FR3003158A1 - INTERVERTEBRAL FUSION IMPLANT AND SURGICAL INSTRUMENT FOR THE PLACEMENT OF THIS IMPLANT - Google Patents

Abstract

The invention relates to a flattened bean-shaped intervertebral fusion implant (1) having, at one end, a housing for accommodating a surgical instrument fixation system (100), according to the invention. host has a form of bayonet socket, with a main well receiving a journal of said fastening system and at least one groove which forms a cam path formed in recess in the lateral face of the main well for the passage a lateral stud of said fastening system. The invention also relates to a surgical instrument for implant placement, comprising a handle (140) extended by a rod (130) and a gripping head (120) which carries a bayonet fastening system, with a trunnion and a side pin manoeuvrable at the handle.

Description

TECHNICAL FIELD TO WHICH THE INVENTION RELATES The present invention relates generally to the field of intervertebral fusion. It relates more particularly to an intervertebral fusion implant having a housing for receiving a system for fixing a surgical instrument. The invention finds a particularly advantageous application in the realization of transformational lumbar intervertebral fusion implants (better known as TLIF implants for "Transforaminal Lumbar Interbody Fusion"). It also relates to a surgical instrument for placing an intervertebral fusion implant between two vertebrae of a patient, comprising a handle extended by a rod and a gripping head of said intervertebral fusion implant. It also relates to an assembly comprising an intervertebral fusion implant and a surgical instrument as mentioned above. BACKGROUND ART An intervertebral fusion implant is intended to block two vertebrae relative to one another and to promote bone fusion between these two vertebrae. The insertion technique of such an implant consists of making an incision in the back of a patient, to release an access to the space between the two vertebrae, to remove the disk which interposes naturally between these two vertebrae, then insert the implant in place of the disc. To do this, it is necessary to circumvent the articular elements of the patient's column. The path of engagement of the implant between the two vertebrae consists of a rectilinear part to reach the space between the two vertebrae, and a curved part to bypass the articular elements of the vertebral column. Document FR2977474 discloses an intervertebral fusion implant and a surgical instrument as mentioned above. In this document, the gripping head of the surgical instrument is rotatably mounted in the rod and opens out of it by a threaded portion. A wheel provided in the handle then makes it possible to rotate the gripping head in the rod. In correspondence, the receiving housing of the intervertebral fusion implant houses a threaded socket, in which can be screwed the gripping head of the surgical instrument. This sleeve is rotatably mounted in the receiving housing, between a first stable position used to make the implant traverse the rectilinear part of its engagement trajectory, and a second stable position used to make the implant traverse the part curve of its engagement trajectory. The major disadvantage of this vertebral fusion implant is that its separation from the surgical instrument, which requires unscrewing the gripping head, is in practice tedious to implement. OBJECT OF THE INVENTION In order to overcome the above-mentioned drawback of the state of the art, the present invention proposes a novel means for fixing the intervertebral fusion implant to the surgical instrument. More particularly, it is proposed according to the invention an intervertebral fusion implant as defined in the introduction, wherein said receiving housing is in the form of a bayonet socket, with a main well receiving a trunnion of said system. and at least one groove which forms a cam track recessed in the side face of the main well for the passage of a lateral stud of said fastening system. Thus, thanks to the invention, it is possible to connect and disconnect the surgical instrument of the intervertebral fusion implant, by operating the fixing system so that it operates a simple quarter-turn. Preferably, the lateral face of the intervertebral fusion implant has two recessed notches, located on either side of said housing, to accommodate teeth of said surgical instrument. Advantageously, these two notches have different shapes and / or sizes. This difference in shapes and / or sizes between the notches allows them to provide a keying function. In this way, the intervertebral fusion implant can be fixed to the surgical instrument in a single position. So, when the surgical instrument is intended to allow the implant to rotate according to the curved portion of its engagement path, it is ensured that the implant is correctly oriented to rotate in the desired direction. Advantageously, the intervertebral fusion implant has two flattened main faces and a graft housing that opens on each of the two main faces. The invention also provides a surgical instrument as defined in the introduction, wherein said gripping head carries a bayonet fixing system of said intervertebral fusion implant, which comprises a journal rotatably mounted relative to said gripping head, and a lateral stud protruding from said journal, and wherein said handle comprises a first operating means accessible to the surgeon for pivoting said journal relative to said gripping head. Other advantageous and non-limiting characteristics of the surgical instrument in accordance with the invention are the following: said gripping head comprises two teeth situated on either side of said fastening system and adapted to engage in two notches provided in said intervertebral fusion implant; said first actuating means comprises a wheel which is rotatably mounted on a frame of the handle and which is connected to said journal via a first rod housed in said rod; a hinge is provided between the said rod and the said pivoting pin gripping head orthogonal to the longitudinal axis of the said rod, and on the other hand, the said handle comprises a second means of maneuver accessible to the surgeon for pivoting purposes; said gripping head with respect to said rod; - said wheel is connected to said trunnion via a cardan connected, on one side, to said first rod, and, on the other, said trunnion; said second actuating means comprises a lever which is mounted to pivot on a frame of the handle and which is connected to said gripping head via a second rod which is housed in said rod and which is connected to said gripping head by a link; - The handle comprises a frame and an indicator mounted to rotate on the frame, whose orientation relative to the longitudinal axis of said rod is identical to the orientation of said gripping head relative to the longitudinal axis of said rod; and there are provided means for locking said second operating means in a fixed position. DETAILED DESCRIPTION OF AN EXEMPLARY EMBODIMENT The following description with reference to the accompanying drawings, given as non-limiting examples, will make it clear what the invention consists of and how it can be achieved. In the accompanying drawings: - Figure 1 is a schematic perspective view of an intervertebral fusion implant mounted on the gripping head of a surgical instrument; - Figure 2 is a view similar to that of Figure 1, wherein the gripping head is in the tilted position; - Figure 3 is a sectional view along the plane A-A of Figure 1; FIG. 4 is a schematic perspective view of the intervertebral fusion implant of FIG. 1; - Figure 5 is a sectional view along the plane B-B of Figure 4; FIG. 6 is a detailed view of the zone VI of FIG. 3; - Figure 7 is a view similar to that of Figure 6, wherein the locking means of the surgical instrument are unlocked; FIG. 8 is a sectional view of the end of the surgical instrument of FIG. 1; FIG. 9 is a schematic perspective view of the end of the surgical instrument of FIG. 1; - Figure 10 is a partial sectional view of the handle of the surgical instrument of Figure 1; and FIG. 11 is a sectional view along the plane CC of FIG. 7. FIGS. 1 and 2 show an intervertebral fusion implant (denoted infra "implant 1") mounted at the end of a surgical instrument 100. This surgical instrument 100 is designed to allow positioning the implant 1 between two vertebrae of a patient. It comprises for this purpose a handle 140 which is extended by a rod 130 itself extended by a gripping head 120 at which the implant 1 is fixed. The handle 140 comprises a frame 141 which forms a handle that is easily manipulated by the surgeon, behind which is provided a plug 143 screwed on the frame 141. This plug 143 has on the rear face a striking zone on which the surgeon can hit with a weight to facilitate insertion implant 1 between the two vertebrae.

In the rest of the description, the terms "before" and "back" will be used relative to the back of the patient. The front of an element will designate the side of this element that is turned towards the patient's vertebrae and the back will point to the side of that element that is facing the surgeon. As best shown in Figure 4, the implant 1 has a flattened bean shape, with two main faces 2, 3 flattened and a side face 4 which borders and extends between the two main faces 2, 3. In form of bean means an oblong and curved shape. The two main faces 2, 3 of the implant 1 are toothed, in that they have a plurality of projecting teeth allowing the implant 1 to cling better to the vertebrae of the patient. These two main faces 2, 3 could extend in parallel. However, they are here slightly inclined relative to each other, so as to adapt to the relative orientation of the two vertebrae of the patient considered. This implant 1 comprises a graft housing 5 which is through and which thus opens on each of the two main faces 2, 3. This graft housing 5 is centered in the implant 1 and has a bean-shaped section. It allows to receive the graft prior to the placement of the implant 1 between the two vertebrae of the patient, to promote bone fusion of these two vertebrae.

The implant 1 also comprises two windows 6 which open on either side of the implant 1, on its lateral face 4, and which communicate with the graft housing 5. These two windows 6 allow, after the implant 1 was placed between the two vertebrae of the patient to receive extra graft to promote bone fusion of these two vertebrae.

The implant 1 has a front end 1B devoid of teeth, by which the surgeon engages the implant 1 between the two vertebrae of the patient, and an opposite rear end 1A by which the surgical instrument 100 is fixed to the implant 1. The implant 1 has more particularly, recessed in this rear end 1A, a receiving housing 10 of a fastening system 110 of the surgical instrument 100. According to a particularly advantageous feature of the invention, this fastening system 110 is a bayonet system and the receiving housing 10 provided in the implant 1 has a form of bayonet socket. As shown in Figure 9, the fastening system 110 then comprises a pin 111, here in the form of a cylinder of revolution about an axis A3, which is rotatably mounted on the gripping head 120 about the axis A3. It also comprises at least one lateral pin 112 projecting from the pin 111. In practice, it comprises here two lateral pins 112 which extend radially with respect to the axis A3, on either side of the pin 111. Surgical instrument 100 then comprises operating means for pivoting the trunnion 111 about the axis A3, which will be described in detail later in this presentation.

The receiving housing 10 provided at the rear end 1A of the implant 1 has in correspondence a main well 11 of the trunnion 111 and two grooves 12 which form recessed cam paths, the opposite l one of the other, in the lateral face of the main well 11, for the passage of the two lateral pins 112.

More specifically, as shown in Figures 4 and 5, the main shaft 11 has a cylindrical hole shape of cylindrical revolution. It opens at the rear end 1A of the implant 1 on a flat surface 15. A chamfer 14 is provided at the junction between the edge of the main well 11 and the flattened portion 15. The two grooves 12 each have a front portion rectilinear 12A axis parallel to the axis of the main well 11, which opens on the flat portion 15, and a triangular rear portion 12B. This triangular rear portion 12B delimits a ramp 12C against which can press the corresponding lateral pin 12 of the surgical instrument 100 after the pin 111 has pivoted about its axis A3, in order to retain the implant 1.

As shown in FIG. 4, if the rectilinear front portions 12A of the grooves 12 are machined via the rear end 1A of the implant 1, the triangular rear portions 12B are machined through orifices 13 made through the main faces. 2, 3 of the implant 1. It is also seen in Figures 4 and 5 that the lateral face 4 of the implant 1 has two recesses 16, 17 recessed, located on either side of the rear end 1A of the implant 1. These notches 16, 17 are designed to accommodate teeth 126, 127 provided on the surgical instrument 100, in order to optimize the attachment of the implant 1 to the surgical instrument 100. These notches 16 , 17 here have planar faces 16A, 17A parallel to each other and perpendicular to the flat part 15, hollowed out in the lateral face 4 of the implant 1. These flat faces 16A, 17A are bordered by flanges 16B, 17B in a U-shape, 10 which open towards the rear end 1A of the implant 1 , to allow the engagement of the teeth 126, 127 of the surgical instrument 100. Here, these two notches 16, 17 have different sizes, the notch 17 having a length greater than that of the notch 16. Alternatively, they could have different shapes. For its part, as shown in FIGS. 8 and 9, the gripping head 120 of the surgical instrument 100 has a flat front face 125 adapted to be applied against the flat portion 15 of the implant 1, and two teeth 126, 127 which rise from the opposite edges of this flat front face 125 to engage in the two notches 16, 17 of the implant 1. These two teeth 126, 127 have inner faces (facing to -vvis) which are flat, parallel, and spaced from each other by an equal distance, at the mounting clearance, to the distance between the planar faces 16A, 17A of the two notches 16, 17 of the implant 1. They have contours of shapes and sizes respectively identical to those of the two notches 16, 17 of the implant 1. These two teeth 126, 127 thus form the two arms of a fork adapted to ride the implant 1 by its rear end 1A. It will be understood that the bayonet fixation system 110 of the surgical instrument 100 serves to retain the implant 1 in this fork. As shown in FIG. 9, the trunnion 111 of this fastening system 110 passes through the grasping head 120 of the surgical instrument 100 so as to project at the rear and front of the gripping head 120. It has, on its front part emerging from the front face 125 of the gripping head 120, a diameter equal, with the mounting clearance, to the diameter of the main well 11 of the implant 1.

The two lateral pins 112 are in turn formed in one piece, by a rod which is engaged in force in a hole made in the trunnion 111 along an axis perpendicular to the axis A3. Thanks to this fastening system 110 with bayonets, the pin 111 is adapted to be engaged in the main well 11 of the implant 1, so that the lateral pins 12 navigate in the straight front portions 12A of the grooves 12 of the implant 1 and that the teeth 126, 127 engage in the notches 16, 17 of the implant 1. Then, when the end face 125 of the gripping head 120 of the surgical instrument 100 abuts against the flat part 15 of the implant 1, it is possible to rotate the pin 111 about the axis A3, so that the lateral pins 112 bear against the ramps 12C formed by the triangular rear portions 12B of the grooves 12 of the implant 1. Thus, the lateral pins 112 are wedged in these grooves 12 and allow to firmly retain the implant 1 in a fixed position on the gripping head 120. The aforementioned maneuvering means are designed to allow the surgeon to force the touri llon 111 to pivot about the axis A3, since the handle 140. As shown in Figures 1 and 2, these actuating means comprise a wheel 150 which is rotatably mounted on the frame 141 of the handle 140 around the Al axis of the rod 130. In practice, this wheel 150 is located on the front side of the handle 140, near the rod 130. This wheel 150 is connected to the pin 111 via a first rod 151 and a cardan 152 (Figure 8 ).

As shown in Figure 3, the rod 130 has a tubular shape for housing two rods 151, 161, including the first rod 151. These two rods then extend along parallel axes but distinct from the longitudinal axis Al of the rod 130. Therefore, since they do not rotate along axes coincident, the wheel 150 and the first rod 151 are not directly attached to one another. As shown in Figures 10 and 11, there is instead provided a screw 153, whose head is mounted free in translation in a radial housing 154 of the wheel 150 and whose threaded end is screwed radially into the first rod 151. In this way, when the surgeon rotates the wheel 150 by a quarter of a turn, it forces the screw to pivot about the longitudinal axis A1 and to navigate in its radial housing 154, which allows the pivot to rotate. trunnion 111 of a quarter turn around the axis A3. As is known, for the placement of the implant 1 between the two vertebrae of the patient, it is necessary to circumvent the articular elements of the patient's spine. As shown in Figures 8 and 9, the surgical instrument 100 then comprises a hinge 163 between the rod 130 and the gripping head 120, pivot axis A2 orthogonal to the longitudinal axis A1 of the rod 130. This hinge 163 then makes it possible to tilt the gripping head 120 and the implant 1 which is fixed thereto, about the pivot axis A2, between a straight position (FIG. 1) and a tilted position (FIG. 2).

At this stage, it will be noted that the operating means for pivoting the pin 111 about the axis A3 does not hinder this tilting mobility, thanks to the cardan 152 provided between the first rod 151 and the pin 111. Advantageously, it is then provided means for maneuvering the gripping head 20, which control its tilting about the pivot axis A2, at a desired angle of inclination Alpha (Figure 8). As shown in FIGS. 1 and 2, these operating means comprise a lever 160 which is rotatably mounted about an axis A4 perpendicular to the longitudinal axis A1. This lever 160 here has a U-shape 25 so as to be easily manipulated by the surgeon. The end of one of the branches of this U defines an opening engaged on a bearing 145 of the frame 141 of the handle 140, which allows the lever 160 to pivot about the axis A4. As shown in Figures 2 and 7, the operating means 30 also comprise, from the lever 160 to the gripping head 120, a connecting rod 164, a castellated sheath 165, a second rod 161 housed in the rod 130, and A link 162. As shown in Figure 7, the crenellated sheath 165 has a rod shape in one end of which is provided a tapped bore 165A. Thanks to this threaded bore 165A, the crenellated sheath 165 is screwed onto one end of the second rod 161. This crenellated sheath 165 has recessed in its outer face, peripheral grooves whose function will be explained later.

This crenellated sheath 165 is mounted free in translation in a housing 166 provided inside the frame 141 of the handle 140, along an axis coincident with the axis of the second rod 161. The connecting rod 164 is connected, on one side, to this crenellated sheath 165 by a first axis pivot A5 parallel to the axis A4 of the lever 160, and, on the other hand, to the lever 160 by a second axis pivot A6 parallel and distinct from the axis A4. In this way, when the surgeon pulls the lever 160 away from the frame 141 of the handle 140, it forces the notched sheath 165 back in its housing 166. As shown in Figure 8, at the other end of the second rod 161, the rod 162 is connected, on one side, to this other end of the second rod 161 by a third pivot axis A7 parallel to the axis A4 of the lever 160, and, on the other, to the gripping head 120 by a fourth axis pivot A8 parallel and distinct from the pivot axis A2. The difference between these axes A2 and A8 is called "lever arm". It allows, when the surgeon pulls on the lever 160 to force the second rod 161 to move back in the rod 130, to tilt the gripping head 120 about the tilting axis A2. As shown in Figure 9, to prevent these efforts do bend the second rod 161, the third axis pin A7 is mounted at both ends in oblong openings 135 provided at the front end of the rod 130. oblong openings 135 being elongated along axes parallel to the longitudinal axis Ai, the third axis pivot A7 is free to slide along an axis parallel to the longitudinal axis A1. Here, as shown in FIGS. 1, 2 and 6 the handle 140 includes a control 142 for indicating the angle of inclination Alpha (FIG. 8) of the gripping head 120 (and thus of the implant 1) with respect to the longitudinal axis Al of the rod 130 Indeed, once the implant 1 engaged between the vertebrae of the patient, the surgeon no longer has visible access to the gripping head 120 and the implant 1. 3003 15 8 11 The witness 142 placed on the 140 handle allows him to know, monitor, and adjust the angle precisely Alpha tilt. Here, this indicator 142 is formed by a cover which is fixed on the opening of the lever 160 (that engaged on the bearing 145 of the frame 141 of the handle 140), which protrudes from the external face of the handle 140, and which presents in relief a representation of the implant. The witness 142 thus pivots with the same inclination as the lever 160. In order for the inclination of the control 142 to correspond to that of the implant 1, the operating means of the gripping head 120 are then designed so that an inclination of one degree of the lever 160 causes a one-degree inclination of the gripping head 120. Preferably, the surgical instrument 100 also comprises locking means 170 of the lever 160 in a fixed position. These locking means 170 allow the surgeon to block the inclination of the gripping head 120 at will, which is particularly useful when he has to move the implant 1 in translation. As shown in FIGS. 6 and 7, these locking means 170 comprise a handle 176 accessible to the surgeon, a tilting arm 171 and return means 172. The tilting arm 171 has a Z shape. It is pivotably mounted around a tilting axis A9 parallel to the axis A4 of rotation of the lever 160. The tilting arm 171 has, on one side of this tilting axis A9, a notched end 171A whose notches are adapted to catch to the peripheral grooves of the castellated sheath 165 to block the translation of the latter in its housing 166. Here, the rocker arm 171 has a plurality of notches and the castellated sheath 165 has a plurality of peripheral grooves, which makes it possible to block the translation the crenellated sheath 165 in different distinct positions (corresponding to different angles of inclination 30 Alpha of the gripping head 120). The rocking arm 171 has, on the other side of the tilting axis A9, a rear end on which the lever 176 is mounted free in translation, along an axis orthogonal to the tilting axis A9. It can thus be seen in FIGS. 6 and 7 that the lever 176 comprises two flanges 176A which delimit between them a rail mounted on the rear end of the tilting arm 171. Each of these two flanges 176A then has an oblong opening 176B in which a 171B rod attached to the swing arm 171. This rod 171B, axis parallel to the axis of tilting A9, then allows to guide the sliding of the handle 176 on the rear end of the rocker arm 171. The return means 172 are provided to automatically return the rocker arm 171 to a locked position in which its notches cooperate with the peripheral grooves of the notched sheath 165 to block the latter in translation. In this case these return means comprise a compression spring 172 which is interposed between the frame 141 of the handle 140 and the rear end of the rocking arm 171. Two studs 173, 174 respectively fixed to the frame 141 and the rocker arm 171 allow to maintain the compression spring 172 in position. The handle 176 carries, projecting from its inner face turned towards the longitudinal axis Ai, a finger 175 adapted to be housed in a cavity 144 provided in the frame 141 of the handle 140. As shown in FIG. 6, when the joystick 176 is in the advanced position and that the rocker arm 171 is in the locked position, this finger 175 is located at a distance from the cavity 144. As shown in FIG. 7, when the surgeon exerts on the lever 176 a pressure directed towards the longitudinal axis Al and towards the rear, it allows the swinging arm 171 to swing to release the notched sheath 165 and the handle 176 to retreat until the finger 175 comes to be housed in the cavity 144. This finger 175 then allows to hold the swing arm 171 in the unlocked position. Then, the surgeon is free to tilt the gripping head 120 by a desired angle of inclination Alpha, by pulling the lever 160.

When it wishes to lock again the orientation of the gripping head 120, the surgeon brings the lever 176 forward, which has the effect of releasing the finger 175 from the cavity 144. The compression spring 172 then returns automatically the rocker arm 171 in the locked position. Here, as shown in Figure 10, the handle 140 is provided to be removed from the rest of the surgical instrument 100. The handle 140 has for this purpose a front end 146 adapted to engage in the rear end of the rod 130, and two locking screws 147 adapted to lock the front end 146 of the handle 140 in the rod 130.

The two links 151, 152 are each made in two parts that can be separated from each other when the handle 140 is removed from the rest of the surgical instrument 100. The implant 1 is here made of a single piece polyetheretherketone (better known by the acronym peek). It is therefore little visible by conventional means of medical imaging. As shown in Figure 5, the implant 1 then has holes 20 designed to accommodate titanium rods better visible by these conventional means of medical imaging. The present invention is not limited to the embodiments described and shown, but the skilled person will be able to make any variant within his mind. For example, it would be possible to replace the universal joint connecting the first rod to the trunnion, by a flexible rod capable of transmitting the torque from the first rod to the trunnion. It could also be expected that the surgical instrument is free of hinge, in which case the gripping head can not tilt relative to the rod. According to another variant of the invention, it could be provided that the implant is not a lumbar intervertebral fusion implant ("TLIF implant"), but a posterior lumbar intervertebral fusion implant ("PLIF implant"). or an anterior lumbar intervertebral fusion implant ("ALIF implant"). In these variants, the implant will not necessarily have a flattened bean shape and the receiving housing provided in the implant to accommodate the end of the surgical instrument will not necessarily be located at the end of the implant. .

Claims (13)

REVENDICATIONS1. Intervertebral fusion implant (1) having a receiving housing (10) for a fixation system (110) of a surgical instrument (100), characterized in that said receiving housing (10) has a shape of bayonet bushing, with a main well (11) for receiving a journal (111) of said fastening system (110) and at least one groove (12) which forms a cam track formed in the lateral face of the main well (11) for the passage of a lateral stud (112) of said fastening system (110). 2. Intervertebral fusion implant (1) according to the preceding claim, having two main faces (2, 3) flattened and a side face (4) which borders said two main faces (2, 3) and which has two notches (16, 17) recessed, located on either side of said housing (10), for accommodating teeth (126, 127) of said surgical instrument (100). 3. Intervertebral fusion implant (1) according to the preceding claim, wherein said two notches (16, 17) have different shapes and / or sizes. 4. intervertebral fusion implant (1) according to one of the preceding claims, having a flattened bean form, with two main faces (2, 3) and a graft housing (5) which opens on each of the two main faces ( 2, 3). 5. Surgical instrument (100) for placing an intervertebral fusion implant (1) between two vertebrae of a patient, comprising a handle (140) extended by a rod (130) and a gripping head (120) said intervertebral fusion implant (1), characterized in that said gripping head (120) carries a bayonet fixing system (110) of said intervertebral fusion implant (1), which comprises a journal (111) rotatably mounted relative to said gripping head (120), and a lateral stud (112) projecting from said trunnion (111), and said handle (140) having a first operating means (150) accessible to the surgeon for pivoting said trunnion (111) with respect to said gripping head (120). 6. surgical instrument (100) according to the preceding claim, wherein said gripping head (120) comprises two teeth (126, 127) located on either side of said fastening system (110) and adapted to engage in two notches (16, 17) provided in said intervertebral fusion implant (1). 7. surgical instrument (100) according to one of claims 5 and 6, wherein said first actuating means comprises a wheel (150) which is rotatably mounted on a frame (141) of the handle (140) and which is connected to said trunnion (111) via a first rod (151) housed in said rod (130). 8. surgical instrument (100) according to one of claims 5 to 7, wherein there is provided: - a hinge (163) between said rod (130) and said gripping head (120) pivot axis (A2 ) orthogonal to the longitudinal axis (A1) of said rod (130), and - said handle (140) comprises second operating means (160) accessible to the surgeon for pivoting said gripping head (120) relative to said rod (130). 9. Surgical instrument (100) according to the two preceding claims, wherein said knob (150) is connected to said pin (111) via a universal joint (152) connected on one side to said first rod (151), and on the other, to said trunnion (111). 10. Surgical instrument (100) according to one of the two preceding claims, wherein said second actuating means comprises a lever (160) which is mounted pivotally on a frame (141) of the handle (140) and which is connected said gripping head (120) via a second rod (161) which is housed in said rod (130) and which is connected to said gripping head (120) by a link (162). 11. Surgical instrument (100) according to one of the three preceding claims, wherein the handle (140) comprises a frame (141) and a control (142) rotatably mounted on the frame (141), whose orientation relative to the longitudinal axis (A1) of said rod (130) is identical to the orientation of said gripping head (120) relative to the longitudinal axis (A1) of said rod (130). 12. Surgical instrument (100) according to one of the four preceding claims, wherein there is provided locking means (170) of said second actuating means (160) in a fixed position. 13. An assembly comprising an intervertebral fusion implant (1) according to one of claims 1 to 4 and a surgical instrument (100) according to one of claims 5 to 12, the fixing system (110) is engaged in the housing host (10) of said intervertebral fusion implant (1).