 1741, <B> 1761 </ B> which corresponds < B> to </ B> the vertical dimension of the implant placed, increases towards its anterior part, in anatomical vertical position of the rest of the patient.

La figure<B>6</B> illustre un cinquième mode de réalisation l'implant intervertébral, désigné dans son ensemble par la référence<B>.</B> Ce dernier comprend une bille rigide entourée par un anneau périphérique<B>226,</B> d'axe principal parallèle a l'axe principal de la colonne vertébrale, anneau étant réalisé en un matériau élastique tel que caoutchouc. Les extrémités latérales de l'anneau sont solidaires de plaques 224 qui entrent en contact avec corps vertébraux respectifs 4, 4'. Figure <B> 6 </ B> illustrates a fifth embodiment of the intervertebral implant, generally designated by the reference <B>. </ B> The latter comprises a rigid ball surrounded by a peripheral ring <B> 226, </ B> of main axis parallel to the main axis of the spine, ring being made of an elastic material such as rubber. The lateral ends of the ring are integral with plates 224 which come into contact with respective vertebral bodies 4, 4 '.

Les implants<B>18, 68, 118, 168, 218</B> décrits ci-dessus sont des prothèses totales de disque. Il est également possible de faire appel<B>à</B> un implant<B>268,</B> illustré sur la figure<B>7,</B> est une prothèse partielle de disque, ou cage inter-somatique. Cette cage<B>268,</B> qui est insérée dans le disque<B>270,</B> disposée de façon décalée, par rapport<B>à</B> l'axe principal<B>A</B> de la chaîne vertébrale qui, lorsque le patient se trouve en position debout, est un axe vertical passant par le plan médian P s'étendant d'arrière en avant du patient. Implants <B> 18, 68, 118, 168, 218 </ B> described above are total disc prostheses. It is also possible to use <B> to </ B> an implant <B> 268, </ B> shown in Figure <B> 7, </ B> is a partial disc prosthesis, or cage inter somatic. This cage <B> 268, </ B> which is inserted in disk <B> 270, </ B> arranged in an offset manner, with respect to <B> at </ B> the main axis <B> A < / B> of the vertebral chain which, when the patient is in a standing position, is a vertical axis passing through the median plane P extending from behind to the patient.

Cette cage est, par exemple conforme<B>à</B> l'enseignement de WO-A-99/32054. Elle peut être insérée par vissage dans l'espace intervertébral, conformément<B>à</B> l'enseignement de dernier document. Il est également possible de l'insérer dans le disque par impactage. This cage is, for example <B> to </ B> the teaching of WO-A-99/32054. It can be inserted by screwing into the intervertebral space, according to <B> to </ B> the teaching of last document. It is also possible to insert it into the disc by impact.

Cette cage<B>268</B> est associée<B>à</B> un organe d'amortissement <B>20A,</B> qui disposée, de façon décalée, du même c8té de<B>l'</B> <B>A</B> que la cage<B>268.</B> This <B> 268 </ B> cage is associated with <B> a <B> 20A damping member, </ B> arranged in a staggered way on the same side of <B> <B> A </ B> that the cage <B> 268. </ B>

On peut associer<B>à</B> la cage<B>268,</B> une cage supplémentaire <B>268',</B> située de l'autre câté de l'axe<B>A.</B> Cette cage<B>2681,</B> qui est représentée en traits mixtes, peut être analogue<B>à</B> la cage <B>268</B> étant entendu qu'il est possible de conférer<B>à</B> ces deux cages<B>268, 268'</B> des hauteurs différentes, de manière<B>à</B> compenser un éventuel effondrement du disque se produisant de façon asymétrique, en vue de derrière. La cage<B>1</B> est associee <B>à</B> un organe d'amortissement supplémentaire 20B, représenté en traits mixtes, qui est prévu du même c8té de l'axe que la cage<B>268'.</B> We can associate <B> with </ B> the cage <B> 268, </ B> an extra cage <B> 268 ', located on the other side of the axis <B> A. </ B> This cage <B> 2681, </ B> which is shown in phantom, may be analogous <B> to </ B> the cage <B> 268 </ B> being understood that it is possible to give <B> to </ B> these two <B> 268, 268 '</ B> cages of different heights, so as <B> to </ B> compensate for any asymmetric collapse of the disk, in view of behind. The cage <B> 1 </ B> is associated <B> with </ B> an additional damping member 20B, shown in phantom, which is provided on the same side of the axis as the cage <B> 268 . </ B>

La figure<B>8</B> représente les deux organes d'amortissement <B>20A,</B> 20B disposés de part et d'autre des articulaires<B>8,</B> Ces organes d'amortissement présentent une partie métallique et sont par exemple conformes<B>à</B> l'enseignement de FR- <B>-</B> 2<B>751</B> 864. Ils sont avantageusement reliés l'un<B>à</B> l'autre au moyen une tige transversale<B>272,</B> s'étendant sensiblement horizontalement. La liaison entre chaque organe 20,<B>20A</B> la tige 2 est rigide, et fait par exemple intervenir une soudure. Elle est avantageusement réalisée au niveau la partie mediane de ces organes d'amortissement. Figure <B> 8 </ B> represents the two damping members <B> 20A, </ B> 20B arranged on either side of the articular <B> 8, </ B> These damping devices have a metal part and are for example <B> to </ B> the teaching of FR- <B> - <B> 751 </ B> 864. They are advantageously connected one < B> to </ B> the other by means of a transverse rod <B> 272, </ B> extending substantially horizontally. The connection between each member 20, <B> 20A </ B> the rod 2 is rigid, and for example involves a weld. It is advantageously carried out at the middle part of these damping members.

L'invention n'est pas limitée aux exemples décrits et représentés. En effet, on peut prévoir d'utiliser une bille unique analogue<B>à</B> celle<B>228,</B> qui confère trois degrés de liberte en rotation, ainsi que deux degrés de liberte en translation aux corps vertébraux 4, 4'<B>.</B> Il est également possible de réaliser l'implant intervertébral sous forme une enveloppe renfermant un gel hydrophile ou de l'eau, implant constituant une prothèse de nucleus. The invention is not limited to the examples described and shown. Indeed, it can be expected to use a single ball analogous <B> to </ B> that 228, </ b> which gives three degrees of freedom in rotation, and two degrees of freedom in translation to the bodies vertebral 4, 4 '<B>. </ B> It is also possible to make the intervertebral implant in the form of an envelope containing a hydrophilic gel or water, implant constituting a nucleus prosthesis.

Il est également possible de fixer l'implant sur la paroi verticale des corps vertébraux, par exemple par vissage conformément<B>à</B> l'enseignement de EP-A-0 346<B>269,</B> cet implant étant alors inséré seulement partiellement entre deux corps vertébraux. It is also possible to fix the implant on the vertical wall of the vertebral bodies, for example by screwing according to <B> to </ B> the teaching of EP-A-0 346 <B> 269, </ B>. implant is then inserted only partially between two vertebral bodies.

invention permet de réaliser les objectifs précedemment mentionnés. The invention makes it possible to achieve the objectives mentioned above.

cas de pathologie dégénérative du disque interverté bral, il se produit une diminution de la hauteur de ce disque, qui induit une désorganisation de l'ensemble des mouvements de l'articulation intervertébrale. Prévoir un implant intervertébral, inséré au moins partiellement entre corps vertébraux voisins, permet de restaurer la hauteur ce disque. De plus, conformément<B>à</B> l'invention, cet implant est apte<B>à</B> conférer aux deux corps voisins au moins un degre de iberté mutuelle, de façon<B>à</B> rappeler le mouvement interverté bral naturel. case of degenerative pathology of the intervertebral disc bral, there is a decrease in the height of this disc, which induces a disorganization of all movements of the intervertebral joint. Provide an intervertebral implant, inserted at least partially between neighboring vertebral bodies, to restore the height of this disk. Moreover, according to the invention, this implant is capable of conferring on the two neighboring bodies at least one degree of mutual freedom, from <B> to </ B>. > recall the natural inverted intervertebral movement.

Cependant, prévoir uniquement un tel implant n, pas satisfaisant, dans la mesure où la structure mécanique ce dernier ne peut reproduire, de façon satisfaisante, la structure mécanique du disque, qui est particulièrement complexe. En d'autres termes, la liberté de mouvements conférée par cet implant ne s'accompagne pas d'une régulation suffisante de ces mouvements, de sorte que l'emploi unique de implant conduit<B>à</B> un échec. However, to provide only such an implant n, not satisfactory, insofar as the mechanical structure of the latter can not reproduce, satisfactorily, the mechanical structure of the disc, which is particularly complex. In other words, the freedom of movement imparted by this implant is not accompanied by a sufficient regulation of these movements, so that the single use of implant leads to failure.

Dans cette optique, prévoir au moins un organe d'amortis sement extra-discal permet de réguler les mouvements autorisés par l'implant intervertébral, que ce dernier ne peut controler par lui-même. Cette régulation peut se traduire soit sous la forme d'une réduction du nombre de degrés de liberté, soit par une réduction de l'amplitude de ces différents degrés de liberté, leur nombre étant inchangé. In this context, providing at least one extra-discal cushioning member makes it possible to regulate the movements authorized by the intervertebral implant, which the latter can not control by itself. This regulation can be expressed either in the form of a reduction in the number of degrees of freedom, or by a reduction in the amplitude of these different degrees of freedom, their number being unchanged.

Ainsi, dans le cas d'une bille intercalée entre les deux corps vertébraux, l'organe d'amortissement extra-discal ne réduit pas le nombre de degrés de liberté autorisés par cette bille, mais réduit la course des débattements permis par cette bille. Dans le cas d'une prothèse telle que celle décrite<B>à</B> la figure<B>5,</B> l'organe d'amortissement extra-discal permet de réduire le nombre de degrés de liberté autorisés par cette prothèse. Thus, in the case of a ball interposed between the two vertebral bodies, the extra-discal damping member does not reduce the number of degrees of freedom allowed by this ball, but reduces the stroke of the movements allowed by this ball. In the case of a prosthesis such as that described <B> to </ B> Figure <B> 5, </ B> the extra-discal damping member makes it possible to reduce the number of degrees of freedom allowed by this prosthesis.

Le dispositif de stabilisation de l'invention garantit ainsi que le mouvement relatif des deux vertèbres qu'il relie est suffisamment proche du mouvement autorisé par un disque vertébral naturel, pour que napparaisse pas de dysf onctionne- ment majeur au niveau de l'ensemble de la chaîne vertébrale. The stabilization device of the invention thus ensures that the relative movement of the two vertebrae that it connects is sufficiently close to the movement authorized by a natural vertebral disc, so that no major dysfunction in the whole of the vertebral disc appears. the vertebral chain.

L'emploi de deux organes d'amortissement extra-discaux, disposés de part et d'autres d'un axe principal de la colonne vertébrale est avantageux. En effet, il assure une composante supplémentaire d'amortissement, lorsque le patient se penche sur les côtés. The use of two extra-discarding damping members, arranged on either side of a main axis of the spine is advantageous. Indeed, it provides an additional component of damping, when the patient leans on the sides.

Prévoir des moyens de liaison entre ces deux organes d'amortissement est avantageux, dans la mesure où cela assure une réduction sensible du cisaillement horizontal interverté- bral, comme en cas de rupture ou<B>dl</B> absence d'un ou deux massifs articulaires postérieurs. Providing connecting means between these two damping members is advantageous, insofar as it ensures a significant reduction in the intervertebral horizontal shear, such as in case of rupture or <B> dl </ B> absence of one or two posterior articular masses.

Réaliser l'implant intervertébral sous la forme d'au moins une prothèse partielle, ou cage intersomatique est avantageux. En effet, de telles cages, du fait leur dimensions peuvent être introduites depuis l'arriere du patient, sorte qu'il peut être fait appel<B>à</B> une unique opération, au cours de laquelle ces cages sont implantées en même temps que l'organe d'amortissement. Achieving the intervertebral implant in the form of at least one partial prosthesis, or interbody cage is advantageous. Indeed, such cages, because of their size can be introduced from the rear of the patient, so that it can be called <B> to </ B> a single operation, during which these cages are implanted in same time as the damping organ.

Prévoir une unique cage, associée<B>à</B> un unique organe <B>d'</B>amortissement extra-discal, tous deux décalés<B>d'</B>un même côté de l'axe principal de la chaîne vertébrale, permet de remédier <B>à</B> des effondrements asymétriques de l'espace intervertébral, vu de derrière. De tels effondrements asymétriques peuvent également être palliés en faisant appel<B>à</B> deux cages interso- matiques de hauteurs différentes, disposées de part et autre de l'axe principal de la chaîne vertébrale.Provide a single cage, associated <B> with </ B> a single body <B> of extra-discard damping, both offset <B> from </ B> on the same side of the axis principal of the vertebral chain, makes it possible to remedy <B> asymmetric collapses of the intervertebral space, seen from behind. Such asymmetric collapses can also be overcome by using two interseiling cages of different heights arranged on either side of the main axis of the vertebral chain.

Claims (1)

<U>REVENDICATIONS</U> <B>1.</B> Dispositif de stabilisation intervertébral destiné<B>à</B> relier deux vertèbres voisines (2, 21<B>) ,</B> caractérisé en ce qu'il comprend un implant<B>(18 ; 68 ; 118 ; 168 ; 218 ; 268)</B> destiné<B>à</B> être inséré au moins partiellement entre les corps vertebraux (4, 4' des deux vertèbres voisines, ledit implant <B>(18 - 68 ; 118 168 ; 218 ; 268)</B> étant apte<B>à</B> conférer auxdits deux corps vertébraux voisins (4, 41) au moins un degre de liberté mutuel, ledit dispositif comprenant également au moins un organe extra-discal (20), disposé<B>à</B> l'arrière de l'espace intervertébral (12), propre<B>à</B> amortir un déplacement entre lesdites vertèbres (2, 21 au moins dans le sens de la flexion intervertébrale. 2. Dispositif selon la revendication<B>1,</B> caractérisé en ce ledit implant<B>(18 ; 68)</B> est apte<B>à</B> conférer aux deux corps vertébraux (4, 4') au moins un degré de liberté en rotation, autour d'un pivot fixe<B>(28 ; 78)</B> dudit implant. <B>3.</B> Dispositif selon la revendication 2 caractérisé en ce qu'il est prévu des moyens supplémentaires d'amortissement <B>(30)</B> au moins dans le sens de la flexion intervertébrale, disposés vers la partie antérieure dudit implant<B>(18 ; 68).</B> 4. Dispositif selon la revendication<B>1</B> caractérisé en ce que ledit implant<B>(118)</B> est apte<B>à</B> conférer aux deux corps vertébraux (4, 4') au moins un degré de liberté en rotation, autour d'un pivot mobile<B>(128 ; 228)</B> dudit implant. <B>5.</B> Dispositif selon la revendication<B>1</B> caractérisé en ce que ledit implant<B>(168)</B> comprend une âme elastique <B>(178),</B> notamment réalisée en un polymère de silicone ou un élastomè re, partiellement recouverte par un enrobage (174,<B>176)</B> réalisé en un matériau rigide. <B>6.</B> Dispositif selon l'une quelconque revendications précédentes, caractérisé en ce qu'il est prevu deux organes d'amortissement extra-discaux <B>(20A,</B> 20B) disposés de part et d'autre d'un axe principal<B>(A)</B> de la chaîne vertébrale. <B>7.</B> Dispositif selon la revendication<B>6</B> caractérisé en ce qu'il est prévu en outre des moyens de solidarisation <B>(272)</B> des organes d'amortissement<B>(20A,</B> 20B) entre eux, au moins selon une direction verticale. <B>.</B> Dispositif selon l'une des revendications précedentes, caractérisé en ce que ledit implant comprend au moins une prothese partielle<B>(268, 268' )</B> de disque, ou cage intersomati- que. Dispositif selon la revendication<B>8,</B> caracterisé en ce ledit implant intervertébral comprend une unique cage intersomatique <B>(268) ,</B> associée<B>à</B> un unique organe<B>(20A)</B> d'amortissement extra-discal, tous deux étant décalés d'un même côté par rapport<B>à</B> l'axe principal<B>(A)</B> de chaîne vertebrale. <B>10.</B> Dispositif selon la revendication<B>9,</B> caracterisé en ce ledit implant intervertébral comprend deux cages inter- somatiques <B>(268, 268' )</B> disposées de part et<B>d'</B>autre dudit axe principal<B>(A) ,</B> ainsi que deux organes<B>(20A,</B> 20B) d'amortisse ment extra-discaux, disposés de part et d'autre dudit axe<B>(A) .</B><U> CLAIMS </ U> <B> 1. </ B> Intervertebral stabilization device for connecting two neighboring vertebrae (2, 21 <B>), </ B>, characterized in that it comprises an implant <B> (18; 68; 118; 168; 218; 268) </ B> intended to be inserted at least partially between the vertebral bodies (4, 4 ') and two adjacent vertebrae, said implant <B> (18 - 68; 118 168; 218; 268) </ B> being adapted <B> to </ B> to give said two neighboring vertebral bodies (4, 41) at least one degree of mutual freedom, said device also comprising at least one extra-discal organ (20), arranged <B> to </ B> the rear of the intervertebral space (12), clean <B> to </ B> cushion a displacement between said vertebrae (2, 21 at least in the direction of intervertebral flexion) 2. Device according to claim 1, characterized in that said implant <B> (18; 68) </ B > is suitable for conferring on the two vertebral bodies (4, 4 ') at least one rotational degree of freedom around a fixed pivot <B> (28; 78) </ B> of said implant. <B> 3. </ B> Device according to claim 2 characterized in that there is provided additional damping means <B> (30) </ B> at least in the direction of the intervertebral flexion, arranged towards the anterior portion of said <B> implant (18; 68). 4. The device of claim 1, wherein said <B> implant (118) is suitable. <B> to </ B> impart to the two vertebral bodies (4, 4 ') at least one rotational degree of freedom, about a movable pivot <B> (128; 228) </ B> of said implant. <B> 5. </ B> The device of claim 1, characterized in that said <B> implant (168) includes an elastic core (178), </ b> B> in particular made of a silicone polymer or an elastomer, partially covered by a coating (174, <B> 176) </ B> made of a rigid material. <B> 6. </ B> Device according to any preceding claim, characterized in that there are provided two extra-discarding damping members <B> (20A, </ B> 20B) arranged on both sides. else of a main axis <B> (A) </ B> of the vertebral chain. <B> 7. </ B> Device according to claim <B> 6 </ B> characterized in that it is further provided means for fastening <B> (272) </ B> damping members <B> (20A, </ B> 20B) between them, at least in a vertical direction. <B>. </ B> Device according to one of the preceding claims, characterized in that said implant comprises at least one partial prosthesis <B> (268, 268 ') </ B> of disk, or intersomatic cage . Device according to claim 8, characterized in that said intervertebral implant comprises a single interbody cage <B> (268), associated <B> with </ B> a single organ <B> (20A) </ B> extra-discal damping, both being offset on the same side with respect to <B> at </ B> the main axis <B> (A) </ B> of vertebral chain . <B> 10. </ B> The device according to claim 9, wherein said intervertebral implant comprises two interstitial cages <B> (268, 268 ') </ B> arranged from and <B> of </ B> other said main axis <B> (A), </ B> as well as two organs <B> (20A, </ B> 20B) damping extra-disc, arranged on both sides of the <B> (A) axis. </ B>
FR9915160A 1999-12-01 1999-12-01 INTERVERTEBRAL STABILIZATION DEVICE Expired - Fee Related FR2801782B3 (en)

Priority Applications (11)

Application Number Priority Date Filing Date Title
FR9915160A FR2801782B3 (en) 1999-12-01 1999-12-01 INTERVERTEBRAL STABILIZATION DEVICE
PCT/FR2000/003368 WO2001039678A1 (en) 1999-12-01 2000-12-01 Intervertebral stabilising device
AU21824/01A AU778410B2 (en) 1999-12-01 2000-12-01 Intervertebral stabilising device
AT00985390T ATE336952T1 (en) 1999-12-01 2000-12-01 DEVICE FOR INTERVERBEL STABILIZATION
US10/148,693 US7291150B2 (en) 1999-12-01 2000-12-01 Intervertebral stabilising device
JP2001541414A JP4294901B2 (en) 1999-12-01 2000-12-01 Intervertebral stabilizer
DE60030313T DE60030313T2 (en) 1999-12-01 2000-12-01 DEVICE FOR INTERMEDIATE STABILIZATION
EP00985390A EP1233711B1 (en) 1999-12-01 2000-12-01 Intervertebral stabilising device
ES00985390T ES2270888T3 (en) 1999-12-01 2000-12-01 INTERVERTEBRAL STABILIZATION DEVICE.
CA002392868A CA2392868C (en) 1999-12-01 2000-12-01 Intervertebral stabilising device
US11/982,761 US8172880B2 (en) 1999-12-01 2007-11-05 Intervertebral stabilising device

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