JP2017538551A - 脊椎インプラント及びその埋込み方法 - Google Patents
脊椎インプラント及びその埋込み方法 Download PDFInfo
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- JP2017538551A JP2017538551A JP2017533449A JP2017533449A JP2017538551A JP 2017538551 A JP2017538551 A JP 2017538551A JP 2017533449 A JP2017533449 A JP 2017533449A JP 2017533449 A JP2017533449 A JP 2017533449A JP 2017538551 A JP2017538551 A JP 2017538551A
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- end plate
- assembly
- rounded
- tapered
- multiaxial
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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- A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
- A61F2/4465—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages having a circular or kidney shaped cross-section substantially perpendicular to the axis of the spine
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- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30537—Special structural features of bone or joint prostheses not otherwise provided for adjustable
- A61F2002/30556—Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting thickness
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30565—Special structural features of bone or joint prostheses not otherwise provided for having spring elements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2002/4415—Joints for the spine, e.g. vertebrae, spinal discs elements of the prosthesis being arranged in a chain like manner
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2/442—Intervertebral or spinal discs, e.g. resilient
- A61F2/4425—Intervertebral or spinal discs, e.g. resilient made of articulated components
- A61F2002/443—Intervertebral or spinal discs, e.g. resilient made of articulated components having two transversal endplates and at least one intermediate component
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/0041—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws
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Abstract
Description
本発明は、脊椎インプラント、インプラントトライアル(trial)、及びこれらのデバイスを埋込むのに使用される方法に関する。
〔背景技術〕
多くのタイプの脊髄の不規則性は、痛み、運動範囲の制限、または脊柱内部の神経系の損傷を引き起こす可能性がある。これらの不規則性は、以下に限定されないが、外傷、腫瘍、椎間板変性症、及び疾病に起因する可能性がある。脊髄の不規則性の一例は、脊髄または馬尾などの脊髄神経の圧迫をもたらし得る、脊柱管狭窄症、即ち脊柱管の狭細化である。次に、神経圧迫は、痛み、痺れ、または脱力をもたらし得る。脊柱管狭窄症は、骨棘の発達、靱帯の肥大、骨折、及び椎間板変性症(例えば、関節炎が原因)などの、1つ以上の状態によって引き起こされる可能性がある。
〔発明の概要〕
本明細書におけるいくつかの実施形態は、丸みを帯びたヘッド部から延在するネック部材を備える係止部材であって、ネック部がそれを通って延在する先細溝穴を備える、係止部材と、丸みを帯びた圧縮可能本体部から延在する板部を備える関節接合可能な板部材であって、丸みを帯びた圧縮可能本体部が、そこに係止部材の丸みを帯びたヘッド部を受容するように構成された空洞、及び、それを通って係止部材のネック部を受容するように構成された開口部を画定する、関節接合可能な板部材と、一定直径部及び可変直径部を備える軸方向導管を備える受容部材であって、第1及び第2の先細穴が、導管と交差する先細チャネル、及び、先細チャネルと交差するソケットを画定し、可変直径部が、その中に関節接合可能な板部材の丸みを帯びた圧縮可能本体部を受容するように構成された、受容部材と、先細横断面を備え、受容部材のチャネル内に受容されるように構成された、楔部材と、受容部材のソケット内に受容されるように構成された、固定要素と、を含み得る、多軸エンドプレート組立体を対象とする。
〔図面の簡単な説明〕
本実施形態は、以下の詳細な説明及び添付図面からより十分に理解されることとなろう。
〔図1A〕本明細書において説明されるように、多軸エンドプレート組立体の横断面図を示す。
〔図1B〜D〕本明細書において説明されるように、多軸エンドプレート組立体の斜視図を示す。
〔図1E〕本明細書において説明されるように、脊椎インプラントと係合された多軸エンドプレート組立体の斜視図を示す。
〔図2A〕本明細書において説明されるように、多軸エンドプレート組立体の斜視底面図を示す。
〔図2B〕本明細書において説明されるように、多軸エンドプレート組立体の横断面図を示す。
〔図2C〕本明細書において説明されるように、関節接合可能な板部材に係合するクランプ組立体の横断面図を示す。
〔図2D〕本明細書において説明されるように、クランプ組立体の斜視図を示す。
〔図3A〕本明細書において説明されるように、エンドプレートトライアルの斜視図を示す。
〔図3B〕本明細書において説明されるように、エンドプレートトライアルの横断面図を示す。
〔図3C〕本明細書において説明されるように、エンドプレートトライアルの斜視図を示す。
〔図3D〕本明細書において説明されるように、エンドプレートトライアル及び拡張可能なトライアル組立体を示す。
〔図3E〕本明細書において説明されるように、拡張可能なトライアル組立体と係合したエンドプレートトライアルの横断面図を示す。
〔図3F〕本明細書において説明されるように、拡張可能なトライアル組立体と係合したエンドプレートトライアルの斜視図を示す。
〔図4A〕本明細書において説明されるように、エンドプレートトライアルの斜視図を示す。
〔図4B〕本明細書において説明されるように、拡張可能なトライアル組立体と係合したエンドプレートトライアルの横断面図を示す。
〔図4C〕本明細書において説明されるように、エンドプレートトライアルの斜視底面図を示す。
〔図4D〕本明細書において説明されるように、拡張可能なトライアル組立体と係合したエンドプレートトライアルの斜視図を示す。
〔図5〜10〕本明細書において説明されるように、エンドプレートトライアルの代替的な実施形態を示す。
〔発明を実施するための形態〕
椎体部分切除術の処置において、脊柱管は拡張されることができ、圧迫された神経の圧力は、圧迫された神経に隣接する、1つ以上の椎体を部分的または完全に取り除くことによって、開放されることができる。1つ以上の椎間板及び他の関連した物質も取り除かれ得る。インプラント(例えば、ケージ、スペーサ、椎体置換、または他の補綴)は、脊柱をその後安定化させるために、結果として生じる空洞に挿入され得る。いくつかの例において、インプラントは、脊椎腔の輪郭に適応するように選択されている、上位及び下位のエンドプレートに結合された、任意に拡張可能な本体を含むことができる。挿入に先立ち、外科医または他の開業医は、エンドプレートの適切なサイズ及び前弯または後弯角度に接近し(例えば、キャリパーまたはインプラントトライアルなどの、画像及び/または身体測定デバイスを介して)、所望の角度に最も厳密に合致するエンドプレートを選択し、かつ、選択されたエンドプレートをインプラント本体と接続させることによってインプラントを組み立て得る。いったんインプラントが組立てられ、脊椎腔に挿入されると、外科医はエンドプレートの角度をさらに現場で調整することができなくなり得る。エンドプレートの角度と隣接する椎体の角度との間の不一致は、沈降または体軸方向の不均衡をもたらす可能性がある。その結果、本明細書において開示されるのは、新しく改良されたモジュール式脊椎インプラント及び多軸エンドプレートを有する組立体であり、その角度は、組立て及び/または埋込みの後、枢動可能に調整されることができる。
第2のクランプ部材204、206を収縮かつ/または圧縮することを含むことができる。第1及び第2のクランプ部材204、206は、それと共に固定要素210と係合することによって、収縮され得る。本明細書において説明されるように、固定要素210が止めネジであり、また、第1及び第2のクランプ部材204、206がネジ山付き中央ソケットを含む、実施形態において、止めネジが中央ソケット243、254に螺入されるにつれて、止めネジは、事実上、第1及び第2のクランプ部材204、206を一緒に圧縮し得るかまたはまとめ得る。本体部214が収縮、圧迫かつ/または圧縮される場合、タブ222は、受容部材208との強化された摩擦係合において、内側に曲がり得、その結果、脊椎インプラント組立体に対して第1の関節接合可能な板部材202の向き(例えば、角度)を係止、安定化、かつ/または固定することを、当業者は認識し得る。係止、安定化、かつ/または固定された構成における場合、第1の関節接合可能な板部材202は、事実上、第1のクランプ部材203及び/または第1の受容部材208に対して、枢動、関節接合、かつ/または回転することは可能ではない。
Claims (20)
- 丸みを帯びたヘッド部から延在するネック部を備える係止部材であって、前記ネック部がそれを通って延在する先細溝穴を備える、係止部材と、
丸みを帯びた圧縮可能本体部から延在する板部を備える関節接合可能な板部材であって、前記丸みを帯びた圧縮可能本体部が、空洞の中に前記係止部材の前記丸みを帯びたヘッド部を受容するように構成された前記空洞、及び開口部を通って前記係止部材の前記ネック部を受容するように構成された前記開口部を画定する、関節接合可能な板部材と、
一定直径部及び可変直径部を備える軸方向導管を備える受容部材であって、第1及び第2の先細穴が、前記導管と交差する先細チャネル、及び前記先細チャネルと交差するソケットを画定し、前記可変直径部が、その中に前記関節接合可能な板部材の前記丸みを帯びた圧縮可能本体部を受容するように構成された、受容部材と、
先細横断面を備え、前記受容部材の前記チャネル内に受容されるように構成された、楔部材と、
前記受容部材の前記ソケット内に受容されるように構成された、固定要素と、を備える、多軸エンドプレート組立体。 - 前記先細溝穴が、前記係止部材の長手方向軸に対して横に延在するトラフを画定する、請求項1に記載の多軸エンドプレート組立体。
- 前記先細溝穴が、前記先細溝穴の深さが増加するにつれて減少する高さを有する、請求項1に記載の多軸エンドプレート組立体。
- 前記丸みを帯びた圧縮可能本体部が、溝穴によって隔てられた複数のタブを備える、請求項1に記載の多軸エンドプレート組立体。
- 前記丸みを帯びた圧縮可能本体部の前記開口部が、前記係止部材の前記ヘッド部の最大直径未満である直径を有する、請求項1に記載の多軸エンドプレート組立体。
- 丸みを帯びたヘッド部から延在するネック部を備える係止部材であって、前記ネック部が、それを通って延在する先細溝穴を備える、係止部材と、
丸みを帯びた本体部から延在する板部を備える関節接合可能な板部材であって、前記丸みを帯びた本体部が、凹形空洞及び中央開口部を画定する複数のタブを備える、関節接合可能な板部材と、
一定直径部及び可変直径部を備える軸方向導管、前記軸方向導管と交差する先細チャネル、及び前記先細チャネルと交差するソケットを備える、受容部材と、
先細横断面を備える、楔部材と、
前記受容部材に対して前記板部材の向きを安定化させるように構成された固定要素と、を備える、多軸エンドプレート組立体。 - 前記関節接合可能な板部材が、前記本体部と前記板部との間の交わり部に円周方向溝を有する外表面を備える、請求項6に記載の多軸エンドプレート組立体。
- 前記軸方向導管の前記可変直径部が、前記受容部材の遠位端に凹形受け口を画定する、請求項6に記載の多軸エンドプレート組立体。
- 前記受容部材が、脊椎インプラントを係合させるように構成された少なくとも1つの結合要素をさらに備える、請求項6に記載の多軸エンドプレート組立体。
- 前記受容部材の前記ソケットが、前記軸方向導管の長手方向軸に対して垂直である長手方向軸を有する、請求項6に記載の多軸エンドプレート組立体。
- 前記受容部材の前記ソケットが、前記チャネルに対して垂直である、請求項6に記載の多軸エンドプレート組立体。
- 前記楔部材が、丸みを帯びた台形の横断面を有する、請求項6に記載の多軸エンドプレート組立体。
- 丸みを帯びたヘッド部から延在するネック部を備える係止部材であって、前記ネック部が、それを通って延在する先細溝穴を備える、係止部材と、
丸みを帯びた本体部から延在する板部を備える関節接合可能な板部材であって、前記丸みを帯びた本体部が、凹形空洞及び中央開口部を画定する複数のタブを備える、関節接合可能な板部材と、
一定直径部及び可変直径部を備える軸方向導管を備える受容部材であって、第1及び第2の先細穴が、前記導管と交差する先細チャネル、及び前記先細チャネルと交差するソケットを画定する、受容部材と、
前記受容部材及び前記係止部材に力をかけるように構成された、楔部材と、
前記楔部材に力をかけるように構成された、固定要素と、を備える、多軸エンドプレート組立体。 - 前記第1及び第2の先細穴のそれぞれが台形状である、請求項13に記載の多軸エンドプレート組立体。
- 前記第1及び第2の先細穴のそれぞれが上壁及び下壁によって画定され、前記下壁が前記上壁より急勾配である、請求項13に記載の多軸エンドプレート組立体。
- 前記楔部材が、縦断面に沿って非対称である、請求項13に記載の多軸エンドプレート組立体。
- 前記楔部材が、上壁及び下壁を備え、前記下壁が前記上壁より急勾配である、請求項13に記載の多軸エンドプレート組立体。
- 前記楔部材の前記下壁が、前記係止部材と係合するように構成され、前記楔部材の前記上壁が、前記受容部材と係合するように構成される、請求項17に記載の多軸エンドプレート組立体。
- 前記固定要素が、前記楔部材と接触するように構成された端を備える、請求項13に記載の多軸エンドプレート組立体。
- 前記固定要素が、止めネジを備える、請求項13に記載の多軸エンドプレート組立体。
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