FR2900814A1 - Intervertebral cage implantation instrument for use by practitioner, has pusher that translates cage, and unit that guides cage during its displacement and with sleeve having inner section determined so that elementary cages are translated - Google Patents
Intervertebral cage implantation instrument for use by practitioner, has pusher that translates cage, and unit that guides cage during its displacement and with sleeve having inner section determined so that elementary cages are translated Download PDFInfo
- Publication number
- FR2900814A1 FR2900814A1 FR0604268A FR0604268A FR2900814A1 FR 2900814 A1 FR2900814 A1 FR 2900814A1 FR 0604268 A FR0604268 A FR 0604268A FR 0604268 A FR0604268 A FR 0604268A FR 2900814 A1 FR2900814 A1 FR 2900814A1
- Authority
- FR
- France
- Prior art keywords
- cage
- elementary
- sleeve
- curved
- cages
- 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
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Classifications
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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
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4603—Special 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
- A61F2/4611—Special 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
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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
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2/4455—Joints 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
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- 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
- A61F2/02—Prostheses implantable into the body
- A61F2/022—Artificial gland structures using bioreactors
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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
- A61F2/28—Bones
- A61F2002/2835—Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
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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
- A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
- A61F2002/3006—Properties of materials and coating materials
- A61F2002/30092—Properties of materials and coating materials using shape memory or superelastic materials, e.g. nitinol
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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
- 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
- A61F2002/30108—Shapes
- A61F2002/3011—Cross-sections or two-dimensional shapes
- A61F2002/30112—Rounded shapes, e.g. with rounded corners
- A61F2002/30133—Rounded shapes, e.g. with rounded corners kidney-shaped or bean-shaped
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- 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
- A61F2/02—Prostheses implantable into the body
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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
- A61F2/02—Prostheses implantable into the body
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- A—HUMAN NECESSITIES
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- 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
- A61F2002/30316—The 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
- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
- A61F2002/30378—Spherically-shaped protrusion and recess
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- 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
- A61F2/02—Prostheses implantable into the body
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- A61F2002/30316—The 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
- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30383—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
- A61F2002/3039—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove with possibility of relative movement of the rib within the groove
- A61F2002/30392—Rotation
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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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- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30462—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements retained or tied with a rope, string, thread, wire or cable
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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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- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
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- A61F2002/30537—Special structural features of bone or joint prostheses not otherwise provided for adjustable
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- A61F2002/4485—Joints for the spine, e.g. vertebrae, spinal discs comprising multiple adjacent spinal implants within the same intervertebral space or within the same vertebra, e.g. comprising two adjacent spinal implants comprising three or more adjacent spinal implants
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- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
- A61F2002/4625—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use
- A61F2002/4627—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
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- 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
- A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2210/0014—Particular 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
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- 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
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- A—HUMAN NECESSITIES
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- 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
- A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
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- 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
- A61F2220/0075—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements sutured, ligatured or stitched, retained or tied with a rope, string, thread, wire or cable
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- 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
- A61F2220/0091—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements connected by a hinged linkage mechanism, e.g. of the single-bar or multi-bar linkage type
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- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0004—Rounded shapes, e.g. with rounded corners
- A61F2230/0015—Kidney-shaped, e.g. bean-shaped
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- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0017—Angular shapes
- A61F2230/0019—Angular shapes rectangular
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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
- 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
- A61F2230/0069—Three-dimensional shapes cylindrical
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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
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0004—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
- A61F2250/0006—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting angular orientation
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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
- 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
- A61F2310/00017—Iron- or Fe-based alloys, e.g. stainless steel
Landscapes
- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Transplantation (AREA)
- Neurology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Cardiology (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Physical Education & Sports Medicine (AREA)
- Prostheses (AREA)
Abstract
Description
CAGE INTERSOMATIQUE APTE A ETRE INTERCALEE ENTRE DEUX VERTEBRESINTERSOMATIC CAGE THAT CAN BE INTERCALE BETWEEN TWO VERTEBRATES
CONSECUTIVES ET INSTRUMENT POUR IMPLANTER UNETELLE CAGE INTERSOMATIQUE ENTRE DEUX VERTEBRES CONSECUTIVES La présente invention concerne les cages intersomatiques aptes à être intercalées entre deux vertèbres consécutives, ainsi que les instruments permettant d'implanter ces cages. Il est connu que, selon les traumatismes subis par une colonne vertébrale, les Praticiens sont amenés à effectuer deux sortes d'intervention chirurgicale. The present invention relates to intersomatic cages capable of being interposed between two consecutive vertebrae, as well as the instruments making it possible to implant these cages. SUMMARY OF THE INVENTION It is known that, according to the trauma suffered by a spine, Practitioners are led to perform two kinds of surgery.
Quand le traumatisme ne concerne qu'un disque intervertébral et que les deux vertèbres consécutives encadrant ce disque sont en bon état, le Praticien peut opter pour le remplacement du disque par une prothèse dont la fonctionnalité est sensiblement équivalente à celle du disque originel, c'est-à-dire laissant aux deux vertèbres la possibilité de se déplacer l'une par rapport à l'autre dans des mouvements de rotation etlou de translation. En revanche, quand le traumatisme est plus important, le Praticien peut choisir de solidariser les deux vertèbres consécutives par ostéosynthèse. Pour ce faire, le disque intervertébral est partiellement ou en totalité détruit et remplacé par une cage intervertébrale associée généralement à un élément favorisant l'ostéosynthèse, par exemple un greffon osseux. II existe actuellement deux types de cages intersomatiques qui permettent de réaliser ces interventions, avec, pour chaque type, une gamme de produits relativement importante de façon à pouvoir apporter la solution la plus adaptée au cas de chaque patient, ce qui nécessite un stock de produits important. On conçoit donc que le coût de revient de ces cages intersomatiques soit relativement élevé. De plus, ces cages intersomatiques sont implantables essentiellement par deux voies, l'une dite "antérieure", l'autre dite "postérieure", chacune de ces voies ayant ses avantages et ses inconvénients. When the trauma concerns only an intervertebral disc and the two consecutive vertebrae surrounding this disc are in good condition, the Practitioner can opt for the replacement of the disc by a prosthesis whose functionality is substantially equivalent to that of the original disc, it that is to say, leaving the two vertebrae the possibility of moving relative to each other in rotational and / or translational movements. On the other hand, when the trauma is more important, the Practitioner can choose to join the two consecutive vertebrae together by osteosynthesis. To do this, the intervertebral disk is partially or completely destroyed and replaced by an intervertebral cage generally associated with an osteosynthesis promoting element, for example a bone graft. There are currently two types of intersomatic cages that make it possible to perform these interventions, with, for each type, a relatively large product range so as to be able to provide the most appropriate solution to the case of each patient, which requires a stock of products. important. It is therefore conceivable that the cost price of these intersomatic cages is relatively high. In addition, these intersomatic cages are essentially implantable by two ways, one called "anterior", the other called "posterior", each of these routes having its advantages and disadvantages.
Il semblerait cependant évident que l'implantation par la voie postérieure soit la plus normale car le chemin utilisé par le Praticien pour l'intervention chirurgicale est relativement court. Mais elle est très délicate car ce chemin passe très près d'éléments essentiels pour la vie du patient, à savoir la moelle épinière et les nerfs qui commandent notamment les mouvements du patient. However, it seems obvious that the posterior implantation is the most normal because the path used by the Practitioner for the surgical procedure is relatively short. But it is very delicate because this path passes very close to essential elements for the patient's life, namely the spinal cord and the nerves that control the movements of the patient.
C'est pour cette raison que certains Praticiens optent pour la voie dite "antérieure" qui implique un chemin d'intervention beaucoup plus long, mais en théorie moins dangereux pour le patient. A contrario, le temps d'intervention est plus long que celui par la voie postérieure, ce qui peut présenter un inconvénient pour la santé et la récupération du patient. Aussi, la présente invention a-t-elle pour but de réaliser une cage intersomatique dont la structure permet une implantation par la voie postérieure beaucoup plus facile que celle des cages intersomatiques de l'art antérieur, et donc moins dangereuse pour le patient. It is for this reason that some Practitioners opt for the so-called "anterior" pathway which involves a much longer intervention path, but in theory less dangerous for the patient. Conversely, the intervention time is longer than that by the posterior route, which can be a disadvantage for the health and recovery of the patient. Also, the present invention aims to achieve an interbody cage whose structure allows implantation by the posterior route much easier than that of interbody cages of the prior art, and therefore less dangerous for the patient.
La présente invention a aussi pour but de réaliser un instrument pour implanter une cage intersomatique selon l'invention. Plus précisément, la présente invention a pour objet une cage intersomatique apte à être intercalée entre deux vertèbres consécutives en remplacement d'au moins une partie du disque intervertébral situé entre ces deux 15 vertèbres, caractérisée par le fait qu'elle comporte : • au moins deux cages élémentaires, et • des moyens de pivotement entre les deux dites cages élémentaires de façon que les deux dites cages élémentaires soient aptes à prendre différentes positions angulaires l'une par rapport à l'autre. 20 La présente invention a aussi pour objet un instrument pour implanter, entre deux vertèbres consécutives, une cage intersomatique telle que définie ci-dessus, caractérisé par le fait qu'il comporte : • un poussoir apte à translater ladite cage intersomatique, et • des moyens pour guider ladite cage intersomatique lors de son 25 déplacement en translation. D'autres caractéristiques et avantages de l'invention apparaîtront au cours de la description suivante donnée en regard des dessins annexés à titre illustratif mais nullement limitatif, dans lesquels : La figure 1 représente un schéma permettant de comprendre la fonction de 30 la cage intersomatique selon l'invention, ainsi que la façon dont une telle cage peut être implantée entre deux vertèbres consécutives pour remplacer le disque ou une partie du disque intervertébral, La figure 2 représente, en vue schématique de dessus, un premier mode de réalisation d'une cage intersomatique selon l'invention, La figure 3 représente, en vue schématique de dessus, un deuxième mode de réalisation d'une cage intersomatique selon l'invention, Les figures 4 et 5 représentent, en vue schématique de dessus, un troisième mode de réalisation d'une cage intersomatique selon l'invention, la figure 4 représentant la cage quand elle est prête à être implantée, la figure 5 représentant cette même cage après son implantation entre deux vertèbres, La figure 6 représente, sous une forme schématique, une cage selon le premier mode de réalisation illustré sur la figure 2, en configuration d'implantation et associée à un premier mode de réalisation de l'instrument selon l'invention permettant cette implantation, et La figure 7 représente, sous une forme schématique, une cage ayant une structure sensiblement identique à celle illustrée sur la figure 2 en association avec un second mode de réalisation de l'instrument selon l'invention permettant son implantation entre deux vertèbres. Another object of the present invention is to provide an instrument for implanting an intersomatic cage according to the invention. More specifically, the subject of the present invention is an intersomatic cage capable of being inserted between two consecutive vertebrae in replacement of at least a part of the intervertebral disc situated between these two vertebrae, characterized in that it comprises: • at least two elementary cages, and • pivoting means between the two so-called elementary cages so that the two said elementary cages are able to take different angular positions relative to each other. The present invention also relates to an instrument for implanting, between two consecutive vertebrae, an intersomatic cage as defined above, characterized in that it comprises: a pusher able to translate said intersomatic cage, and means for guiding said intersomatic cage as it moves in translation. Other features and advantages of the invention will become apparent from the following description given with reference to the accompanying drawings for illustrative but not limiting purposes, in which: FIG. 1 represents a diagram making it possible to understand the function of the intervertebral cage according to the invention, as well as how such a cage can be implanted between two consecutive vertebrae to replace the disc or part of the intervertebral disc, Figure 2 shows, in schematic view from above, a first embodiment of a cage 3 shows, in schematic view from above, a second embodiment of an intersomatic cage according to the invention. FIGS. 4 and 5 show, in schematic view from above, a third embodiment of the invention. of an intersomatic cage according to the invention, FIG. 4 showing the cage when it is ready to be implanted, FIG. entering the same cage after its implantation between two vertebrae, FIG. 6 represents, in a schematic form, a cage according to the first embodiment illustrated in FIG. 2, in implantation configuration and associated with a first embodiment of the invention. instrument according to the invention allowing this implantation, and Figure 7 shows, in a schematic form, a cage having a substantially identical structure to that illustrated in Figure 2 in combination with a second embodiment of the instrument according to the invention. invention allowing its implantation between two vertebrae.
Il est tout d'abord précisé que, sur les figures, les mêmes références désignent les mêmes éléments, quelle que soit la figure sur laquelle elles apparaissent et quelle que soit la forme de représentation de ces éléments. De même, si des éléments ne sont pas spécifiquement référencés sur l'une des figures, leurs références peuvent être aisément retrouvées en se reportant à une autre figure. Il est aussi précisé que les figures représentent plusieurs modes de réalisation de l'objet selon l'invention, mais qu'il peut exister d'autres modes de réalisation qui répondent à la définition de cette invention. II est en outre précisé que, lorsque, selon la définition de l'invention, l'objet de l'invention comporte "au moins un" élément ayant une fonction donnée, le mode de réalisation décrit peut comporter plusieurs de ces éléments. Réciproquement, si le mode de réalisation de l'objet selon l'invention tel qu'illustré comporte plusieurs éléments de fonction identique et si, dans la description, il n'est pas spécifié que l'objet selon cette invention doit obligatoirement comporter un nombre particulier de ces éléments, l'objet de l'invention pourra être défini comme comportant "au moins un" de ces éléments. II est enfin précisé que lorsque, dans la présente description, une expression définit à elle seule, sans mention particulière spécifique la concernant, un ensemble de caractéristiques structurelles, ces caractéristiques peuvent être prises, pour la définition de l'objet de la protection demandée, quand cela est techniquement possible, soit séparément, soit en combinaison totale et/ou partielle. II est tout d'abord fait référence à la figure 1 qui représente schématiquement une vertèbre Vt, ainsi que la moelle épinière Moe et deux nerfs N1 et N2 commandant par exemple des mouvements des membres inférieurs du patient sur lequel doit être implantée une cage intersomatique Ci selon l'invention. La cage intersomatique Ci est conçue pour être implantée par la voie postérieure, plus particulièrement par la voie dite "postéro-latérale" VP, c'est-à-dire par une voie dont l'entrée est située dans le dos du patient. Pour ce faire, la structure de la cage intersomatique Ci permet tout d'abord de l'introduire entre les deux nerfs N1 et N2 selon une première configuration référencée PCE sur la figure 1, puis en évitant la moelle épinière Moe en passant au ras de celle-ci ou, si besoin, en décalant très légèrement la moelle épinière au moyen d'un ancillaire adapté, et enfin de la positionner dans l'espace intervertébral Eiv entre les deux corps de vertèbres, sous une seconde configuration schématisée en PCI. Pour permettre une telle implantation par la voie postéro-latérale comme défini ci-dessus, la cage intersomatique Ci selon l'invention comprend au mois deux cages élémentaires 11, 12, ... et des moyens de pivotement 14 entre ces deux cages élémentaires 11, 12 de façon qu'elles soient aptes à prendre différentes positions angulaires l'une par rapport à l'autre. La cage intersomatique Ci est introduite dans le corps du patient dans sa configuration PCE (figure 1) dans laquelle les cages élémentaires, 11, 12, ... sont sensiblement alignées sur une droite Di, et dans laquelle elle présente un encombrement latéral au plus égal, et avantageusement inférieur, à la distance Esp séparant les deux nerfs N1 et N2. Lorsque la cage intersomatique Ci a atteint l'espace intervertébral Eiv, elle est déformée et guidée de façon à prendre la configuration courbée PCI (figure 1) tout en venant se positionner dans l'espace intervertébral, cette configuration courbée PCI étant obtenue en faisant pivoter, comme explicité ci-après, les cages élémentaires 11, 12 l'une par rapport à l'autre, ou les cages élémentaires les unes par rapport aux autres si la cage Ci en comporte plus de deux. Il est précisé, au sens de la présente description, que chaque cage élémentaire 11, 12 est constituée d'une pièce définie entre deux faces parallèles ou faisant entre elles un angle non nul de faible valeur, la distance entre ces deux faces étant sensiblement égale à l'épaisseur du disque intervertébral originel, ou de la partie de ce disque à remplacer. Chaque pièce est en outre délimitée par une paroi latérale fermée de différentes formes. C'est ainsi que l'on peut concevoir une paroi latérale en forme dite de "haricot", figure 3, ou constituée de faces planes pour donner à la pièce la forme par exemple d'un parallélépipède rectangle ou analogue. D'autres formes sont possibles pour ces pièces. Chaque cage élémentaire peut en outre comporter tous les éléments qu'une cage normale connue de l'art antérieur peut comprendre, par exemple des crans sur les deux faces parallèles, une ou plusieurs cavités pour recevoir et contenir un ou des greffons osseux, des percées aptes à coopérer avec des outils ou analogues, etc. Ces pièces peuvent être réalisées en différents matériaux, par exemple en titane, en acier inoxydable ou en un matériau biodégradable comme celui connu sous la dénomination PEEK (Polyéther Ether Cétone), ou même en un alliage à mémoire de forme. Par "moyens de pivotement 14" entre ces deux cages élémentaires 11, 12, il est bien compris au sens de la présente description, tous moyens quelle que soit leur forme et leur structure, matérielle ou non, qui permettent aux deux cages élémentaires 11, 12 de pivoter l'une par rapport à l'autre. Selon une réalisation avantageuse, les moyens de pivotement 14 de l'une par rapport à l'autre des deux cages élémentaires 11, 12 sont constitués, figures 2, 6 et 7, par un pivot 16 comportant un palier 17, un arbre de rotation 18 apte à pivoter dans ce palier, et des moyens 19, 20 pour lier, par exemple par solidarisation, le palier 17 et l'arbre 18 respectivement aux deux cages élémentaires 11, 12. Cependant, selon un autre mode de réalisation, il est possible que les moyens de pivotement 14 de l'une par rapport à l'autre des deux cages élémentaires soient constitués, figure 4 et 5, par une rotule 24 comportant deux parties respectivement femelle 25 et mâle 26, la partie mâle 26 étant apte à pivoter dans la partie femelle, et des moyens pour lier la partie mâle et la partie femelle respectivement aux deux cages élémentaires. It is first of all specified that, in the figures, the same references designate the same elements, whatever the figure on which they appear and whatever the form of representation of these elements. Similarly, if elements are not specifically referenced in one of the figures, their references can be easily found by referring to another figure. It is also stated that the figures represent several embodiments of the object according to the invention, but that there may be other embodiments that meet the definition of this invention. It is further specified that, when, according to the definition of the invention, the object of the invention comprises "at least one" element having a given function, the embodiment described may comprise several of these elements. Conversely, if the embodiment of the object according to the invention as illustrated has several elements of identical function and if, in the description, it is not specified that the object according to this invention must obligatorily comprise a number particular of these elements, the object of the invention may be defined as comprising "at least one" of these elements. Lastly, it should be noted that when, in the present description, an expression defines, by itself, without a specific particular mention concerning it, a set of structural characteristics, these characteristics may be taken, for the definition of the object of the protection requested, when technically possible, either separately, or in full and / or partial combination. Reference is first made to FIG. 1, which schematically represents a vertebra Vt, as well as the spinal cord Moe, and two nerves N1 and N2 controlling, for example, movements of the lower limbs of the patient on which an intersomatic cage Ci must be implanted. according to the invention. The intersomatic cage Ci is designed to be implanted by the posterior route, more particularly by the so-called "posterolateral" way VP, that is to say by a path whose entry is located in the back of the patient. To do this, the structure of the intersomatic cage Ci first allows to introduce it between the two nerves N1 and N2 in a first configuration referenced PCE in Figure 1, then avoiding the spinal cord Moe passing through it or, if necessary, by shifting very slightly the spinal cord by means of a suitable ancillary, and finally to position it in the intervertebral space Eiv between the two bodies of vertebrae, in a second configuration schematized in PCI. To allow such implantation by the posterolateral approach as defined above, the interbody cage Ci according to the invention comprises at least two elementary cages 11, 12, and pivoting means 14 between these two elementary cages. , 12 so that they are able to take different angular positions relative to each other. The intersomatic cage Ci is introduced into the body of the patient in its PCE configuration (FIG. 1) in which the elementary cages 11, 12,... Are substantially aligned on a line Di and in which it has a lateral bulk at most equal, and advantageously lower, to the distance Esp separating the two nerves N1 and N2. When the intersomatic cage Ci has reached the intervertebral space Eiv, it is deformed and guided so as to take the curved configuration PCI (FIG. 1) while coming to be positioned in the intervertebral space, this curved configuration PCI being obtained by rotating , as explained below, the elementary cages 11, 12 relative to each other, or the elementary cages with respect to each other if the cage Ci has more than two. It is specified, in the sense of the present description, that each elementary cage 11, 12 consists of a part defined between two parallel faces or forming between them a non-zero angle of small value, the distance between these two faces being substantially equal to the thickness of the original intervertebral disk, or the part of this disk to be replaced. Each piece is further delimited by a closed side wall of different shapes. Thus one can design a shaped side wall called "bean", Figure 3, or made of flat faces to give the piece the shape for example of a rectangular parallelepiped or the like. Other shapes are possible for these pieces. Each elementary cage may further comprise all the elements that a normal cage known from the prior art can comprise, for example notches on the two parallel faces, one or more cavities for receiving and containing one or more bone grafts, breakthroughs able to cooperate with tools or the like, etc. These parts may be made of different materials, for example titanium, stainless steel or a biodegradable material such as that known under the name PEEK (Polyether Ether Ketone), or even a shape memory alloy. By "pivoting means 14" between these two elementary cages 11, 12, it is well understood in the sense of the present description, any means whatever their shape and structure, material or not, which allow the two elementary cages 11, 12 to pivot relative to each other. According to an advantageous embodiment, the pivoting means 14 of one of the two elementary cages 11, 12 are constituted, FIGS. 2, 6 and 7, by a pivot 16 comprising a bearing 17, a rotation shaft 18 adapted to pivot in this bearing, and means 19, 20 for binding, for example by securing, the bearing 17 and the shaft 18 respectively to the two elementary cages 11, 12. However, according to another embodiment, it is possible that the pivoting means 14 of one with respect to the other of the two elementary cages are constituted, FIG. 4 and 5, by a ball joint 24 comprising two female and male portions respectively 26, the male part 26 being able to pivoting in the female part, and means for linking the male part and the female part respectively to the two elementary cages.
Selon une réalisation particulièrement avantageuse, les moyens pour lier la partie mâle 26 et la partie femelle 25 respectivement aux deux cages élémentaires 11, 12 sont constitués par le fait que les deux parties mâle et femelle sont réalisées directement dans une extrémité respectivement de chaque cage élémentaire 11, 12. Bien entendu, selon le cas d'intervention chirurgicale pour remplacer un disque intervertébral ou une partie d'un tel disque, la rotule 24 est constituée par l'une des rotules suivantes : une rotule cylindrique de révolution ou une rotule sphérique. La rotule cylindrique présente l'avantage de pouvoir plus facilement maintenir les deux cages élémentaires dans un même plan, tandis que la rotule sphérique présente l'avantage de pouvoir orienter les deux cages élémentaires l'une par rapport à l'autre dans tout l'espace. En plus, il est préférable que la cage intersomatique Ci comporte en outre des moyens 30 pour commander la rotation des deux cages élémentaires 11, 12 l'une par rapport à l'autre, plutôt que de tenter de les orienter manuellement. De tels moyens 30 sont par exemple constitués, figures 2, 4, 5 et 6 par au moins un lien souple 32, par exemple en un matériau biodégradable comme du fil de suture, de la tresse métallique, un produit comme un ligament constitué par exemple par un fil en polyester ou analogue, etc., des moyens 33 pour fixer une extrémité du lien à l'une des deux cages élémentaires et des moyens 34 pour monter ce lien en translation en au moins un point de l'autre cage élémentaire. De cette façon, si on suppose que les deux cages élémentaires 11, 12, ... sont alignées et que l'on tire sur l'extrémité libre 39 du lien 32 qui est monté coulissant sur l'une 11 des deux cages élémentairesl1, 12, ces dernières s'orientent l'une par rapport à l'autre, par le principe de la triangulation, selon une courbe illustrée sur les figures 5 ou 6, dont la courbure est une fonction de la longueur de lien qui est déplacée par rapport à la cage élémentaire 11. Cependant, il est aussi possible que les moyens 30 pour commander la rotation des deux cages élémentaires 11, 12 l'une par rapport à l'autre soient constitués, figure 3, par une extrémité 36 de l'une 11 des deux cages adoptant une forme convexe, par une extrémité 37 de l'autre cage 12 sensiblement en pan coupé ou analogue, cette extrémité en pan coupé 37 étant apte à venir au contact de l'extrémité convexe 36 lors de la translation des deux cages élémentaires, et par des moyens de butée 56, 57 montés en association avec la cage élémentaire 11 comportant l'extrémité convexe 36. Ces moyens de butée sont constitués par tous moyens qui permettent à la cage élémentaire 11 translatée sous l'action d'une poussée exercée par l'autre cage élémentaire 12, de basculer en rotation comme illustré sur la figure 3. Ces moyens sont constitués par exemple par un ergot 56 venant buter contre un crochet 57 solidaire d'un autre élément qui peut être un ancillaire ou un instrument d'implantation particulier Inst comme celui qui sera décrit plus en détail ci-après. According to a particularly advantageous embodiment, the means for linking the male part 26 and the female part 25 respectively to the two elementary cages 11, 12 are constituted by the fact that the two male and female parts are made directly in one end respectively of each elementary cage 11, 12. Of course, depending on the surgical case to replace an intervertebral disk or a part of such a disc, the ball 24 is constituted by one of the following ball joints: a cylindrical ball of revolution or a spherical ball . The cylindrical ball has the advantage of being able to more easily maintain the two elementary cages in the same plane, while the spherical ball has the advantage of being able to orient the two elementary cages relative to each other in all the space. In addition, it is preferable that the intersomatic cage Ci further comprises means 30 for controlling the rotation of the two elementary cages 11, 12 relative to each other, rather than attempting to direct them manually. Such means 30 are for example constituted, 2, 4, 5 and 6 by at least one flexible link 32, for example a biodegradable material such as suture, the metal braid, a product such as a ligament constituted for example by a polyester thread or the like, etc., means 33 for attaching an end of the link to one of the two elementary cages and means 34 for mounting this link in translation at at least one point of the other elementary cage. In this way, if it is assumed that the two elementary cages 11, 12, ... are aligned and that one pulls on the free end 39 of the link 32 which is slidably mounted on one 11 of the two elementary cagesl1, 12, the latter are oriented relative to each other, by the principle of triangulation, according to a curve shown in Figures 5 or 6, whose curvature is a function of the link length which is displaced by relative to the elementary cage 11. However, it is also possible that the means 30 for controlling the rotation of the two elementary cages 11, 12 relative to each other are constituted, FIG. 3, by an end 36 of the one 11 of the two cages adopting a convex shape, one end 37 of the other cage 12 substantially cutaway or the like, this cutaway end 37 being adapted to come into contact with the convex end 36 during the translation of two elementary cages, and by stop means 56, 57 mounted in association with the elementary cage 11 having the convex end 36. These abutment means are constituted by any means which allow the elementary cage 11 translated under the action of a thrust exerted by the other elementary cage 12, to turn in rotation as shown in Figure 3. These means are constituted for example by a lug 56 abutting against a hook 57 integral with another element which may be an ancillary or a particular implantation instrument Inst like that which will be described in more detail below.
Dans ce mode de réalisation, la cage élémentaire 11 est en forme de "haricot" et la cage 12 en forme de coin ou analogue. Il est possible que cette cage élémentaire 12 soit de très petite longueur selon le chemin VP, tandis que la cage élémentaire 11 ait une longueur très proche de celle qui est souhaitée pour réaliser le remplacement du disque intervertébral. In this embodiment, the elementary cage 11 is in the form of a "bean" and the cage 12 is wedge-shaped or the like. It is possible that this elementary cage 12 is of very short length along the path VP, while the elementary cage 11 has a length very close to that which is desired to achieve the replacement of the intervertebral disc.
Dans ce cas, après que les deux cages élémentaires 11, 12 aient été implantées, il est possible de retirer la cage 12, pour ne laisser en place que la cage 11. Selon ce mode de réalisation, la cage élémentaire 12 est essentiellement utilisée pour réaliser l'implantation de la cage élémentaire 11 qui est, dans cette réalisation, la cage élémentaire essentielle. In this case, after the two elementary cages 11, 12 have been implanted, it is possible to remove the cage 12, leaving only the cage 11 in place. According to this embodiment, the elementary cage 12 is essentially used to implement the implantation of the elementary cage 11 which is, in this embodiment, the essential elementary cage.
Comme présenté au préambule de la présente description, la présente invention a aussi pour objet un instrument Inst pour implanter, entre deux vertèbres consécutives, une cage intersomatique Ci. Cet instrument est décrit ci-après pour l'implantation d'une cage intersomatique selon au moins un mode de réalisation décrit ci-dessus, bien qu'il puisse être aussi utilisé pour l'implantation de toute autre cage intersomatique de l'art antérieur. L'instrument selon l'invention comporte essentiellement, figures 3, 6 et 7, un poussoir 40 apte à translater, en la poussant, la cage intersomatique Ci, et des moyens 43 pour guider cette cage intersomatique Ci lors de son déplacement en translation comme il sera décrit ci-après. Selon une réalisation préférentielle, les moyens 43 pour guider la cage intersomatique lors de son déplacement en translation sont constitués par un manchon 50 dont la section intérieure est déterminée de façon que, sous l'action de la poussée exercée sur la cage à l'aide du poussoir, les deux cages élémentaires 11, 12 puissent s'y translater en étant alignées selon la droite Di, comme celles, au nombre de quatre, illustrées en traits continus sur la figure 7. Cependant, dans une réalisation perfectionnée par rapport à celle décrite ci-dessus, les moyens 43 pour guider la cage intersomatique Ci lors de son déplacement en translation comportent en outre au moins une première lame élastique 60 comportant une extrémité préformée courbée 61 de forme concave, et des moyens 62 pour commander le passage de cette première lame 60 entre deux positions, l'une dite "rentrée" Pm, l'autre dite "sortie" Psi, la position rentrée Prs étant celle dans laquelle toute l'extrémité préformée courbée concave 61 est située à l'intérieur du manchon 50, la position sortie Psi étant celle dans laquelle l'extrémité préformée courbée concave 61 est située en dehors du manchon. De cette façon, quand l'extrémité préformée courbée concave 61 de la première lame 60 est en position sortie Psi, la cage intersomatique Ci constituée d'une pluralité de cages élémentaires 11, 12, ... montées pivotantes les unes par rapport aux autres, lorsqu'elles sont poussées à l'aide du poussoir 40, suivent la courbure de la lame et prennent une position courbe comme représenté en traits interrompus sur la figure 7, et ainsi occuper au mieux tout l'espace intervertébral Eiv (figure 1). Cependant, dans un souci de sécurité pour la mise en place de la cage intersomatique, ces moyens 43 pour guider la cage intersomatique Ci lors de son déplacement en translation comportent en outre une seconde lame élastique 70 comportant une extrémité préformée courbée 71 de forme convexe, et des moyens 72 pour commander le passage de cette seconde lame 70 entre deux positions, l'une dite "rentrée" Pr2, l'autre dite "sortie" Ps2, la position rentrée Pr2 étant celle dans laquelle toute l'extrémité préformée courbée convexe 71 est située à l'intérieur du manchon 50, la position sortie Ps2 étant celle dans laquelle toute l'extrémité préformée courbée convexe est située en dehors du manchon. De plus, il est avantageux que les moyens 62, 72 pour commander le passage de la première lame concave 60 et de la seconde lame convexe 70, toutes les deux entre les deux positions, sont agencés de façon que les deux lames 60, 70 soient sensiblement parallèles dans toutes leurs positions et se translatent en synchronisme, et que, lorsqu'elles sont toutes les deux dans leur position sortie Psi, Pst, leurs extrémités courbées forment un canal courbe 80 dans lequel peuvent se translater les cages élémentaires 11, 12 en se positionnant angulairement l'une par rapport à l'autre selon une valeur angulaire déterminée. Ces moyens 62, 72 ont été représentés schématiquement par deux flèches, étant entendu que leur réalisation et/ou leur mise en oeuvre ne poseront aucune difficulté à un homme du métier, en soulignant qu'ils peuvent même être manuels. Selon une forme de réalisation avantageuse, au moins l'une des deux lames 60, 70, sinon de façon préférentielle les deux, peuvent être réalisées en un alliage à mémoire de forme pour leur donner automatiquement la forme voulue quand elles sont en position sortie. Il en est avantageusement de même pour le manchon 50 pour qu'il puisse automatiquement se courber lorsqu'il est implanté et ainsi favoriser la mise de la cage intersomatique Ci. Pour l'implantation de la cage Ci à l'aide de l'instrument Inst selon le mode de réalisation décrit ci-dessus, il est facile de comprendre que le manchon 50 avec les deux lames 60, 70 en position rentrée Pri, Pr2 est introduit par la voie postérieure suivant la droite Di entre les deux nerfs N1 et N2 et en passant au ras de la moelle épinière Moe, de façon que son extrémité de sortie 51 se trouve sensiblement au niveau de l'espace intervertébral Eiv. Puis, le Praticien commande la sortie des deux lames pour qu'elles prennent leur position de sortie respective Psi et Pst et forment le canal courbe 80 dans l'espace intervertébral Eiv, ce qui permet en outre d'exercer un effort de distraction entre les deux vertèbres définissant cet espace Eiv. Ensuite, la cage intersomatique Ci formée de la pluralité de cages élémentaires 11, 12, ... en configuration sensiblement rectiligne PCE est introduite dans le manchon 50 par son extrémité opposée à l'extrémité 51 définie ci-avant, puis poussée avec le poussoir 40. Elle émerge du manchon et entre dans le canal courbe 80 formé par les extrémités courbées 61, 71 des deux lames 60, 70. De cette façon, le Praticien est certain que la cage intersomatique Ci selon l'invention prend la forme voulue puisque elle est définie par celle du canal 80. Ensuite, les deux lames sont rentrées dans le manchon, tout en laissant en place la cage Ci. Cette cage Ci a alors la même fonction que les cages intersomatiques de l'art antérieur. Elle présente cependant plusieurs avantages par rapport à ces cages de l'art antérieur. En premier lieu, le chemin VP suivi pour son implantation est encore plus court que celui utilisé pour l'implantation par voie postérieure des cages de l'art antérieur car, pour les raisons exposées dans le préambule de la présente description, ces dernières sont implantées en passant en biais, bien en dehors de l'espace occupé par les épines dorsales des vertèbres. De plus, l'utilisation du manchon 50 évite que, lors de son introduction, la 5 cage Ci selon l'invention, qui comporte toujours notamment des arêtes vives n'endommage des éléments comme les nerfs N1, N2, la moelle épinière Moe, etc. As presented in the preamble of the present description, the present invention also relates to an instrument Inst for implanting, between two consecutive vertebrae, an intersomatic cage Ci. This instrument is described below for the implantation of an intervertebral cage according to least one embodiment described above, although it can also be used for the implantation of any other intersomatic cage of the prior art. The instrument according to the invention essentially comprises, FIGS. 3, 6 and 7, a pusher 40 adapted to translate, by pushing it, the intersomatic cage Ci, and means 43 for guiding this intersomatic cage Ci during its displacement in translation as it will be described below. According to a preferred embodiment, the means 43 for guiding the intervertebral cage during its displacement in translation are constituted by a sleeve 50 whose inner section is determined so that, under the action of the thrust exerted on the cage using the pusher, the two elementary cages 11, 12 can translate there being aligned along the line Di, like those, four in number, shown in continuous lines in Figure 7. However, in an improved embodiment compared to that described above, the means 43 for guiding the intersomatic cage Ci during its displacement in translation further comprise at least one first elastic blade 60 having a curved preformed end 61 of concave shape, and means 62 for controlling the passage of this first blade 60 between two positions, one said "return" Pm, the other so-called "output" Psi, the retracted position Prs being the one in which all the e concave curved preformed end 61 is located inside the sleeve 50, the output position Psi being that in which the curved concave preformed end 61 is located outside the sleeve. In this way, when the curved concave preformed end 61 of the first blade 60 is in the output position Psi, the intersomatic cage Ci consists of a plurality of elementary cages 11, 12, ... pivotally mounted relative to each other when they are pushed using the pusher 40, follow the curvature of the blade and take a curved position as shown in dashed lines in FIG. 7, and thus occupy at best all the intervertebral space Eiv (FIG. 1) . However, for the sake of safety for the placement of the intervertebral cage, these means 43 for guiding the intersomatic cage Ci during its displacement in translation further comprise a second elastic blade 70 having a curved preformed end 71 of convex shape, and means 72 for controlling the passage of this second blade 70 between two positions, one said "retracted" Pr2, the other so-called "exit" Ps2, the retracted position Pr2 being that in which the entire curved convex preformed end 71 is located inside the sleeve 50, the outlet position Ps2 being the one in which the entire curved convex curved end is located outside the sleeve. In addition, it is advantageous that the means 62, 72 for controlling the passage of the first concave blade 60 and the second convex blade 70, both between the two positions, are arranged so that the two blades 60, 70 are substantially parallel in all their positions and are translated in synchronism, and that, when they are both in their output position Psi, Pst, their curved ends form a curved channel 80 in which can translate the elementary cages 11, 12 in angularly positioned relative to each other according to a determined angular value. These means 62, 72 have been schematically represented by two arrows, it being understood that their realization and / or their implementation will not pose any difficulty to a person skilled in the art, by emphasizing that they may even be manual. According to an advantageous embodiment, at least one of the two blades 60, 70, if not preferably both, may be made of a shape memory alloy to automatically give them the desired shape when they are in the extended position. It is advantageously the same for the sleeve 50 so that it can automatically bend when it is implanted and thus promote the placing of the interbody cage Ci. For the implantation of the cage Ci using the instrument Inst according to the embodiment described above, it is easy to understand that the sleeve 50 with the two blades 60, 70 in the retracted position Pri, Pr2 is introduced by the posterior path along the line Di between the two nerves N1 and N2 and passing flush with the spinal cord Moe, so that its outlet end 51 is substantially at the intervertebral space Eiv. Then, the Practitioner controls the output of the two blades so that they take their respective output position Psi and Pst and form the curved channel 80 in the intervertebral space Eiv, which also allows to exert a distraction effort between the two vertebrae defining this space Eiv. Then, the intersomatic cage Ci formed of the plurality of elementary cages 11, 12, ... in a substantially rectilinear configuration PCE is introduced into the sleeve 50 at its end opposite the end 51 defined above, then pushed with the pusher 40. It emerges from the sleeve and enters the curved channel 80 formed by the curved ends 61, 71 of the two blades 60, 70. In this way, the practitioner is certain that the interbody cage Ci according to the invention takes the desired shape since it is defined by that of the channel 80. Then, the two blades are retracted into the sleeve, while leaving in place the cage Ci. This cage Ci then has the same function as the interbody cages of the prior art. However, it has several advantages over these cages of the prior art. Firstly, the path VP followed for its implantation is even shorter than that used for the posterior implantation of the cages of the prior art because, for the reasons explained in the preamble of the present description, the latter are implanted. passing at an angle, well outside the space occupied by the dorsal spines of the vertebrae. In addition, the use of the sleeve 50 prevents, when it is inserted, the cage Ci according to the invention, which always comprises in particular sharp edges, damage to elements such as the nerves N1, N2, the spinal cord Moe, etc.
Claims (6)
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FR0604268A FR2900814B1 (en) | 2006-05-15 | 2006-05-15 | INTERSOMATIC CAGE MAY BE INTERCALE BETWEEN TWO CONSECUTIVE VERTEBRA, AND INSTRUMENT FOR IMPLANTING SUCH AN INTERSOMATIC CAGE BETWEEN TWO CONSECUTIVE VERTEBERS |
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Also Published As
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