US20040158254A1 - Instrument and method for milling a path into bone - Google Patents

Instrument and method for milling a path into bone Download PDF

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Publication number
US20040158254A1
US20040158254A1 US10/752,724 US75272404A US2004158254A1 US 20040158254 A1 US20040158254 A1 US 20040158254A1 US 75272404 A US75272404 A US 75272404A US 2004158254 A1 US2004158254 A1 US 2004158254A1
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United States
Prior art keywords
keel
instrument
bone
guide member
bit
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
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US10/752,724
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English (en)
Inventor
Lukas Eisermann
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Warsaw Orthopedic Inc
Original Assignee
SDGI Holdings Inc
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Filing date
Publication date
Application filed by SDGI Holdings Inc filed Critical SDGI Holdings Inc
Priority to US10/752,724 priority Critical patent/US20040158254A1/en
Assigned to SDGI HOLDINGS, INC. reassignment SDGI HOLDINGS, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: EISERMANN, LUKAS
Priority to US10/773,494 priority patent/US20050043802A1/en
Publication of US20040158254A1 publication Critical patent/US20040158254A1/en
Assigned to WARSAW ORTHOPEDIC, INC. reassignment WARSAW ORTHOPEDIC, INC. MERGER (SEE DOCUMENT FOR DETAILS). Assignors: SDGI HOLDINGS, INC.
Abandoned legal-status Critical Current

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Definitions

  • the present disclosure relates generally to the field of orthopedics and spinal surgery, and in some embodiments, the present disclosure relates to intervertebral prosthetic joints for use in the total or partial replacement of a natural intervertebral disc, and methods and tools for use therewith.
  • this disclosure relates to an instrument that aids in the insertion of alternatives to spinal fusion.
  • An instrument for cutting a path in bone includes a curved guide member defining a curved opening extending therein, and a bit member positioned within the opening of the guide member.
  • the bit member is adapted to move within the opening of the guide member to cut a path in bone.
  • an instrument for cutting a path in bone includes a curved guide member defining a curved opening extending therein, a bit member positioned within the opening of the guide member, a rotatable element operatively connected to the bit member to impart rotational movement to the bit member, and a handle operatively connected to the bit member to impart translational movement to the bit member.
  • the bit member is adapted to cut a curved path into bone via rotational movement in and translational movement through the guide member.
  • a method for cutting a curved path into bone includes providing an instrument having a curved guide member, the curved guide member defining a curved opening therein, positioning a bit member within the opening of the guide member, actuating the instrument to impart rotational movement to the bit member, engaging the bit member with bone, and imparting a translational force to the bit member to cut a curved path in bone.
  • FIG. 1 is a lateral view of a portion of a spondylosed vertebral column.
  • FIG. 2 is a lateral view of a pair of adjacent vertebral endplates of FIG. 1.
  • FIG. 3 a is a lateral view of the pair of adjacent vertebral endplates of FIG. 2 with a rod and screw arrangement.
  • FIG. 3 b is a longitudinal, partial sectional view of the pair of adjacent vertebral bodies of FIG. 3 a.
  • FIG. 4 a is an isometric view of an articulating prosthetic joint for lateral insertion according to one embodiment of the present disclosure.
  • FIG. 4 b is an isometric view of an articulating prosthetic joint for lateral insertion according to another embodiment of the present disclosure.
  • FIG. 4 c is a front view of the articulating prosthetic joint for lateral insertion of FIG. 4 b.
  • FIG. 5 is a longitudinal view of the prosthetic joint of FIG. 4 a.
  • FIG. 6 is a lateral view of the prosthetic joint of FIG. 4 a.
  • FIG. 7 is a lateral, partial sectional view of the prosthetic joint of FIG. 4 a disposed between a pair of spondylosed vertebral endplates.
  • FIG. 8 is a lateral, partial sectional view of an alternative articulating prosthetic joint disposed between a pair of vertebral endplates.
  • FIG. 9 is an isometric view of an alternative articulating prosthetic joint according to another embodiment of the present disclosure.
  • FIG. 10 is a lateral, partial sectional view of the prosthetic joint of FIG. 9 disposed between a pair of spondylosed vertebral endplates.
  • FIG. 1I is a lateral, partial sectional view of an alternative articulating prosthetic joint disposed between a pair of vertebral endplates.
  • FIG. 12 is an isometric view of a disc prosthesis according to another embodiment of the present disclosure.
  • FIG. 13 is an isometric view of an alternative disc prosthesis according to another embodiment of the present disclosure.
  • FIG. 14 is an isometric view of an alternative articulating prosthetic joint for anterior insertion according to another embodiment of the present disclosure.
  • FIG. 15 is a longitudinal view of the prosthetic joint of FIG. 14.
  • FIG. 16 is a lateral view of the prosthetic joint of FIG. 14.
  • FIG. 17 is a lateral view of the prosthetic joint of FIG. 14 disposed between a pair of spondylosed vertebral endplates.
  • FIG. 18 is a longitudinal view of an alternative articulating prosthetic joint for anterior insertion according to another embodiment of the present disclosure.
  • FIG. 19 is a longitudinal view of an alternative articulating prosthetic joint for anterior insertion according to yet another embodiment of the present disclosure.
  • FIG. 20 is a longitudinal view of an alternative articulating prosthetic joint for anterior insertion according to yet another embodiment of the present disclosure.
  • FIG. 21 is a longitudinal view of a pair of verterbral endplates having slots for receiving the prosthetic joint of FIG. 18.
  • FIG. 22 is a longitudinal view of a pair of verterbral endplates having slots for receiving the prosthetic joint of FIG. 19.
  • FIG. 23 is a longitudinal view of a pair of verterbral endplates having slots for receiving the prosthetic joint of FIG. 20.
  • FIG. 24 is a lateral, partial sectional view of the prosthetic joint of FIG. 14 disposed between a pair of spondylosed vertebral endplates and an orthopedic implant.
  • FIG. 25 is a lateral, partial sectional view of the prosthetic joint of FIG. 14 disposed between a pair of spondylosed vertebral endplates and a lag screw.
  • FIG. 26 is a schematic top view of the arrangement depicted in FIG. 25.
  • FIG. 27 is a schematic top view of a vertebral body depicting a path for transforaminal insertion.
  • FIG. 28 is an isometric view of an alternative articulating prosthetic joint for transforaminal insertion according to another embodiment of the present disclosure.
  • FIG. 29 is a lateral view of the prosthetic joint of FIG. 28.
  • FIG. 30 is a longitudinal view of the prosthetic joint of FIG. 28.
  • FIG. 31 a is a lateral, partial sectional view of the prosthetic joint of FIG. 28 disposed between a pair of vertebral endplates.
  • FIG. 31 b is a longitudinal, partial sectional view of the prosthetic joint of FIG. 28 disposed between a pair of vertebral endplates.
  • FIG. 32 is a schematic top view depicting a transforaminal slot formed in a vertebral endplate.
  • FIG. 33 is a schematic top view depicting a milling apparatus shown inserted above a vertebral endplate.
  • FIG. 34 a is a lateral view of the milling apparatus of FIG. 33 shown disposed between a pair of adjacent vertebral endplates.
  • FIG. 34 b is a detailed view of a milling tool of the milling apparatus of FIG. 34 a.
  • FIG. 34 c is a detailed view of an alternative milling tool.
  • FIG. 35 is a schematic view of the milling apparatus of FIG. 33.
  • FIG. 36 is an isometric view of an alternative articulating prosthetic joint for transforaminal insertion according to another embodiment of the present disclosure.
  • FIG. 37 is a lateral view of the prosthetic joint of FIG. 36.
  • FIG. 38 is a longitudinal view of the prosthetic joint FIG. 36.
  • FIG. 39 is an isometric view of an alternative articulating prosthetic joint for anterior-oblique insertion according to another embodiment of the present disclosure.
  • FIG. 40 is a longitudinal view of the prosthetic joint of FIG. 39.
  • FIG. 41 is a lateral view of the prosthetic joint of FIG. 39.
  • FIG. 42 is lateral, partial sectional view of the prosthetic joint of FIG. 39 disposed between a pair of vertebral endplates.
  • FIG. 43 is a longitudinal, partial sectional view of the prosthetic joint of FIG. 39 disposed between a pair of vertebral endplates.
  • FIG. 44 a is a top, schematic view depicting a slot formed in a vertebral endplate for receiving the prosthetic joint of FIG. 39.
  • FIG. 44 b is a schematic view depicting an alignment process associated with the insertion of the prosthetic joint of FIG. 39.
  • FIG. 45 is an exploded view an alternative prosthetic joint according to yet another embodiment of the present disclosure.
  • FIG. 46 is an isometric view of the prosthetic joint of FIG. 45.
  • FIG. 47 is a longitudinal view of the prosthetic joint of FIG. 46.
  • FIG. 48 is a longitudinal view of a pair of adjacent vertebral endplates.
  • FIG. 49 a is a plan view of an articular component of the prosthetic joint of FIG. 45.
  • FIG. 49 b is a sectional view of the articular component of FIG. 49 a taken along the line 49 b - 49 b.
  • FIG. 50 a is a plan view of a modular projection member of the prosthetic joint of FIG. 45.
  • FIG. 50 b is a sectional view of the modular projection member of FIG. 50 a taken along the line 50 b - 50 b.
  • FIG. 51 is a plan view of the modular projection member of FIG. 50 a inserted into the articular component of FIG. 49 a.
  • FIG. 52 is a plan view of the modular projection member of FIG. 50 a inserted into the articular component of FIG. 49 a depicting the modular projection member in a different position relative to FIG. 51.
  • one or more vertebral bodies can be displaced with respect to other vertebrae or the sacrum.
  • a spondylolisthesis reduction can be a technically demanding procedure requiring great care to prevent neurological impairment and damage to surrounding soft tissue.
  • FIG. 1 shown therein is a lateral view of a portion of a spinal column 10 , illustrating a group of adjacent upper and lower vertebrae V 1 , V 2 , V 3 , V 4 separated by natural intervertebral discs D 1 , D 2 , D 3 .
  • the illustration of four vertebrae is only intended as an example. Another example would be a sacrum and one vertebrae.
  • vertebrae V 2 is dislocated from the vertebrae V 1 in a direction shown by arrow 22 .
  • vertebrae V 3 is dislocated in a direction shown by arrow 23 and vertebrae V 4 is dislocated in a direction shown by arrow direction 24 . It is desired that the position of vertebrae V 2 , V 3 , V 4 be corrected by moving them in a direction opposite to the arrows 22 , 23 , 24 , respectively.
  • V L two of the displaced vertebrae will be discussed, designated as the lower vertebrae V L and the upper vertebrae V U .
  • some or all of the natural disc that would have been positioned between the two vertebrae V L , V U is typically removed via a discectomy or a similar surgical procedure, the details of which would be known to one of ordinary skill in the art. Removal of the diseased or degenerated disc results in the formation of an intervertebral space S between the upper and lower vertebrae V U , V L .
  • correction of spondylolisthesis can be addressed from a lateral approach by, for example, providing a pair of bone screws 30 , 32 for insertion into the vertebrae V U , V L , respectively.
  • the bone screws 30 , 32 are bi-cortical. However, it is understood that the bone screws may alternatively be uni-cortical.
  • the bone screws 30 , 32 may be formed of a variety of materials such as any resorbable material, titanium, and PEEK. The PEEK embodiment is advantageous due to the radiotranslucent properties resulting from the use of PEEK material.
  • the bone screws 30 , 32 may alternatively be of any other mechanical structure, and as such, may take the form of pins or rivets, for example. Moreover, the bone screws 30 , 32 are not limited to having threaded portions to engage the vertebrae V U , V L .
  • the bone screws 30 , 32 may be linked to one another via a rod 34 , which is configured to rotate about both of the bone screws. It is understood that a variety of connecting members may be used other than the rod 34 .
  • a non-uniform linkage member may be used to link the bone screws 30 , 32 .
  • a non-uniform linkage member may provide a plurality of slots and/or grooves that can be engaged in order to aid in its rotation about the bone screws.
  • the rod 34 may be connected prior to insertion of the bone screws 30 , 32 into the vertebrae V U , V L , or alternatively, may be subsequently connected after placement of the screws.
  • the upper vertebra V U By applying a rotating force to the rod 34 in the direction of arrow 36 , the upper vertebra V U is encouraged back into a desired position relative to the lower vertebra V L .
  • the rotating force can be applied, for example, by a rotatable wrench (not shown) that can be used by a surgeon. It is understood that the upper vertebra V U may not reach entirely to a fully corrected position in relation to the lower vertebra V L , but the displacement can at least be reduced.
  • additional rods 34 and bone screws 30 , 32 are contemplated for use in rotating the spondylosed vertebrae V U , V L back into a desired position relative to one another. Additional rods 34 and bone screws 30 , 32 may provide additional stability during the procedure.
  • FIGS. 4 a , 5 , and 6 shown therein is one embodiment of an offset intervertebral articulating prosthetic joint 40 for insertion into the intervertebral space S (FIG. 2) to aid in the correction of spondylolisthesis.
  • the articulating prosthetic joint 40 extends generally along a longitudinal axis L and includes a first articular component 42 and a second articular component 44 .
  • the articular components 42 , 44 cooperate to form the prosthetic joint 40 which is sized and configured for disposition within the intervertebral space S (FIG. 2) between adjacent vertebral bodies V U , V L (FIG. 2).
  • the prosthetic joint 40 provides relative pivotal and rotational movement between the adjacent vertebral bodies to maintain or restore motion substantially similar to the normal bio-mechanical motion provided by a natural intervertebral disc. More specifically, the articular components 42 , 44 are permitted to pivot relative to one another about a number of axes, including lateral or side-to-side pivotal movement about longitudinal axis L and anterior-posterior pivotal movement about a transverse axis T. It should be understood that in one embodiment of the disclosure, the articular components 42 , 44 are permitted to pivot relative to one another about any axes that lies in a plane that intersects longitudinal axis L and transverse axis T.
  • the articular components 42 , 44 each include a bearing surface 46 , 48 , respectively, that may be positioned in direct contact with vertebral bone and is preferably coated with a bone-growth promoting substance, such as, for example, a hydroxyapatite coating formed of calcium phosphate. Additionally, the bearing surfaces 46 , 48 of the articular components 42 , 44 , respectively, may be roughened prior to being coated with the bone-growth promoting substance to further enhance bone on-growth. Such surface roughening may be accomplished by way of, for example, acid etching, knurling, application of a bead coating, or other methods of roughening that would occur to one of ordinary skill in the art.
  • Articular component 42 includes a support plate 50 having an articular surface 52 and the opposite bearing surface 46 .
  • Support plate 50 is sized and shaped to substantially correspond to the size and shape of a vertebral endplate of the adjacent vertebral body V L (FIG. 2).
  • the support plate 50 may include one or more notches 54 or other types of indicia for receiving or engaging with a corresponding portion of a surgical instrument (not shown) to aid in the manipulation and insertion of the prosthetic joint 40 within the intervertebral space S (FIG. 2) between the adjacent vertebral bodies V U , V L (FIG. 2).
  • the articular component 42 includes a projection 56 having a convex shape, which may be configured as a spherical-shaped ball (half of which is shown). It should-be understood that other configurations of the projection 56 are also contemplated, such as, for example, cylindrical, elliptical or other arcuate configurations or possibly non-arcuate configurations. It should also be understood that the remaining portion of articular component 42 may take on planar or non-planar configurations, such as, for example, an angular or conical configuration extending about the projection 56 .
  • a flange member or keel 58 extends from the bearing surface 46 and is configured for disposition within a preformed opening in the adjacent vertebral endplate.
  • the keel 58 may be coated with a bone-growth promoting substance, such as, for example, a hydroxyapatite coating formed of calcium phosphate. Additionally, the keel 58 may be roughened prior to being coated with the bone-growth promoting substance to further enhance bone on-growth.
  • the keel 58 extends along the transverse axis T and is substantially centered along the bearing surface 46 . However, it should be understood that other positions and orientations of the keel 58 are also contemplated.
  • the keel 58 includes three openings 60 extending therethrough to facilitate bone through-growth to enhance fixation to the adjacent vertebral bodies V U , V L (FIG. 2).
  • any number of openings 60 may be defined through the keel 58 , including a single opening or two or more openings.
  • the openings 60 need not necessarily extend entirely through the keel 58 , but may alternatively extend partially therethrough.
  • the keel 58 need not necessarily define any openings 60 extending either partially or entirely therethrough.
  • the openings 60 are illustrated as having a circular configuration, it should be understood that other sizes and configurations of openings 60 are also contemplated.
  • the articular surface 72 includes a recess 76 .
  • the recess 76 has a concave shape, and is configured as a spherical-shaped socket.
  • other configurations of the recess 76 are also contemplated, such as, for example, cylindrical, elliptical or other arcuate configurations or possibly non-arcuate configurations.
  • the remaining portion of the articular surface 72 can be angled or otherwise configured to facilitate the insertion and/or use of the prosthesis.
  • the concave recess 76 is illustrated as having a generally smooth, uninterrupted articular surface, it should be understood that a surface depression or cavity may be defined along a portion of the recess 76 to provide a means for clearing out matter, such as particulate debris, that is disposed between the abutting articular components 42 , 44 .
  • the convex articular surface of the projection 56 may alternatively define a generally smooth, uninterrupted articular surface.
  • each of the convex projection 56 and the concave recess 76 may define a surface depression to facilitate removal of particulate matter disposed between the abutting articular components 42 , 44 .
  • a flange member or keel 68 configured similar to the keel 58 of articular component 42 , extends from the bearing surface 48 .
  • the keel 68 extends along the transverse axis T and is offset from the center of the bearing surface 48 .
  • Such an embodiment would accommodate insertion of the prosthetic joint 40 using a lateral approach.
  • other shapes, positions and orientations of the keel 68 are also contemplated. For example, in FIGS.
  • the keel 68 also includes three openings 70 extending therethrough to facilitate bone through-growth to enhance fixation to the adjacent vertebra.
  • any number of openings 70 may be defined through keel 70 , including a single opening or two or more openings. It should also be understood that the openings 70 need not necessarily extend entirely through the keel 68 , but may alternatively extend partially therethrough. It should further be understood that the keel 68 need not necessarily define any openings 70 extending either partially or entirely therethrough. Additionally, although the openings 70 are illustrated as having a circular configuration, it should be understood that other sizes and configurations of openings 70 are also contemplated.
  • one or both of the keels 58 , 68 may include a sharp forward edge, illustrated by edge 68 a of FIG. 4. By having such an edge, insertion of the keel into the associated vertebral body is facilitated. Also, the edge 68 a can be of sufficient sharpness that the adjacent vertebral bodies do not require a slot for receiving the keel 68 , discussed in greater detail below.
  • the partially corrected upper and lower vertebrae V U , V L can be prepared to accept the prosthetic joint 40 (shown in section in FIG. 7 a ) therebetween.
  • elongate openings or slots 80 , 82 may be formed along the vertebral endplates of the upper and lower vertebrae V L , V U , respectively, at a predetermined width and to a predetermined depth.
  • the slots 80 , 82 can be laterally offset from each other to accommodate the displaced vertebrae V L and/or V U .
  • the elongate slots 80 , 82 are rectangular-shaped and extend laterally through the vertebrae V L , V U , respectively.
  • the slots 80 , 82 are formed by chiseling or curetting.
  • other methods of forming slots 80 , 82 are also contemplated as would occur to one of ordinary skill in the art, such as, for example, by drilling or reaming.
  • the keels 58 and/or 68 can form their own corresponding slots 80 , 82 , respectively.
  • the upper and lower vertebrae V U , V L may be fully corrected, and thus, an alternative articulating prosthetic joint 90 may be used in correcting spondylolisthesis.
  • the articulating joint 90 may be substantially similar to the prosthetic joint 40 with the exception of the orientation of various elements of the articulating joint 90 .
  • the articulating joint 90 may include a laterally-extending keel 92 that is substantially centered on an upper articulating component 94 of the articulating joint and a laterally-extending keel 96 that is substantially centered on a lower articulating component 98 .
  • the upper articulating component 94 may include a recess 100 that is substantially centered to correspond to a substantially centered projection 102 extending from the lower articulating component 98 .
  • the upper and lower articulating components 94 , 98 are substantially flush with one another when disposed between fully corrected upper and lower vertebrae V U , V L .
  • the fully corrected upper and lower vertebrae V U , V L can be prepared to accept the prosthetic joint 90 therebetween.
  • elongate openings or slots 104 , 106 may be formed along the vertebral endplates of the upper and lower vertebrae V U , V L , respectively, at a predetermined width and to a predetermined depth.
  • the slots 104 , 106 can be substantially aligned with each other to accommodate the fully corrected upper and lower vertebrae V U , V L .
  • the elongate slots 104 , 106 are rectangular-shaped and extend laterally through the vertebrae V U , V L , respectively.
  • the slots 104 , 106 are formed by chiseling or curetting.
  • other methods of forming slots 104 , 106 are also contemplated as would occur to one of ordinary skill in the art, such as, for example, by drilling or reaming.
  • the keels 92 and/or 96 can form their own corresponding slots 104 , 106 , respectively.
  • a slidable prosthetic joint 110 can be used to help with the lateral approach for treating spondylolisthesis.
  • the sliding joint 110 extends generally along the longitudinal axis L and includes a first slidable component 112 and a second slidable component 114 .
  • the slidable components 112 , 114 cooperate to form the sliding joint 110 which is sized and configured for disposition within an intervertebral space between adjacent vertebral bodies.
  • the sliding joint 110 provides movement between the adjacent vertebral bodies to maintain or restore some of the motion similar to the normal bio-mechanical motion provided by a natural intervertebral disc. More specifically, the slidable components 112 , 114 are permitted to translate relative to one another in the axial plane.
  • the slidable components 112 , 114 of prosthetic joint 110 may be formed from a wide variety of materials, in one embodiment, the slidable components 112 , 114 are formed of a cobalt-chrome-molybdenum metallic alloy (ASTM F-799 or F-75). However, in alternative embodiments, the slidable components 112 , 114 may be formed of other materials such as titanium or stainless steel, a polymeric material such as polyethylene, or any other biocompatible material that would be apparent to one of ordinary skill in the art.
  • the surfaces of the slidable components 112 , 114 that are positioned in direct contact with vertebral bone are preferably coated with a bone-growth promoting substance, such as, for example, a hydroxyapatite coating formed of calcium phosphate. Additionally, the surface of the slidable components 112 , 114 that are positioned in direct contact with vertebral bone are preferably roughened prior to being coated with the bone-growth promoting substance to further enhance bone on-growth. Such surface roughening may be accomplished by way of, for example, acid etching, knurling, application of a bead coating, or other methods of roughening that would occur to one of ordinary skill in the art.
  • Slidable component 112 includes a support plate 116 having a slidable surface 118 and an opposite bearing surface 120 .
  • Support plate 116 is preferably sized and shaped to substantially correspond to the size and shape of the vertebral endplate of an adjacent vertebra.
  • the support plate 116 can include one or more notches 122 or other types of indicia for receiving and engaging with a corresponding portion of a surgical instrument (not shown) to aid in the manipulation and insertion of the prosthetic joint 110 within an intervertebral space between adjacent vertebrae.
  • a flange member or keel 124 extends from the bearing surface 120 and is configured for disposition within a preformed opening in the adjacent vertebral endplate.
  • the keel 124 extends perpendicularly from the bearing surface 120 and is approximately centrally located along the bearing surface 120 .
  • the keel 124 also includes openings 126 extending therethrough to facilitate bone through-growth to enhance fixation to the adjacent vertebra.
  • any number of openings 126 may be defined through keel 124 , including a single opening or three or more openings.
  • the openings 104 need not necessarily extend entirely through the keel 124 , but may alternatively extend partially therethrough.
  • the keel 124 need not necessarily define any openings 126 extending either partially or entirely therethrough.
  • the openings 126 are illustrated as having a circular configuration, it should be understood that other sizes and configurations of openings 126 are also contemplated.
  • the slidable component 114 includes a support plate 128 having a slidable surface 130 and an opposite bearing surface 132 .
  • Support plate 128 is preferably sized and shaped to substantially correspond to the size and shape of the vertebral endplate of an adjacent vertebra.
  • the support plate 128 can include one or more notches 134 or other types of indicia for receiving and engaging with a corresponding portion of a surgical instrument, such as discussed above with reference to slidable element 112 .
  • the surfaces of the slidable component 114 that are in direct contact with vertebral bone are preferably coated with a bone-growth promoting substance.
  • the bearing surface 132 and the surfaces of the keel 136 can be coated with hydroxyapatite to promote bony engagement with the adjacent vertebrae.
  • the bearing surface 132 and the surfaces of keel 136 can be roughened prior to application of the hydroxyapatite coating.
  • one or both of the keels 124 , 136 may include a sharp forward edge, illustrated by edges 124 a , 136 a .
  • edges 124 a , 136 a By having such an edge, insertion of the keels 124 , 136 into the associated vertebral body is facilitated.
  • the edges 124 a , 136 a can be of sufficient sharpness that the vertebral body does not require a slot for receiving the keels 124 , 136 , respectively, discussed in greater detail below.
  • the lower and upper vertebrae V L , V U can be prepared to accept the prosthetic joint 110 therebetween.
  • elongate openings or slots 142 , 144 may be formed along the vertebral endplates of the lower and upper vertebrae V L , V U , respectively, at a predetermined width and to a predetermined depth.
  • the slots 142 , 144 can be laterally offset from each other to accommodate the displaced vertebrae V L and/or V U .
  • a prosthesis 190 includes a plate 192 , an upper keel 194 , a lower keel 196 , an upper support plate 198 , and a lower support plate 200 .
  • the plate 192 can be used to maintain a desired distance between the two support plates 198 , 200 and promote fusion. Since the plate 192 can be relatively thin, the remainder of the disc space can be filled with biological material, bone material, and or other bone growth promoting materials.
  • the articular components 212 , 214 of prosthetic joint 210 may be formed from a wide variety of materials, in one embodiment, the articular components 212 , 214 are formed of a cobalt-chrome-molybdenum metallic alloy (ASTM F-799 or F-75). However, in alternative embodiments, the articular components 212 , 214 may be formed of other materials such as titanium or stainless steel, a polymeric material such as polyethylene, or any other biocompatible material that would be apparent to one of ordinary skill in the art.
  • Articular component 212 includes a support plate 216 having an articular surface 218 and an opposite bearing surface 220 .
  • Support plate 216 may be sized and shaped to substantially correspond to the size and shape of the vertebral endplate of an adjacent vertebra.
  • the support plate 216 can include one or more notches 222 or other types of indicia for receiving and engaging with a corresponding portion of a surgical instrument (not shown) to aid in the manipulation and insertion of the articulating joint 210 within an intervertebral space between adjacent vertebrae.
  • the convex articular surface of the projection 224 is interrupted by a surface depression or cavity 226 extending along the projection 224 .
  • the surface depression 226 is configured as a groove.
  • the groove 226 may aid in clearing out matter such as, for example, particulate material, that is disposed between the abutting articular surfaces of components 212 , 214 .
  • a flange member or keel 230 extends from the bearing surface 220 and is configured for disposition within a preformed opening in the adjacent vertebral endplate.
  • the keel 230 extends perpendicularly from the bearing surface 220 and is approximately centrally located along the bearing surface 220 .
  • it should be understood that other positions and orientations of the keel 230 are also contemplated.
  • the keel 230 extends along substantially the entire length of the support plate 216 . Such an embodiment would accommodate insertion of the articulating joint 210 using an anterior approach.
  • the keel 230 may be angled, tapered, or configured in some other shape to facilitate the functional demands of the keel.
  • the keel 230 may be configured as a winged keel, including a transverse portion (not shown) extending across the main body portion of keel 230 .
  • the keel 230 also includes a pair of openings 232 extending therethrough to facilitate bone through-growth to enhance fixation to the adjacent vertebra.
  • any number of openings 232 may be defined through keel 230 , including a single opening or three or more openings.
  • the openings 232 need not necessarily extend entirely through the keel 230 , but may alternatively extend partially therethrough.
  • the keel 230 need not necessarily define any openings 232 extending either partially or entirely therethrough.
  • the openings 232 are illustrated as having a circular configuration, it should be understood that other sizes and configurations of the openings 232 are also contemplated.
  • the surfaces of the articular component 212 that are in direct contact with vertebral bone are preferably coated with a bone-growth promoting substance.
  • the bearing surface 220 and the surfaces of the keel 230 can be coated with hydroxyapatite to promote bony engagement with the adjacent vertebrae.
  • the bearing surface 220 and the surfaces of keel 230 can be roughened prior to application of the hydroxyapatite coating.
  • the articular surface 242 includes a recess 250 , which has a convex shape, such as that of a spherical-shaped socket.
  • a convex shape such as that of a spherical-shaped socket.
  • other configurations of the recess 250 are also contemplated, such as, for example, cylindrical, elliptical or other arcuate configurations or possibly non-arcuate configurations.
  • the remaining portion of the articular surface 242 can be angled or otherwise configured to facilitate the insertion and/or use of the articulating joint 210 .
  • the concave recess 250 is illustrated as having a generally smooth, uninterrupted articular surface, it should be understood that a surface depression or cavity may be defined along a portion of the recess 250 to aid in clearing out matter, such as particulate debris, that is disposed between the abutting articular surfaces of articular components 212 , 214 .
  • the convex articular surface of the ball 224 may alternatively define a generally smooth, uninterrupted articular surface.
  • each of the convex projection 224 and the concave recess 250 may define a surface depression to facilitate removal of particulate matter disposed between the abutting articular surfaces.
  • a flange member or keel 260 configured similar to the keel 230 of articular component 212 , extends from the bearing surface 244 .
  • the keel 260 extends perpendicularly from the bearing surface 244 and is approximately centrally located along bearing surface 244 .
  • the articular component 214 may include two or more keels 260 extending from the bearing surface 244 .
  • the keel 260 extends along substantially the entire length of the support plate 240 . Such an embodiment would accommodate insertion of the prosthetic joint 210 using an anterior approach.
  • the keel 260 may be angled, tapered, or configured in some other shape to facilitate the functional demands of the keel.
  • the keel 260 may be configured as a winged keel, including a transverse portion (not shown) extending across the main body portion of keel 260 .
  • the keel 260 also includes a pair of openings 262 extending therethrough to facilitate bone through-growth to enhance fixation to the adjacent vertebra.
  • any number of openings 262 may be defined through keel 260 , including a single opening or three or more openings.
  • the openings 262 need not necessarily extend entirely through the keel 260 , but may alternatively extend partially therethrough.
  • the keel 260 need not necessarily define any openings 262 extending either partially or entirely therethrough.
  • the openings 262 are illustrated as having a circular configuration, it should be understood that other sizes and configurations of openings 262 are also contemplated.
  • the surfaces of the articular component 214 that are in direct contact with vertebral bone are preferably coated with a bone-growth promoting substance.
  • the bearing surface 244 and the surfaces of the keel 260 can be coated with hydroxyapatite to promote bony engagement with the adjacent vertebrae.
  • the bearing surface 244 and the surfaces of keel 260 can be roughened prior to application of the hydroxyapatite coating.
  • one or both of the keels 230 , 260 may include a sharp forward edge, illustrated by edge 260 a of FIG. 14. By having such an edge, insertion of the keel into the associated vertebral body is facilitated. Also, the edge 260 a can be of sufficient sharpness that the vertebral body does not require a slot for receiving the keel 260 , discussed in greater detail below.
  • such displacement can be effected by positioning one or more of the projection 224 in an offset position on the articular surface 218 of the articular component 212 , and positioning one or more of the recess 250 in an offset position on the articular surface 242 of the articular component 214 . This allows an uncorrected or partially corrected displacement to be mobilized.
  • the projection 224 is offset relative to the articular surface 218 .
  • the articular component 212 may be configured such that the projection 224 is offset in the anterior direction relative to the articular surface 218 .
  • the upper vertebra V U is therefore offset from the lower vertebra V L in the anterior direction (illustrated by arrow A in FIG. 17), and thus, the articular component 214 may be configured such that the recess 250 is offset in the posterior direction relative to the articular surface 242 .
  • the articular components 212 , 214 can be configured to engage one another via the projection 224 and the recess 250 , yet be offset from one another to accommodate the spondylosed relationship of the upper and lower vertebrae V U , V L of FIG. 17.
  • the articulating joint 210 may be modified such that the support plate 216 includes an extended section 270 to accommodate a more pronounced displacement relative to FIG. 17 (illustrated by arrow 272 ) and/or provide additional stability against subluxation.
  • the projection 224 may be positioned on the extended section 270 to provide for the more pronounced displacement between articular components 212 , 214 .
  • the upper and lower vertebrae V U , V L can be prepared to accept the prosthetic joint 210 therebetween.
  • elongate openings or slots 280 , 282 are formed along the vertebral endplates of the upper and lower vertebrae V U , V L , respectively, at a predetermined width and to a predetermined depth.
  • the elongate slots 280 , 282 are rectangular-shaped and extend from an anterior side 284 of the vertebrae V U , V L toward a posterior side.
  • the slots 280 , 282 are formed by chiseling or curetting.
  • the slots 280 , 282 are also contemplated as would occur to one of ordinary skill in the art, such as, for example, by drilling or reaming.
  • the keels 230 and/or 260 can form their own corresponding slots 280 , 282 , respectively.
  • the preparation and example sizes of the slots 280 , 282 are described in further detail in co-pending and presently incorporated U.S. Ser. No. 10/042,589.
  • one or both of the articular components 212 , 214 may include different numbers of keels and/or modified keels.
  • two keels designated 290 and 292 , extend from the bearing surface 244 and are configured for disposition within preformed openings in the adjacent vertebral endplate.
  • both keels 290 , 292 extend perpendicularly from the bearing surface 244 and are parallel and equally spaced along a central portion of the bearing surface 244 .
  • two keels extend from the bearing surface 224 and are configured for disposition within preformed openings in the adjacent vertebral endplate.
  • both keels 294 , 296 extend perpendicularly from the bearing surface 224 and are parallel and equally spaced along a central portion of the bearing surface 224 . It should be understood that other positions and orientations of the keels 290 , 292 , 294 , and 296 are also contemplated.
  • a keel 298 extends from the bearing surface 244 similar to the keel 260 of FIG. 14, except that the keel 298 includes a laterally-extending or “winged” portion 300 opposing the bearing surface 244 .
  • the winged portion 300 can provide several functions, including maintaining the bearing surface 244 tightly against the body V U , and substantially preventing any longitudinal movement of the articular component 214 .
  • a keel 302 extends from the bearing surface 224 and includes a winged portion 304 opposing the bearing surface 224 .
  • the winged portion 304 can provide several functions, including maintaining the bearing surface 224 tightly against the body V L , and substantially preventing any longitudinal movement of the articular component 212 .
  • the upper and lower vertebrae V U , V L can be prepared to accept each of the articulating joints 210 therebetween.
  • FIG. 21 for the configuration of the prosthetic joint 210 of FIG. 18, multiple slots 310 and 312 are formed along the vertebral endplate of the upper vertebrae V U , and a single slot 314 is formed along the vertebral endplate of the lower vertebrae V L .
  • FIG. 22 for the configuration of the prosthetic joint 210 of FIG.
  • multiple slots 316 , 318 and 320 , 322 are formed along the vertebral endplates of the upper vertebrae V U , and lower vertebrae V L , respectively.
  • winged slots 324 , 326 are formed along the vertebral endplates of the upper vertebrae V U and the lower vertebrae V L , respectively.
  • the preparation of the slots 310 , 312 , 314 , 316 , 318 , 320 , 322 , 324 , 326 can be accomplished in a similar manner to those discussed above with respect to FIG. 17.
  • a standard chisel can be used, or alternatively, a unique wing-shaped chisel can be used.
  • a woven orthopedic implant 330 can be used to act as an artificial ligament between the two vertebrae V U , V L .
  • One embodiment of the woven implant 330 is disclosed in U.S. Ser. No. 10/082,579, which is incorporated by reference.
  • the implant 330 functions as a natural ligament would function, and helps to stabilize and further secure the two vertebrae V U , V L together, and helps to discourage further displacement (or prevent the displacement from returning to the way it was pre-surgery).
  • a pars fracture such as is illustrated by a fracture in a bony element 332 that connects a posterior element, such as an articular process 334 to the vertebra V L , may also be treated during correction of spondylolisthesis from the anterior approach. It is understood that the fractured bony element 332 is exaggerated in the FIG. 25 for the sake of improved clarity.
  • the pars fracture can be repaired by driving a lag screw 336 having a threaded portion 336 a and a non-threaded portion 336 b into an opening 338 in the vertebral body V L , through the bony element 332 , and into the articular process 334 .
  • all or part of the opening 338 can be pre-drilled with a drill or chisel (not shown).
  • the lag screw 336 is inserted and accessed through the anterior direction, and multiple screws can be used to repair multiple processes. By capturing the fractured posterior element and tightening the lag screw 336 , the vertebrae V L is repaired.
  • the disc V is approached as shown by the arrow 400 .
  • the approach is between a posterior approach and a lateral approach, and in some cases, only one side of the disc needs to be exposed (right or left) in order to perform the procedure.
  • FIGS. 28 - 30 shown therein is an intervertebral articulating prosthetic joint 410 according to another form of the present disclosure.
  • the articulating joint 410 extends generally along a longitudinal axis L and includes a first articular component 412 and a second articular component 414 .
  • the articular components 412 , 414 cooperate to form the articulating joint 410 which is sized and configured for disposition within an intervertebral space between adjacent vertebral bodies.
  • the prosthetic joint 410 provides relative pivotal and rotational movement between the adjacent vertebral bodies to maintain or restore motion substantially similar to the normal bio-mechanical motion provided by a natural intervertebral disc. More specifically, the articular components 412 , 414 are permitted to pivot relative to one another about a number of axes, including lateral or side-to-side pivotal movement about longitudinal axis L and anterior-posterior pivotal movement about a transverse axis T. It should be understood that in one embodiment, the articular components 412 , 414 are permitted to pivot relative to one another about any axes that lies in a plane that intersects longitudinal axis L and transverse axis T.
  • the articular components 412 , 414 are preferably permitted to rotate relative to one another about a rotational axis R.
  • the articulating joint 410 has been illustrated and described as providing a specific combination of articulating motion, it should be understood that other combinations of articulating movement are also possible and are contemplated as falling within the scope of the present disclosure. It should also be understood that other types of articulating movement are also contemplated, such as, for example, relative translational or linear motion.
  • the articular components 412 , 414 of prosthetic joint 410 may be formed from a wide variety of materials, in one embodiment, the articular components 412 , 414 are formed of a cobalt-chrome-molybdenum metallic alloy (ASTM F-799 or F-75). However, in alternative embodiments, the articular components 412 , 414 may be formed of other materials such as titanium or stainless steel, a polymeric material such as polyethylene, or any other biocompatible material that would be apparent to one of ordinary skill in the art.
  • the surfaces of the articular components 412 , 414 that are positioned in direct contact with vertebral bone are preferably coated with a bone-growth promoting substance, such as, for example, a hydroxyapatite coating formed of calcium phosphate.
  • a bone-growth promoting substance such as, for example, a hydroxyapatite coating formed of calcium phosphate.
  • the surface of the articular components 412 , 414 that are positioned in direct contact with vertebral bone are preferably roughened prior to being coated with the bone-growth promoting substance to further enhance bone on-growth.
  • Such surface roughening may be accomplished by way of, for example, acid etching, knurling, application of a bead coating, or other methods of roughening that would occur to one of ordinary skill in the art.
  • Articular component 412 includes a support plate 416 having an articular surface 418 and an opposite bearing surface 420 .
  • Support plate 416 may be sized and shaped to substantially correspond to the size and shape of the vertebral endplate of an adjacent vertebra.
  • the support plate 416 is shaped to facilitate a transforaminal insertion approach.
  • the support plate 416 includes curved side portions 422 a , 422 b , which are defined as the generally elongated portions of the support plate 416 extending between articular surface 418 and the bearing surface 420 .
  • a flange member or keel 426 extends from the bearing surface 410 and is configured for disposition within a preformed opening in the adjacent vertebral endplate.
  • the keel 426 extends perpendicularly from the bearing surface 420 and is approximately centrally located along the bearing surface 420 .
  • the keel 426 also includes three openings 428 extending therethrough to facilitate bone through-growth to enhance fixation to the adjacent vertebra.
  • any number of openings 428 may be defined through keel 426 , including a single opening or three or more openings.
  • the openings 428 need not necessarily extend entirely through the keel 426 , but may alternatively extend partially therethrough.
  • the keel 426 need not necessarily define any openings 428 extending either partially or entirely therethrough.
  • the openings 428 are illustrated as having a circular configuration, it should be understood that other sizes and configurations of openings 428 are also contemplated.
  • the concave recess 440 is illustrated as having a generally smooth, uninterrupted articular surface, it should be understood that a surface depression or cavity may be defined along a portion of the recess 440 to provide a means for clearing out matter, such as particulate debris, that is disposed between the abutting articular surfaces of components 412 , 414 .
  • the convex articular surface of the ball 424 may alternatively define a generally smooth, uninterrupted articular surface.
  • each of the convex projection 424 and the concave recess 440 may define a surface depression to facilitate removal of particulate matter disposed between the abutting articular surfaces.
  • a flange member or keel 450 configured similar to the keel 426 of articular component 412 , extends from the bearing surface 434 .
  • the keel 450 can be centrally located, and is positioned directly or parallel in-line with the keel 450 .
  • the keel 450 is curved, in a direction similar to the keel 426 and the arrow 400 of FIG. 27.
  • the degree of curvature of the keel 450 may be substantially similar to and congruous with the degree of curvature of the side portions 436 a , 436 b .
  • the position of the keel 450 can be offset to help circumvent veins, arteries, bony portions, or other obstacles that may be in place during the insertion of the joint 410 .
  • one or both of the keels 426 , 450 may include a sharp forward edge, illustrated by edges 460 , 462 , respectively, of FIG. 28 c .
  • edges 460 , 462 can be of sufficient sharpness that the vertebral bodies do not require a slot for receiving the keels 426 , 450 , discussed in greater detail below.
  • a milling guide 500 may be used in conjunction with a milling tool 502 to cut the curved slots 470 , 472 (represented by 472 in FIG. 32) in the upper and lower vertebral bone V U , V L .
  • the milling guide 500 and milling tool 502 may be formed of any material including biocompatible materials such as titanium.
  • the milling guide 500 includes an elongated curved member 503 , which defines a curved opening 504 to correspond to the shape of the desired curve for the slots 470 , 472 .
  • the degree of curvature of the milling guide 500 may vary depending on the desired curve of the slots 470 , 472 .
  • the milling guide 500 is formed of a pliable material that retains a rigid shape upon reforming such that the degree of curvature of the curved opening 504 may be altered without having to swap out milling guides.
  • the milling guide 500 , and therefore the curved opening 504 is also of sufficient length so that if the slots 470 , 472 need to be continued through any posterior elements of the vertebrae, such extension of the slots can be accomplished at the same time.
  • the milling bit 510 is also adapted to receive a translational force such that the milling bit can be moved back and forth in the curved opening 504 .
  • a milling bit handle 530 is connected in any conventional manner to a housing 522 (a portion of which is shown).
  • the handle 530 extends from the housing 522 and through a slot 532 formed in a proximal end 534 of the milling guide 500 relative to a surgeon (not depicted).
  • the handle 530 can be translated by a surgeon, thereby translating the milling bit 510 through the curved opening 504 .
  • the handle 530 is adapted to impart translational movement to the milling bit 510 .
  • a pair of bearing assemblies 512 , 514 may be positioned adjacent to the housing 522 to guide the milling bit 510 along the curved opening.
  • the gear assembly 524 further includes a bit gear 531 , which is connected to and extends annularly around the milling bit 510 .
  • the bit gear 531 is positioned on the milling bit 510 such that the bit gear is orthogonal relative to and in contact with the drive gear 526 .
  • rotation of the shaft 528 imparts rotation to the milling bit 510 via the gear assembly 524 .
  • a pair of annular shoulders 535 , 536 are also connected to the milling bit 510 such that the milling bit can easily move back and forth through the curved opening 504 without slippage in the upper or lower directions as viewed in FIG. 34 b .
  • the gear assembly 524 is merely exemplary of an assembly that may be used to impart rotational motion to the milling bit 510 .
  • Other types of rotation-imparting assemblies are contemplated as falling within the present disclosure such as pneumatic-type systems.
  • a pneumatic system 538 may be employed to impart rotation to the milling bit 510 .
  • a Medtronic Midas Rex® LegendTM motor is used to supply power (represented by P) to the pneumatic system.
  • a conventional valve 539 is used to control the air flow and pressure supplied to rotate the milling bit 510 .
  • manual or combination power supplies are contemplated as being the preferred power supply 516 (FIG. 34 b ) and P (FIG. 34 c ).
  • a guide handle 540 is further provided such that the milling guide 500 is independently movable relative to the milling bit 510 .
  • the milling guide 500 can be held via the guide handle 540 with one hand while the milling bit 510 may be moved within the curved opening 504 via the handle 530 with the other hand.
  • the handle 530 may extend through the guide handle 540 as shown in FIG. 34 b .
  • the milling bit 510 is adapted to rotate in a direction indicated by arrow R 1 , and is adapted to be translated through the curved opening 504 in the directions indicated by arrow R 2 .
  • the milling guide 500 and the milling tool 502 can be used to cut a slot, such as the slot 472 , to prepare the vertebral body V L to receive the lower portion of the prosthetic joint 410 .
  • the surgeon first selects the desired amount of curvature to impart to the slot 472 and selects or configures the corresponding milling guide 500 .
  • the surgeon then approaches the vertebral body V L from the transforaminal approach to position the milling guide 500 into the disc space between the upper and lower vertebrae V U , V L and to abut the milling bit 510 against the upper and lower vertebrae V U , V L .
  • the surgeon may then actuate the milling tool 502 via the power supply 516 to begin cutting into the upper and lower vertebrae V U , V L with the milling bit 510 .
  • the milling guide 500 may be held by the surgeon or via an external instrument such that the milling guide is stationary during translational movement of the milling bit 510 through the milling guide.
  • the curvature of the milling guide 500 guides the milling bit 510 transforaminally through the upper and lower vertebrae V U , V L to cut a transforaminal slot, such as the slot 472 depicted in the lower vertebra V L FIG. 32, to prepare the upper and lower vertebrae to receive the transforaminal prosthetic joint 410 .
  • the shortness of the keels 550 , 560 and the ease with which such keels follow the openings 470 , 472 , respectively, allows the keels to be configured as either straight or curved keels, which increases the design options of the prosthetic joint 410 .
  • the keels 550 , 560 may also be tapered to assist in insertion of the keels into the upper and lower vertebrae V U , V L .
  • anterior oblique approach Another approach that can be used to avoid potential damage to important anatomical structures such as nerve roots, dura, ligamentum flavum and interspinous ligament is the anterior oblique approach.
  • anterior oblique approach the straight anterior approach to the disc space between vertebra L 4 and L 5 , as well as the superior disc levels, can present high surgical risks during the insertion of a total disc replacement implant because of the attachment of the major vessels to the anterior aspect of the spine.
  • articular components 602 , 604 may be permitted to rotate relative to one another about a rotational axis R.
  • the articulating joint 600 has been illustrated and described as providing a specific combination of articulating motion, it should be understood that other combinations of articulating movement are also possible and are contemplated as falling within the scope of the present disclosure. It should also be understood that other types of articulating movement are also contemplated, such as, for example, relative translational or linear motion.
  • the surfaces of the articular components 602 , 604 that are positioned in direct contact with vertebral bone are preferably coated with a bone-growth promoting substance, such as, for example, a hydroxyapatite coating formed of calcium phosphate. Additionally, the surface of the articular components 602 , 604 that are positioned in direct contact with vertebral bone are preferably roughened prior to being coated with the bone-growth promoting substance to further enhance bone on-growth. Such surface roughening may be accomplished by way of, for example, acid etching, knurling, application of a bead coating, or other methods of roughening that would occur to one of ordinary skill in the art.
  • Articular component 602 includes a support plate 610 having an articular surface 612 and an opposite bearing surface 614 .
  • Support plate 610 may be sized and shaped to substantially correspond to the size and shape of the vertebral endplate of an adjacent vertebra.
  • the support plate 610 is shaped in a triangular-like configuration to facilitate an oblique insertion approach from either the left or right side of the spine, and as such, includes side portions P 1 , P 2 and P 3 .
  • the side portions P 1 , P 2 and P 3 may take a variety of configurations including curved (illustrated by P 2 ) or straight (illustrated by P 1 and P 3 ) configurations.
  • the support plate 610 can include one or more notches 616 or other types of indicia for receiving and engaging with a corresponding portion of a surgical instrument (also not shown) to aid in the manipulation and insertion of the prosthetic joint 600 within an intervertebral space between adjacent vertebrae.
  • the surgical instrument (not shown) is preferably configured to hold the articular components 602 , 604 at a predetermined orientation and spatial relationship relative to one another during manipulation and insertion of the prosthetic joint 600 , and to release the articular components 602 , 604 once properly positioned between the adjacent vertebrae.
  • the articular surface 612 includes a projection 620 having a convex shape, which may be configured as a spherical-shaped ball (half of which is shown). It should be understood that other configurations of the projection 620 are also contemplated, such as, for example, cylindrical, elliptical or other arcuate configurations or possibly non-arcuate configurations. It should also be understood that the remaining portion of articular surface 612 may take on planar or non-planar configurations, such as, for example, an angular or conical configuration extending about the projection 620 .
  • a flange member or keel 640 extends from the bearing surface 614 and is configured for disposition within a preformed opening in the adjacent vertebral endplate. In one embodiment, the keel 640 extends perpendicularly from the bearing surface 614 and is approximately centrally located along the bearing surface 614 . However, it should be understood that other positions and orientations of the keel 640 are also contemplated. Furthermore, more keels 640 can be used, for similar or additional reasons.
  • the keel 640 extends along a substantial portion of the support plate 610 .
  • the keel 640 is straight, but extends along a direction towards the notches 616 and is parallel with one of the side portions P 1 of the support plate 610 .
  • the keel 640 is positioned between the transverse axis T and lateral axis L.
  • the keel 640 may be angled, tapered, or configured in some other shape to facilitate the functional demands of the keel.
  • the keel 640 may be configured as a winged keel, including a transverse portion (not shown) extending across the main body portion of keel 640 .
  • the keel 640 also includes a pair of openings 646 extending therethrough to facilitate bone through-growth to enhance fixation to the adjacent vertebra. Additionally, a gap 648 may also be formed in the keel 640 to further facilitate bone through-growth. The gap 648 also provides a reference point such that an X-ray can be used to evaluate the positioning and alignment of the support plate 602 during insertion of the prosthetic joint 600 . It should be understood that any number of openings 646 or gaps 648 may be defined through keel 640 , including a single opening or gap or several openings and gaps. It should also be understood that the openings 646 and gap 648 need not necessarily extend entirely through the keel 640 , but may alternatively extend partially therethrough.
  • the keel 640 need not necessarily define any openings 646 or gaps 648 extending either partially or entirely therethrough. Additionally, although the openings 646 are illustrated as having a circular configuration, it should be understood that other sizes and configurations of openings 646 are also contemplated.
  • the surfaces of the articular component 602 that are in direct contact with vertebral bone may be coated with a bone-growth promoting substance.
  • the bearing surface 614 and the surfaces of the keel 640 can be coated with hydroxyapatite to promote bony engagement with the adjacent vertebrae.
  • the bearing surface 614 and the surfaces of keel 640 can be roughened prior to application of the hydroxyapatite coating.
  • the articular component 604 includes a support plate 650 having an articular surface 652 and an opposite bearing surface 654 .
  • Support plate 650 may be sized and shaped to substantially correspond to the size and shape of the vertebral endplate of an adjacent vertebra.
  • the support plate 610 is shaped in a triangular-like configuration to facilitate an oblique insertion approach from either the left or right side of the spine, and as such, includes side portions P 4 , P 5 and P 6 .
  • the side portions P 4 , P 5 and P 6 may take a variety of configurations including curved (illustrated by P 5 ) or straight (illustrated by P 4 and P 6 ) configurations.
  • the support plate 650 can include one or more notches 656 or other types of indicia for receiving and engaging with a corresponding portion of a surgical instrument, such as discussed above with reference to articular component 602 .
  • the articular surface 652 includes a recess 660 having a convex shape, which may be configured as a spherical-shaped socket.
  • a recess 660 having a convex shape, which may be configured as a spherical-shaped socket.
  • other configurations of the recess 660 are also contemplated, such as, for example, cylindrical, elliptical or other arcuate configurations or possibly non-arcuate configurations.
  • the remaining portion of the articular surface 652 can be angled or otherwise configured to facilitate the insertion and/or use of the prosthesis.
  • the concave recess 660 is illustrated as having a generally smooth, uninterrupted articular surface, it should be understood that a surface depression or cavity may be defined along a portion of the recess 660 to provide a means for clearing out matter, such as particulate debris, that is disposed between the abutting articular surfaces of components 602 , 604 .
  • the convex articular surface of the ball 620 may alternatively define a generally smooth, uninterrupted articular surface.
  • each of the convex projection 620 and the concave recess 660 may define a surface depression to facilitate removal of particulate matter disposed between the abutting articular surfaces.
  • a flange member or keel 670 configured similar to the keel 640 of articular component 602 , extends from the bearing surface 654 .
  • the keel 670 can be centrally located, and is positioned directly or parallel in-line with the keel 640 .
  • the keel 640 is straight, but extends along a direction towards the notches 656 and is parallel with one of the side portions P 4 of the support plate 650 .
  • the position of the keel 670 can be offset to help circumvent veins, arteries, bony portions, or other obstacles that may be in place during the insertion of the joint 600 .
  • the keel 670 may be angled, tapered, or configured in some other shape to facilitate the functional demands of the keel.
  • the keel 670 may be configured as a winged keel, including a transverse portion (not shown) extending across the main body portion of keel 670 .
  • the keel 670 also includes a pair of openings 676 extending therethrough to facilitate bone through-growth to enhance fixation to the adjacent vertebra. Additionally; a gap 678 may also be formed in the keel 670 to further facilitate bone through-growth. The gap 678 also provides a reference point such that an X-ray can be used to evaluate the positioning and alignment of the support plate 604 during insertion of the prosthetic joint 600 . It should be understood that any number of openings 676 or gaps 678 may be defined through keel 670 , including a single opening or gap or several openings or gaps.
  • the openings 676 and gap 678 need not necessarily extend entirely through the keel 670 , but may alternatively extend partially therethrough. It should further be understood that the keel 670 need not necessarily define any openings 676 or gaps 678 extending either partially or entirely therethrough; Additionally, although the openings 676 are illustrated as having a circular configuration, it should be understood that other sizes and configurations of openings 676 are also contemplated.
  • the surfaces of the articular component 602 that are in direct contact with vertebral bone are preferably coated with a bone-growth promoting substance.
  • the bearing surface 654 and the surfaces of the keel 670 can be coated with hydroxyapatite to promote bony engagement with the adjacent vertebrae. As also discussed above, the bearing surface 654 and the surfaces of keel 670 can be roughened prior to application of the hydroxyapatite coating.
  • one or both of the keels 640 , 670 may include a sharp forward edge, illustrated by edges 680 , 682 .
  • edges 680 , 682 By having such an edge, insertion of the keels 640 , 670 into the associated vertebral body is facilitated.
  • the edges 680 , 682 can be of sufficient sharpness that the vertebral body does not require a slot for receiving the keel 640 , 670 , discussed in greater detail below.
  • the upper and lower vertebrae V U , V L can be prepared to accept the prosthetic joint 600 therebetween.
  • FIG. 43 for the configuration of the prosthetic joint 600 of FIGS. 38 - 40 , multiple slots 690 , 692 are formed along the vertebral endplates of the lower vertebrae V L and the upper vertebrae V U , respectively.
  • the slots 690 , 692 can be created by the keels 640 , 670 themselves, or can be prepared beforehand by one or more of the methods discussed above. It can be seen from FIGS.
  • the implant 600 design also ensures a sufficient contact surface for contacting the bony endplates of the vertebrae V U , V L .
  • An oblique pin 698 of the oblique guide member 696 is then impacted into the upper vertebra V U to fix the oblique guide member, thereby indicating the entering reference point and the direction of implant insertion for the prosthetic joint 600 .
  • the 4-in-1 guide (not shown) can then be used to implant the prosthetic joint 600 into the intervertebral space from an anterior-oblique approach, the details of which are more fully discussed in co-pending application U.S. Ser. No. 10/430,473.
  • a mobile-bearing prosthetic joint for anterior insertion is generally referred to by reference numeral 700 . It is understood that the mobile-bearing prosthetic joint 700 is described with respect to anterior insertion for the sake of clarity only, and therefore, a variety of insertion directions are contemplated for the mobile-bearing prosthetic joint.
  • the prosthetic joint 700 provides relative pivotal and rotational movement between the adjacent vertebral bodies V S , V I to maintain or restore motion substantially similar to the normal bio-mechanical motion provided by a natural intervertebral disc but with the added element of translational motion. More specifically, the articular components 702 , 704 are permitted to pivot relative to one another about a number of axes, including lateral or side-to-side pivotal movement about a longitudinal axis L and anterior-posterior pivotal movement about a transverse axis T. It should be understood that in one embodiment, the articular components 702 , 704 are permitted to pivot relative to one another about any axes that lies in a plane that intersects longitudinal axis L and transverse axis T. Additionally, the articular components 702 , 704 are permitted to rotate relative to one another about a rotational axis R. In addition, the articular components 702 , 704 are permitted to translate relative to one another as will be further described.
  • a recess 714 is formed in the articular surface 708 .
  • a circumferential edge 716 defining the recess 714 along the articular surface 708 is in a concentric relationship with a recess surface 718 , yet has a smaller diameter relative to the recess surface due to a diverging circular side 720 (FIG. 48 b ) of the recess 714 .
  • the recess 714 may take any number of shapes such as square, triangular, or rectangular shapes.
  • the recess 714 (FIG. 49 b ) is designed to receive a portion of a modular projection member 722 .
  • the projection member 722 includes a flange portion 724 , which is shaped to correspond to the shape of the recess 714 .
  • the flange portion 724 includes a diverging circumferential side 726 , which terminates at a substantially planar engagement surface 728 .
  • the engagement surface 728 is adapted to engage the substantially planar recess surface 718 (FIG. 49 b ). It is understood, however, that although depicted as being substantially planar, the engagement surface 728 and the recess surface 718 may take any number of corresponding shapes.
  • the diameter of the engagement surface 728 is smaller than the diameter of the recess surface 718 , thereby allowing translation of the modular projection member 722 relative to the articular component 702 .
  • the remaining portion of the modular projection member 722 is defined by a projection 730 having a convex shape, which may be configured as a spherical-shaped ball (half of which is shown). It should be understood that other configurations of the projection 730 are also contemplated, such as, for example, cylindrical, elliptical or other arcuate configurations or possibly non-arcuate configurations. It should also be understood that the remaining portion of articular surface 708 may take on planar or non-planar configurations, such as, for example, an angular or conical configuration extending about the projection 224 .
  • the convex articular surface of the projection 730 is interrupted by a surface depression or cavity 732 extending along the projection 730 .
  • the surface depression 732 is configured as a groove.
  • the groove 732 may aid in clearing out matter such as, for example, particulate material, that is disposed between the abutting articular surfaces of components 702 , 704 .
  • a flange member or keel 740 extends from the bearing surface 710 and is configured for disposition within a preformed opening in the adjacent vertebral endplate (such as V I in FIG. 47).
  • the keel 740 extends perpendicularly from the bearing surface 710 and is approximately centrally located along the bearing surface 710 .
  • it should be understood that other positions and orientations of the keel 740 are also contemplated.
  • the keel 740 extends along substantially the entire length of the support plate 706 . Such an embodiment would accommodate insertion of the articulating joint 700 using an anterior approach. However, as discussed above, other approaches such as lateral, transforaminal, and anterior-oblique approaches are also contemplated for insertion of the prosthetic joint 700 .
  • the keel 740 may be angled, tapered, or configured in some other shape to facilitate the functional demands of the keel.
  • the keel 740 may be configured as a winged keel, including a transverse portion (not shown) extending across the main body portion of keel 740 .
  • the keel 740 also includes a pair of openings 742 extending therethrough to facilitate bone through-growth to enhance fixation to the adjacent vertebra.
  • any number of openings 742 may be defined through keel 740 , including a single opening or three or more openings.
  • the openings 742 need not necessarily extend entirely through the keel 740 , but may alternatively extend partially therethrough.
  • the keel 740 need not necessarily define any openings 742 extending either partially or entirely therethrough.
  • the openings 742 are illustrated as having a circular configuration, it should be understood that other sizes and configurations of the openings 742 are also contemplated.
  • the surfaces of the articular component 702 that are in direct contact with vertebral bone are preferably coated with a bone-growth promoting substance.
  • the bearing surface 710 and the surfaces of the keel 740 can be coated with hydroxyapatite to promote bony engagement with the adjacent vertebrae.
  • the bearing surface 710 and the surfaces of keel 740 can be roughened prior to application of the hydroxyapatite coating.
  • the articular component 704 includes a support plate 750 having an articular surface 752 and an opposite bearing surface 754 .
  • Support plate 750 may be sized and shaped to substantially correspond to the size and shape of the vertebral endplate of an adjacent vertebra.
  • the support plate 750 can include one or more notches 756 or other types of indicia for receiving and engaging with a corresponding portion of a surgical instrument, such as discussed above with reference to articular component 702 .
  • the articular surface 752 includes a recess 758 (FIG. 47), which has a convex shape, such as that of a spherical-shaped socket.
  • a recess 758 FIG. 47
  • other configurations of the recess 758 are also contemplated, such as, for example, cylindrical, elliptical or other arcuate configurations or possibly non-arcuate configurations.
  • the remaining portion of the articular surface 752 can be angled or otherwise configured to facilitate the insertion and/or use of the articulating joint 700 .
  • the concave recess 758 is illustrated as having a generally smooth, uninterrupted articular surface, it should be understood that a surface depression or cavity may be defined along a portion of the recess 758 to aid in clearing out matter, such as particulate debris, that is disposed between the abutting articular surfaces of articular components 702 , 704 .
  • the convex articular surface of the projection 730 may alternatively define a generally smooth, uninterrupted articular surface.
  • each of the convex projection 730 and the concave recess 758 may define a surface depression to facilitate removal of particulate matter disposed between the abutting articular surfaces.
  • a flange member or keel 760 configured similar to the keel 740 of articular component 702 , extends from the bearing surface 754 .
  • the keel 760 extends perpendicularly from the bearing surface 754 and is approximately centrally located along bearing surface 754 .
  • the articular component 704 may include two or more keels 760 extending from the bearing surface 754 .
  • the keel 760 extends along substantially the entire length of the support plate 750 . Such an embodiment would accommodate insertion of the prosthetic joint 700 using an anterior approach. However, as discussed above, other approaches such as lateral, transforaminal, and anterior-oblique approaches are also contemplated for insertion of the prosthetic joint 700 .
  • the keel 760 may be angled, tapered, or configured in some other shape to facilitate the functional demands of the keel.
  • the keel 760 may be configured as a winged keel, including a transverse portion (not shown) extending across the main body portion of keel 760 .
  • the keel 760 also includes a pair of openings 762 extending therethrough to facilitate bone through-growth to enhance fixation to the adjacent vertebra.
  • any number of openings 762 may be defined through keel 760 , including a single opening or three or more openings.
  • the openings 762 need not necessarily extend entirely through the keel 760 , but may alternatively extend partially therethrough.
  • the keel 760 need not necessarily define any openings 762 extending either partially or entirely therethrough.
  • the openings 762 are illustrated as having a circular configuration, it should be understood that other sizes and configurations of openings 762 are also contemplated.
  • the surfaces of the articular component 704 that are in direct contact with vertebral bone are preferably coated with a bone-growth promoting substance.
  • the bearing surface 754 and the surfaces of the keel 760 can be coated with hydroxyapatite to promote bony engagement with the adjacent vertebrae.
  • the bearing surface 754 and the surfaces of keel 760 can be roughened prior to application of the hydroxyapatite coating.
  • one or both of the keels 740 , 760 may include a sharp forward edge, illustrated by edge 760 a of FIGS. 45 and 46. By having such an edge, insertion of the keel 740 , 760 into the associated vertebral body is facilitated. Also, the edge 760 a can be of sufficient sharpness that the vertebral body does not require a slot for receiving the keel 760 , discussed in greater detail below.
  • the mobile-bearing prosthetic joint 700 is assembled by inserting the modular projection 722 member into the recess 714 formed in the articular surface 708 of articular component 702 . Upon assemblage, the prosthetic joint 700 is ready to be inserted into the disc space S 1 between adjacent vertebral bodies V S , V I (FIG. 48).
  • the adjacent vertebral bodies V S , V I can be prepared to accept the prosthetic joint 700 therebetween.
  • slots 770 , 772 are formed along the vertebral endplates of the vertebrae V S and the vertebrae V I , respectively.
  • the slots 770 , 772 can be created by the keels 740 , 760 themselves, or can be prepared beforehand by one or more of the methods discussed above.
  • the prosthetic joint 700 Upon insertion into the disc space S 1 , the prosthetic joint 700 allows translational movement of the articular component 704 relative to the articular component 702 due to the engagement of the modular projection 722 with the concave recess 758 of articular component 704 .
  • the modular projection member 722 is shown in a posterior position (which would result in movement of the articular component 704 in the posterior direction P), while in FIG. 52, the modular projection member 722 is shown in an anterior position (which would result in movement of the articular component 704 in the anterior direction A).
  • 51 and 52 are of course only exemplary of the translational movement allowed by the implementation of modular projection member 722 and the corresponding recess 714 , and thus, the amount of translational movement of the modular projection member 722 , and therefore the articular component 704 , relative to the articular component 702 can vary, including in directions other than P and A.
  • the positioning of the modular projection member 722 within the recess 714 of the articular component 702 allows the modular projection to spin relative to the articular component 702 .
  • the modular projection member 722 adds the benefit of being able to impart rotation to the articular component 704 (via the engagement with the recess 758 ) independent of translational movement imparted to the articular component 704 .
  • Such independent relationship between translational and rotational movement adds to the amount of mobility experienced at the prosthetic joint 700 relative to prosthetic joints for which translational movement is dependent upon rotational movement and vice versa.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Surgery (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • Public Health (AREA)
  • Neurology (AREA)
  • Transplantation (AREA)
  • Cardiology (AREA)
  • Dentistry (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Vascular Medicine (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Prostheses (AREA)
  • Materials For Medical Uses (AREA)
  • Surgical Instruments (AREA)
US10/752,724 2003-02-12 2004-01-07 Instrument and method for milling a path into bone Abandoned US20040158254A1 (en)

Priority Applications (2)

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US10/752,724 US20040158254A1 (en) 2003-02-12 2004-01-07 Instrument and method for milling a path into bone
US10/773,494 US20050043802A1 (en) 2003-02-12 2004-02-06 Articular disc prosthesis for lateral insertion

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US44696303P 2003-02-12 2003-02-12
US10/752,724 US20040158254A1 (en) 2003-02-12 2004-01-07 Instrument and method for milling a path into bone

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US10/752,724 Abandoned US20040158254A1 (en) 2003-02-12 2004-01-07 Instrument and method for milling a path into bone
US10/752,860 Expired - Lifetime US7364589B2 (en) 2003-02-12 2004-01-07 Mobile bearing articulating disc
US10/774,135 Active 2028-10-23 US7850735B2 (en) 2003-02-12 2004-02-06 Articular disc prosthesis and method for treating spondylolisthesis
US10/774,157 Active 2026-01-13 US7503934B2 (en) 2003-02-12 2004-02-06 Articular disc prosthesis for anterior-oblique insertion
US10/773,815 Abandoned US20040220668A1 (en) 2003-02-12 2004-02-06 Method and device for correcting spondylolisthesis from the lateral approach
US10/774,078 Abandoned US20040220567A1 (en) 2003-02-12 2004-02-06 Instruments and methods for aligning implants for insertion
US10/773,494 Abandoned US20050043802A1 (en) 2003-02-12 2004-02-06 Articular disc prosthesis for lateral insertion
US10/773,814 Active 2025-05-24 US7331995B2 (en) 2003-02-12 2004-02-06 Method for inserting an articular disc prosthesis via the transforaminal approach
US10/776,754 Abandoned US20040230307A1 (en) 2003-02-12 2004-02-11 Device for fusing two bone segments
US12/788,150 Abandoned US20100324684A1 (en) 2003-02-12 2010-05-26 Spinal Prosthetic Joints
US12/942,774 Active 2025-02-28 US8617243B2 (en) 2003-02-12 2010-11-09 Spinal disc prosthesis and associated methods
US12/943,656 Active 2025-01-15 US8591553B2 (en) 2003-02-12 2010-11-10 Spinal disc prosthesis and associated methods

Family Applications After (11)

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US10/752,860 Expired - Lifetime US7364589B2 (en) 2003-02-12 2004-01-07 Mobile bearing articulating disc
US10/774,135 Active 2028-10-23 US7850735B2 (en) 2003-02-12 2004-02-06 Articular disc prosthesis and method for treating spondylolisthesis
US10/774,157 Active 2026-01-13 US7503934B2 (en) 2003-02-12 2004-02-06 Articular disc prosthesis for anterior-oblique insertion
US10/773,815 Abandoned US20040220668A1 (en) 2003-02-12 2004-02-06 Method and device for correcting spondylolisthesis from the lateral approach
US10/774,078 Abandoned US20040220567A1 (en) 2003-02-12 2004-02-06 Instruments and methods for aligning implants for insertion
US10/773,494 Abandoned US20050043802A1 (en) 2003-02-12 2004-02-06 Articular disc prosthesis for lateral insertion
US10/773,814 Active 2025-05-24 US7331995B2 (en) 2003-02-12 2004-02-06 Method for inserting an articular disc prosthesis via the transforaminal approach
US10/776,754 Abandoned US20040230307A1 (en) 2003-02-12 2004-02-11 Device for fusing two bone segments
US12/788,150 Abandoned US20100324684A1 (en) 2003-02-12 2010-05-26 Spinal Prosthetic Joints
US12/942,774 Active 2025-02-28 US8617243B2 (en) 2003-02-12 2010-11-09 Spinal disc prosthesis and associated methods
US12/943,656 Active 2025-01-15 US8591553B2 (en) 2003-02-12 2010-11-10 Spinal disc prosthesis and associated methods

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US (12) US20040158254A1 (zh)
EP (7) EP1596774B1 (zh)
JP (7) JP2006517458A (zh)
CN (3) CN100539966C (zh)
AT (3) ATE555730T1 (zh)
AU (7) AU2004210710B2 (zh)
CA (7) CA2515643A1 (zh)
WO (7) WO2004071348A2 (zh)

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US20100324684A1 (en) 2010-12-23
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