JP3768508B2 - Spine surgery spacer - Google Patents

Description

  The present invention relates to a spinal surgery spacer used for spinal laminoplasty.

  There is a method called posterior spinal decompression as a surgical treatment for spinal diseases such as ligament ossification and spinal stenosis. The cervical vertebrae and thoracic vertebrae contain a nerve tissue called the spinal cord, and the lumbar spinal canal contains a neural tissue called the tail, which takes up space such as ligament thickening, ossification, and tumor. When this occurs, the nerve tissue is subjected to pressure and develops symptoms such as upper limb and lower limb movement / sensory disturbances. This treatment includes not only a method of excision of the vertebral arch, but also the spinal process and the ligament attached to the vertebral arch, the spinal process is removed, the spinal canal is enlarged, and then the autologous bone is applied to the enlarged portion. There is also a method of sandwiching and fastening with a suture thread such as a wire or a synthetic thread. Also, spine surgery is performed in which a vertebral spacer is sandwiched with the autologous bone. Examples of such vertebral arch spacers include Patent Documents 1 to 3, and examples of spinal surgery spacers sandwiched together with autologous bone include Patent Documents 4 and 5.

As one of the above-mentioned methods of laminoplasty, there is a method in which the spine is expanded from the back side, the spinous process is excised, and is slid and returned after the operation. Specifically, as shown in FIGS. 2 to 3, the hypodermis is peeled to expose the spinous process B and the vertebral arch A on one side, and the base of the spinous process B is cut (FIG. 2 (a)). Next, it is expanded until the opposite vertebral arch A is exposed by the fenestration device, and the spinal column is divided vertically (FIG. 2 (b)), and then the groove m is dug in the vertebral arch A on both sides (see FIG. 2). 3 (a)), the vertebral arch is enlarged (FIG. 3 (b)). Then, the size of the lamina spacer is selected, and the selected lamina spacer is placed on the enlarged lamina A. After the vertebral arch spacer is installed, the vertebral arch spacer and vertebral arch A are fastened with bolts, wires, or threads. Then, the preserved spinous process B is returned, the spinous process B is fixed to the vertebral spacer with a thread, and the skin is closed. In addition, the code | symbol S is a spinal canal.
JP 2001-149392 A Special table 2001-522633 JP 2000-179544 A JP-A-6-285099 JP-A-9-122160

  In spinal decompression surgery (laminoplasty), the vertebral arch that protects the spinal cord and cauda equina is no longer protected, and is susceptible to postoperative scar formation and external force from the vertebrae. The used surgery has been devised. Conventionally, the shape of a general vertebral arch spacer is basically a shape similar to a rectangular parallelepiped, or has a cross section formed in an arc shape or a substantially trapezoidal shape so as not to cause re-compression to a nerve. There are some (Patent Document 2, Patent Document 3, etc.). However, with these shapes, the larch spacer could not be sandwiched with the autologous bone collected from the patient. That is, the conventional vertebral arch spacer is created only for the purpose of filling the gap of the resected bone, and the vertebral arch cannot be regenerated by bone grafting.

  Furthermore, the conventional larch spacer cannot be reconstructed by returning the spinous process, and there is no portion for sewing the spinous process. Patent Document 4 and Patent Document 5 replace a damaged or degenerated spinal disc and are different from the object of the present invention.

  Therefore, the object of the present invention is to place a prosthesis with a self-collected autologous bone between the bones from which the vertebra has been excised, and can be installed at a stable position on the edge of the excised vertebra, thereby stabilizing the autologous bone. An object of the present invention is to provide a spinal surgical spacer that can be placed in a position to promote the regeneration of the vertebral arch and that can be aligned and supported when the spinous process is returned, that is, the spinous process can be reconstructed.

The spinal surgery spacer according to claim 1 of the present invention is a spinal surgery spacer used for a laminoplasty in which a vertebral arch is inserted between prosthetic bones and used for prosthesis, and the self-collected self-bone obtained from the excision or the a mounting surface portion for placing the processing bone was processed autologous bone, and a pair of side wall portions facing each other are arranged so as to protrude upward from this to the mounting surface portion, the placing surface portion, in cross section circular It is formed in an arc shape or a substantially trapezoidal shape, and a large number of holes penetrating the placement surface portion are formed . Here, the removed self-collected autologous bone is a transplanted bone, and includes an excised autologous bone and a bone that has been sized to a predetermined size. Although it says what crushed autologous bone and processed it into kneaded form, it is not limited to this.

According to the present invention, a prosthesis is inserted by inserting a bone between excised vertebral arches, and a placement surface portion on which the excised self-collected autologous bone or a processed bone obtained by processing the autologous bone is placed, and the placement surface portion A pair of side walls projecting above and facing each other, when placing the self-collected auto bone or the processed bone processed from the auto bone on the placement surface portion, the pair of side walls If placed between the parts, the autologous bone or the processed bone can be stably placed without being displaced. Further, according to the present invention, since the cross section is formed in an arc shape or a substantially trapezoidal shape, the placement surface portion follows the shape of the dural tube (nerve tube) between the bones from which the vertebral arch has been excised. Thus, it can be stably fitted. In addition, since a large number of holes penetrating the mounting surface portion are formed, when the cut self-collected autologous bone or a processed bone obtained by processing this autologous bone is mounted on the mounting surface portion, a large number of holes are formed on the surface. Even if the frictional effect is exerted and the cross section of the mounting surface portion is formed in an arc shape or a substantially trapezoidal shape, a situation of sliding down is prevented. Then, while fixing the spinal surgery spacer through threads and wires through a large number of holes penetrating the placement surface, the wounded self-collected autologous bone or the processed bone obtained by processing the autologous bone is also wound. Can be fixed. In this manner, a new vertebral arch can be regenerated and guided at a desired position by stably performing bone grafting and spacer placement.

The spinal surgery spacer according to claim 2 of the present invention is a spinal surgery spacer which is used in a laminoplasty used for prosthesis in which a spinal process is cut off and then inserted between bones after the spinal arch is resected. A mounting surface portion on which the self-collected autologous bone or a processed bone obtained by processing this autologous bone is placed, a pair of side wall portions that are arranged to protrude above the placement surface portion and face each other, and the pair of opposing surfaces A central beam that supports the spinous process when the cut spinous process is returned to the center of the side wall, and the mounting surface is formed in an arc shape or a substantially trapezoidal cross section and penetrates the mounting surface. A number of holes are formed .

According to the present invention , a prosthesis is inserted by inserting a bone between excised vertebral arches, and a placement surface portion on which the excised self-collected autologous bone or a processed bone obtained by processing the autologous bone is placed, and the placement surface portion A pair of side walls projecting above and facing each other, when placing the self-collected auto bone or the processed bone processed from the auto bone on the placement surface portion, the pair of side walls If placed between the parts, the autologous bone or the processed bone can be stably placed without being displaced. Further, according to the present invention, since the cross section is formed in an arc shape or a substantially trapezoidal shape, the placement surface portion follows the shape of the dural tube (nerve tube) between the bones from which the vertebral arch has been excised. Thus, it can be stably fitted. In addition, since a large number of holes penetrating the mounting surface portion are formed, when the cut self-collected autologous bone or a processed bone obtained by processing this autologous bone is mounted on the mounting surface portion, a large number of holes are formed on the surface. Even if the frictional effect is exerted and the cross section of the mounting surface portion is formed in an arc shape or a substantially trapezoidal shape, a situation of sliding down is prevented. Then, while fixing the spinal surgery spacer through threads and wires through a large number of holes penetrating the placement surface, the wounded self-collected autologous bone or the processed bone obtained by processing the autologous bone is also wound. Can be fixed. In this manner, a new vertebral arch can be regenerated and guided at a desired position by stably performing bone grafting and spacer placement. Furthermore, according to the present invention, since a central rail is provided at the center of the pair of opposing side wall portions, it serves as a guide for alignment for supporting the spinous process, and the resection placed on the placement surface portion described above Thus, it becomes possible to stably hold the self-collected autologous bone or the processed bone obtained by processing the autologous bone. Then, the spinous process can be reconstructed by joining the bone transplanted in this way to the separated spinous process.

According to the spacer for spinal surgery according to claim 1 of the present invention, when placing the excised self-collected autologous bone or the processed bone obtained by processing the autologous bone on the placement surface portion, between the pair of side wall portions. It only has to be placed and can be placed in a simple and accurate position in a short time. Thus, regeneration of the transplanted bone and the excised vertebral arch can be performed.

According to claim 2 spinal surgical spacer according to the present invention, it is possible to bond the disconnect spinous processes and autologous bone was placed in spinal surgery for spacers or machined bone was processed this autologous bone regeneration The guided vertebral arch and the separated spinous process can be returned and sewn so that the spinous process can be reconstructed.

  Hereinafter, the best mode for carrying out the present invention will be described in detail with reference to the drawings.

(First embodiment)
First, as shown in FIG. 1, the present embodiment is arranged on the placement surface portion 2 on which the removed self-collected autologous bone or the processed bone K processed from the self-bone is placed, and the placement surface portion 2. This is a spinal surgery spacer 1 having a pair of side wall portions 3 and 3. The spacer 1 is made of a so-called bioceramic such as alumina or hydroxyapatite, but is not limited thereto, and is made of a biocompatible material or an absorptive material such as a bone graft (autologous bone) Ga, Gb or the like. It shall have affinity or adhesion. The spacer 1 has an arc-shaped cross section, but the spacer 1 is prepared in various sizes to be prosthetic by being inserted between bones obtained by excising a part of the spine A. Is done.

  The mounting surface portion 2 has an arc shape in cross section, but may have a substantially trapezoidal cross section. This is to correspond to the shape of the dural tube (nerve tube). The mounting surface portion 2 is formed with a large number of holes 2c penetrating therethrough. The role of the large number of holes 2c is, first, in order to prevent the self bone from slipping down by exhibiting a surface friction effect when transplanting the auto bone. When the processed bones Ka and Kb, which are obtained by crushing the autologous bone, which will be described later, and processed into a kneaded shape (or a minced shape), are placed, the processed bones Ka and Kb in the kneaded shape are hooked into the numerous holes 2c. , Will not slip off. Secondly, the plurality of holes 2c are used for fixing the spinal surgery spacer 1 through a thread or a wire, and for fixing the excised self-collected autologous bones Ga, Gb and the like. . It should be noted that the fixing with the thread or the wire using the numerous holes 2 exerts the fixing effect in a place where screwing is not preferable when the vertebral arch is extremely thin or the deformation is strong. Here, the shape of the hole 2c in the present embodiment is circular, but is not limited thereto, and may be a polygon such as a quadrangle, and the shape is not limited.

  The pair of side wall parts 3 and 3 are for preventing the autologous bone to be transplanted from protruding from the placement surface part 2 or falling after placement, so as to oppose the longitudinal end of the placement surface part 2. A pair is provided. The pair of side wall portions 3, 3 are integrally formed with the mounting surface portion 2, and are formed on the mounting surface portion 2 so as to protrude upward. Each of the pair of side wall portions 3 is provided with a pair of latching protrusions 3b. The latching protrusion 3b has a role of obtaining a hook at the time of joining the edge Aa and the edge Ab of the cut vertebral arch A, and has a role of preventing a positional shift. Projected at the end.

  A central rail 3a is provided between the pair of side wall portions 3,3. The central crosspiece 3a is provided for returning the separated spinous processes and returning them in a stable position to stably support the original standing state when obtaining a joint with the transplanted autologous bone. Further, the central rail 3a also has a role of alignment when returning the separated spinous processes B, so that it is bridged between the one side wall 3 and the other side wall 3. Is provided. In the present embodiment, it is bridged between the side wall portions 3 and 3, but it is not always necessary to be provided in the entire area as long as it is arranged at least in the central portion. The center beam 3a is provided with an insertion hole 3c. The insertion hole 3c mainly returns the spinous process B, and when a connection between the spinous process B and the spacer 1 or the autologous bones Ga and Gb is obtained, a suture thread such as a wire or a synthetic thread is passed through the insertion hole 3c. Used to tie these together. It can also be used for connection when placing processed bones Ka and Kb that have been crushed and kneaded (or minced) from the autologous bone, regardless of the shape and number of the insertion holes 3c. It may be in shape. It is also possible to use the main spacer 1 without the central beam 3c, or to use the main spacer 1 with the central beam 3c provided only at the center. In this specification, autologous bone is a self-collected bone, and is used in the meaning that includes a bone that has been processed into a predetermined shape, or that has been crushed and processed into a kneaded shape (or minced shape). To do.

(Usage example 1)
A case where a cervical laminoplasty is performed using the spinal surgery spacer 1 will be described. First, after the spine is deployed from the rear, the spinous process B is separated, and the separated spinous process B is slid. That is, as shown in FIGS. 2 to 3, the hypodermis is peeled to expose the spinous process B and the vertebral arch A on one side, and the base of the spinous process B is cut (FIG. 2 (a)). Next, it is expanded until the opposite vertebral arch A is exposed by a fenestration device, a shallow groove (temporary groove) is dug in the vertebral arch A on both sides, and the spinal column is divided vertically (FIG. 2 (b)). This is called a midline vertical split and is usually done using a diamond bar. Next, a groove (main groove) is dug in the vertebral arches Aa and Ab on both sides (FIG. 3A). The mobility of the vertebral arch A is confirmed while observing the excavation state of this groove. After confirming the mobility of the vertebral arch, the excavation is finished, the vertebral arch is enlarged with tweezers or the like (FIG. 3B), and the size of the spacer 1 is selected. The selected spacer 1 is placed on the vertebral arch A that has been sandwiched and enlarged by a sandwiching tool (FIG. 4). In the clamping tool, the end portions of the pair of side wall portions 3 and 3 are clamped and joined so as to be hooked to the edge Aa and the edge Ab of the vertebral arch A where the hooking projection 3b is enlarged. That is, the hooking protrusion 3b of the spacer 1 is hooked on the edge Aa and the edge Ab of the enlarged vertebral arch A (FIG. 5).

  After the spacer 1 is correctly installed, the self-collected autologous bones Ga and Gb are placed on the placement surface 2 (FIG. 5). Self-collected autologous bones Ga and Gb are obtained by using the autologous bones Ga and Gb that have been plate-shaped from the excised vertebral arch or patient's iliac bone, etc. 3a and the other inclined surface 3b. When placed in this way, the plate-like autogenous bones Ga and Gb placed on the one inclined surface 3a and the other inclined surface 3b are in contact with the edge Aa and the edge Ab of the enlarged vertebra A. It is preferable to arrange so that the other sides of the plate-like autogenous bones Ga and Gb are joined to each other. That is, the other sides placed on the left and right at the position of the central rail are joined to each other. When placed in this way, since the pair of side wall portions 3 and 3 are provided, the plate-like autogenous bones Ga and Gb do not protrude from the placement surface portion 2 or fall from the end portions in the longitudinal direction. In addition, since the left and right inclined surfaces are each formed with a large number of holes 2c, the surface friction effect is exerted, and even if the above-described mounting surface portion 2 is formed in an arc shape or a substantially trapezoidal shape, The situation of sliding down is prevented. After the autologous bones Ga and Gb are thus placed, the plate-shaped autologous bones Ga and Gb, the main spacer 1 and the vertebral arch A are fastened with a wire and a thread. At this time, the spine surgical spacer 1 is fixed through a number of holes 2 penetrating the placement surface portion 2 through threads and wires, and is also fixed so as to be wound around the excised autologous bones Ga and Gb. In addition, when the processed bone K, which is obtained by crushing the autologous bone and processed into a kneaded shape (or a minced shape), is placed, the kneaded properties are locked into the numerous holes 2 without using a thread or a wire. It is also possible to prevent slipping from the inclined surface.

  Thereafter, the preserved spinous process B is returned, and the spinous process B is fixed to the spacer 1 with a thread or a wire (FIG. 7). That is, the spinous process B that has been slid back is returned to the plate-like autogenous bones Ga and Gb placed on the placement surface 2, and then the spinous process B is applied to the autogenous bone with a thread or wire. It fixes to this spacer 1 via Ga and Gb. When the spinous process B is returned, the central beam 3a that connects the centers of the pair of opposite side wall portions 3 and 3 is provided. In this way, bone fusion can be obtained between the separated spinous processes B and the autologous bones Ga and Gb, and the mounted autologous bones Ga and Gb and the enlarged edge Aa of the vertebral arch A Regenerative guidance of the vertebral arch between the edges Ab is obtained. As described above, when the spacer 1 is used, the spinal nerve can be decompressed, the vertebral arch can be regenerated, and the spinous processes can be reconstructed, thereby obtaining a good alignment.

(Usage example 2)
Next, an example of laminoplasty using the processed bones Ka and Kb obtained by processing the autologous bone instead of the autologous bone Ga and Gb described above will be described. As the processed bones Ka and Kb obtained by processing the autologous bones, autologous bones Ga and Gb collected from the excised vertebral arch or the iliac bones of the patient and the like were used after being processed into a kneaded shape. It is also possible to use a material obtained by crushing the excised vertebral arch and processing it into a kneaded shape, or a material obtained by crushing and mixing a sample taken from a patient's iliac bone. Then, the placing surface portion 2 of the spacer 1 is placed on the kneaded processed bones Ka and Kb instead of the above-described autologous bones Ga and Gb (FIG. 6). Since the mounting surface portion 2 is formed with a large number of holes 2c, even if the mounting surface portion 2 is formed in an arc shape or a substantially trapezoidal cross section, some of the kneaded processed bones Ka and Kb are formed. There is no situation where the large number of holes 2c enter or the large number of holes 2c exert a surface friction effect and slide down. Moreover, since the insertion hole 3c and the groove | channel are formed in the center crosspiece 3a, the connection of the kneaded process bones Ka and Kb each mounted in one inclined surface 3a and the other inclined surface 3b is also achieved. . After that, the spinous process B which has been preserved is returned as in the first use example, and the spinous process B is fixed to the spacer 1 via the processed bones Ka and Kb with a thread or a wire (FIG. 7).

(Second Embodiment)
Next, as shown in FIG. 8, the present embodiment has the placement surface portion 2 and a pair of side wall portions 3, 3 arranged on the placement surface portion 2. The spinal surgery spacer 11 is the same as that of the above embodiment except that it has a portion 3d without the central crosspiece 3a. That is, the portion with the central rail 3a and the portion 3d without the central rail 3a are provided, and the central rail 3a is provided on both sides so as to sandwich the portion without the central rail 3a, and an insertion hole 3c is formed in each of them. . As described above, various types of the central rail 3a can be considered.

(Usage example 3)
A case of performing lumbar laminoplasty using the spinal surgery spacer 11 will be described. The same applies to the case of using the first embodiment. First, after deploying the spine from the back, the spinous process B is dissected, and the cut spinous process B is slid until the opposite vertebral arch is exposed (FIG. 9), and is applied to the retractor to secure a visual field behind the vertebral arch. . Thereafter, grooves m on both sides of the vertebral arch A are excavated, and vertebral arch resection is performed at the decompression point (FIGS. 10A and 10B). When the lumbar laminectomy is performed, the dura mater is exposed, and then the thickened yellow ligament J protruding to the inner side of the vertebral canal S and excess bone that compresses the dura mater can be excised. For this reason, laminectomy of the lumbar vertebra is often performed more widely than cervical vertebra. After the pressure on the dural tube is sufficiently released, the resection width of the vertebral arch A is measured with a device (such as tweezers), and the size of the spacer 11 is selected. A bone hole for passing a wire for fixing or a synthetic thread through a portion where the spacer 11 is installed is prepared. Further, two bone grooves n are formed on one side (FIG. 10 (b)), and the latching protrusion 3b is fitted into the scaffold to obtain a stable installation. The selected spacer 11 is clamped with a clamp and placed between the excised vertebral arch A (FIGS. 11 (a) and 11 (b)), the latching protrusion 3b is fitted into the bone groove n, a wire or a synthetic thread And tighten through the small bone hole. The hooking protrusion 3b of the spacer 11 is hooked to the edge Aa and the edge Ab of the excised vertebral arch A (FIGS. 11A and 11B).

  After the spacer 11 is correctly installed, the self-collected autologous bones Ga and Gb are placed on the placement surface 2 (FIG. 12). Self-collected autologous bones Ga and Gb are obtained by using the autologous bones Ga and Gb that have been plate-shaped from the excised vertebral arch or patient's iliac bone, etc. And the other inclined surface. Such a mounting method is the same as in the usage example of the first embodiment.

  Also in the present embodiment, since the central beam 3a is provided, the spinous process B is returned so as to be positioned on the central beam 3a, and the spinous process B is passed through the own bones Ga and Gb with a thread or a wire. Fixed to the spacer 1. As a result, the reconstructed spinous processes B and autologous bones Ga and Gb can be reconstructed. However, there is an advantage that the autologous bones Ga and Gb are connected to each other through the portion 3d without the central rail 3a (FIG. 13). On the other hand, the example of the laminoplasty using the processed bones Ka and Kb obtained by processing the autologous bone is the same as the example of the first embodiment (FIG. 14). However, since the processed bones Ka and Kb obtained by processing the autologous bone through the portion 3d without the central crosspiece 3a are placed in a connected state, there is an advantage that a strong mounting state can be obtained.

  As described above, in the present embodiment, the example of cervical vertebra and lumbar vertebral laminoplasty has been described. However, the spinal surgery spacer 1 of the present invention can of course be used for thoracic vertebral laminoplasty.

It is a perspective view which shows the spacer for spinal surgery of the 1st Embodiment of this invention. It is a figure explaining the method of the laminoplasty of a cervical vertebra. It is a figure explaining the method of the laminoplasty of a cervical vertebra. It is a front view which shows the state which fitted the spacer of the said 1st Embodiment between the bones which resected the vertebral arch. It is sectional drawing of the state which mounted the own bone in the spacer of the said 1st Embodiment. It is sectional drawing of the state which mounted the autologous bone (processed bone) in the spacer of the said 1st Embodiment. It is sectional drawing which shows the state which reconstructed the spinous process. It is a perspective view which shows the spacer for spinal surgery of the 2nd Embodiment of this invention. It is a figure explaining the method of the lumbar laminoplasty. It is a figure explaining the method of the lumbar laminoplasty. It is a front view which shows the state which fitted the spacer of the said 2nd Embodiment between the bones which resected the vertebral arch. It is sectional drawing which shows the said 2nd implementation. It is sectional drawing of the state which mounted the autologous bone in the spacer of the said 2nd Embodiment. It is sectional drawing which reconstructed the spinous process in the state which mounted the autologous bone processed into the spacer.

Explanation of symbols

1,11 Spinal surgery spacer (this spacer),
2 mounting surface part, 2c many holes,
3 side wall part, 3a center beam, 3b latching protrusion, 3c insertion hole,
3d The part without the central cross,
A, Aa, Ab Intervertebral joint, vertebral arch or its end (edge),
B Spinous process,
Ga, Gb autologous bone,
Ka, Kb Processed bone made from autologous bone,
S spinal canal, m groove, J yellow ligament, n groove for insertion of latching process,

Claims (2)

In a spinal surgery spacer used for laminoplasty in which a vertebral arch is inserted between prosthetic bones for prosthesis,
It has a mounting surface portion on which the cut-out self-collected autologous bone or a processed bone obtained by processing this autologous bone is mounted, and a pair of side wall portions that are arranged to protrude above this mounting surface portion and face each other.
A spacer for spinal surgery , wherein the placement surface portion is formed in an arc shape or a substantially trapezoidal cross section, and a plurality of holes penetrating the placement surface portion . In spinal surgery spacers used for laminoplasty, where the spinous process is cut off and then the vertebral arch is inserted between the resected bones for prosthesis,
A mounting surface portion for placing the resected autologous bone or processed bone has been processing the autologous bone autologous collection, a pair of side wall portions that face disposed to protrude upward from this to the mounting surface portion, said opposing In the center of the pair of side wall portions, there is a central beam that supports the spinous process when the separated spinous process is returned,
A spacer for spinal surgery , wherein the placement surface portion is formed in an arc shape or a substantially trapezoidal cross section, and a plurality of holes penetrating the placement surface portion .

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