JP2006136734A - Spinous projection spacer - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To extensively shorten a time needed to fix a spinous projection spacer for maintaining an expanded place by pinching a spinous projection between spinous projections expanded after vertically dividing the spinous projection, when treating vertebral arch plastic surgery in a vertical division method for cervical vertebra spinous projection used for treatment of cervical vertebra inflammatory osteomyelitis, cervical vertebra disk herniation, neck stenochoria spinal canal stenosis or ossification of posteria longitudinal ligament, etc. <P>SOLUTION: This spinous projection spacer 1 has side faces 111, 112 making contact with vertically divided spinous projections. Projections 12, 13 are attached to both side faces 111, 112. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

The present invention relates to a spinous process in the case of cervical spinous process longitudinal splitting used in treating cervical spondylotic myelopathy, cervical disc herniation, cervical spinal stenosis, posterior longitudinal ligament ossification, etc. The present invention relates to a spinous process spacer that is sandwiched between spinous processes that have been expanded after splitting to maintain the expanded position.

  Surgical treatment is one of the treatments for diseases such as ossification of posterior longitudinal ligament of the cervical spine and cervical spondylotic myelopathy. There are mainly two types of surgical methods. In other words, one of the left and right vertebral arches is split vertically, the other side is formed with a lateral groove and the vertebral arch is opened on one side, and the cervical spinous process is vertically expanded by splitting the spinous process vertically. This is a split laminoplasty. We think that there are fewer complications such as nerve root disorders, and we are performing cervical spinous process longitudinal split laminoplasty.

  In this method, after the cervical vertebra is expanded from the rear, a lateral groove is formed in the joint portion between both vertebrae, the tip of the spinous process is excised, and the spinous process is further divided vertically. Then, autologous bones or other bones such as bones collected from the iliac bone or bones of the excised spinous process tip are processed and transplanted in the expanded part, or trapezoidal or arcuate ceramic spinous process spacers are divided vertically. The spinal process of the cervical vertebra is expanded between the spinous processes. As a result, the pressure applied to the spinal cord compressed by the narrow spinal canal can be removed.

However, this method divides the spinous process vertically, and when enlarged, the cranial and caudal sides are not enlarged equally, the cranial side opens wider than the caudal side, and the difficulty that the spacer holding this enlargement is not stable is difficult. is there. Therefore, there is a difficulty that the spacer holding this enlargement is not stable. Therefore, when inserting and fixing the spacer for holding this enlargement, a thread or wire must be used. When using a thread or wire when the surgical field is quite narrow, fixing is complicated and time consuming, and problems such as an extended operation time and an increased amount of bleeding also occur.
JP 2001-149392 A Japanese Utility Model Publication No. 6-38936 KAIKAI 2-104019 Design Registration No. 851785 Hirabayashi “On the unilateral cervical spinal dilation as a posterior decompression method for cervical myelopathy” Surgery: 11 1978 Three people from Tsuzuki, “Cervical spine”, East Japan Rikaikai Vol. 3, No. 3, October 1991 1999 Objection No. 75013

  In the conventional example, when bone transplantation is performed, it is necessary to collect a bone fragment from autologous bone before transplantation, and in particular, collection from the iliac bone requires a secondary invasion that damages a healthy part.

  In addition, at this time, it is not always possible to collect a sufficient amount of bone for treatment, and more time is required to process the bone for transplantation, which causes problems such as longer operation time and increased amount of bleeding.

On the other hand, when an existing ceramic spinous process spacer is used, the problem of transplanted bone can be solved, but there is a problem that the adhesiveness with the surface of the vertically divided spinous process is insufficient and the fixing property is poor. In other words, when the spinous process is vertically divided and enlarged, not only the back side (the spinous process distal end from the spinous process base) opens wider than the spinal canal side, but also the cranial side and the cranial side wide open on the cranial side.

  However, the conventional spacer does not fully consider this point.

  In addition, since the opening process of the spinous process varies considerably from person to person, it is difficult to create a shape that suits each patient's individual constitution, which makes it more difficult to adhere to the vertical surface of the spinous process (conformity). ing. Therefore, it has been considered difficult to devise and produce a shape common to all patients.

With existing ceramic spinous process spacers, it was necessary to fasten and fix them with wires, silk threads, synthetic threads and the like. In addition, the surgical field is narrow in this type of surgery, so when using a conventional spacer, it is not easy to pass the wire, silk thread, or synthetic thread through the vertically split spinous process hole, and then through the spacer, and it takes time. . Furthermore, it takes a considerable amount of time to fix 5-6 spacers at a time in normal surgery.
This causes problems such as prolonging the operation time and increasing the amount of bleeding.

  Further, if the initial fixation of the spacer to the vertically divided spinous process is poor, the spinous process is absorbed by the movement of the spacer and the spacer fixing property is further deteriorated. In addition, the wire, silk thread, and synthetic thread used for fixation may be cut, causing the spacer to fall into the spinal canal.

  However, conventionally, it has been believed that it is safest to fasten and fix with a thread or wire, and other fixing means have not been considered at all.

  The object of the present invention is to form a protrusion with respect to the spacer, in place of the conventional fastening and fixing structure, to solve the above-mentioned problems in cervical laminoplasty, etc. It is an object of the present invention to provide a spacer that has good fixation and compatibility, can be easily inserted in any spinal surgery, and can greatly reduce the operation time.

  In order to solve the above-described conventional problems, the present invention provides a spinous process spacer having side surfaces in contact with a vertically divided spinous process at both ends, and the spinous process spacer to which processes are attached on both side surfaces. There is.

  The process has an inclined angle, and the angle provides a spinous process spacer of about 50 to 85 degrees to improve compatibility with the spinous process.

  A spinous process spacer having a side surface and a both ends that contact a vertically divided spinous process, and a procession is attached to each side surface, and the length of the process is fixed to about 1 mm to several mm.

  The process of the spinous process spacer provides a spinous process spacer that is made of a material that is different from the main body part and is made of at least a rigid material, and is intended to be fixed.

  The process of the spinous process spacer is attached so as to be movable. In the living body, the process of the spinous process is reduced and the spinous process spacer is designed to be fixed so that the insertion is easy. . That is, if the projection is movable, insertion is easy regardless of the direction in which the spinous process spacer is formed when the spinous process spacer is inserted, and no technique is required for the insertion.

  The cross-section of the spinous process spacer has a circular shape, thereby ensuring ease of insertion.

  There is provided a spinous process spacer having a side surface in contact with a vertically divided spinous process at both ends, and a procession integrally formed on both side surfaces.

  By using the spinous process spacer of the present invention, bone collection becomes unnecessary. In addition, it can be brought into close contact with the longitudinally split surface of the vertically divided spinous processes. In addition, it is confirmed that the fixation is sufficient compared to a conventional spacer such as a wire, silk thread, synthetic thread, etc., and the time required for surgery can be greatly shortened. The amount can be reduced.

  Further, since the protrusion is attached to the main body, there is an advantage that the material of the protrusion can be selected, and further, there is an advantage that the strength and length of the protrusion can be selected according to the size of the spinous process.

  Hereinafter, the spinous process spacer 1 of the present invention will be described in detail. FIG. 1 shows an embodiment of the present invention.

  The spinous process spacer 1 includes a main body portion 11 having side surfaces 111 and 112 in contact with the longitudinal plane of the spinous process, and projections 12 and 13 formed at substantially central portions of the side surfaces 111 and 112.

  The angle α formed by the side surfaces 111 and 112 may be appropriately selected within a range of about 50 to 85 degrees. When this angle is outside the above range, it is not preferable to make intimate contact with the spinous processes.

  From the viewpoint of preventing the spinal canal from being compressed, it is preferable that the main body portion 11 has an arcuate shape from the viewpoint of strength against stress. In addition, the attachment structure of the protrusions 12 and 13 is shown in FIG.

  However, it may be trapezoidal when viewed from the plane, front, or side, or any other shape.

  In other words, the plane is trapezoidal, the front is bow-shaped ((1) in FIG. 3), the trapezoidal shape ((2) in FIG. 3) when viewed from either the plane or the front, the front is rectangular, and the front is trapezoidal (( 3)), the front is rectangular, and only the front lower edge is arcuate ((4) in FIG. 3).

  In addition, when the lower part is made into an arcuate shape, it is not necessary to press when approaching the spinal cord.

  The angle formed between the head-side surface 113 and the back-side surface 114 of the main body portion 11 is preferably chamfered, but may not be chamfered. That is, this portion protrudes toward the head side during rotation, so that when the patient bends the head backward, the adjacent spacer and the corner portion do not come into contact with each other.

  Further, it is preferable that the corner portion formed by the spinal canal side surface 115 of the head side surface 113 is also chamfered, but the chamfer may be omitted. That is, this portion protrudes toward the spinal canal during rotation, so that the corner does not press the spinal cord.

  The cross-sectional shape of the protrusions 12 and 13 may be any shape such as a circle ((1) in FIG. 4), a square ((2) in FIG. 4), a trapezoid ((3) in FIG. 4). If the cross section is made cylindrical, the rotation of the spacer 1 can be facilitated, the gap between the spinous process and the processus 12 and 13 can be minimized, and the fixability can be further improved. .

  The direction of the protrusion may be perpendicular to the side surface of the main body or in any direction. For example, the plane may be facing backward ((1) in FIG. 5) or facing forward ((1) in FIG. 5).

  The number of protrusions may be one, but may be two or more as shown in FIG. If it is two or more, the insertion becomes difficult, but the fixing property can further increase the strength.

  As a result of the trial test, it was found that the length of the process can be about 1 mm to several mm, and if it is about 4 mm, even if there are individual differences in the length of the spinous process, it is almost satisfied. However, although it is possible with about 10 mm, it can be said that the above range of length is preferable.

  Thus, although it was a short length originally conceived, it was confirmed as a result of an experiment that the fixing was sufficient, and it was confirmed that it could be replaced with a conventional method for fixing a thread or the like.

  As described above, in the present invention, it has been found that fixing is sufficient by forming protrusions, which is an unexpected discovery.

  Further, the size of the protrusion is desirably about 2 mm as a standard, but it has been proved as a result of the test that it may be thinner or thicker.

  The protrusions 12 and 13 are preferably formed and inclined perpendicular to the side surfaces 111 and 112, but may not be vertical. In the case of the vertical, when the spacer 1 is rotated and the side surfaces 111 and 112 are brought into close contact with the longitudinal surface of the spinous process, the protrusions 12 and 13 are perpendicular to the longitudinal surface of the spinous process and are fixed well. Sex is obtained.

  The protrusion may be movable or fixed. If the projections 12 and 13 are movable as shown in FIG. 6 (2), the insertion is easy regardless of the direction in which the spinous process spacer is formed when inserting the spinous process spacer. Rather, any spine surgeon is possible.

  However, since stability cannot be obtained if there is mobility even after insertion, it is desirable that the mobility be reduced and fixed when inserted. For this purpose, there is an example in which it is cooled in advance so that it can be expanded and fixed at body temperature (about 37 degrees) and then expanded and fixed at the body temperature. High material may be used.

  If the tip of the protrusion is sharpened as shown in (3) of FIG. 6, it can be fixed by being stabbed into the spinous process. Therefore, there is an advantage that it is not necessary to make a hole in advance as in the above embodiment.

  The protrusions 12 and 13 may be made of a different material in addition to the same material as the main body portion, but are preferably made of at least a rigid material. The advantage of the same quality is that it can be made easily from the same material. The advantage of the heterogeneity is that a material having a strength equal to or higher than that of the projection can be selectively used separately from the main body portion.

  Further, it is possible to integrally form the main body portion 11 and the protrusions 12 and 13 with the same kind of material, and in this case, the manufacture becomes easy.

  For example, if the main body is made of artificial bone and the protrusion is made of metal (particularly, hard material such as titanium, stainless steel, or its kind alloys), it is difficult to break. Moreover, only the protrusion part is inserted and assembled during use during surgery. And even in the case of other dissimilar materials of the same quality, if a screw is provided on the projection, it can be fixed if inserted during use during surgery.

  The position of the protrusion is best at the center of the side surfaces 111 and 112, but may be other than this part. When the spacer 1 is produced at the center, it is easy to rotate when the spacer 1 is rotated with the side surfaces 111 and 112 being brought into close contact with the longitudinal surface of the spinous process.

  The spacer having the above structure is composed of tricalcium phosphate, a composite material of tricalcium phosphate and hydroxyapatite, ceramic materials such as alumina, zirconia, hydroxoxyapatite, calcium phosphate, and tetracalcium phosphate, calcium phosphate glass, calcium phosphate crystal Any material can be used as long as the material is highly biocompatible, such as bioactive glass materials such as vitrified glass, organic compounds with high biocompatibility such as high density polyethylene (HDPE), and metal materials such as titanium. is there.

  Among these, it is particularly preferable to prepare a spacer with a bioactive material such as hydroxyapatite, calcium phosphate, tetracalcium phosphate, calcium phosphate glass, and calcium phosphate crystallized glass because direct bonding with natural bone becomes possible.

  Next, how to use the spinous process spacer of the present invention will be described with reference to FIG.

  First, the lateral grooves 21 and 22 are formed in the vertebral arch 2, and then the spinous process is vertically divided and enlarged. Next, a fixing hole (not shown) is formed in a substantially central portion of the vertically divided spinous processes 31 and 32.

  Subsequently, the spacer protrusions 12 and 13 are inserted into the fixing holes formed. Thereafter, the spacer side surfaces 111 and 112 are placed on the longitudinal surface of the spinous process by slightly turning so that the surface 114 of the spinal canal side of the spacer faces the caudal side (that is, the back side surface 116 faces the cranial side). Keep in close contact. An example of how the protrusions 12 and 13 are attached to the main body 11 is shown in FIG. Various examples of the attachment method are conceivable. However, when attaching with screws, the lengths of the protrusions 12 and 13 can be changed as appropriate, or can be freely changed to those of different materials.

  After the operation, the longitudinally divided spinous process tends to be occluded, and the spacer placed between the spinous processes is pressed from both sides. Due to the pressing force and the presence of the protrusions 111 and 112, the spacer 1 of the present invention is firmly fixed between the spinous processes.

    Thus, in the spinous process spacer of the present invention, the angle formed by both sides is set to about 50 to 85 degrees with good compatibility so that the horizontal cross section of the spacer is larger on the dorsal side than on the spinal canal side. ing. Furthermore, since the spinous process spacer of the present invention has protrusions on both sides, it can be slightly rotated after being inserted into the fixing hole of the vertically divided spinous process. Therefore, by rotating slightly so that the surface of the spacer spinal canal side faces the caudal side (that is, the back side faces the cranial side), the vertical cross section between the vertically divided spinous processes is the cranial side. The degree of opening on the caudal side can be changed by adjusting the degree of rotation. Therefore, it will be understood that if the shape of the protrusion is circular, the degree of rotation is improved. Further, if the length × width of the side surface of the spacer is, for example, 6 × 6 mm, the condition of rotation will be further facilitated.

  Also, in this type of surgery, the surgical field is narrow, and only the portion of the protrusion protruding from the spacer itself becomes longer, so it is not easy to insert the spacer. However, if the length of the protrusion is shortened, it easily falls out. In order to solve this problem, that is, as a result of the test, a numerical range of facilitating insertion and preventing slippage has been found with a protrusion length of about 1 mm to several mm. is there.

  Although the present invention has been described with the above embodiments, the present invention is not limited to the above embodiments, and various modifications can be made by those skilled in the art based on the technical idea of the present invention.

It is explanatory drawing which shows one Example of the spinous process spacer of this invention, (1) shows the top view of a spacer, (2) shows the front view, (3) shows the side view. It is explanatory drawing which shows the use condition of the spinous process spacer which is one Example of this invention. It is a figure which shows the example of the shape of the spinous process spacer main-body part 11 which is one Example of this invention. It is a figure which shows each Example of protrusion 12 and 13 shape attached to a main-body part. It is a figure which shows the Example of the direction of processus | protrusion 12,13. It is explanatory drawing of each example of the example of 2 number of protrusions, the example of a movable protrusion, and the front-end | tip shape of a protrusion. In the embodiment of the present invention, the spinous process spacer is attached between the vertebral arches when the spinous process is short or thin and broken. It is a figure which shows the aspect which attaches a processus | protrusion to the spinous process spacer main-body part 11 which is one Example of this invention.

Explanation of symbols

1 Spinous process 11 Body portion 111, 112 Side surface 12, 13 Process

Claims (8)

A spinous process spacer having side surfaces in contact with the vertically divided spinous processes at both ends, wherein the processes are attached to both side faces. A spinous process spacer having both sides having side surfaces in contact with a vertically divided spinous process, wherein both side surfaces have an inclination angle, and a process is provided on each side surface. A spinous process spacer having side surfaces in contact with the vertically divided spinous processes at both ends, the protrusions are provided on both side faces, and the inclination angle is about 50 to 85 degrees. spacer A spinous process spacer having side surfaces in contact with a vertically divided spinous process at both ends, and a protrusion is provided on each side face, and the length of the process is about 1 mm to several mm. Protrusion spacer. The spinous process spacer according to claim 1, wherein the process of the spinous process spacer is made of a material that is different from the main body portion and is at least rigid. A spinous process spacer having side surfaces in contact with the vertically divided spinous processes at both ends, provided with processes on both side surfaces, and the processes of the spinous process spacer are attached so as to be movable, A spinous process spacer characterized in that its mobility is reduced and fixed in vivo. A spinous process spacer having side surfaces in contact with the vertically divided spinous processes at both ends, the protrusions are provided on both side surfaces, and the cross section of the process is circular. A spinous process spacer having side faces in contact with the vertically divided spinous processes at both ends, wherein the processes are integrally formed on both side faces.

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