JPH06500711A - artificial spine - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

[Detailed description of the invention] artificial spine The present invention provides two support plates for attaching an artificial vertebra to the end faces of stable adjacent vertebral bodies. and these support plates are provided with fixing means for fixing the artificial vertebra to the vertebral body. and are connected by one or more length-adjustable spacers. 1 The present invention also relates to a vertebral prosthesis used as a replacement for one or more destroyed vertebral bodies. relates to a second prosthetic device for manipulating vertebrae.

Disease may occur due to metastasis of the vertebral body, epidural metastasis, or instability of the column. When a broken or destroyed vertebral body must be removed from the column.

Traditionally, the diseased or destroyed vertebral body is completely removed from the column and the healthy remainder of the column is replaced. It was necessary to insert a prosthesis between the remaining vertebral bodies.

In order to match the length, two different fixed length prostheses can be attached to the vertebrae or the prosthesis can be attached to one vertebrae. section was used. In this case, the interval to be bridged during surgery should be matched to the healthy remaining vertebral body. After measuring the gap between the Assembling the prosthesis is done by having intermediate members of 9 different lengths. A multi-part prosthesis is described for example in LIS-PS4599086. ing.

The disadvantages of this known prosthesis are its complex structure with many parts and The problem is that the operations during loading and charging are complicated. EP-PSQ179695 and DE-OS No. 2,365,873 describes a similar artificial vertebra with fixed length.

On the other hand, the alloplastic substitute vertebral body described in DD-PS235416 As in the case, artificial vertebrae can be individually fabricated during surgery. however , the second substitute vertebral body can be secured to the healthy adjacent vertebral body with only one screw or round nail. The disadvantage is that the The cylindrical laminated envelope, which is individually fabricated intraoperatively, has a through hole in the outer wall to allow bone fragments and Or, the bone cement is filled with localized bone cement while it hardens. However, it has the disadvantage of reaching temperatures that can cause necrosis of the surrounding tissue.

Additionally, artificial vertebrae are known whose length can be adjusted by various means. Adjustable length The artificial vertebrae that can be used are US-PS4657550. US-PS4553273 and It is described in DE-O53729600. Both of these have two supports The arrangement is such that the distance between the two can be adjusted using a worm gear in the center. US-P The block-shaped support with the T-mugia described in S4553273 is , produced in each adjacent vertebral body. Preferably, it is buried in a polygonal recess. did Therefore, its disadvantage is that the recess must be created during surgery, which is a complicated process that takes two hours. This requires a processing method. The recess should be precisely aligned with the dimensions of the support and placed in the adjacent vertebrae. Cuts must be made into the body, otherwise the squid will not be securely fixed. l”+’t’ allo, DE-O8372960oi = square support as described without fixation to the end face of the vertebral body.

It is only screwed in from the side with bone screws.

Another possibility for anchoring the support, i.e. anchoring it to the adjacent vertebral body by means of spikes A method for doing so is described in US-PS 4,657,550. However, this A common disadvantage of all these configurations is that they require a center spacing retainer that can be adjusted in length. In some cases, grafts cannot be used.

Furthermore, DE-Al 3023942 includes spacers for artificial vertebrae and one artificial device. A tool is described for loading a substitute vertebral body by the public. In this case too, the graft The tool is a bench-like device with specially formed pliers legs and and a fixation device that firmly holds the legs in the open position.

The object of the present invention is to improve the above-mentioned known prostheses without the disadvantages of the vertebrae and to house the graft centrally. , it can be fixed if necessary, and even only a part of the destroyed vertebral body can be compensated, that is, a part of the vertebral body can be fixed. Depending on the length, it is not necessary to remove the entire vertebral body, even if the damage is significant. The objective is to provide an easily adjustable vertebral prosthesis. Therefore, here "adjacent vertebrae" When we say "body" we also mean the stable remaining portion of a partially removed vertebral body. Also , a “stable vertebral body” is, from the surgeon's point of view, a stable vertebral body that is sufficiently stable for the inserted prosthesis. It should be understood as a vertebral body or part of a vertebral body that can guarantee support.

In order to achieve the above object, the artificial vertebra of the present invention is constructed such that the spacing device is located at the center of the support plate. The prosthesis defined by Empty storage space for accommodating grafts made of natural and artificial materials. Can be adjusted to various lengths by eccentrically arranging the 5 space holding parts provided. The graft can then be placed in a stable prosthesis. By doing so, people The load on the structure of the instrument is significantly reduced. This is because even a graft can be used as a pillar. This is because it can absorb a significant portion of the applied pressure. Of course, all suitable Artificial substitutes can form implants. However, natural, in the best case raw Bone made from bone grafts or bone segments taken from the body's own bone and bone cement A graft is preferred; in any case, according to the invention, the tissue to be placed into the patient's body It is possible to minimize the amount of isomeric materials.

Conveniently, the fixing means are spikes.

In this case, if you insert an artificial vertebra and stop the necessary lengthening of the patient's column during the surgery, this will occur. These spikes automatically penetrate into adjacent vertebral bodies.

Using a bone graft by using a support plate with one or more through holes When installing, it is preferable that natural coalescence of the aggregate group occurs inside the column through the support plate. It's convenient. If there are multiple such perforations, special Provides stable support. Additionally, it allows only part of the vertebral body to be removed and a stable It also becomes possible to reliably connect the remaining vertebral body parts.

In the second case, it is advantageous for the through-hole to have a circular shape. Because that This makes it easier to create through-holes.

According to a preferred embodiment of the invention, the adjacent A connecting piece having one or more through holes for a bone screw that penetrates the body from the side provides support. connected to the board. In this case, the bone screw is long enough to reach the vertebral arch of the vertebral body. You can choose. In addition to the spikes that penetrate into the vertebral body, thereby stabilizing the fixation is obtained. Diseased or destroyed vertebral bodies can easily be partially removed. Becomes Noh.

Of course, when using long bone screws, they are Place these spikes so that the bone screw can penetrate between them. I can do it. By virtue of the fact that these connecting pieces are generally in extension of the spacer, It also becomes possible to minimize the surgical wound as much as possible. Because in this case , slightly shift the height from the same side to the screw on the connection piece and the adjustment mechanism on the spacing retainer. This is because you can get close to it with just a hand.

The use of connecting pieces for artificial vertebral structures is known in the art. For example, US-P S4599086, DE-O82365873 and EP179695 contain A connecting piece for artificial vertebrae of defined length is described, DE-O53729 According to 600, a connecting piece with a square support is provided.

These supports themselves are connected by center spacing retainers that allow adjustment of the spacing. . The connecting piece described in DE-O 82365873 runs along most of the outer circumference of the support plate. It is arranged as follows. To do this, by means of several bone screws that penetrate into the vertebral body, It can cause stress, fracture and dehiscence within the bone. Also, place the connecting piece around the vertebral body. A large perforation side must be made in order to screw on the DE-O 83729600 includes a vertical part of the rectangular support that grows the through hole for the bone screw. Therefore, it was formed. A connecting piece is described that attaches to the vertebral body. however , in this kind of configuration, reliable coupling of the vertebral bodies in relation to torsional forces is given No, because the end faces of the vertebral bodies are not connected directly to the vertical parts of the square supports. That's because there isn't.

The connecting piece is shifted outward with respect to the spacing retainer, and is connected via the support plate and the connecting part. It is convenient that it is. This will ensure that the adjacent vertebral bodies can be accommodated. In most cases, the eccentric spacing device slides approximately below the end surface of the adjacent vertebra; Preferred for mechanical reasons, nevertheless, for implants used in There is enough space left.

According to another embodiment of the invention, a penetration for a bone screw that penetrates the adjacent vertebral body laterally is provided. A connecting piece having one or more through holes is connected to the support plate on the opposite side of the support plate from the spacing member. is connected to. By doing so, the space for receiving the graft is freed up by the prosthesis. Even if a can be approached from the same side. However, in case 2, the vertical adjustment means is fixed at the time of charging. or if you are trying to compress the wound even smaller. Access to the longitudinal adjustment means must be made through a hole drilled in the implant.

In another preferred configuration, the joint piece is formed between two bony bones that penetrate laterally into the adjacent vertebral bodies. Each has two eccentrically arranged through holes for the same purpose. In this configuration , if necessary, remove spikes from the support plate that would obstruct the insertion of the bone screw into the vertebral body. At the edge of , you can omit 2 and .

Spikes directed into the receiving space are installed on the support plate to secure the graft. It's convenient that it's hidden. By doing so, it fixes, encloses and cavities The use of bone cement (Paracos) to fill the bone can be significantly avoided. As we all know.

As bone cement hardens, temperatures reaching up to 95° are generated, causing damage to the surrounding tissue structures. In contrast, the spikes provided in the present invention cause burns. Permanent fixation of grafts, especially bone grafts, is guaranteed without the use of bone cement. Ru.

In the configuration described above, the spikes are provided for fixation to a stable adjacent vertebral body. preferably placed on the extension of the spikes, thereby This greatly simplifies the creation of an artificial vertebra.

This is because double conical spikes are installed in the support plate for these spikes. This is because it can be pushed into a hole that has been cut.

In this case, it is advantageous that the spikes are provided radially outside the through holes in the support plate. This is the case. The spikes extend as one piece above and below each support plate.

Preferably located symmetrically, for example at the corner points of a virtual hexagon, in this case 1 through hole (which is originally known by DE-O 33729600) has a hexagonal These penetrations inside the sides of the shape, for example formed as large or slits Fusion of the 19-vertebral body and the artificial graft with the vertebrae and spikes firmly fixed through the foramen. becomes possible. In contrast, the through hole described in DE-O83729600 In some cases, only the bony substance of the vertebral body can grow into the prosthesis.

Because does this prosthesis have the possibility of accommodating grafts, especially bone grafts? It is et al.

The length of the conical spike is conveniently between 3 and 50 mm. It can be used in all areas of the column in patients of all ages, making prosthesis a Therefore, the size of the spikes can also be designed in several different sizes to suit different applications. Therefore, in children, the adjacent vertebral body and the graft to be placed Depending on the size of the adult, choose artificial vertebrae and spikes of smaller dimensions . For example, when reconstructing the cervical vertebrae, it is necessary to Select. The length of the spike is at least approximately 3 m thick covering the end face of the vertebral body. It is preferable that it be able to penetrate through m hard layers.

There is almost no limit to the length of the spike, and the spike completely penetrates the healthy adjacent vertebral body It can even penetrate the next vertebral body. However, as a result, the luck of the pillar mobility is restricted. Therefore, the length of the spike may not be intended otherwise for some reason. If the support plate is circular, it should not exceed the height of the adjacent vertebral bodies. This makes manufacturing on a lathe much easier. Hexagonal shapes can also be produced stably and easily. Ru.

According to a preferred embodiment, the eccentric spacer has a length of 51 sections in the form of a ratchet. Wear. The exact length of the vertebral prosthesis required is often unknown to the surgeon. The ratcheting adjustment mechanism of the septal retainer allows the prosthesis to be placed between the two healthy remaining vertebral bodies. A quick and precise adaptation to the spacing to be bridged is guaranteed. With two `` The expression ratchet refers to the fact that the prosthetic vertebral spacing devices are aligned in one direction, preferably reciprocally. It can be adjusted by pushing it in the opposite direction, and movement in the opposite direction is prevented by the stop means. This means that when the patient stops extending the column, the prosthesis shortens. , the length of the prosthesis can be adjusted more or less automatically in the loaded state. Wear.

The process of adapting the prosthesis during surgery is as follows. The surgeon will perform a preliminary examination. Appropriate dimensions of the prosthesis are determined based on the data obtained from the Select a law. 1 prosthesis that extends the patient's column and removes the destroyed vertebral body (part) Determine the length and shape of the graft to be placed between the support plates of the organ and prepare or Finish the harvested graft to the required dimensions. The graft is opened widely outside the patient's body. Place the prosthesis in the housing space and push the prostheses together by hand. The spikes already attached to the inside of the support plate are inserted into the graft and secure it. Second, the prosthesis is inserted between the remaining healthy adjacent vertebral bodies and the patient's column is extended. stop. At this time, significant pressure is applied to the vertebral body, so the The girder spikes are drilled further into the graft and the spacers are further pushed together. , or in the case of a ratchet, engages “teeth to tooth” and at the same time is attached to the outside of the support plate. The attached spike penetrates the end surface of the adjacent vertebral body. The support plate is attached to the adjacent vertebral body and Once against the end of the graft, insert it into the through-hole of the connection piece for additional fixation if necessary. Screw in the bone screw.

According to a preferred embodiment, an eccentric spacer (designed in the form of a ratchet) is provided. Two rails that are removably connected to each other. These rails are rigidly (connected) to each support plate. . This seems to be the simplest and most reliable structure.

In the second case, furthermore, at least one of the rails is due to longitudinal movement of the other rail. It is advantageous to have guiding means of. By doing so, vertical movement This prevents the two rails from tilting.

Preferably, the guide means are provided at the end of the rail opposite the support plate. Due to the arrangement configuration.

Reliable guidance can be obtained even when the two rails are fully opened.

Furthermore, it is possible that the guide means is formed by a band ring surrounding the other rail. It's convenient. The second belt ring allows you to run the other rail even if the two rails are loose. Measures should be taken to securely maintain the information to the extent that it will not be lost.

According to a preferred embodiment, the guide means are arranged so that the guide means are arranged in a manner that the guide means have a smaller overall length of the longitudinal edge of one of the rails. It is formed by curving or bending at least part of it into a flange shape. child Two rails are loosely connected and guided in a straight line accurately using a guiding means such as This is guaranteed.

The rails of the spacing device hold the prosthesis in a cross-section transverse to the longitudinal axis of the vertebra. Both are preferable and have a convex curve with respect to the axis, which is considered particularly suitable. The resulting configuration increases the longitudinal strength of the prosthesis.

In the second case, the connecting piece also has one prosthesis with a cross section transverse to the longitudinal axis of the vertebra, along this axis. Advantageously, it is convexly curved. By doing so, connect The segments will also fit better into adjacent vertebral bodies. This form is further supported circularly. When combined with a plate, the entire artificial tank can be easily produced using a lathe.

Furthermore, the rails are provided with mutually interlocking teeth on opposite sides. is convenient. By doing so, the teeth on one rail will match the teeth on the other rail. A positive fixation of the 5-spacing retainer is provided each time it engages with the recess.

In this case, for each rail, the tooth surface of St is connected to the support plate that is firmly connected to this rail. Vertical on the side facing the support plate and oblique on the side facing the other support plate Preferably, the tooth is formed in this way on the rail so that one spacing is maintained. The holders can be pushed into each other, but the vertical flanks of the teeth may end up touching each other. Therefore, it will not be pulled out unintentionally.

Each rail of the spacer is provided with teeth only on the edges adjacent to the longitudinal edges on both sides. It is also convenient that the This configuration has one spacer rail.

In a section transverse to its longitudinal axis, the prosthesis is curved convexly with respect to the longitudinal axis of the vertebrae By writing the teeth on the internal area of the rail, which is particularly preferred when the rail is formed with Therefore, the elastic action when connecting the rails is strengthened. This is because the teeth are all over the rail. This is because extending across the width increases the rigidity of the rail in the radial direction.

Furthermore, the two rails are provided with removable fastening means such as pins or screws. It is advantageous for the two to be connected to each other. This secures the fixing means. A prosthesis with a zero-order graft that allows for easy adjustment of the two rails when the Once the cap is adjusted to its final length, the fixing means can be easily tightened and closed, thereby firmly press the two rails of the spacer together. This allows the prosthesis to It is almost impossible for all parts of the fixing means to be adjusted to an undesirable length. It is preferable that the screws are held tightly so that they are not lost. , after the screw is inserted, the end opposite the head is crushed into a rivet-like shape. This is generally achieved by This screw is relatively small and once the prosthesis is inserted. screws and/or Nuts may be lost in the patient's body. This is done as above Therefore, it is prevented. If other fastening means are used, such as a bottle, the bottle should be be rigidly connected to the other rail and always protrude into the other rail, e.g. A threaded hole can be added for attaching a nut. In this case as well, Natsuto is lost. The end of the bottle can be crushed into a rivet to hold it in place. Ru.

When the screws are not tightened, the rails may be attached to springs, e.g. plates, installed under the screw heads. They are elastically pressed together by a spring, which at the same time releases the screw safety device. It is preferable to do this, so that even when the screws are not tightened, the spacing The retainer rails are compressed to a certain extent, thereby allowing for accurate longitudinal alignment of the prosthesis. This makes it easier to connect the rail and prevents the rail from wobbling.At the same time, the spring action This prevents the screw from unintentionally loosening. In this case the spring is, for example, a coil It can be provided as a spring or a curved leaf spring.

A threaded hole is provided in the rail closest to the longitudinal axis of the prosthesis to accommodate the clamping screw. It is also convenient to be seen. The clamp screws used should be adjusted to the dimensions of the prosthesis. The prosthesis with the graft should be the smallest at the post correction point. Screw holes are more convenient than nuts because they are tightened only after they are brought to final length. be. No special measures are required to hold the nut firmly, so tightening the screw is also easy. easily done.

In this case, place the prosthesis on the rail farthest from the vertical axis of the vertebra in the longitudinal direction through which the clamp screw passes. It is preferable to provide a vertical slit.This longitudinal slit simplifies the spacing. , quickly, it is possible to steplessly (as long as it is r stepless J by teeth > g clause becomes. But also space some holes lengthwise on one or both rails. It is originally possible to place them side by side.

In this case, the longitudinal fit is achieved by the screws being each screwed into a row of holes relative to each other. It is done. However, this solution is extremely difficult to create a population corrector. Incurs additional cost because all six of the rails located inside are threaded. and to ensure that the two holes overlap completely, This is because the spacing must be adjusted to the spacing of six.

It is also advantageous for the head of the clamping screw to be recessed. that This allows the outer surface of the spacer to be flattened, but this does not damage the surrounding tissue. This is preferable in view of the possibility of injury.

According to another embodiment, the rails of the spacer are elastically composite. To be so By doing so, the length of the rail can be adjusted outside the patient's body. After inserting the unique zero population compensator, the rail is installed on the rail with a tooth system. This allows the internal grafts to slide further relative to each other until they abut the support plate. here However, additional fixation by additional fixing means such as screws is possible, but if the spring is configured appropriately It's not necessarily necessary if you do.

In particular, the rail is composed of one or more C-shaped spring clips surrounding the outside. I can do two things.

Such a spring clip can be easily installed and removed again. By that This allows you to easily open the prosthesis, e.g. if you insert a graft of the wrong size. Becomes Noh.

In this case, when using two spring clips, these spring clips The prosthesis is placed on the longitudinal edge of the vertebral rail, and the prosthesis is placed outside the lateral rail relative to the longitudinal axis of the vertebra. Advantageously, it engages a longitudinal groove provided in the surface and the inner surface of the inner rail. be. This will prevent the rail from slipping or coming off, Furthermore, protrusions can be avoided.

between the rails, which can be buried in a recess provided on the inner surface of the outer rail; A spring-loaded spacer is provided which crosses the recess. It is advantageous to be able to adjust the extrusion position in both directions. Possibly a second depth Spacers such as the two that can fit into small recesses prevent incorrectly sized grafts from being inserted. Open the prosthesis in the extruded position without removing the spring clips, such as when It becomes possible to In the second case, the spacer connects the two rails and the teeth above them. The teeth no longer engage each other as they resist the spring action of the clip and are forced apart. No.

In this case, the spacer is formed by the web of the T-shaped insert, the legs of which can project outwardly through holes provided in the outer rail.

By doing so, you will be able to respond both when the prosthesis is inserted and outside the patient's body. The spacer can be easily adjusted using a tool formed by the Wear.

mutually in order to partition at least part of the storage space provided between the support plates. It is also advantageous if walls are provided which face each other and preferably connect to each other.

Surgeons often use multiple It is necessary to use a small number of bone fragments and connect them together with bone cement. , it is often advantageous for the storage space to be provided with walls. because For example, these bone fragments can be filled into the receiving space without pre-forming, and bone separators can be used. This is because they only need to be connected to each other with a ment. In this case, 2 bone cement The connection is possible even when the prostheses are separated from each other.

the length of the gap to be bridged by the through hole already provided for the prosthesis; It can also be done in any situation. These walls can be very easily shaped into supporting plates. For example, even in the case of a circular support plate, it can be used to partition the storage space. It is possible to provide a hollow cylindrical wall.

According to a moderate embodiment of the invention, each support plate is rigidly connected to this support plate. Together with the rail and the connecting piece, it forms an integral unit. By doing so Thus, the number of parts of the prosthesis is reduced. Thereby, it is easy to remove the prosthesis before use. Moreover, it becomes possible to synthesize quickly.

In this case, the unit can be formed from one piece. In that case, 5 especially circular The prosthesis with support plate and curved rails and contact radius pieces is lathed from 1M material. It can be made with This allows for subsequent welding, rivets or screw connections. It is ensured that the unit is constructed reliably and firmly without any binding. this species These connections can form local batteries within the patient's body that can erode or create weak points. As a raw material, special steel such as (A) FM138 sea bream (USi A suitable member made from

Another object of the invention is to provide a device for manipulating the above-mentioned artificial vertebrae. Ru. For this purpose, 5 two mutually parallel arms with inserts as working elements and , one or more guide means, and 14-bar means, the arm of the device being adjusted during adjustment. are guided parallel to each other on one plane by the guiding means, and the two axes are guided by the adjusting means parallel to each other on one plane. A device is used that allows controlled adjustment of the mutual spacing of the beams. For devices like this Therefore.

When using an insert for fixing a prosthesis, the method according to the invention is, in principle, This greatly simplifies the task of loading, unfolding, and possibly removing relatively small prostheses. Be stripped down. These inserts can be used for other purposes, such as six for spikes. If you use it to open the hole from the beginning, the surgery will be even easier.

The guiding means and the adjusting means are each provided by a rod, and the adjusting means is provided by a screw thread attached to the rod. It can be formed extremely easily. In the second case, the threads simplify the spacing between the arms. It becomes possible to make simple and stepless adjustments.

Adjustment can also be made by two threads running in opposite directions on the rod, Two threads running in opposite directions then engage corresponding threads in the arm.

The guiding means are formed by mutually parallel rods, preferably on both sides of the adjusting means. This is advantageous for stable guidance even when relatively large loads are applied. Ru.

According to another preferred embodiment, the measuring means for measuring the distance between the two arms are provided. It has been added. This allows the surgeon to quickly adjust the spacing between the remaining vertebral bodies. 5. Prosthesis size selection, and also prior graft preparation Fabrication becomes easier.

a prosthesis having connection pieces and through holes provided in these connection pieces in the vertebra; The screw protrudes through the hole into the insertion member and attaches the 2 prosthetic screws to the 6 pieces of the connecting piece of the vertebrae. connecting with the insertion member with a screw to retain the prosthesis so as to engage the thread; 0 by using screws to secure the prosthesis to the insertion member. This enables a connection that is both real and easily removable.

Another preferred embodiment of the device includes an insert member that serves to retain the prosthesis of the vertebrae. 1. The side of the prosthesis that faces the vertebrae matches the external shape of the connecting piece of the prosthesis to the vertebrae.

Preferably, the insert member is held in the arm in a twist-proof manner. to do so The artificial vertebrae are fixed to the insertion member attached to the arm of this device.

When unfolding the device, the prosthesis can be precisely guided through the vertebral members, allowing the prosthesis to be placed between the vertebrae. This prevents the separation retainer from tilting.

The invention will be explained in more detail below on the basis of advantageous embodiments shown in the drawings.

Figure 1 is a perspective view of the vertebrae with the prosthesis separated from each other. 1 is a bottom view showing the outer side of the prosthesis with respect to the vertebral longitudinal axis, that is, the lower half in Figure 1. .

FIG. 3 is a perspective view of an assembled prosthetic vertebra with a spring configuration; .

FIG. 4 is a plan view of the upper (medial) half of the prosthetic vertebra of FIG. 3;

FIG. 5 is a plan view of the lower (outer) half of a vertebra with an artificial prosthesis configured according to FIGS. 3 and 4. It is.

6 is a top and front view of the spacer for the prosthetic vertebra of FIG. 5; FIG.

FIG. 7 is a perspective view of another prosthetic vertebra with a circular support surface.

FIG. 8 is a partial view of the modified lower (outer 61) half of the vertebra with an artificial prosthesis in another configuration. be.

Bit+9 is a perspective view of the modified upper (medial) half of the prosthetic vertebra.

FIG. 10 is a schematic side view of a vertebra loaded with a prosthesis according to FIG. 1 with an implant; Ru.

111iH11 has a different configuration in which the graft accommodation space is completely surrounded by walls. FIG. 2 is a perspective view of an assembled vertebra with an artificial prosthesis.

FIG. 12 is a plan view of the upper half of the prosthetic vertebra according to FIG. 11;

@13 is a plan view of the lower half of the prosthetic vertebra according to FIG. 11;

[14] FIG. 14 is a perspective view of an assembled vertebra with an artificial vertebra according to another configuration.

FIG. 15 is a perspective view of the upper (medial) half of another modified prosthetic vertebra.

FIG. 16 is a perspective view of the lower (lateral 011) half of another modified prosthetic vertebra.

FIG. 17 is a plan view of the detail of FIG. 16.

13018 is an IIf plane view of a device for manipulating an artificial vertebra.

FIG. 19 is a plan view of the apparatus of FIG. 18.

FIG. 20 shows another insert member.

In FIG. 1, there are shown two parts or halves, each forming an integral unit 2, 3. The artificial vertebra is shown here. Each of these units 2, 3 may essentially be e.g. These support plates, consisting of vertical support plates 4 (any other form is also possible), via a connecting piece 6 preferably arranged at right angles to the connecting part. There is. On the other side of the connection 5 there is also a rail 7, preferably perpendicular to the connection. 8 is extended. The two rails 7.8 are then assembled in pairs and are detailed below. As will be explained, a spacer 9 is formed whose length can be adjusted. Between support plates 4 A space for accommodating the graft is formed in the. Accommodation space is rail 7 and 8, the support plate 4 is only partially partitioned by the ceiling surface of the storage space. It forms the floor surface. The length of the second storage space is determined by the length of the second storage space. You can change the two depending on. When fixing two rails 7 and 8 together The size of the storage space is determined and maintained stably.

The support plate 4 is located at an adjacent vertebral body displaced substantially inwardly from the edge or corner. spikes 10 extending in one or both directions for securing to the It is equipped with spikes 11 for fixing the implanted graft (also not shown). . Of course, spikes 10 and 11 can be staggered and placed in different positions. The cutout can also have different shapes in side view and cross-section. especially artificial grafts In this case, the spikes 11 protruding into the storage space are not necessarily necessary and are In the case of grafts, it is addictive (also inappropriate).

Furthermore, the support plates 4 are provided with a structure that allows the graft located between the support plates 4 to fuse with the adjacent vertebral body. A through hole 12 is provided for this purpose. Where it is desired to grow In some cases, such a through hole is advantageous.

The number and configuration of these through-holes can be varied arbitrarily, but one can make the prosthesis more rigid. Two or more through-holes are provided as appropriate to achieve adhesion of the periphery. It is preferable to provide two.

The connecting piece 6 is provided with a hole 13 through which a bone screw (not shown) is inserted. It can be screwed into the adjacent vertebral body from the side. These six have screw threads. Can be done. Since a stable connection can already be obtained with only spike 10, such There may be no connection piece at all, but the connection piece contributes to increased stability. do.

The two rails 7゜8 of the length-adjustable spacer 9 have teeth on opposite sides. 14 are provided.

The document is vertical on the side facing the support plate 4 connected to the rail 7 or 8, respectively. straight and beveled on the other side. defined by the center of support plate 4 A longitudinal slit 15 is provided in the outer rail 8 of the artificial vertebra 1 with respect to its longitudinal axis. The inner rail 7 is provided with a screw hole 16. Vertical slit 15 The dimensions of the clamp screw 17 are selected such that the shank of the clamp screw 17 can slide longitudinally therein. It is.

When assembling the artificial vertebra, the clamp screw 17 passing through the longitudinal groove 15 is inserted. , a leaf spring I8 arranged between the rail 8 and the head of the screw 17 and having rounded edges. The threaded hole is screwed into the threaded hole 16 provided in the rail 7 while resisting the force of the screw. Squeeze the end protruding from 16 into a rivet shape to prevent it from being lost. can be held firmly. It is also possible to use rails 7 and 8 with flat inner surfaces. However, in that case significantly higher demands are placed on the fixing means. Leh interlocking surfaces formed in any other arbitrary shape on the mutually facing surfaces of the wheels 7 and 8. Protrusions and recesses can also be provided, but a row of teeth is optimal.

As is clear from FIG. 2, the rail 8 of the outer integral unit 3 has a longitudinal slit 1 5 has a step or shoulder 19 on the edge, on which a leaf spring 18 and a clamp are attached. The lower surface of the head of the screw 17 is rounded. By doing so, your head will be below the rail. Placed buried in the surface or outside surface 6 The artificial vertebra I shown at 1113 consists of roughly the same parts as the artificial vertebra shown in FIG. different What happens is that in both halves of the artificial vertebrae 2 and 3 teeth 14 are provided. The point is that the rails 7.8 are removably connected. upper rail 7 A longitudinal groove 20 is provided on the upper surface and the lower surface of the lower rail 8 adjacent to the longitudinal edge. ing. Two C-shaped spring clips 21 are engaged in the two longitudinal grooves and supported therein. , thus compressing the rails 7.8 together. Therefore, the person according to 5 Figure 3 If the graft is inserted into the vertebrae, the clamp screw 17 should be used to insert the graft (not shown). It is not intended to make connections between rails 7.8.

In rM4, the prosthesis according to 81I3 is shown as an integral unit 2 on the upper side of vertebra 1, the connection part Piece 6 embeds a bone screw (not shown) passing through hole 13 around bone screw hole 13. It is provided with a stepped portion 22 (shown in broken lines) for mounting. Two types of configurations, It also has a hole for unit 3.

The lower integral unit 3 shown in Fig. The upper surface C1 of the rule 8 (two right-angled recesses 23 and 23' that intersect perpendicularly to X, A 624 is provided at the intersection of the two recesses.

In this case, the two recesses 23, 23' have depth forces (different; in this case, For example, a recess 23' parallel to the vertical axis C of the unit is a T-shaped spacer 26 in a plan view. (see Figure 6) is deep enough to accommodate the web 25 (shown in dashed lines) completely (see Figure 6). 1 The teeth of the rails 7.8 that come close to each other when the prosthesis is assembled 14 forces (force 1 However, in contrast, the recess 23 (which is much shallower) The web 25 of the pacer 26 (FIG. 6) resists the action of the spring clip 21 to exert an external force. Inside the ivy, that is, direction C of the other rail 7: Press it and rotate it 90 degrees. , the web 25i enters one shallow recess m23, and the web enters the tooth 14i of the other rail 7. It rests on the rail 8 and engages with the teeth 14 of the rail 8. Therefore, the prosthesis IC can be opened without removing the C-shaped clip 21. The two rails 7 and 8 can be slid up and down [double-folded]. Wear.

In FIG. 6, the web 25. and a leg @1127 with a hexagonal recess 28 on the end surface. In this case, details of the spacer 26 used in FIG. 5 are shown in plan and front view. 5 Leg 27 protrudes through 6 24 when assembling the prosthesis and is fitted with a suitable wrench. It can be easily rotated from the outside.

In FIG. 7, the support plates 4 of the two units 2 and 3 of the artificial vertebra l are formed in a circular shape. Other embodiments are shown. With the second configuration, units 2 and 3 can be combined into one member. For example, it can be easily processed using a lathe. In other respects 2 Figure 7 The artificial vertebra l corresponds to the artificial vertebra l shown in FIG.

Figure 8 shows a modified example of rail 7 or 8 (rail 8 in this case) of artificial vertebra I. , in this case the teeth 14 are provided only on the longitudinal edges 29.30 on both sides of the rail. Ru. Additionally, the rail is curved convexly in cross-section transverse to the longitudinal axis of the vertebrae. Ru. The center of curvature of the rail is aligned with the support plate so that it can be manufactured relatively easily using a lathe. Centrally located.

In FIG. 9, another modification of the integrated unit 2 of the artificial vertebra I is shown. in this case, The upper or inner rail 7 has an integral unit 3 (not shown) in several areas along its entire length. ) is curved or bent in the direction of the rail 8 and forms a guide means for the other lower rail 8. A portion 31 is provided.

FIG. 10 shows a schematic side view of a vertebra l loaded with the prosthesis according to FIG. Here, a hanger-like configuration of one artificial vertebra is shown. Furthermore, the support plate The graft located between 4 and M! Healthy adjacency from the side through hole 13 of continuation piece 6 Two bone screws 33 are shown screwed into the vertebral body (eg 34).

Similarly, the spikes 10 and 11 penetrating the vertebral body 34 or implant 32 are indicated by dashed lines. It is shown in

The artificial vertebra I shown in FIG. 11 consists of roughly the same parts as the artificial vertebra 1 shown in FIG. two The difference here is that the walls 4' come out from the support plate 4, face each other, and merge into each other. , 4' are provided. These walls enclose the graft accommodation space; Forming two boxes that can fit into each other.

12 and 13 show the prosthesis of FIG. 12 with walls 4' and 4'' on both halves 2 of vertebra 1. and 3 are shown in front view.

The prosthesis shown in Figure 14 is called vertebra 1, and the prosthesis shown in l1ffll is called vertebra l. They consist of roughly the same parts, but here the connection piece 6 is the support plate 4, and the spacer holder 9 is different from the support plate 4. placed on the opposite side. Furthermore, the support plate 4 is circular and the one-space retainer 9 is 7.8 and the connecting piece 6 have a cross-section transverse to their longitudinal axis that connects the prosthesis to the longitudinal axis of the vertebra 1. A curve that is convexly curved with respect to the axis, with the center of right curvature coinciding with the center of the support plate 4. It is formed by the radius. At the same time, these rails are attached to the walls of the storage space. It forms a minute. In this embodiment.

Only one hole for the screw shank is shown in the outer rail (here 7) as a means of fixation. It is. in this case.

Fixing means provided for loosening the longitudinal connection of the two rails 7 and 8 The movable parts of the rail 8, such as screw heads or nuts, are buried in the underside (invisible side) of the rail 8. It is preferable that the graft remains in place; If tightening, cut a through hole in the graft so that a tool such as a spanner can pass through it. must be established.

FIG. 15 shows another modification of the integrated unit 2 of the artificial vertebra I. child Here, for example, the upper side 5 or inner rail 7 is located at the end opposite to the support plate 4. One lateral protrusion 31a is provided on each side in the longitudinal direction on both sides of the section. child These protrusions protrude downward in the direction of the rail 8 of the lower integrated unit 3 (not shown). Extruding or bending. In this case, the protrusion 31a is the other lower rail 8 forming side guide means. Of course, at the same time, rail 8 (not shown) It is possible to have a similar protrusion 31a. The protrusion s31a is attached to the rail 8 at the end. It can also have a hook-like projection that engages the back surface of the.

FIG. 16 shows another configuration form of the integrated unit 3 of the artificial vertebra l. The guide means of the rail 7 is formed by a band ring 31b arranged at the end of the outer rail 8. be done. This strap ring (reciprocal ratchet movement of the teeth of the rail 7.8 during longitudinal adjustment) The other rail 7 is surrounded with play in the assembled state so that it is possible to Ru. In addition to its guiding function, the band ring 31b also serves as a guide for the two integrated units that make up the artificial vertebrae. Also for the purpose of better assembling and holding together parts 3 in the loose state. have.

Furthermore, unit 3 here has two tongues protruding laterally and two bones. Two side through-holes 13 are provided for accommodating screws (not shown). Deformed connection It has piece 6. Spies protruding outwards that pose an obstacle for bone screw insertion 10 is omitted in this version (see also i31117).

FIG. 18 shows a device 3 used in combination with an artificial vertebra (not shown) during surgery. 5, this device 35 has arms 36 and 35 parallel to each other in one plane. and 37. These arms are preferably connected to two parallel guide rods 40. They are connected to each other by adjustment rods 41 that are in the same plane.

Arms 36 and 37 have replaceable inserts 38, 39 at each end with screws 4. 7 has a screw 646 for fixing. These two inserts themselves are A hole 48 for embedding and accommodating a screw 47 and an artificial vertebra l (not shown here) are provided. and a hole 43 for accommodating a screw 42 for fixing the connecting piece 6 (not shown) through the connecting piece 6. ing. The guide rod 40 is press-fitted into a hole in the arm 36, and the guide rod 40 is press-fitted into a hole in the arm 37. It is possible to move within 49. Furthermore, the guide rod 40 is equipped with a stopper 50 at the end. It is growing. The adjustment rod 41 is fitted with a knurled disc 5 that is pushed in and installed. 2, a shoulder portion 51, and a threaded portion 44, and the threaded portion engages with a threaded hole 53 of the arm 37. It matches. In this case, the part between the shoulder 51 and the knurled disc 52 is .

The arm 36 can freely rotate within the six 54. Therefore, the knurled disc 5 2, the two arms 36 and 37 become flat with each other depending on the direction of one rotation. Move away from or approach the line. Thereby, in a subsequent step, the artificial vertebrae are screwed together. When removed, the spacer 9 of the prosthetic vertebrae (not shown) opens and closes. Ru. Additionally, one of the guide rods 40.

The mutual spacing of the two arms 36 and 37 or the required size of the prosthesis or graft A scale 45 for reading the height is attached.

As for the construction of the guide means, a large number of variants are available at will. the simplest variant The example has screws for the adjustment device at the same time. is the only rotatable rod . If the overall height is large enough, there is no need for the guide rod to protrude; For example, a plate with slits can be used with screws inside the slits. A possible alternative is for the rod to be arranged so that it can rotate. Section 11 device also Can be configured differently.

In FIG. 19, the sides of the two artificial insert members 38 and 39 facing vertebra l are shown in FIG. It is shown that it is compatible with the rounded shape of the connecting piece 6 shown. Other forms of adaptation This can be accomplished quickly, for example, by providing a corresponding concave portion on the front surface of the insert member.

Furthermore, the end of the arm 36 is provided with a hole for accommodating the protrusion #56 of the insertion member 38. 155 is illustrated. This does not twist against the arm (36 in two cases) should be considered as one example among many possibilities of additional fixation for.

FIG. 20 shows another insert formed similarly to the support plate 4 with external spikes. This insertion member is used to drill a hole in the adjacent vertebral body to prepare the prosthetic vertebra for insertion. used for

These inserts may be inserted in any desired manner, for example by dovetail grooves or dovetail springs. Can be fixed to the arm of the device. We gave up on other applications and tried to maintain only the vertebrae with the 2nd prosthesis. 1. In the case where the insert member shown in Figures 18 and 19 is integrally molded with the arm, You can also connect them. However, variations of these insert members are shown in @20. This is advantageous solely because of the availability of inserts according to the invention. Other practical inserts, such as graduation measuring inserts in combination with graduations between the inserts. can be used.

This device is used during surgery as follows.

The interval at which the prosthesis should be bridged with the vertebrae is determined by inserting the device 35 into the column and using a knurled circle. Rotate the plate 52 so that the outside of the insertion member 38 or 39 hits the end surface of the adjacent vertebral body. The zero order, determined by extending the device 35 to and reading the interval A on the scale 45, The device 35 is again removed from the column and an appropriate artificial Select vertebra 1 in advance with the lateral spike using the insertion member according to Figure 20. A hole is made in the adjacent vertebral body for 2 and 1. The prosthesis is then partially pressed into vertebra 1. In the pushed-in state, the through hole 1 (here designed as a screw 6) of the connecting piece 6 Insert the screw 42 into 3 and connect it with the device 35, insert it into the column using the device 35, There it is expanded to the correct length. At the measured length to hold the prosthesis vertebrae It is more advantageous if it is fixed immediately to the insert member. By doing so, the artificial device Officials can use a small amount of force to instantly secure the object to the pillar. after that After removing the device 35 from the surgical side.

A bone screw can be screwed through the through hole 13 of the connecting piece 6, and the length can be finally adjusted. Can be fixed.

In most cases, the preferred prosthesis is the construction of the vertebrae.

FM7, but the alternatives for flat rails 7 and 8 mentioned therein. Instead, a convexly curved rail according to FIG. 8 is used. In the second case, these records The centers of curvature of the wheels are located between the two parts 2 and 2 of the prosthetic lumbar vertebra 1 in the center of each support plate 4 and 3 are integrally formed on a lathe, and the double spikes 10.11 are also lathed. It is installed later.

January 22, 1993

Claims (1)

[Claims] 1. It has two support plates (4) for attachment to the end faces of stable adjacent vertebral bodies; A support plate (4) is provided with fixation means (10) for fixation to said vertebral body and is long. one or more spacers (9) connected by one or more spacers (9) whose height can be adjusted In an artificial spine inserted as a substitute for a destroyed vertebral body, a spacer (9) is eccentric to the longitudinal axis of the artificial spine (1) defined by the center of the supporting vibration (4). one or both of natural and artificial materials are arranged between the support plate (4); An empty accommodation space is formed for accommodating the graft (32) consisting of Characteristic artificial spine. 2. Artificial spine according to claim 1, characterized in that the fixation means (10) are spikes. Shiba. 3. A claim characterized in that the support plate (4) has one or more through holes (12). The artificial spine according to claim 1 or 2. 4. 4. Person according to claim 3, characterized in that the through hole (12) is of circular design. Artificial spine. 5. Penetrating laterally into the adjacent vertebral body, generally in extension of the eccentric spacer (9) A connecting piece (6) with one or more through holes (13) for bone screws (33) is provided with a supporting According to any one of claims 1 to 4, the plate is connected to a plate (4). Artificial spine. 6. The connecting piece (6) has shifted outward with respect to the spacer (9), and the connecting piece (5) ) to the support plate (4). spine. 7. The connecting piece (6) is provided with one or more bone screws (33) for laterally penetrating the adjacent vertebral body. The connecting piece (6) has a through hole (13) on the support plate (4), and the connecting piece (6) Claim 1, characterized in that the support plate (4) is connected to the support plate (4) on the side opposite to the support plate (9). 5. The artificial spine according to any one of 4. 8. The connecting piece (6) is for two bone screws (33) that penetrate laterally into the adjacent vertebral bodies. , each having two eccentrically arranged through holes (13). The artificial spine according to any one of claims 5 to 7. 9. a spy directed towards said receiving space for fixing the graft (32); Claims 1 to 8, characterized in that the support plate (4) is provided with a support plate (4). The artificial spine according to any one of the above. 10. A spike (11) is provided for fixation to a stable adjacent vertebral body. Artificial device according to claim 9, characterized in that it is arranged on the extension of the pike (10). spine. 11. The spikes (10, 11) are radially outward of the through hole (12) of the support plate (4). The artificial spine according to claim 9 or 10, wherein the artificial spine is provided in a. 12. The length of the spikes (10, 11) is 3 to 50 mm. The artificial spine according to any one of claims 9 to 11. 13. Claim characterized in that the support plate (4) is formed circularly or hexagonally. The artificial spine according to any one of Items 1 to 12. 14. Features that the length of the eccentric spacer (9) can be adjusted in a ratchet-like manner. The artificial spine according to any one of claims 1 to 13. 15. two eccentric spacers (9) removably connected to each other; rails (7, 8), and each of these rails is a supporting plate. (4) Any one of claims 1 to 14, characterized in that: Artificial spine described in. 16. At least one of the rails (7 or 8) is connected to the other rail (8 or 8). 7) Due to the vertical movement of -2 Claim 15 characterized in that the guide means (31, 31a, 31b) are provided. Artificial spine described. 17. The guide means (31a, 31b) are connected to the rail ( 17. The prosthesis according to claim 16, characterized in that it is provided at the end of 7 or 8). spine. 18. The guide means (31a) is stretched over the other rail (8 or 7) Claim 16 or 17. The artificial spine according to 17. 19. The guide means (31) guides the longitudinal edge of one of the rails (7 or 8) over its entire length. formed by flange-like curving or bending in at least a portion of the The artificial spine according to claim 16 or 17, characterized in that: 20. The rails (7, 8) of the spacing device (9) are aligned with respect to the longitudinal axis of the artificial spine (1). characterized by a convex curvature with respect to this axis in transverse section The artificial spine according to any one of claims 15 to 19. 21. The connecting piece (6) also has a cross section transverse to the longitudinal axis of the artificial spine (1). 21. The artificial spine according to claim 20, characterized in that it is curved convexly with respect to the axis. 22. Teeth (14) that engage with each other are provided on opposite sides of the rails (7, 8). 22. Artificial material according to any one of claims 15 to 21, characterized in that: spine. 23. In each rail (7, 8), the tooth surface of the tooth (14) is fixed to this rail. It is vertical on the side facing the support plate (4) which is connected to the other support plate (4). 23. The artificial spine according to claim 22, characterized in that the facing sides are diagonally lowered. . 24. Each rail (7, 8) of the spacer (9) connects to a longitudinal groove on both sides. Claim 2 characterized in that only the edges (29, 30) provided with teeth (14) 24. The artificial spine according to any one of Items 2 and 23. 25. The two rails (7, 8) are fitted with removable fastening means, for example pins or Claims 15 to 2 characterized in that they are connected to each other by screws (17). 4. The artificial spine according to any one of 4. 26. all parts of said fixing means are firmly held so as not to be lost; The artificial spine according to claim 25, characterized in that: 27. When the screws (17) are not tightened, the rails (7, 8) may fit under the screw heads. are elastically pressed together by a spring attached, for example an oscillating spring (18); Claim 2 characterized in that this spring at the same time constitutes a safety device for the screw (17). 5 or 26. 28. Attach the clamp screw (17) to the rail (7) near the longitudinal axis of the artificial spine (1). ) is provided with a threaded hole (16) for accommodating the 28. The artificial spine according to any one of items 5 to 27. 29. Attach the clamp screw to the rail (8) furthest from the longitudinal axis of the artificial spine (1). (17) is provided with a longitudinal slit (15) through which it passes. An artificial spine according to any one of claims 25 to 28. 30. The clamp screw (17) is provided so that its head is buried. The artificial spine according to any one of claims 15 to 29. 31. It is noted that the rails (7, 8) of the spacer (9) are elastically connected. 25. The artificial spine according to any one of claims 15 to 24. 32. The rails (7, 8) are fitted with one or more C-shaped clips (2) surrounding the outside. 32. The artificial spine according to claim 31, characterized in that it is connected by: 1). 33. Two spring clips (21) are provided in the longitudinal groove of said rail, These spring clips are attached to the outside of the lateral rail (8) with respect to the longitudinal axis of the artificial spine (1). engaging a longitudinal groove (20) provided in the surface and the inner surface of the inner rail (7). 33. The artificial spine according to claim 32. 34. A recess (23') provided in the inner surface of the outer rail between the rails (7, 8) A spring-loaded spacer (26) is provided which can be embedded in the This spacer can be adjusted in its extruded position in the lateral direction with respect to the recess (23'). The artificial spine according to any one of claims 31 to 33, characterized in that: 35. A spacer (26) is formed by the web (25) of the T-shaped insert. The legs (27) extend outward through holes (24) provided in the outer rail. 35. An artificial spine according to claim 34, characterized in that it is protruding. 36. To partition at least a part of the storage space provided between the support plates (4). vertically extending from the support plate (4) and facing each other, preferably overlapping each other. Connecting walls (4', 4') are provided, and one wall is connected to the rails (7, 8). 36. According to any one of claims 1 to 35, characterized in that it can also be formed by artificial spine. 37. Each support plate (4) has a rail (7 or 8) rigidly connected to this support plate. ) and connecting piece (6) form an integral unit (2 or 3). 37. An artificial spine according to any one of claims 15 to 36. 38. The unit (2 or 3) is formed from one member. The artificial spine according to claim 37. 39. Two mutually parallel axes with insert members (38, 39) installed as working parts. (36, 37), one or more guiding means (40) and adjusting means (41). The arms (36, 37) of the device are guided by guide means (40) during adjustment. The adjustment means (41) are guided parallel to each other in two planes, and the adjustment means (41) are arranged in two arms (36, 3 39. Any one of claims 1 to 38, allowing a controlled adjustment of the mutual spacing of 7). A device for manipulating the artificial spine described in . 40. The guiding means (40) and the adjusting means (41) are each formed by a rod; At this time, the adjusting means (41) is shaped by the threads (44, 44') on the rod. 40. A device according to claim 39, characterized in that it is made of: 41. The guiding means (40) are guided by two rods parallel to each other to suit the purpose. 41. The device according to claim 40, characterized in that the device is formed on both sides of the adjustment means (41). . 42. Measuring means (45) for measuring the distance between the two arms (36, 37) According to any one of claims 39 to 41, additionally provided. equipment. 43. In the insertion member (38, 39) for fixing the artificial spine (1), this The artificial vertebrae are connected to the insertion members (38, 39) by screws (42), and During the process, the screw (42) protrudes through the hole (43) into the insert (38, 39). and provided in each one of the through holes (13) of the connecting piece (6) of the artificial spine (1). 39. According to any one of claims 5 to 38, characterized in that it rests in the thread. 44. A device according to any one of claims 39 to 43 for manipulating an artificial spine of . 44. In the insertion member (38, 39) for fixing the artificial spine (1), this The side of the insertion members (38, 39) facing the artificial spine is the connecting piece (6) of the artificial spine (1). ) and preferably to prevent twisting of the inserts (38, 39). Claims 5 to 38 characterized in that it is held on the arms (36, 37). The artificial spine according to any one of claims 39 to 43 for the artificial spine according to any one of claims 39 to 43. equipment.