WO1991006261A1 - Procede et appareils chirurgicaux pour souder des structures osseuses adjacentes - Google Patents

Procede et appareils chirurgicaux pour souder des structures osseuses adjacentes Download PDF

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Publication number
WO1991006261A1
WO1991006261A1 PCT/US1990/005318 US9005318W WO9106261A1 WO 1991006261 A1 WO1991006261 A1 WO 1991006261A1 US 9005318 W US9005318 W US 9005318W WO 9106261 A1 WO9106261 A1 WO 9106261A1
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WO
WIPO (PCT)
Prior art keywords
bone
thread
bore
vertebrae
pilot
Prior art date
Application number
PCT/US1990/005318
Other languages
English (en)
Inventor
Charles D. Ray
Eugene A. Dickhudt
Original Assignee
Surgical Dynamics, Inc.
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Priority claimed from US07/432,088 external-priority patent/US5026373A/en
Application filed by Surgical Dynamics, Inc. filed Critical Surgical Dynamics, Inc.
Priority to CA002072992A priority Critical patent/CA2072992C/fr
Priority to EP90915561A priority patent/EP0498816B1/fr
Priority to AU65347/90A priority patent/AU648047B2/en
Priority to DE69032788T priority patent/DE69032788T2/de
Publication of WO1991006261A1 publication Critical patent/WO1991006261A1/fr
Priority to KR92701023A priority patent/KR970009551B1/ko
Priority to NO92921773A priority patent/NO921773L/no

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1637—Hollow drills or saws producing a curved cut, e.g. cylindrical
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
    • A61F2/446—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages having a circular or elliptical cross-section substantially parallel to the axis of the spine, e.g. cylinders or frustocones
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30405—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves
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Definitions

  • the invention concerns method and apparatus for fusing two adjacent bony structures such as a bone joint, especially adjacent vertebrae of the spine.
  • the disc a ligamentous cushion between vertebrae
  • the disc shrinks and flattens out, and the distance between the vertebral bodies begins to collapse.
  • the movement-induced pain may be so disabling that in many such cases, the vertebral motion must be eliminated.
  • rigid fusions may be the only present means to stop the translocations and relieve the pain.
  • Such an appliance is not meant to permanently secure immobility of the segments. Bone ingrowth is required for this.
  • Dependency upon such an appliance as the sole stabilizer is ultimately unsuccessful due to the development of a mechanical gap or transition between the bone and the appliance, leading to structural failure of the bone and adjacent connective tissue. Such failure is seen in fractures, erosion and absorption of bone with potential further collapse. The pain may also become progressively disabling.
  • intervertebral fusion Approximately 150,000 lumbar spinal fusions were performed in the USA during 1987, as reported by the American Hospital Association. There are may methods for intervertebral fusion. The most successful have achieved a success rate of about 90% in random cases. However, several of these techniques, especially those requiring complex appliances, are difficult to master and are hazardous to nerve and vessel structures normally lying close to the involved bones. From a biomechanical point of view, the most important location of a spinal fusion is at the mechanical center of rotation between the vertebrae. This point is centered within the disc space. Therefore, an interbody fusion is the most rigid and thus the most sought after method among surgeons. Current methods of interbody fusions are, however, the most hazardous of all spinal fusion methods.
  • a plug, dowel or segment of bone is driven tightly into a cavity carved inside the interbody, intradiscal space. Since there must be a bone-to- bone bridge created during the fusion process, connective tissue and discal tissue must be removed. Deep cuts within the bone must penetrate into the softer, cancellous region to promote bone growth across the space.
  • U.S. Patent 4,501,269 (Bagby) describes a surgical procedure for stabilizing the cervical spine of a horse and says that the procedure: "is applicable to any human or animal joint formed by opposed contiguous bony surfaces which are covered and separated by intervening cartilage and are surrounded by ligaments which resist expansion of the joint. Specific examples of such joints are a spinal joint between adjacent vertebrae or the ankle joint. The process was developed to immediately stabilize the joint and to further promote ultimate bone-to-bone fusion....
  • the implanted structure is in the form of a perforated cylindrical bone basket which can be filled with bone fragments produced during the preparation of the joint. These bone fragments provide autogenous tissue to promote bone growth through the basket, as well as around it.
  • the process involves the initial steps of surgically accessing the joint and removing intervening cartilage located between the contiguous bony surfaces. A transverse cylindrical opening is then bored across the contiguous bony surfaces. Immediate stabilization is achieved by driving into the cylindrical opening a hollow basket having a rigid perforated cylindrical wall whose outside diameter is slightly greater than the inside diameter of the cylindrical opening. The implanting of the basket spreads the bony surfaces apart in opposition to the resistance to expansion of the joint provided by the surrounding ligaments" (col. 2, lines 26- 55) .
  • Vich J. Neurosurg., Vol 63, pp 750-753 (1983) describes a means for cervical spine fusion, using an anterior approach, by surgically implanting a cylindrical bone graft. "Screw threads are placed in the graft with a small, previously sterilized die. The grooves of the thread can be made as deep as required.
  • the vertical cervical bodies are prepared according to • Cloward's technique. After a cylindrical bed has been drilled in the appropriate intervertebral bodies, the graft is screwed into place with instruments especially developed for this purpose" (p. 750).
  • Vich's Fig. 2 legend points out that a threaded graft dowel has a larger contact surface than a plain dowel and a greater resistance to pressure and sliding. Vich also says:
  • an additional desirable effect of an intervertebral fusion is the restoration or maintenance of a normal intervertebral spacing.
  • Spreading devices are generally required in order to restore all or a part of the normal intradiscal height, in the process of placing the fusion material or appliance.
  • a variety of spreaders may be placed between various posterior bony elements normally attached to the vertebrae, such as, dorsal spinous processes or la inas.
  • the plugs are preferably made of an inert metal substrate such as stainless steel ... having a porous coating of metal particles .. -I- (col. 3, lines 8-14).
  • the plug of Fig. 12 "has bone piercing tangs or points 31" (col. 5, line 61) .
  • the present invention provides a method for implanting a fusion cage in order to fuse adjacent bony structures, which method is safer, surer, easier and faster as compared to the implantation of bone dowels or Brantigan' s rigid plug or Bagby's fusion basket or Longfellow's "reinforce.”
  • the novel implantation method involves the following steps:
  • the female thread formed in step (a) preferably is tapped by hand, using a slow motion to ensure against burning the bone. This freshens the bone margins of the bore so that if any bone had been burned by drilling to form the bore, it is now cut away slowly by hand.
  • the tapping process is quite safe, in that the surgeon can feel the progress of the technique.
  • the V-thread or other male-thread fusion cage preferably is screwed by hand into the threaded bore, again permitting the surgeon to feel if the resistance is too great and that rethreading of the bore might be required.
  • a bone dowel typically is driven into a bore using a hammer, and in order to guard against an overly tight fit, the surgeon listens to the sound of the striking hammer and also monitors the degree of resistance.
  • Parent U.S. patent application S.N. 07/259,031 indicates that the V-thread fusion cage preferably is made of implantable-grade stainless steel and that titanium is also useful. Currently, titanium is preferred, it having been shown to be more compatible to bone. Parent U.S. patent application S.N.
  • the V-thread fusion cage preferably is fitted with end caps.
  • the end caps preferably are X-ray transparent to permit post ⁇ operative checks on the status of the developing bone.
  • X-ray transparent end caps can be stamped from a flexible sheet of thermoplastic resin such as "Delrin" acetal resin or polypropylene and may have a small opening for an instrument by which they can be put into place.
  • a threaded bore into which a hollow cylindrical fusion cage can be surgically implanted to fuse adjacent bony structures can be prepared by the steps of:
  • the cancellous bone of the vertebral bodies has internal strength similar to wet balsa wood and a hard shell similar to about a 1.5 mm veneer of white oak, it is difficult to drill parallel bores without the drill bits wandering into a common center, unless a drill guide or jig is provided.
  • This problem is met by the following method of forming and threading a bore between adjacent vertebrae, which method involves the following steps:
  • said pilot rod and the shafts of said hollow lamina drill and tap having markings to show the depths to which they penetrate into the bore.
  • the sides that are to face laterally preferably are closed to prevent disc tissue from growing into the cages, because this could interfere with bone growth between the vertebrae.
  • the fusion cages have greater structural strength, thus permitting the perforations adjacent the vertebrae to be larger.
  • End caps can help to prevent disc tissue from growing into the cages, and for this reason, any openings in the end caps should be small.
  • a large majority of patients requiring intervertebral fusions have narrowing of the disc space, typically 10 mm or less in the lower back. Because minimal penetration into the end plates of the vertebrae is required (about 3mm for each), three major diameters of the fusion cage thread should suffice for most patients, namely, 14, 16 and 18 mm. Because the anterior-posterior dimension of a typical lower lumbar vertebra is about 30 mm, the length of the fusion cage preferably does not exceed 25 mm but is at least 20 mm in length to give sufficient contact as well as a good platform when implanted in pairs. A novel interbody spreader in the form of a scissors jack has been developed to maintain a desirable parallel attitude between the adjacent vertebrae while the bore is drilled and then tapped by a novel instrument.
  • a first novel tapping instrument comprises a hollow cylindrical shaft having a handle at one end and an external thread which is formed at the other end with at least one scallop that exposes a cutting edge, and a pilot rod that slideably fits into said bore, projects beyond said other end of the hollow shaft, and is formed with a central recess that communicates with the scallop in the hollow shaft and provides a reservoir for detritus removed by said cutting edge, thus permitting the detritus to be carried away by removing the pilot rod from the hollow shaft.
  • the portion of the pilot rod that- projects beyond said other end of the hollow shaft preferably is threaded to carry detritus upwardly to the reservoir.
  • the hollow shaft should have an odd number of scallops and cutting edges, preferably three, because an odd number provides more equal removal of recipient bone on both sides of the bore than would an even number.
  • Said first novel tapping instrument and a novel wrench are illustrated in the drawing, together with other instruments that can be used to implant male-thread fusion cages surgically.
  • Fig. 1 is an exploded isometric view of a first V-thread fusion cage of the parent U.S. Patent Application S.N. 07/259,031 and two perforated end caps;
  • Fig. 2 is an isometric view illustrating the formation of a body that can be cut to form a series of second V-thread fusion cages of said U.S. Patent Application S.N. 07/259,031;
  • Fig. 3 is an isometric view of a first tapping instrument (partly cut away to reveal details of construction) for forming female threads in bores into which male-thread fusion cage is to be inserted;
  • Fig. 4 is. an isometric view of a wrench for screwing a male-thread fusion cage into a threaded bore
  • Fig. 5 is an exploded isometric view of a third male-thread fusion cage of said U.S. Patent Application S.N. 07/259,031;
  • Fig. 6 is a plan view of a pilot drill that can be used in preparation for forming a threaded bore laterally between two vertebrae into which a male- thread fusion cage can be surgically implanted;
  • Fig. 7 is a plan view of a pilot rod that also can be used in preparation for forming said threaded bore
  • Fig. 8 is a plan view of a hollow lamina drill that can be used in conjunction with the pilot rod of Fig. 7;
  • Fig. 9 is an isometric view showing the use of a C-retractor in preparation for the surgical implantation of a pair of male-thread fusion cages between two vertebrae;
  • Fig. 10 is a plan view of a hollow vertebral drill that also can be used with the pilot rod of Fig. 7; and
  • Fig. 11 is a plan view of a second tapping instrument that can be used in conjunction with the C- retractor of Fig. 9 to tap a female thread in the bore formed by the hollow vertebral drill of Fig. 10.
  • the fusion cage 10 of Fig. 1 was formed from a solid steel cylinder by drilling eight small, equally space holes 11 in the axial direction, each hold being c&ntered on a circle concentric with the axis of the cylinder. Then a large hole was drilled centered on the axis and having a radius substantially identical to that of the aforementioned circle.
  • a V-thread 12 was then machined in the external surface of the cylinder, thus opening through that surface a perforation 13 extending through the rounded valley 14 of the V-thread at each crossing of the valley and one of the small holes 11.
  • a screw thread 15 was then machined in the internal surface of the fusion cage to threadably receive an end cap 16 that has apertures 18 similar to those of a salt shaker. Snap-on end caps would also be useful.
  • a series of fusion cages can be made from a plurality of rods 22 of rectangular cross-section that can be continuously extruded and fed into each of eight keyways 23 in the surface of a mandrel 24. Simultaneously, a rod 26 of triangular cross-section is extruded, wrapped helically around the rectangular rods 22, and soldered or welded to each of the rectangular rods 22 at every crossing to provide an external V-thread.
  • a fusion cage identical to that of Fig. 2 can be made from a hollow cylinder by machining an external V-thread and broaching a plurality of rectangular internal keyways.
  • the tapping instrument 30 of Fig. 3 has a hollow cylindrical shaft 31 with a T-handle 32 at one end and an external thread 33 at the other end. Slidably received within the hollow shaft is a pilot rod 34, one end 35 of which protrudes beyond the hollow shaft 31 and slidably fits into a bore that has been drilled into the recipient bone. At the other end of the pilot rod is a knurled cap 35A. Projecting from the threaded end of the hollow shaft 31 are cutting teeth 36 that enlarge the bore to the minor diameter of the external thread 33 of the hollow shaft 31. The threaded end of the hollow shaft also is formed with three symmetrical scallops 37 (one shown) to expose a cutting edge 38 at the leading edge of the external thread 33, which cutting edge forms female bone threads.
  • Detritus created by tapping instrument 30 is deposited through the scallops 37 into a reservoir provided by a central recess J9 in the pilot rod 34.
  • the end 35 of the pilot rod which extends from the recess 39 into the bore has external threads which, when the threaded pilot rod 34 is turned, carry detritus upwardly to be deposited through the scallops into the reservoir.
  • the surgeon can feel increased back pressure when the reservoir becomes full and should grasp the knurled cap 35A to remove and clean out the pilot rod. If the gummy nature of the detritus were to prevent the pilot rod from being easily pulled out of the hollow shaft, the knurled cap 35A could be removed to permit the hollow shaft 31 to be unscrewed from the threaded bore, leaving the pilot rod in place.
  • the pilot rod then serves as a guide if the bore has not yet been completely tapped and it is necessary to reinsert the hollow shaft to compete the tapping.
  • Fig. 5 shows a third male-thread fusion cage 50 that has formed from a solid steel cylinder by drilling an axial bore 51 and then broaching out a pair of cylindrical channels 52 that extend to a diameter only a little smaller than the external surface of said cylinder.
  • a V-thread 53 has then been machined in that external surface, thus creating perforations 54 in the valley between adjacent turns of the thread, each perforation extending completely across one of the channels 52.
  • Each end of each land between the channels has been machined to have a recess 56 to enable an end cap 57 to fit flush with the end of the fusion cage.
  • each land has been formed with a small bore 58 into which one of a pair of projections 59 from the end cap 57 fits snugly to hold the end cap in place.
  • a pilot drill 60 has a T-handle 62 at one end of a shaft 63 and at the other end a collar 64 holding a bit 66.
  • a set screw 68 in the collar permits the protruding length of the bit to be adjusted, and the larger diameter of the collar acts as a stop.
  • the bit 66 extends 25 mm beyond the collar 64.
  • a pilot rod 70 has a cylindrical shaft 71, at one end of which is a cylindrical boss 72 that is 30 mm in length and slidably fits into a bore formed by the pilot drill 110 of Fig. 11.
  • the boss 72 has two scribe marks 73 that indicate the depth in cm of the bore.
  • the shaft 71 is formed with a flat 75 that has scribe marks 76 marked to indicate 0, 1, 2 and 3 cm for purposes explained below.
  • Shown in Fig. 8 is a hollow lamina drill 80 which has a cutting edge 82 and a central bore 83 that slidably fits over the shaft 71 of the pilot rod 70.
  • An anodized aluminum handle 84 permits a surgeon to drive the lamina drill by hand.
  • a C-retractor 90 which has a cylindrical sleeve 91 that is formed with an opening 92 across about one-fourth of its circumference over its full length. Extending from one end of the sleeve opposite to said opening 92 is a malleable handle 93 by which the cylindrical sleeve 91 can be fitted through the arcuate laminotomy (formed by the lamina drill 80) down to the vertebrae 94 and 95. At the other end of the sleeve 91 are four spikes 96 in two pairs, one pair on either side of a line that is 180 * from the center of said opening 92.
  • one pair of the spikes can be set into the dorsal surfaces of each vertebra after careful orientation to be concentric with the pilot rod 70 while it is seated in the pilot bore.
  • one purpose of the sleeve 91 of the C-retractor 90 is to keep tools from contacting the dura 98 and the spinal nerve 99.
  • a hollow vertebral drill 100 Shown in Fig. 10 is a hollow vertebral drill 100, the shaft 101 of which is formed with a central bore (not shown) that slidably fits over the shaft 71 of the pilot rod 70 while the C-retractor 90 is in place.
  • At one end of the hollow drill are scalloped cutting edges 105, and at the other is a hard rubber handle 103 that permits a surgeon to drive the vertebral drill by hand.
  • Scribe marks 107 indicate 0, 1, 2 and 3 cm. The 0 mark is at the top of the cylindrical sleeve 91 of the C-retractor when the vertebral drill is first put into place, and it and the other marks sequentially disappear behind the cylindrical sleeve as the vertebral drilling progresses.
  • the scribe marks 76 on the flat 75 of the shaft 71 of the pilot rod 70 appear behind the handle 103 of the vertebral drill. While the surgeon watches the disappearance of the scribe marks 107 on the vertebral drill, a surgical assistant holds the pilot rod at the proper attitude and monitors he progress of the drilling by watching the appearance of the scribe marks 76 on the pilot rod.
  • a second tapping instrument 110 Shown in Fig. 11 is a second tapping instrument 110, the tap 112 of which slidably fits into the cylindrical sleeve 91 of the C-retractor 90.
  • a T-handle 114 At the other end of its shaft 113 is a T-handle 114 by which a surgeon drives the tap until it reaches the depth of the bore.
  • a small window is created in the overlying laminas of each side, namely standard laminoto ies.
  • the neural tissues, dural sac and nerves, are retracted medially.
  • the intervertebral space is cleaned of disc material in a standard surgical fashion. If the disc space has narrowed as a result of degeneration, a scissors-jack type vertebral spreader or a hydraulically inflated bladder is inserted on one (the first) side inside the disc space and opened until the space approximates the normal. This may be confirmed by a lateral x-ray. The height of the disc space is measured on the x-ray so that the proper sizes of drills, tap, and fusion cage may be chosen.
  • a pilot drill (e.g., 5 mm or 8 mm diameter depending upon discal space height) cuts a small channel in the face of each of the vertebrae, penetrating the interdiscal space to a depth of about 25 mm (the normal disc space is about 30 mm deep and 50 mm wide) .
  • a drill stop may be applied to the drill to prevent overboring the hole.
  • a solid rod pilot is then inserted into the pilot hole and a pilot cutter (7 mm or 10 mm) is passed over it and brought downward to enlarge the pilot channels to slidably receive the pilot rod 35 of the tapping instrument 30 of Fig. 3.
  • the cutting thread 33 (12 mm or 16 mm major diameter) cuts female bone threads through the opposing vertebral end plates and into both cancellous regions that will invite the ingrowth of new bone.
  • a V-thread fusion cage of the invention with one end cap in place, is snapped onto the wrench 40 of Fig. 4 by which it is screwed by hand into the threaded intradiscal bore to its full depth. After removing the wrench, the cage is packed with bone chips or other bone-inducing substance, and the second end cap is applied to hold the bone chips securely in place.
  • the dura and nerves on the second side are relaxed and attention is once again directed to the first side which is drilled and tapped to receive a second fusion cage by the same procedure.
  • the bone from the vertebral bodies will grow through the perforations in the fusion cages and unite with the bone-inducing substance inside them, creating a solid fusion.
  • novel fusion cages will primarily be implanted by a posterior approach to the spine, although an anterior approach may be utilized, especially when applied to the vertical spine.
  • Example 1 The fusion cage of Fig. 1 has been machined from a cylinder of surgically implantable stainless steel to have the following dimensions: diameter of starting cylinder 16 mm length of cylinder 25 mm diameter of each small hole 11 3 mm diameter of circle on which holes 11 are centered 11.5 mm diameter of central hole 11 mm pitch of V-thread 12 2.5 mm/turn angle at crown of thread 12 60" fillet radius in valley of thread 12 0.4 mm axial width of perforation 13 1.6 mm circumferential breadth of perfs. 13 2.8 mm when projected onto interior of a cylinder, % of area perforatec 25%
  • the fusion cage of Fig.l 1 has been machined from a stainless-steel cylinder to have the same dimensions as that of Example 1 except that the diameter of the circle on which holes 11 were centered was increased to 12 mm. This results in 70% perforation in each of the areas of the top and bottom quadrants.
  • Example 3 A fusion cage, identical to that of Example 2 except that the cage was made from titanium, was tested in the same way for compressive strength. It resisted 850 pounds before beginning to deform.
  • Example 2 Surgical Experience The fusion cage of Example 2 has been surgically implanted in pairs between adjacent vertebrae of each of three persons. In each case after placement of the first cage, there was an impressive, instant stabilization of the previously unstable vertfibral segment. Upon threading the second cage into its tapped hole, the segment became completely immobile.
  • the first patient on a routine visit at two months postoperative, had an almost full range of painless motion (bending, twisting) of the lumbar spine.
  • the second patient at 18 days postoperative, made an unscheduled visit to ask permission to go biking and reported a greater than 90% relief of all back and leg pains.
  • the third patient showed approximately 1/3 range of normal painless motion of the lumbar spine on the sixth postoperative day.

Abstract

Une cage de soudure (10) présentant un filetage externe (12) peut être implantée par voie chirurgicale dans un alésage fileté s'étendant latéralement entre les structures osseuses adjacentes, telles que deux vertèbres (94, 95), le filetage (12) pénétrant dans l'os spongieux de chacune des vertèbres (94, 95). La cage de soudure (10) est aisément mise en place manuellement par vissage sans endommager les structures osseuses (94, 95). La cage (10) est ensuite garnie d'une substance déclenchant la croissance osseuse, telle que de l'os spongieux. Lorsqu'une paire de ces cages (10) sont implantées entre des vertèbres adjacentes (94, 95), les patients sont en mesure de s'asseoir sans douleur dès le deuxième ou troisième jour, bien plus tôt que cela n'était possible dans des soudures spinales antérieures en dehors de celles mettant en ÷uvre des plaques d'acier et des vis. Enfin, la croissance interne de l'os à travers les perforations (13) dans le creux (14) du filetage (12) de la cage de soudure (10) forme une interconnexion permanente entre les deux structures osseuses (94, 95).
PCT/US1990/005318 1988-10-17 1990-09-18 Procede et appareils chirurgicaux pour souder des structures osseuses adjacentes WO1991006261A1 (fr)

Priority Applications (6)

Application Number Priority Date Filing Date Title
CA002072992A CA2072992C (fr) 1988-10-17 1990-09-18 Methode chirurgicale et appareil pour la soudure de structures osseuses adjacentes
EP90915561A EP0498816B1 (fr) 1988-10-17 1990-09-18 Appareils chirurgicaux pour souder des structures osseuses adjacentes
AU65347/90A AU648047B2 (en) 1988-10-17 1990-09-18 Surgical method and apparatus for fusing adjacent bone structures
DE69032788T DE69032788T2 (de) 1989-11-06 1990-09-18 Vorrichtung zum vereinigen aneinanderstossender knochenstrukturen
KR92701023A KR970009551B1 (en) 1988-10-17 1992-04-30 Surgical method and apparatus for fusing adjacent bone structures
NO92921773A NO921773L (no) 1989-11-06 1992-05-05 Kirurgisk fremgangsmaate og anordning for sammenvoksing avtilstoetende benstrukturer

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US07/432,088 US5026373A (en) 1988-10-17 1989-11-06 Surgical method and apparatus for fusing adjacent bone structures
US432,088 1989-11-06

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