JP2004526506A - Contoured spinal fusion implant - Google Patents

Abstract

An interbody spinal implant adapted for placement across an interbody space formed over the entire height of an intervertebral disc between two adjacent vertebral bodies. The implant has a front end that includes at least a portion of an arc in a lateral direction, and a rear end that has at least a portion that is straight or laterally having another radius of curvature. The implant can be made from cortical bone, bone composite, or a material other than bone.

Description

【Technical field】
[0001]
The present invention generally relates to the purpose of correcting spinal lesions in the intervertebral space between two adjacent vertebral bodies, preferably in an implantable gap created over such an interspace height. An intervertebral spinal implant adapted for placement. The implants are adapted such that at least a portion of the implants undergo fusion through the implants. The implant can be made from cortical bone, bone composite, or a material other than bone.
[Background Art]
[0002]
This application claims priority to provisional application number 60 / 281,187 filed on April 3, 2001 and provisional application number 60 / 281,112 filed on April 2, 2001. Incorporated herein by reference.
[0003]
Implants for placement between adjacent vertebral bodies in the spine vary in shape and size and are made from a variety of materials. Such implants for use in spinal surgery in humans are designed to promote the fusion of adjacent vertebral bodies by allowing bone to grow through the implant and thereby fuse adjacent vertebral bodies. Included are implants made from an inert selected material, such as bone or titanium, having a pre-defined structure.
[0004]
Implants made from bone and used for intervertebral spine surgery are often made from part of the diaphysis. The diaphysis is the axis of the major long bone between the epiphysis, the ends of which form the joints.
[0005]
The diaphyseal annulus is formed by cutting at two locations approximately perpendicular to the long axis of the diaphyseal portion of the major long bone, and the medullary canal forms an opening through the annulus. Such annulus is typically harvested from the femur for use in the lumbar spine. Other bones from arms, legs, or other parts of the human skeleton can also be used in various spinal regions.
[0006]
It is common to cut away to form a bone annulus having a height corresponding to or slightly larger than the disc space to be repaired. Through the intervertebral disc, a bone graft of a diaphyseal annulus is placed in the spine, through the intervertebral disc, and through the entire height of the gap previously occupied by the vertebral disc between adjacent vertebral bodies. Achieve interbody fusion of the body. The diaphyseal annular bone graft is incorporated into the bone fusion over time.
[0007]
However, hitherto, the success of interbody spinal fusion using the diaphyseal ring has been limited. Although not all of the causes of the failure are known, the inconsistency in the interface between the bone ring implant and the adjacent vertebral bodies and the instability of the bone ring implant are still under the control of the surgeon. Seems to be two of the more important factors that cause failure.
[0008]
During surgery to create a fusion between adjacent vertebral bodies of a patient's spine, the surgeon attempts to fuse by removing some or all of the intervertebral disc between adjacent vertebral bodies to be fused Typically, a hole is prepared at the site. Because the outermost layer of bone in the vertebral endplates is relatively inert to new bone growth, the surgeon must replace the endplates so that they can reach the blood-rich vascular bone tissue inside the vertebral body. It must be processed to remove the outermost cell layer of the bone. The vertebrae are prepared in this manner to encourage new bone growth within or through the implant located between the vertebral bodies.
[0009]
Current methods of creating such gaps between adjacent vertebral bodies include one or more of the following: hand-held grasping and grasping instruments, known as rongeurs, drills and drill guides, motorized It typically includes the use of a rotating bar, scalpel and chisel, and a two-wheeled cutter or intervertebral space preparation device. In particular, the two-wheel cutter or intervertebral space preparation device disclosed by Michelson in WO 99/64891, which is incorporated herein by reference, is adapted to be inserted linearly, ie, along a single axis, Thus, there is no need to move the device laterally along the second axis substantially within the disc space. In one such preferred embodiment, the device has at its working end an abrasive element with a width that generally corresponds to the width of the implant to be implanted.
[0010]
It is desired to improve the implant interface to adjacent vertebral bodies and to achieve implant stability. Thus, the contour of the implant closely matches the implantation gap formed between adjacent vertebral bodies and at least in part thereof, allowing for more uniform load transfer across the vertebral bodies. Is an advantage.
DISCLOSURE OF THE INVENTION
[Problems to be solved by the invention]
[0011]
Intervertebral spinal implants, made entirely or almost entirely from cortical bone or bone composites, provide the benefits of such materials, including elasticity and strength appropriate for a given use, and provide osteoinductive, It confers bioactive abilities, including being osteoinductive, osteogenic, and more generally provides a suitable substrate for new bone formation when fusion occurs. Furthermore, being bioabsorbable, over time, the patient's own bone is replaced with bone material, thereby preventing stress interruption and ultimately removing any foreign material from the implantation site. Since it is desirable to take advantage of all of these benefits, improvements made from bone, bone composites, or non-bone materials having a configuration that improves implant-vertebral body alignment and improves implant stability There is a need for a type of interbody spinal fusion implant.
[Means for Solving the Problems]
[0012]
As embodied and broadly described herein, in accordance with the objectives of the present invention, at least a portion is inserted into an implantation gap formed across the height of the intervertebral space between adjacent vertebral bodies of the human spine. To provide an interbody spinal fusion implant made from cortical bone. The implant includes a front end for initial insertion into the intervertebral space and a rear end opposite the front end. The implant has a length from the front end to the back end. The front end is formed in a semicircular shape in the lateral direction. The implant also includes opposing upper and lower portions between the anterior and posterior ends that are adapted to be positioned within the intervertebral space to contact and support adjacent vertebral bodies. The upper and lower portions are non-circular along at least a portion of the length of the implant. The implant also includes opposing sides between the upper and lower portions and between the front and rear ends. At least a portion of at least one of these sides is linear along at least a portion of the length of the implant.
[0013]
As embodied and broadly described herein, in accordance with the objectives of the present invention, at least a portion is inserted into an implantation gap formed across the height of the intervertebral space between adjacent vertebral bodies of the human spine. To provide an interbody spinal fusion implant made from cortical bone. The implant includes a front end for initial insertion into the intervertebral space and a rear end opposite the front end. The implant has a length from the front end to the back end. The front end is formed in a substantially semicircular shape of the first circle in the lateral direction. The rear end has a second radius of curvature in the lateral direction. This second circle has a radius larger than the radius of the first circle. The implant also includes opposing upper and lower portions between the anterior and posterior ends that are adapted to be positioned within the intervertebral space to contact and support adjacent vertebral bodies. The implant has a maximum width that is greater than half the width of an adjacent vertebral body into which the implant is to be inserted.
[0014]
The implants described above are preferably made from bone rings obtained from the major human long bones with a medullary canal. The implant includes at least a portion of a medullary canal passing between an upper portion and a lower portion to form a passage adapted to receive a bone growth promoting material through which bone is vertebraized from a vertebral body. Can grow into the body. Alternatively, the implants described above can be made from bone composites.
[0015]
As embodied and broadly described herein, in accordance with the objectives of the present invention, at least a portion is inserted into an implantation gap formed across the height of the intervertebral space between adjacent vertebral bodies of the human spine. To provide an artificial interbody spinal fusion implant made from a material other than bone. The implant includes a front end for initial insertion into the intervertebral space and a rear end opposite the front end. The implant has a length from the front end to the back end. The front end has a substantially semicircular shape in the lateral direction. The implant also includes opposing upper and lower portions between the anterior and posterior ends that are adapted to be positioned within the intervertebral space to contact and support adjacent vertebral bodies. The upper and lower portions are non-circular along at least a portion of the length of the implant. The upper and lower portions include at least one opening interconnected and adapted to receive a bone growth promoting material so that bone can grow from vertebral body to vertebral body through the implant. The implant also includes opposing sides between the upper and lower portions and between the front and rear ends. At least a portion of at least one of these sides is linear along at least a portion of the length of the implant.
[0016]
As embodied and broadly described herein, in accordance with the objectives of the present invention, at least a portion is inserted into an implantation gap formed across the height of the intervertebral space between adjacent vertebral bodies of the human spine. To provide an artificial interbody spinal fusion implant made from a material other than bone. The implant includes a front end for initial insertion into the intervertebral space and a rear end opposite the front end. The implant has a length from the front end to the back end. The front end is formed in a substantially semicircular shape of the first circle in the lateral direction. The rear end has a second radius of curvature in the lateral direction. This second circle has a radius larger than the radius of the first circle. The implant also includes opposing upper and lower portions between the anterior and posterior ends that are adapted to be positioned within the intervertebral space to contact and support adjacent vertebral bodies. The upper and lower portions include at least one opening interconnected and adapted to receive a bone growth promoting material so that bone can grow from vertebral body to vertebral body through the implant. The implant has a maximum width that is greater than half the width of an adjacent vertebral body into which the implant is to be inserted.
[0017]
Some additional objects and advantages of the invention will be set forth in the description that follows, and in part will be obvious from the description, or may be learned by practice of the invention. The objects and advantages of the invention will be realized and attained by means of the elements and combinations particularly pointed out in the appended claims.
BEST MODE FOR CARRYING OUT THE INVENTION
[0018]
The following description is exemplary and not limiting, and many variations are conceivable in accordance with these teachings and are intended to be included within the scope of the present teachings. . Reference will now be made in detail to preferred embodiments of the invention, examples of which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts.
[0019]
1 to 3 show an implantation gap 50 formed in the lumbar vertebra over the entire height of the gap occupied by the disc D and in the vertebral body V. The implantation gap 50 is preferably formed using the apparatus and method disclosed by Michelson in US Pat. No. 6,083,228 and WO 99/64891, the disclosures of which are both incorporated herein by reference. These instruments and methods are not the subject of this application. The method of preparation of the implantation gap shown therein is one preferred instrument and method for preparing such an implantation gap, and the desired implantation gap can be prepared using any method and instrument suitable for this purpose. Is clear.
[0020]
The implantation gap 50 is preferably formed in the endplate portion ER in the subchondral bone of the vertebral body V. The implantation gap 50 is preferably formed to have a leading edge 52 that includes a substantially semicircular shape of the first circle A in the lateral direction. The posterior portion 54 of the implantation gap 50 preferably includes at least a portion of the anterior vertebral body having a radius of curvature of the second circle B in the lateral direction. Preferably, the radius of the circle A is smaller than the radius of the circle B. The implantation gap 50 can further include side edges 56,58. These side edges 56, 58 preferably comprise at least a straight section, are parallel to one another along the line P and can form a curved transition with the leading edge 52.
[0021]
4 to 6 show the implantation gap 60 formed in the cervical vertebra over the entire height of the gap occupied by the disc D and in the vertebral body V. The implantation gap 60 is preferably formed to have a leading edge 62 that includes a substantially semicircular shape of the first circle A in the lateral direction. The posterior portion of the implantation gap 60 preferably includes at least a portion of the anterior vertebral body having a radius of curvature of the second circle C in the lateral direction. Preferably, the radius of the circle A is smaller than the radius of the circle C. However, the implantation gap 60 preferably does not include straight side edges such as the implantation gap 50 because the depth from the anterior to the posterior surface of the cervical vertebral body is less than the depth from the anterior to the posterior surface of the lumbar vertebral body. Therefore, the radius of the circle C in the cervical vertebra is smaller than the radius of the circle B in the lumbar vertebra.
[0022]
7-12 show an implant 100A according to one preferred embodiment of the present invention. The implant 100A is preferably manufactured from a bone ring obtained from human major long bones. Implant 100A includes a front end 102A for initial insertion into an intervertebral space between two adjacent vertebral bodies, a rear end 104A opposite the front end 102A, and opposing sides 110A, 112A therebetween. Having. The front end 102A is preferably configured to conform to the contour of the leading edge 52 of the implantation gap 50, and the rear end 104A conforms to the contour of the anterior vertebral body at the rear end 54 of the implantation gap 50. It is preferable to configure so that The side surfaces 110A, 112A are preferably generally planar and correspond to the configuration of the side edges 56, 58 of the implantation gap 50.
[0023]
In one preferred embodiment of the present invention, the front end 102A, the rear end 104A, and the opposing sides 110A, 112A have been machined to have various configurations. The front end 102A is preferably machined so as to have a substantially semicircular first circular shape in the lateral direction. If the implantation gap is prepared in the vertebral body with a curved lip or ridge at least in part, the front end 102A can be adapted to abut at least this lip edge of the implantation gap.
[0024]
One or both sides 110A, 112A may also be formed at least partially in an orientation that is generally parallel to the central longitudinal axis of implant 100A and / or to each other. Further, the anterior end 102A may be tapered to facilitate insertion of the implant 100A between two adjacent vertebral bodies.
[0025]
The rear end 104A preferably laterally forms a second circular arc having a radius greater than the radius of the first circle associated with the front end 102A. Preferably, at least a portion of the posterior end 104A is conformal with at least a portion of the peripheral contour of the anterior vertebral body adjacent to the intervertebral space into which the implant is to be inserted, The invention is not so limited.
[0026]
FIG. 12 shows that implant 100A preferably has a driver hole 116A at its rear end 104A for cooperative engagement with an instrument for inserting the implant 100A into the implantation gap. Preferably, the driver hole 116A is configured to be screwed with an insertion instrument.
[0027]
8, 10, and 11 show that at least a portion of the upper and lower surfaces 106A, 108A are in an angled relationship to each other from the posterior end 104A to the anterior end 102A such that adjacent vertebral bodies are angled relative to one another. Indicates that it can be formed. The upper and lower surfaces 106A and 108A are preferably not arcuate in a direction along the central longitudinal axis of the implant 100A. The implant 100A preferably has a maximum height that is less than the maximum width of the implant.
[0028]
As shown in FIG. 9, the upper and lower surfaces 106A, 108A preferably have passages 114A therethrough between respective front and rear ends 102A, 104A and between opposing side surfaces 110A, 112A. . Passageway 114A is preferably adapted to contain a bone growth promoting material such that bone can grow from vertebral body to vertebral body through passageway 114A. In addition to this passageway 114A, the upper and lower surfaces 106A, 108A can also include at least one interconnecting hole to allow bone to grow from vertebral body to vertebral body via the implant 100A, although the present invention is not limited thereto. Is not so limited. The upper and lower surfaces 106A, 108A may be porous and may include a bone ingrowth surface.
[0029]
As shown in FIG. 9, the implants described herein can include a bone engaging surface 118A, such as, for example, a knurl. The bone engaging surface 118A is configured to engage the bone of an adjacent vertebral body after implantation to maintain the implant 100A within the adjacent vertebral body. Other preferred embodiments of the bone engaging surface include a roughened surface, a claw tooth, a splined implant surface, or include at least one projection that penetrates and engages a bone of a vertebral body. Can be. By way of example only, the implants of the present invention may include the surface configuration taught by Michelson in U.S. Patent Application No. 09 / 457,228, entitled "Spinal Implant Surface Configuration," the disclosure of which is incorporated herein by reference. Incorporate in the book.
[0030]
The implant 100A is preferably made from the diaphyseal bone annulus, but need not be made therefrom. Preferably, the diaphyseal bone ring is obtained from the major long bones of the human skeleton. The bone annulus is formed by cutting at two locations approximately perpendicular to the long axis of the diaphysis of the major long bone, and a portion of the medullary canal forms an opening through the annulus. . Such annulus is typically harvested from the femur for use in the lumbar spine. Bone from the arms, legs, or other parts of the human skeleton can also be used in various areas of the spine. The long bone can be cut to form a bone annulus having an upper surface and a lower surface generally perpendicular to the longitudinal axis of the diaphysis or at other angles transverse to the axis. Cutting at an angle to each other results in a bone annulus having upper and lower surfaces that are angled with respect to each other. Due to the angled relationship between the upper and lower surfaces of the bone annulus, the next time the annulus is made into an implant and implanted in the spine, adjacent vertebral bodies are positioned in an angled relationship to each other, e.g., Restores the natural curvature of the spine, like lordosis.
[0031]
The bone is machined to form an implant having the selected shape appropriate for the intended purpose. Examples of tools that can be used for machining an implant include, but are not limited to, bars, reamers, mills, saws, drills, chisels, and the like. By way of example only, the front end can be shaped approximately laterally in a semicircle. The sides can be at least partially machined linearly. The posterior end can be machined to any desired shape suitable for the intended purpose, and preferably is an anatomical profile of an adjacent vertebral body adapted to have an implant inserted therebetween. It can be shaped to conform. The medullary canal preferably defines a passage adapted to contain a bone growth promoting material and / or substance. Where appropriate, it is desirable to leave at least part of the natural curvature around the bone ring as part of the implant configuration.
[0032]
Implant 100A may have a length greater than one-half this vertebral body depth, measured between the anterior and posterior aspects of the vertebral body adjacent to the intervertebral space into which the implant is to be inserted. preferable. Implant 100A also preferably has a maximum width that is greater than one-half the width of the adjacent vertebral body into which the implant is to be inserted.
[0033]
For any embodiment of the implant of the present invention made from at least a portion of bone, rather than machined from a single bone portion, at least one of cortical bone fibers, bone microfibrils, bone particles, or bone powder. In addition, implants can be made from a composite bone material containing a binding material that may or may not be bioactive and / or bioabsorbable, such as, for example, plastics, ceramics, and the like. By way of example only, and not limitation, the bioabsorbable material can include polygalactone. Once the composite implant material is formed, it is machined or molded into the desired shape.
[0034]
Figures 13-18 show an implant 100B, preferably made from a material other than bone, according to one preferred embodiment of the present invention. The implant 100B includes a front end 102B for initial insertion into an intervertebral space between two adjacent vertebral bodies, a rear end 104B opposite the front end 102B, and opposing sides 110B, 112B therebetween. Having. The front end 102B is preferably configured to conform to the contour of the leading edge 52 of the implantation gap 50, and the rear end 104B conforms to the contour of the anterior vertebral body in the posterior portion 54 of the implantation gap 50. It is preferable that it is comprised so that it may become. The sides 110B, 112B are preferably generally planar and correspond to the configuration of the side edges 56, 58 of the implantation gap 50.
[0035]
In one preferred embodiment of the present invention, the front end 102B, the rear end 104B, and the opposing sides 110B, 112B can have various configurations. The front end portion 102B preferably has a substantially semicircular first circular shape in the lateral direction. If the implantation gap is prepared in the vertebral body with a curved lip or ridge at least in part, the front end 102B can be adapted to abut at least this lip margin of the implantation gap.
[0036]
One or both sides 110B, 112B may also be formed at least partially in an orientation that is generally parallel to the central longitudinal axis of implant 100B and / or to each other. One or both sides 110B, 112B may include at least one hole 119B through which bone can pass and grow into implant 100B, but does not limit the invention as such. Further, the anterior end 102B may be tapered to facilitate insertion of the implant 100B between two adjacent vertebral bodies.
[0037]
The rear end 104B preferably laterally forms a second circular arc having a radius greater than the radius of the first circle associated with the front end 102B. Preferably, at least a portion of the posterior end 104B is conformal with at least a portion of the peripheral contour of the anterior vertebral body adjacent to the intervertebral space into which the implant is to be inserted, The invention is not so limited.
[0038]
FIG. 18 shows that the implant 100B preferably has a driver hole 116B at its rear end 104B for cooperatively engaging an instrument for inserting the implant 100 into the implantation gap. It is preferable that the driver hole 116B is configured to be screwed with the insertion instrument.
[0039]
14, 16, and 17 show that at least a portion of the upper and lower surfaces 106B, 108B are in an angled relationship to each other from the posterior end 104B to the anterior end 102B such that adjacent vertebral bodies are angled relative to one another. Indicates that it can be formed. The upper and lower surfaces 106B and 108B are preferably not arcuate in a direction along the central longitudinal axis of the implant 100B. Implant 100B preferably has a maximum height that is less than the maximum width of the implant.
[0040]
As shown in FIG. 15, the upper and lower surfaces 106B, 108B have at least one opening 114B therethrough between each of the front and rear ends 102B, 104B and between the opposing side surfaces 110B, 112B. Is preferred. The opening 114 is preferably adapted to receive a bone growth promoting material so that bone can grow from vertebral body to vertebral body through the opening 114B and through the implant 100B. The upper and lower surfaces 106B, 108B may be porous and may include bone ingrowth surfaces.
[0041]
As shown in FIG. 15, the implants described herein can include a bone engaging surface 118B, such as, for example, a knurl. The bone engaging surface 118B is configured to engage the bone of an adjacent vertebral body after implantation to maintain the implant 100B within the adjacent vertebral body. Other preferred embodiments of the bone engaging surface include a roughened surface, a claw tooth, a splined implant surface, or include at least one projection that penetrates and engages a bone of a vertebral body. Can be.
[0042]
The substrate material used to form the implants of FIGS. 13-18 is preferably a material other than bone. In one preferred embodiment, the material of the implant is a metal, including but not limited to titanium and its alloys, an ASTM material, cobalt chrome or tantalum, a ceramic, various surgical grade plastics, plastic composites. It can be formed from artificial materials such as wood, carbon fiber composites, corals, etc., and can at least partially include bioabsorbable artificial materials.
[0043]
The implant 100B has a length greater than one half of the vertebral body depth, measured between the anterior and posterior surfaces of the vertebral body adjacent to the intervertebral space into which the implant is to be inserted. Is preferred. Implant 100B also preferably has a maximum width that is greater than half the width of the adjacent vertebral body into which the implant is inserted.
[0044]
FIG. 19 illustrates another preferred embodiment of the present invention of an implant made from bone or bone composite for use in the cervical spine, generally designated by the numeral 200A. Implant 200A is similar to that used in connection with the lumbar spine, but with instruments and methods modified for use in the cervical spine, the implantation gap created in the endplate of the vertebral body of the adjacent cervical vertebra. Preferably, it is configured to be conformal to the shape of 60. The implant 200A can have, for example, a front end 202A formed to have a substantially semicircular first circular shape in the lateral direction. Preferably, the rear end 204A can be formed as a second circular arc in the lateral direction that intersects the curved portion of the front end 202A in the lateral direction. Preferably, the radius of the second circle associated with the rear end 204A is greater than the radius of the first circle associated with the front end 202A.
[0045]
FIG. 20 illustrates another preferred embodiment of the present invention of an implant made from bone or bone composite for use in the cervical spine, indicated generally by the numeral 200B. The implant 200B is preferably configured to conform to the shape of the implantation gap 60 formed in the endplate of the adjacent cervical vertebral body. The implant 200B can have, for example, a front end 202B formed to have a substantially semicircular first circular shape in the lateral direction. Preferably, the rear end 204B can be formed as a second circular arc in the horizontal direction intersecting the curved portion of the front end 202B in the horizontal direction. The radius of the second circle associated with the rear end 204B is preferably greater than the radius of the first circle associated with the front end 202B.
[0046]
Figures 21-26 show an implant 300A, preferably made from bone or bone composite, adapted for use from the anterior approach to the spine, according to another preferred embodiment of the present invention. FIG. 21 is a perspective view showing the implant 300A from behind. Implant 300A includes at least two members 300A ', 300A "adapted to be placed side-by-side with respect to each other. Member 300A' is preferably, but need not be, a mirror image of 300A". The description with respect to member 300A 'is equally applicable to member 300A ". Member 300A' includes a front end 302A 'for initial insertion between two adjacent vertebral bodies and a front end 302A'. The member 300A 'has an opposing rear end 304A' The member 300A 'has a top surface 306A', a bottom surface 308A ', an inner surface 310A', and an outward surface 312A 'opposite the inward surface 310A'. The phrase, as used herein, refers to a side of a member that is oriented toward an inner surface of one member when a pair of members are inserted side-by-side into an intervertebral space. Represent. In one preferred embodiment, the inner surface 310A 'comprises at least a portion of the medullary canal of the bone annulus.
[0047]
The respective front ends 302A ', 302A "of each member 300A', 300A" form the front end 302A of the implant 300A when the members are placed side by side with respect to each other. The front end 302A of the implant 300A is preferably configured in the shape of a first semicircle in the lateral direction. When the members 300A ', 300A "are placed side by side, the back end 304A, consisting of the back ends 304A', 304A", has a radius greater than the radius of the first circle associated with the front end 302A of the implant 300A. It can be, but need not be, formed as an arc of a second lateral circle having.
[0048]
With member 300A 'placed side by side with member 300A ", the medullary canal portion of the inner surface 310A' of each member forms a passage 314A adjacent to and penetrating implant 300A. Passage 314A is defined by passage 314A. Preferably, the member 300A 'is adapted to contain a bone growth promoting material to allow bone to grow from one vertebral body to another through the vertebral body. Preferably, it has a maximum width W of less than about one half of the width, and the combined width of both members 300A ', 300A "is the width of the adjacent vertebral body adapted to insert these members. Preferably, it is greater than half the width.
[0049]
The members 300A ', 300A "provide the additional advantage of penetrating a smaller gap than a single larger implant and achieving the same effect as this larger implant.
[0050]
27-32 show an implant 300B made from a material other than bone in accordance with another preferred embodiment of the present invention, adapted for use from the anterior approach to the spine. FIG. 27 is a perspective view showing the implant 300B from behind. Implant 300B includes at least two members 300B ', 300B "adapted to be placed side by side with respect to each other. Member 300B' is preferably, but need not be, a mirror image of 300B". The description with respect to member 300B 'is equally applicable to member 300B ". Member 300B' includes an anterior end 302B 'for initial insertion between two adjacent vertebral bodies and an anterior end 302B'. The member 300B 'has an opposing rear end 304B' The member 300B 'has a top surface 306B', a bottom surface 308B ', an inner surface 310B', and an outward surface 312B 'opposite the inward surface 310B'.
[0051]
The respective front end 302B ', 302B "of each member 300B', 300B" forms the front end 302B of the implant 300B when the members are placed side by side. The front end 302B of the implant 300B is preferably configured in the shape of a first semicircle in the lateral direction. When the members 300B ', 300B "are placed side by side with each other, the posterior end 304B, comprising the posterior ends 304B', 304B", has a radius greater than the radius of the first circle associated with the anterior end 302B of the implant 300B. It can be, but need not be, formed as an arc of a second lateral circle having.
[0052]
The member 300B 'is arranged side by side with the member 300B ", and the inner surface 310B' portion of each member is adjacent to each other. The top surface 306B 'and the bottom surface 308B' pass therethrough and have respective front and rear ends. There is at least one opening 314B 'between 302B', 304B 'and between sides 310B', 312B 'to allow bone to grow from vertebral body to vertebral body through this opening 314B. The inner surface 310B 'is also adapted to receive a bone growth promoting material. At least the inner surface 310B' is also configured to allow bone to grow between and into adjacent members 300B ', 300B ". It can have one hole 314B '. The member 300B 'preferably has a maximum width W that is less than about one-half the width of the adjacent vertebral body into which the member is inserted. Also, the combined width of both members 300B ', 300B "is preferably greater than half the width of the adjacent vertebral body into which these members are inserted.
[0053]
The members 300B ', 300B "provide the additional advantage of penetrating a smaller gap than a single larger implant, with the same effect as this larger implant.
[0054]
FIG. 33 shows an implant 400A adapted for use from the anterior approach of the spine, according to another preferred embodiment of the present invention. Implant 400A is similar to implant 100A and has a front end 402A shaped as a substantially semicircle of the first circle. Implant 400A is adapted to have a maximum width between sides 410A, 412A that is less than half the width of an adjacent vertebral body into which implant 400A is to be inserted. The rear end 404A forms a second circular arc having a radius substantially greater than the radius of the first circle associated with the front end 402A. Implant 400A can be made from bone, bone composite, or a material other than bone.
[0055]
FIG. 34 illustrates an implant 500A according to another preferred embodiment of the present invention, adapted for use from the anterior approach of the spine. The implant 500A is similar to the implant 400A except that the front end 502A and the rear end 504A are preferably in the shape of a lateral semicircle. Implant 500A can be made from bone, bone composite, or a material other than bone.
[0056]
FIG. 35 illustrates an implant 600A according to another preferred embodiment of the present invention, adapted for use from the posterior approach of the spine. The implant 600A is similar to the implant 400A except that the posterior end 604A is preferably at least partially laterally straight. Implant 600A can be made from bone, bone composite, or a material other than bone.
[0057]
36-42 illustrate an implant 700A made from bone or bone composite, according to another embodiment of the present invention. This implant 700A is similar to the implant 100A, and has a front end 702A having a substantially semicircular shape of the first circle A and a rear end 704A formed as an arc of the second circle C. Implant 700A preferably includes straight portions 711A, 713A along at least a portion of each side 710A, 712A, which are preferably mutually parallel along line P. Implant 700A also preferably includes a curved transition from each straight portion 711A, 713A of each side 710A, 712A to a back end 704A to form a respective curved portion 715A, 717A. These curved portions 715A, 717A may preferably be arcs of a third circle E having a smaller radius than the circle A associated with the front end 702A and / or the circle C associated with the rear end 704A.
[0058]
In one preferred embodiment, the implant 700A is machined, preferably made from cortical bone, but need not be, and may include at least one pair of opposing appropriately sized bone screws 722A at the posterior end. 704A can be received through the bone screw receiving hole 720A. The bone engaging screws 722A can be aligned with each other or staggered. At least one bone screw 722A engages each of the vertebral bodies adjacent to the intervertebral space to be fused and into which implant 700A is implanted. One purpose of the bone screw is to secure the implant inside the vertebral segment. Another purpose is to draw each of the adjacent vertebral bodies towards the implant and towards each other. The posterior end 704A of the implant 700A cooperates to receive a recess 724A having a bone screw receiving hole 720A therein and a fixation cap 728A adapted to secure at least one bone screw 722A to the implant 700A. Preferably, it includes a configured hole 726A.
[0059]
As shown in FIG. 41, the implant 700A is further machined to receive a fastener 728A, preferably made of cortical bone, at the posterior end 704A to secure the bone engaging screw 722A in the posterior end 704A. In addition, it is preferable to prevent the screws from falling off. The fixing cap 728A has a head 730A, a shaft 732A, and a tool engagement portion 734A. In use, a fixation cap cooperates with a hole 726A in the posterior end 704A of the implant 700A to secure at least one bone screw to the implant 700A. If desired, locking cap 728A can also include threads on shaft 732A so that locking cap 728A can be rotated to engage implant 700A.
[0060]
FIG. 42 illustrates another embodiment of a securing cap generally indicated by reference numeral 736A. The fixation cap 736A includes a head 738A having a thread 740A on its outer periphery such that the thread cooperates with a corresponding threaded recess in the implant.
[0061]
Bone implants, bone screws, and / or fasteners can be made from bioabsorbable materials including, but not limited to, cortical bone, plastic, and composite plastic. Suitable plastics include lactides, galactides, glycolides, capronlactone, trimethylene carbonate (trimethylene carbonate), dioxanone (dioxone or dioxon) in various polymeric forms. Plastics composed of these combinations can be included.
[0062]
43-49 illustrate an implant 700B made from a material other than bone according to another embodiment of the present invention. This implant 700B is similar to the implant 100B, and has a front end 702B having a substantially semicircular shape of the first circle A and a rear end 704B formed as an arc of the second circle C. Implant 700B preferably includes straight portions 711B, 713B along at least a portion of each side 710B, 712B, preferably parallel to each other along line P. Implant 700B also preferably includes a curved transition from each straight portion 711B, 713B of each side 710B, 712B to a trailing end 704B to form curved portions 715B, 717B. These curved portions 715B, 717B may preferably be arcs of a third circle E having a smaller radius than the circle A associated with the front end 702B and / or the circle C associated with the rear end 704B.
[0063]
In one preferred embodiment, implant 700B can receive at least a pair of opposing suitably sized bone screws 722B through bone screw receiving holes 720B in posterior end 704B. The bone engaging screws 722B can be aligned with each other or staggered. At least one bone screw 722B engages each of the vertebral bodies to be fused and adjacent the intervertebral space into which implant 700B is to be implanted. The posterior end 704B of the implant 700B cooperates to receive a recess 724B having a bone screw receiving hole 720B therein and a fixation cap 728B adapted to secure at least one bone screw 722B to the implant 700B. Preferably, it includes a configured hole 726B.
[0064]
As shown in FIG. 48, the implant 700B can receive the fastener 728B at the posterior end 704B to secure the bone engaging screw 722B in the posterior end and prevent the screw from dropping out. preferable. The fixed cap 728B has a head 703B, a shaft 732B, and a tool engagement portion 734B. In use, a fixation cap cooperates with a hole 726B in the posterior end 704B of the implant 700B to secure at least one bone screw to the implant 700B. If desired, the locking cap 728B can also include threads on the shaft 732B so that the locking cap 728B can be rotated to engage the implant 700B.
[0065]
FIG. 49 illustrates another embodiment of a securing cap generally indicated by reference numeral 736B. The fixation cap 736B includes a head 738B having a thread 740B on its outer periphery that is adapted to cooperate with a corresponding threaded recess in the implant.
[0066]
Implant 700B, bone screw 722B, and / or fasteners 728B, 736B can be made from a bioabsorbable material, including but not limited to plastic and composite plastic. Suitable plastics can include plastics composed of lactide, galactide, glycolide, caprolactone, trimethylene carbonate, dioxanone, and / or combinations thereof in various polymeric states.
[0067]
By way of example and not limitation, for use in the lumbar spine, the implant of the present invention may have a depth of about 28-36 mm, a width of about 30-38 mm, and a height (maximum) of about 8-20 mm. Can be. The radius of curvature at the front end may be about 15-19 mm, and the radius of curvature at the rear end may be about 20-30 mm.
[0068]
In any of the embodiments of the present invention, the implant comprises, is made from, or is treated with artificially or naturally occurring materials and / or substances suitable for implantation in the human spinal cord. It can be coated with, coated with, filled with, used in combination with, or have an opening, hollow or passage containing them. These materials and / or substances include bone formation, bone growth promoting materials, bone, bone-derived materials or products, demineralized bone matrix, mineralized proteins, ossified proteins, bone morphogenic proteins, hydroxyapatite, bone-producing codes. Any source is included, including, but not limited to, bone genes and cortical bone. The implant can include at least a portion of a bioabsorbable and / or resorbable material in the body, such as bone and / or a bone growth promoting material. The implants of the present invention can be formed from a porous material or can be formed from a material that is inherently involved in bone growth from one of the adjacent vertebral bodies to the other of the adjacent vertebral bodies. If such implants are for posterior implantation, the posterior end of such implants can be used in a chemical treatment, coating, or combination to inhibit the formation of scar tissue in the spinal canal. . The implants of the present invention may be modified or used in combination with materials to render the implants antimicrobial, such as, but not limited to, electroplating or plasma spraying with silver ions or other materials. it can. At least a portion of the implant can be treated to promote bone ingrowth between the implant and adjacent vertebral bodies. The implants of the present invention include, but are not limited to, intervertebral spinal implants, structural bone grafts, meshes, cages, spacers, staples, bone screws, flat plates, mandrels, artificial tendons or wire tethers, or other It can be used in combination with a spinal fixation implant of any such object, regardless of the material, as long as it can be inserted into any part of the spine, such as a spinal fixation fitting of the present invention.
[0069]
While the shape of the various aspects of the implant has been elaborated, it is not intended to limit the scope of the invention thereto, only to mention, for example, slight irregularities, such as for bone engagement purposes. It is readily envisioned that the contours can be disturbed to encourage bone ingrowth or bone growth through.
[0070]
Although certain innovative features have been presented with reference to specific examples, they are merely examples and various combinations of these innovative features may be taught in addition to the specifically illustrated combinations. It is to be understood that they can now be readily combined, as an alternative, and are contemplated and claimed herein.
[Brief description of the drawings]
[0071]
FIG. 1 is a top view of a vertebral body in the lumbar spine with an implant gap formed therein for receiving a spinal implant, the spinal implant having a curvature of the posterior end of the anterior vertebral body between the implant gaps. The front end has a radius of curvature smaller than the radius.
FIG. 2 is a side view of two adjacent vertebral bodies in the lumbar spine, wherein the implantation gap of FIG. 1 has been formed throughout the height of the spinal disc and in adjacent vertebral bodies.
FIG. 3 is a side perspective view showing the implantation gap of FIG. 1;
FIG. 4 is a top view of a vertebral body in the cervical vertebra with an implantation gap formed therein for receiving a spinal implant, the spinal implant having a front end smaller than the posterior end of the vertebral body with a radius of curvature smaller than the posterior end; Has a radius of curvature of
5 is a side view of two adjacent vertebral bodies in the cervical vertebrae, wherein the implantation gap of FIG. 4 has been formed throughout the height of the spinal disc and in adjacent vertebral bodies.
FIG. 6 is a side perspective view showing the implantation gap of FIG. 4;
7 is a top view of a vertebral body in the lumbar spine and one preferred embodiment of an implant according to the present invention inserted into the implantation space of FIG. 1;
FIG. 8 is a side elevational view showing two vertebral bodies, with the implant of FIG. 7 inserted into the implantation gap of FIG. 1 formed throughout the height of the spinal disc and in adjacent vertebral bodies.
FIG. 9 is a top view showing the implant of FIG. 7;
FIG. 10 is a side view showing the implant of FIG. 7;
FIG. 11 shows a front end of the implant of FIG. 7;
FIG. 12 shows a rear end of the implant of FIG. 7;
FIG. 13 is a top view of another preferred embodiment of an implant according to the present invention, inserted into the implantation space of FIG.
FIG. 14 is a side elevational view showing two adjacent vertebral bodies, with the implant of FIG. 13 inserted into the implantation gap of FIG. 1 formed throughout the height of the spinal disc and in the adjacent vertebral bodies; .
FIG. 15 is a top view showing the implant of FIG.
FIG. 16 is a side view showing the implant of FIG. 13;
FIG. 17 shows the front end of the implant of FIG.
FIG. 18 shows a rear end of the implant of FIG.
FIG. 19 is a top view of another preferred embodiment of an implant according to the present invention for use in the implantation gap of FIG. 4;
20 is a top view of another preferred embodiment of an implant according to the present invention for use in the implantation gap of FIG.
FIG. 21 is a rear perspective view of another preferred embodiment of an implant according to another preferred embodiment of the present invention, having two members that are preferably mirror images of one another.
FIG. 22 is a top view showing one of the members of the implant of FIG. 21.
FIG. 23 is a view showing one inner surface of the member of the implant of FIG. 21;
FIG. 24 shows one outer side of the member of the implant of FIG. 21.
FIG. 25 shows one front end of a member of the implant of FIG. 21.
FIG. 26 shows one rear end of the member of the implant of FIG. 21;
FIG. 27 is a rear perspective view of another preferred embodiment of an implant according to another preferred embodiment of the present invention, having two members that are preferably mirror images of one another.
FIG. 28 is a top view showing one of the members of the implant of FIG. 27.
FIG. 29 shows one inner surface of the member of the implant of FIG. 27.
FIG. 30 shows one outer side of the member of the implant of FIG. 27.
FIG. 31 shows one front end of the member of the implant of FIG. 27.
FIG. 32 shows one posterior end of the member of the implant of FIG. 27.
FIG. 33 is a top view of an implant according to the present invention and another preferred embodiment of a second implant, which is a mirror image of the implant shown in dashed lines, both implants being dashed from the anterior approach to the spine. Shown is implanted in the indicated vertebral body.
FIG. 34 is a top view of another preferred embodiment of an implant according to the present invention and a second implant that is a mirror image of this implant shown in dashed lines, both implants being shown in dashed lines from the anterior approach to the spine. Shown is implanted in the indicated vertebral body.
FIG. 35 is a top view of another preferred embodiment of an implant according to the present invention and a second implant that is a mirror image of this implant shown in dashed lines, both implants being shown in dashed lines from the posterior approach to the spine. Shown is implanted in the indicated vertebral body.
FIG. 36 is a top view of another preferred embodiment of an implant according to the present invention having a bone engaging screw.
FIG. 37 is a side view showing the implant of FIG. 36.
FIG. 38 shows the front end of the implant of FIG. 36.
FIG. 39 shows the posterior end of the implant of FIG. 36 with the bone engaging screws and fasteners attached.
FIG. 40 shows the posterior end of the implant of FIG. 39 with the bone engaging screws and fasteners removed.
FIG. 41 is a partial side cross-sectional view illustrating one preferred embodiment of a bone screw fastener according to the present invention for use with the implant of FIG. 36.
FIG. 42 is a side sectional view showing another preferred embodiment of a bone screw fastener according to the present invention.
FIG. 43 is a top view of another preferred embodiment of an implant according to the present invention having a bone engaging screw.
FIG. 44 is a side view showing the implant of FIG. 43.
FIG. 45 shows the front end of the implant of FIG. 43.
FIG. 46 shows the posterior end of the implant of FIG. 43 with the bone engaging screws and fasteners attached.
FIG. 47 shows the posterior end of the implant of FIG. 46 with the bone engaging screws and fasteners removed.
FIG. 48 is a partial side cross-sectional view illustrating one preferred embodiment of a bone screw fastener according to the present invention for use with the implant of FIG. 43.
FIG. 49 is a side sectional view showing another preferred embodiment of a bone screw fastener according to the present invention.

Claims (195)

An interbody spinal implant made from cortical bone for inserting at least a portion into an implantation gap formed across the height of an intervertebral space between adjacent vertebral bodies of a human spine, comprising: Has a front and rear surface and a depth between them,
A front end for initial insertion into the intervertebral space and a rear end opposite the front end, wherein the implant has a length between the front end and the rear end; When,
Opposing upper and lower portions between the anterior and posterior ends, at least partially disposed within and throughout the intervertebral space to contact and support adjacent vertebral bodies Opposing upper and lower portions that are non-circular along at least a portion of the length of the implant;
Opposing sides between the upper and lower parts and between the front and rear ends defining a width of the implant, at least a portion of at least one of the opposing sides being the length of the implant. A straight line along at least a portion of the implant, wherein the front end is configured in a generally semi-circular shape from one of the opposing sides to the other of the opposing sides, the circle being approximately equal to the width of the implant. Having opposing sides having a diameter,
A medullary canal made from a bone annulus obtained from a major long bone of a human having a medullary canal and passing through the upper and lower portions to form at least a portion of a passage adapted to receive a bone growth promoting material An implant comprising at least a portion of a bone, through which bone can grow from vertebral body to vertebral body. The implant of claim 1, wherein the implant has a maximum width between the opposing sides that is greater than one-half the width of an adjacent vertebral body adapted to insert the implant. The implant of claim 1, wherein the implant has a maximum width between the opposing sides that is less than one-half the width of an adjacent vertebral body that is adapted to insert the implant. 4. The implant of claim 3, wherein the implant is adapted to be inserted side-by-side with a second one of the implants into an intervertebral space between adjacent vertebral bodies. The implant of claim 1, wherein at least a portion of the anterior end has a low height to facilitate insertion of the implant between two adjacent vertebral bodies. 2. The posterior end is adapted to be laterally conformal with at least a portion of a peripheral contour of at least one of an anterior and / or posterior surface of a vertebral body adjacent to the intervertebral space into which the implant is to be inserted. An implant according to claim 1. The implant of claim 1, wherein the passage is between the opposing sides of the implant. The implant of claim 1, wherein the passage intersects at least one of the opposing sides. The implant of claim 1, wherein the passage is between the front end and the back end of the implant. The implant of claim 1, wherein the implant has a central longitudinal axis along a length, and at least a portion of at least one of the opposing sides is oriented generally parallel to the central longitudinal axis of the implant. Implant. The implant of claim 1, wherein at least some of the opposing sides are generally parallel to one another. 2. The method of claim 1, wherein at least a portion of the upper and lower surfaces are angled relative to each other from a posterior end to an anterior end such that adjacent vertebral bodies can form angles with each other. Implant. 2. The implant of claim 1, wherein the implant has a maximum length that is less than and approximates a depth from the posterior to anterior vertebral bodies. A bone engaging surface formed on at least the upper and lower outer surfaces for engaging adjacent vertebral bodies, the bone engaging surface comprising a projection, a claw tooth, a nail-like projection, a spline; The implant of claim 1, comprising at least one of trolls and knurls. The implant includes at least two members, each member having a front, a back, a top surface, a bottom surface, and at least one side, each member being arranged in a side-by-side arrangement with another of the members; The implant of claim 1, wherein the front portion of the member forms the front end of the implant when placed side by side. 16. The implant of claim 15, wherein the implant includes two of the members, each member being a mirror image of the other. 16. The implant of claim 15, wherein each member includes at least a portion of the passage. The implant of claim 1, wherein at least a portion of the implant comprises a bone growth promoting material. The bone growth promoting material is selected from one of bone, bone-derived products, demineralized bone matrix, mineralized proteins, ossified proteins, bone morphogenic proteins, hydroxyapatite, and bone production encoding genes; An implant according to claim 18. 2. The implant of claim 1, wherein the implant is in combination with a bone growth promoting material. The bone growth promoting material is selected from one of bone, bone-derived products, demineralized bone matrix, mineralized proteins, ossified proteins, bone morphogenic proteins, hydroxyapatite, and bone production encoding genes; An implant according to claim 20. The implant of claim 1, wherein the implant has been treated with a bone growth promoting material. The implant of claim 1, wherein at least a portion of the implant is resorbable. 2. The implant of claim 1, in combination with a chemical adapted to inhibit scar formation. 2. The implant of claim 1, wherein the implant is in combination with an antimicrobial material. The implant of claim 1, wherein at least a portion of the implant has been treated to promote bone ingrowth between the implant and the adjacent vertebral body. 2. The implant of claim 1, further combined with at least one spinal fixation implant. The implant of claim 1, wherein the posterior end is adapted to receive at least one bone screw adapted to engage at least one vertebral body when inserted through the implant. 29. The implant according to claim 28, further comprising a fastener for securing at least one bone screw to the implant. 30. The implant of claim 29, wherein the fastener is made from one of cortical bone and a bioabsorbable material. 29. The implant of claim 28, wherein the screw is made from one of cortical bone and a bioabsorbable material. An interbody spinal implant made from cortical bone for inserting at least a portion into an implantation gap formed across the height of an intervertebral space between adjacent vertebral bodies of a human spine, comprising: Has a front and rear surface and a depth between them,
A front end for initial insertion into the intervertebral space and a rear end opposite the front end, wherein the implant has a length between the front end and the rear end; When,
Opposing upper and lower portions between the anterior and posterior ends, at least partially disposed within and throughout the intervertebral space to contact and support adjacent vertebral bodies And opposing upper and lower portions,
Having a maximum width that is greater than one-half the width of an adjacent vertebral body adapted to insert the implant, wherein the anterior end is substantially half a circle of a first circle along the width of the implant. And wherein the posterior end has a radius of curvature of a second circle along the width of the implant, the second circle having a radius greater than the radius of the first circle, and further having a medullary canal Comprising at least a portion of a medullary canal made from a bone annulus obtained from a major human long bone and passing through the upper and lower portions to form a passage adapted to receive a bone growth promoting material; An implant in which bone can grow from vertebral body to vertebral body through passages. 33. The implant of claim 32, wherein the anterior end and the posterior end of the implant intersect at opposite ends of the implant. 33. The implant of claim 32, wherein the width of the implant is approximately equal to a diameter of a first circle. 33. The implant of claim 32, wherein the implant has a height from the top to the bottom, wherein the height of the implant is less than a maximum width of the implant. 33. The implant of claim 32, wherein at least a portion of the front end has a low height to facilitate insertion of the implant between two adjacent vertebral bodies. 33. The posterior end is adapted to be laterally conformal with at least a portion of a peripheral contour of at least one of an anterior and / or posterior surface of a vertebral body adjacent to the intervertebral space into which the implant is to be inserted. An implant according to claim 1. 33. The implant of claim 32, wherein the implant has a perimeter, and wherein the passage is inside the perimeter of the implant. 33. The implant of claim 32, wherein the implant has a perimeter, and wherein the passage intersects at least a portion of the perimeter. 33. The implant of claim 32, wherein the passage is between the front and rear ends of the implant. 33. The implant of claim 32, further comprising opposing sides between the front end and the rear end. 42. The implant of claim 41, wherein at least a portion of at least one of the opposing sides is linear along at least a portion of a length of the implant. 42. The implant of claim 41, wherein the implant has a central longitudinal axis along its length, and at least a portion of at least one of the opposing sides is oriented generally parallel to the central longitudinal axis of the implant. Implant. 42. The implant of claim 41, wherein at least some of the opposing sides are generally parallel to one another. 33. The method of claim 32, wherein at least a portion of the upper and lower surfaces are in an angled relationship to each other from a posterior end to an anterior end such that adjacent vertebral bodies can form an angle with each other. Implant. 33. The implant of claim 32, wherein the implant has a maximum length that is less than and approximates the depth from the posterior to anterior vertebral bodies. A bone engaging surface formed on at least the upper and lower outer surfaces for engaging adjacent vertebral bodies, the bone engaging surface comprising a projection, a claw tooth, a nail-like projection, a spline; 33. The implant of claim 32, comprising at least one of trolls and knurls. The implant includes at least two members, each member having a front, a back, a top surface, a bottom surface, and at least one side, each member being arranged in a side-by-side arrangement with another of the members; 33. The implant of claim 32, wherein the front of the member forms the front end of the implant when placed side by side. 48. The implant of claim 47, wherein the implant includes two of the members, each member being a mirror image of the other. 49. The implant of claim 48, wherein each member includes at least a portion of the passage. 33. The implant of claim 32, wherein at least a portion of the implant comprises a bone growth promoting material. The bone growth promoting material is selected from one of bone, bone-derived products, demineralized bone matrix, mineralized proteins, ossified proteins, bone morphogenic proteins, hydroxyapatite, and bone production encoding genes; 52. The implant of claim 51. 33. The implant of claim 32 in combination with a bone growth promoting material. The bone growth promoting material is selected from one of bone, bone-derived products, demineralized bone matrix, mineralized proteins, ossified proteins, bone morphogenic proteins, hydroxyapatite, and bone production encoding genes; 54. The implant of claim 53. 33. The implant of claim 32, wherein the implant has been treated with a bone growth promoting material. 33. The implant of claim 32, wherein at least a portion of the implant is resorbable. 33. The implant of claim 32, in combination with a chemical adapted to inhibit scar formation. 33. The implant of claim 32 in combination with an antimicrobial material. 33. The implant of claim 32, wherein at least a portion of the implant has been treated to promote bone ingrowth between the implant and the adjacent vertebral body. 33. The implant of claim 32, further combined with at least one spinal fixation implant. 41. The implant of claim 40, further comprising a curved transition between at least one of the opposing sides and the rear end, wherein the curved transition forms at least a portion of an arc. 33. The implant of claim 32, wherein the posterior end is adapted to receive at least one bone screw adapted to engage at least one vertebral body when inserted through the implant. 63. The implant of claim 62, further comprising a fastener for securing at least one bone screw to the implant. 64. The implant of claim 63, wherein the fastener is made from one of cortical bone and a bioabsorbable material. 63. The implant of claim 62, wherein the screw is made from one of cortical bone and a bioabsorbable material. An intervertebral spinal implant made from a bone composite material for inserting at least a portion into an implantation gap formed across the height of an intervertebral space between adjacent vertebral bodies of a human spine, comprising: The body having an anterior and posterior surface and a depth therebetween;
A front end for initial insertion into the intervertebral space and a rear end opposite the front end, wherein the implant has a length between the front end and the rear end; When,
Opposing upper and lower portions between the anterior and posterior ends, at least partially disposed within and throughout the intervertebral space to contact and support adjacent vertebral bodies Opposing upper and lower portions that are non-circular along at least a portion of the length of the implant;
Opposing sides between the upper and lower parts and between the front and rear ends defining a width of the implant, at least a portion of at least one of the opposing sides being the length of the implant. A straight line along at least a portion of the implant, wherein the front end is configured in a generally semi-circular shape from one of the opposing sides to the other of the opposing sides, the circle being approximately equal to the width of the implant. Having opposing sides having a diameter,
Wherein the upper and lower portions of the implant are made of a bone composite material, wherein the upper and lower portions of the implant include at least one interconnecting opening to form at least a portion of a passage adapted to receive a bone growth promoting material; An implant that allows bone to grow from vertebral body to vertebral body through passages. 67. The implant of claim 66, wherein the bone composite comprises at least one of cortical bone fibers, bone fibrils, bone particles, and bone powder. 67. The implant of claim 66, further comprising a bonding material. 60. The implant of claim 59, wherein the binding material is at least one of bioactive and bioabsorbable. 67. The implant of claim 66, wherein the implant has a maximum width between the opposing sides that is greater than one-half the width of an adjacent vertebral body adapted to insert the implant. 67. The implant of claim 66, wherein the implant has a maximum width between the opposing sides that is less than one-half the width of an adjacent vertebral body into which the implant is inserted. 72. The implant of claim 71, wherein the implant is adapted to be inserted side-by-side with a second one of the implants into an intervertebral space between adjacent vertebral bodies. 67. The implant of claim 66, wherein at least a portion of the front end has a low height to facilitate insertion of the implant between two adjacent vertebral bodies. 67. The posterior end is adapted to be laterally conformal with at least a portion of a peripheral contour of at least one of an anterior and / or posterior surface of a vertebral body adjacent to the intervertebral space into which the implant is to be inserted. An implant according to claim 1. 67. The implant of claim 66, wherein the passage is between the opposing sides of the implant. 67. The implant of claim 66, wherein the passage intersects at least one of the opposing sides of the implant. 67. The implant of claim 66, wherein the passage is between the leading and trailing ends of the implant. 67. The implant of claim 66, wherein the implant has a central longitudinal axis, and at least a portion of at least one of the opposing sides is oriented generally parallel to the central longitudinal axis of the implant. 67. The implant of claim 66, wherein at least some of the opposing sides are generally parallel to one another. 67. The method of claim 66, wherein at least a portion of the upper and lower surfaces are angled relative to each other from a posterior end to an anterior end such that adjacent vertebral bodies can form angles with each other. Implant. 67. The implant of claim 66, wherein the implant has a maximum length that is less than and approximates the depth from the posterior to anterior vertebral bodies. A bone engaging surface formed on at least the upper and lower outer surfaces for engaging adjacent vertebral bodies, the bone engaging surface comprising a projection, a claw tooth, a nail-like projection, a spline; 67. The implant of claim 66, comprising at least one of trolls and knurls. The implant includes at least two members, each member having a front, a back, a top surface, a bottom surface, and at least one side, each member being arranged in a side-by-side arrangement with another of the members; 67. The implant of claim 66, wherein the front portion of the member forms the front end of the implant when placed side by side. 84. The implant of claim 83, wherein the implant includes two of the members, each member being a mirror image of the other. 84. The implant of claim 83, wherein each member includes at least a portion of the passage. 67. The implant of claim 66, wherein at least a portion of the implant comprises a bone growth promoting material. The bone growth promoting material is selected from one of bone, bone-derived products, demineralized bone matrix, mineralized proteins, ossified proteins, bone morphogenic proteins, hydroxyapatite, and bone production encoding genes; 87. The implant of claim 86. 67. The implant of claim 66 in combination with a bone growth promoting material. The bone growth promoting material is selected from one of bone, bone-derived products, demineralized bone matrix, mineralized proteins, ossified proteins, bone morphogenic proteins, hydroxyapatite, and bone production encoding genes; 90. The implant of claim 88. 67. The implant of claim 66, wherein the implant has been treated with a bone growth promoting material. 67. The implant of claim 66, wherein at least a portion of the implant is resorbable. 67. The implant of claim 66, in combination with a chemical adapted to inhibit scar formation. 67. The implant of claim 66, in combination with an antimicrobial material. 67. The implant of claim 66, wherein at least a portion of the implant has been treated to promote bone ingrowth between the implant and the adjacent vertebral body. 67. The implant of claim 66, further combined with at least one spinal fixation implant. 67. The implant of claim 66, wherein the posterior end is adapted to receive at least one bone screw adapted to engage at least one vertebral body when inserted through the implant. 97. The implant of claim 96, further comprising a fastener for securing at least one bone screw to the implant. 100. The implant of claim 97, wherein the fastener is made from one of cortical bone and a bioabsorbable material. 97. The implant of claim 96, wherein the screw is made from one of cortical bone and a bioabsorbable material. An intervertebral spinal implant made from a bone composite material for inserting at least a portion into an implantation gap formed across the height of an intervertebral space between adjacent vertebral bodies of a human spine, comprising: The body having an anterior and posterior surface and a depth therebetween;
A front end for initial insertion into the intervertebral space and a rear end opposite the front end, wherein the implant has a length between the front end and the rear end; When,
Opposing upper and lower portions between the anterior and posterior ends, at least partially disposed within and throughout the intervertebral space to contact and support adjacent vertebral bodies And opposing upper and lower portions,
Having a maximum width that is greater than one-half the width of an adjacent vertebral body adapted to insert the implant, wherein the anterior end is substantially half a circle of a first circle along the width of the implant. Wherein the posterior end has a radius of curvature of a second circle along the width of the implant, the second circle having a radius greater than the radius of the first circle, and further comprising a bone composite material. The upper and lower portions of the implant are formed and include at least one interconnecting opening to form a passage adapted to receive a bone growth promoting material, through which bone is passed through the vertebral body. An implant that can grow from the body to the vertebral body. 110. The implant of claim 100, wherein the bone composite comprises at least one of cortical bone fibers, bone fibrils, bone particles, and bone powder. 110. The implant of claim 100, further comprising a bonding material. 103. The implant of claim 102, wherein the binding material is at least one of bioactive and bioabsorbable. 110. The implant of claim 100, wherein the anterior end and the posterior end of the implant intersect at diametrically opposed points on the implant. The implant of claim 100, wherein the width of the implant is approximately equal to a diameter of a first circle. 110. The implant of claim 100, wherein the implant has a height from the top to the bottom, wherein the height of the implant is less than a maximum width of the implant. 110. The implant of claim 100, wherein at least a portion of the anterior end has a low height to facilitate insertion of the implant between two adjacent vertebral bodies. 110. The posterior end is adapted to be laterally conformal to at least a portion of a peripheral profile of at least one of an anterior and / or posterior surface of a vertebral body adjacent to the intervertebral space into which the implant is to be inserted. An implant according to claim 1. 110. The implant of claim 100, wherein the implant has a perimeter, and at least a portion of the passage is within the perimeter of the implant. 110. The implant of claim 100, wherein the implant has a perimeter, and wherein the passage intersects at least a portion of the perimeter of the implant. 110. The implant of claim 100, wherein the passage is between the front and rear ends of the implant. 110. The implant of claim 100, further comprising opposing sides between the front end and the rear end. 1 13. The implant of claim 112, wherein at least a portion of at least one of the opposing sides is linear along at least a portion of a length of the implant. 112. The implant of claim 112, wherein the implant has a central longitudinal axis along its length, and at least a portion of at least one of the opposing sides is oriented generally parallel to the central longitudinal axis of the implant. Implant. 112. The implant of claim 112, wherein at least some of the opposing sides are generally parallel to one another. 100. The method of claim 100, wherein at least a portion of the upper and lower surfaces are angled relative to each other from a posterior end to an anterior end such that adjacent vertebral bodies can form angles with each other. Implant. 110. The implant of claim 100, wherein the implant has a maximum length that is less than and approximates a depth from the posterior to anterior vertebral bodies. A bone engaging surface formed on at least the upper and lower outer surfaces for engaging adjacent vertebral bodies, the bone engaging surface comprising a projection, a claw tooth, a nail-like projection, a spline; 110. The implant of claim 100, comprising at least one of trolls and knurls. The implant includes at least two members, each member having a front, a back, a top surface, a bottom surface, and at least one side, each member being arranged in a side-by-side arrangement with another of the members; 110. The implant of claim 100, wherein the front of a member forms the front end of the implant when placed side by side. 120. The implant of claim 119, wherein the implant includes two of the members, each member being a mirror image of the other. 120. The implant of claim 119, wherein each member includes at least a portion of the passage. 110. The implant of claim 100, wherein at least a portion of the implant comprises a bone growth promoting material. The bone growth promoting material is selected from one of bone, bone-derived products, demineralized bone matrix, mineralized proteins, ossified proteins, bone morphogenic proteins, hydroxyapatite, and bone production encoding genes; The implant of claim 122. 110. The implant of claim 100, in combination with a bone growth promoting material. The bone growth promoting material is selected from one of bone, bone-derived products, demineralized bone matrix, mineralized proteins, ossified proteins, bone morphogenic proteins, hydroxyapatite, and bone production encoding genes; 125. The implant of claim 124. 110. The implant of claim 100, wherein the implant has been treated with a bone growth promoting material. 110. The implant of claim 100, wherein at least a portion of the implant is resorbable. 110. The implant of claim 100, in combination with a chemical adapted to inhibit scar formation. 110. The implant of claim 100, wherein the implant is in combination with an antimicrobial material. 110. The implant of claim 100, wherein at least a portion of the implant has been treated to promote bone ingrowth between the implant and the adjacent vertebral body. 110. The implant of claim 100, further in combination with at least one spinal fixation implant. 112. The implant of claim 111, further comprising a curved transition between at least one of the opposing sides and the rear end, wherein the curved transition forms at least a portion of an arc. 110. The implant of claim 100, wherein the posterior end is adapted to receive at least one bone screw adapted to engage at least one vertebral body when inserted through the implant. 143. The implant of claim 133, further comprising a fastener for securing at least one bone screw to the implant. 135. The implant of claim 134, wherein the fastener is made from one of cortical bone and a bioabsorbable material. 135. The implant of claim 133, wherein the screw is made from one of cortical bone and a bioabsorbable material. An artificial interbody spinal implant for inserting at least a portion into an implantation gap formed across the height of an intervertebral space between adjacent vertebral bodies of the human spine, the vertebral body comprising an anterior and a vertebral body. Having a rear surface and a depth between them,
A front end for initial insertion into the intervertebral space and a rear end opposite the front end, wherein the implant has a length between the front end and the rear end; When,
Opposing upper and lower portions between the anterior and posterior ends, at least a portion disposed within and throughout the intervertebral space to contact and support adjacent vertebral bodies Opposing upper and lower portions that define a height of the implant and are non-circular along at least a portion of the length of the implant;
Opposing sides between the upper and lower portions and between the front and rear ends, defining a width of the implant, wherein at least a portion of at least one of the opposing sides is at least a portion of the implant. Linear along at least a portion of the length, wherein the front end is configured in a generally semi-circular shape from one of the opposing sides to the other of the opposing sides, wherein the circle is approximately the width of the implant. Opposing sides having equal diameters, wherein the width of the implant is greater than the height of the implant;
Made from a material other than bone, the upper and lower portions of the implant are interconnected and adapted to receive a bone growth promoting material so that bone can grow from vertebral body to vertebral body through the implant. An implant comprising at least one opening. 138. The implant of claim 137, wherein the implant has a maximum width between the opposing sides that is greater than one-half the width of an adjacent vertebral body adapted to insert the implant. 138. The implant of claim 137, wherein the implant has a maximum width between the opposing sides that is less than one-half the width of an adjacent vertebral body adapted to insert the implant. 140. The implant of claim 139, wherein the implant is adapted to be inserted side-by-side with a second one of the implants into an intervertebral space between adjacent vertebral bodies. 138. The implant of claim 137, wherein at least a portion of the anterior end has a low height to facilitate insertion of the implant between two adjacent vertebral bodies. 137. The posterior end is adapted to be laterally conformal with at least a portion of a peripheral contour of at least one of an anterior and / or posterior surface of a vertebral body adjacent to the intervertebral space into which the implant is to be inserted. An implant according to claim 1. 138. The implant of claim 137, wherein the posterior end has a second circular radius of curvature in a lateral direction. 144. The implant of claim 143, wherein the radius of curvature of the rear end is greater than the radius of curvature of the front end of the implant. 138. The implant of claim 137, wherein the at least one opening is between the opposing sides of the implant. 138. The implant of claim 137, wherein the at least one opening intersects at least one of the opposing sides. 138. The implant of claim 137, wherein the at least one opening is between the front end and the back end of the implant. 138. The implant of claim 137, wherein the implant has a central longitudinal axis along its length, and at least a portion of at least one of the opposing sides is oriented generally parallel to the central longitudinal axis of the implant. Implant. 138. The implant of claim 137, wherein at least some of the opposing sides are generally parallel to one another. 138. The method of claim 137, wherein at least a portion of the upper and lower surfaces are angled relative to each other from a posterior end to an anterior end such that adjacent vertebral bodies can form an angle with each other. Implant. 138. The implant of claim 137, wherein the implant has a maximum length that is less than and approximates a depth from the posterior to anterior vertebral bodies. A bone engaging surface formed on at least the upper and lower outer surfaces for engaging adjacent vertebral bodies, the bone engaging surface comprising a projection, a claw tooth, a nail-like projection, a spline; 138. The implant of claim 137, comprising at least one of trolls and knurls. The implant includes at least two members, each member having a front, a back, a top surface, a bottom surface, and at least one side, each member being arranged in a side-by-side arrangement with another of the members; 138. The implant of claim 137, wherein the front portion of the member forms the front end of the implant when placed side by side. 153. The implant of claim 153, wherein the implant includes two of the members, each member being a mirror image of the other. 153. The implant of claim 153, wherein each member includes at least a portion of said at least one opening. 137. The implant of claim 137, in combination with a bone growth promoting material. The bone growth promoting material is selected from one of bone, bone-derived products, demineralized bone matrix, mineralized proteins, ossified proteins, bone morphogenic proteins, hydroxyapatite, and bone production encoding genes; 157. The implant of claim 156. 138. The implant of claim 137, wherein said implant is treated with a bone growth promoting material. 138. The implant of claim 137, wherein at least a portion of the implant is resorbable. 137. The implant of claim 137, in combination with a chemical adapted to inhibit scar formation. 138. The implant of claim 137, wherein the implant is in combination with an antimicrobial material. 138. The implant of claim 137, wherein at least a portion of the implant has been treated to promote bone ingrowth between the implant and the adjacent vertebral body. 138. The implant of claim 137, further in combination with at least one spinal fixation implant. 138. The implant of claim 137, wherein the posterior end is adapted to receive at least one bone screw adapted to engage at least one vertebral body when inserted through the implant. 165. The implant of claim 164, further comprising a fastener for securing at least one bone screw to the implant. An artificial interbody spinal implant for inserting at least a portion into an implantation gap formed across the height of an intervertebral space between adjacent vertebral bodies of the human spine, the vertebral body comprising an anterior and a vertebral body. Having a rear surface and a depth between them,
A front end for initial insertion into the intervertebral space and a rear end opposite the front end, wherein the implant has a length between the front end and the rear end; When,
Opposing upper and lower portions between the anterior and posterior ends, at least partially disposed within and throughout the intervertebral space to contact and support adjacent vertebral bodies And opposing upper and lower portions,
Having a maximum width that is greater than one-half the width of an adjacent vertebral body adapted to insert the implant, wherein the anterior end is substantially half a circle of a first circle along the width of the implant. Wherein the posterior end has a radius of curvature of a second circle along the width of the implant, the second circle having a radius greater than the radius of the first circle, and further comprising a material other than bone And wherein the upper and lower portions of the implant are interconnected and adapted to receive a bone growth promoting material such that bone can grow from vertebral body to vertebral body through the implant. An implant, including an opening. 169. The implant of claim 166, wherein the anterior end and the posterior end of the implant intersect at diametrically opposed locations on the implant. 166. The implant of claim 166, wherein the width of the implant is approximately equal to a diameter of a first circle. 169. The implant of claim 166, wherein the implant has a height from the top to the bottom, wherein the height of the implant is less than a maximum width of the implant. 169. The implant of claim 166, wherein at least a portion of the anterior end has a low height to facilitate insertion of the implant between two adjacent vertebral bodies. 170. The implant of claim 166, wherein the posterior end is adapted to be laterally conformal with at least a portion of a peripheral contour of a front surface of a vertebral body adjacent to the intervertebral space into which the implant is to be inserted. 169. The implant of claim 166, wherein the implant has a perimeter, and wherein the at least one opening is inside the perimeter of the implant. 169. The implant of claim 166, wherein the implant has a perimeter, and wherein the at least one opening intersects at least a portion of the perimeter of the implant. 169. The implant of claim 166, wherein the at least one opening is between the front and rear ends of the implant. 169. The implant of claim 166, further comprising opposing sides between the front end and the rear end. 178. The implant of claim 175, wherein at least a portion of at least one of the opposing sides is linear along at least a portion of a length of the implant. 178. The implant of claim 175, wherein the implant has a central longitudinal axis along its length, and at least a portion of at least one of the opposing sides is oriented generally parallel to the central longitudinal axis of the implant. Implant. 178. The implant of claim 175, wherein at least some of the opposing sides are generally parallel to one another. 170. The method of claim 166, wherein at least a portion of the upper and lower surfaces are angled relative to each other from a posterior end to an anterior end such that adjacent vertebral bodies can form an angle with each other. Implant. 169. The implant of claim 166, wherein the implant has a maximum length that is less than and approximates a depth from the posterior to anterior vertebral bodies. A bone engaging surface formed on at least the upper and lower outer surfaces for engaging adjacent vertebral bodies, the bone engaging surface comprising a projection, a claw tooth, a nail-like projection, a spline; 169. The implant of claim 166, comprising at least one of trolls and knurls. The implant includes at least two members, each member having a front, a back, a top surface, a bottom surface, and at least one side, each member being arranged in a side-by-side arrangement with another of the members; 169. The implant of claim 166, wherein the front portion of the member forms the front end of the implant when placed side by side. 183. The implant of claim 182, wherein the implant includes two of the members, each member being a mirror image of the other. 183. The implant of claim 182, wherein each member includes at least a portion of the at least one opening. 169. The implant of claim 166, in combination with a bone growth promoting material. The bone growth promoting material is selected from one of bone, bone-derived products, demineralized bone matrix, mineralized proteins, ossified proteins, bone morphogenic proteins, hydroxyapatite, and bone production encoding genes; 189. The implant of claim 185. 169. The implant of claim 166, wherein the implant is treated with a bone growth promoting material. 169. The implant of claim 166, wherein at least a portion of the implant is resorbable. 170. The implant of claim 166, in combination with a chemical adapted to inhibit scar formation. 169. The implant of claim 166, in combination with an antimicrobial material. 169. The implant of claim 166, wherein at least a portion of the implant has been treated to promote bone ingrowth between the implant and the adjacent vertebral body. 169. The implant of claim 166, further in combination with at least one spinal fixation implant. 178. The implant of claim 175, further comprising a curved transition between at least one of the opposing sides and the rear end, wherein the curved transition forms at least a portion of an arc. 169. The implant of claim 166, wherein the posterior end is adapted to receive at least one bone screw adapted to engage at least one vertebral body when inserted through the implant. 195. The implant of claim 194, further comprising a fastener for securing at least one bone screw to the implant.