WO1992001428A1 - Artificial vertebra - Google Patents

Artificial vertebra Download PDF

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Publication number
WO1992001428A1
WO1992001428A1 PCT/AT1991/000090 AT9100090W WO9201428A1 WO 1992001428 A1 WO1992001428 A1 WO 1992001428A1 AT 9100090 W AT9100090 W AT 9100090W WO 9201428 A1 WO9201428 A1 WO 9201428A1
Authority
WO
WIPO (PCT)
Prior art keywords
characterized
prosthesis according
intervertebral prosthesis
rail
rails
Prior art date
Application number
PCT/AT1991/000090
Other languages
German (de)
French (fr)
Inventor
Mohamed Ibrahim Rasheed
Original Assignee
Mohamed Ibrahim Rasheed
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 to ATA1557/90 priority Critical
Priority to AT155790A priority patent/AT394307B/en
Application filed by Mohamed Ibrahim Rasheed filed Critical Mohamed Ibrahim Rasheed
Publication of WO1992001428A1 publication Critical patent/WO1992001428A1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7059Cortical plates
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8004Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for extending or compressing the bone or bones
    • A61B17/8009Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for extending or compressing the bone or bones the plate having a ratchet
    • AHUMAN NECESSITIES
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    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30433Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws
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    • A61F2/00Filters 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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    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30476Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
    • A61F2002/30487Circumferential cooperating grooves and beads on cooperating lateral surfaces of a mainly longitudinal connection
    • A61F2002/30489Circumferential cooperating serrations
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    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30476Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
    • A61F2002/30507Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism using a threaded locking member, e.g. a locking screw or a set screw
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    • A61F2/00Filters 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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    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30518Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements with possibility of relative movement between the prosthetic parts
    • A61F2002/3052Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements with possibility of relative movement between the prosthetic parts unrestrained in only one direction, e.g. moving unidirectionally
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    • A61F2/00Filters 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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    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30518Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements with possibility of relative movement between the prosthetic parts
    • A61F2002/3052Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements with possibility of relative movement between the prosthetic parts unrestrained in only one direction, e.g. moving unidirectionally
    • A61F2002/30522Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements with possibility of relative movement between the prosthetic parts unrestrained in only one direction, e.g. moving unidirectionally releasable, e.g. using a releasable ratchet
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    • A61F2/00Filters 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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    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30537Special structural features of bone or joint prostheses not otherwise provided for adjustable
    • A61F2002/3055Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting length
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30537Special structural features of bone or joint prostheses not otherwise provided for adjustable
    • A61F2002/3055Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting length
    • A61F2002/30551Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting length at different discrete positions, e.g. at equidistant intervals
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    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30565Special structural features of bone or joint prostheses not otherwise provided for having spring elements
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    • A61F2/00Filters 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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    • A61F2002/30772Apertures or holes, e.g. of circular cross section
    • A61F2002/30774Apertures or holes, e.g. of circular cross section internally-threaded
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Abstract

Described is an artificial vertebra designed to be implanted in place of one or more damaged vertebrae, the artifical vertebra having two bracket plates designed to rest against the ends of the neighbouring stable vertebrae. The bracket plates have spikes for anchoring them in these neighbouring vertebrae and are connected to each other by a brace whose length can be adjusted. The brace (9) is disposed out of the longitudinal axis of the artificial vertebra (1), as defined by the line joining the mid-points of the two bracket plates (4). The brace (9) has two flat bars (7, 8) with, on the two facing sides, rows of teeth (14) which engage with each other, the bars (7, 8) being joined to each other by a bolt (17). An empty space is left between the bracket plates (4) to hold an implant (32) made of natural and/or synthetic material. Also described is a device for handling the artificial vertebra, in particular for inserting it.

Description

prosthesis

The present invention relates to an intervertebral prosthesis for insertion in place of one or more of destroyed Wirbelkör¬ by, with two support plates for abutment against the end faces benach¬ barter stable vortex body, said support plates Veran¬ kerungsmittel for anchoring in these vertebral bodies having and at least one in the length Abstand¬ adjustable holders are connected.

Furthermore, the invention relates to a device for handling this prosthesis.

If one or more diseased or damaged vertebral body must be removed from the spine, it is that the Wir¬ are belkörper afflicted with metastases was, it was because of epidural spinal canal metastases or due to functional instability of the spine, it has been necessary, sick or comminuted remove disturbed vertebral body entirely of the spine and a prosthesis between the remaining healthy Wirbelkör¬ pern spinal use.

Length adjustment Wirbelprothe¬ were, for example, Sen, respectively, used parts of the intervertebral prostheses with different fixed length dimensions, the adaptation to über¬ bridging distance during the operation by measuring the gap between the remaining healthy vertebral bodies and selection of the appropriate prosthesis or a suitable intermediate part, with Zu¬ sammenbau of the prosthesis during the operation, is carried out. A mehr¬ part prosthesis with different length spacers is spielsweise described in U.S. Patent No. 4,599,086. A disadvantage die¬ ser known prosthesis is in their complicated structure of many parts and complicated manipulation during insertion. The EP-PS 0,179,695 and DE-OS 2,365,873 describe similar prostheses fixed length.

On the other hand, the prosthesis can be made individually during Opera¬ tion, as in the case of alloplastic vertebral body replacement described in DD-PS 235,416. Nach¬ part it is, however, that this vertebral body replacement is anchored with a screw and a wire pin in the adjacent healthy vertebrae. The cylindrical-shaped metal jacket shown in EP-A 0,268,115, likewise individually produced during the operation with the openings in the shell wall, the ücken with bone and / or bone cement is filled, has the disadvantage that the bone cement during the curing locally Tempera ¬ tures reached, which can lead to necrosis of the surrounding tissue.

In addition, prostheses are known which are adjustable by various means in its length. In length adjustable intervertebral prostheses US-PS 4,553,273 and DE-OS 37 29 600 are described in U.S. Patent No. 4,657,550. These are always located to arrangements in which the distance between two supporting bodies by means of a central spindle drive is adjustable. The block-shaped support body described in U.S. Patent No. 4,553,273, on which the spindle drive is supported, are to be created in the respective adjacent vertebral bodies, preferred wise polygonal recesses sunk. Therefore, a disadvantage thereof is that the recesses must be created during the surgery, which makes a time-consuming and complicated process required. The recesses have to be cut exactly to the dimensions of the supporting body into the adjacent vertebral bodies, otherwise no secure attachment is given. The angle-shaped supporting bodies described in DE-OS 37 29 600 are only screwed laterally without fixing at the end faces of the vertebral bodies by bone screws with this. Another way of fixing the supporting body is described in U.S. Patent 4,657,550, namely by the anchoring pins in the adjacent vertebrae. All such training, however, the common disadvantage that in providing a central längen¬ adjustable spacer no implant can be used.

Furthermore, the DE-Al 30 23 942 describes a spacer for the prosthetic vertebral body and a tool for inserting same. Again, no implant can be used and the tool consists of a pincer-like Vorrich¬ tung with specially designed pliers limb and a Rast¬ means for retaining its expanded position.

An object of the present invention is now to provide a longitudinally easily adjustable intervertebral prosthesis which does not have the disadvantages of the known prostheses mentioned above, but centrally accommodate an implant and gege¬ appropriate, may freeze and through which also destroyed only parts of can be replaced vertebral bodies, that is, the entire vertebral body must be removed not always, even if it is only partially damaged. Therefore, when here is "adjacent vertebral bodies" is mentioned, so that the failure to ver¬ stable parts of the partially removed vertebrae meant. Furthermore, among "stable vertebral bodies (Share)" means those vertebral bodies or vertebral body parts, the visibility of the surgeon to An¬ are capable to provide the prosthesis used sufficient support.

This object is inventively achieved in that the spacer is arranged eccentrically with respect to the through Mittelpunk¬ te of the support plates defined longitudinal axis of the prosthesis, in which between the supporting plates a free up-receiving space for receiving an implant from natural and / or artificial material is left. The eccentric arrangement of the spacer makes it possible to insert an implant in a stable, adjustable on verschie¬ dene lengths prosthesis. The prosthesis structure can be greatly relieved by the fact that the implant can also absorb a considerable part of the fluidized column on oppressive pressure. Of course, any suitable artificial replacement part can form the implant. Be¬ is vorzugt but a natural, taken out from the body's own bone best bone implant or one made of bone tissue and bone cement. In any case, the amount of to be inserted into the patient's body gewebsfremden material can then be kept to a minimum with the present invention.

is advantageous if the anchoring means are spikes. This then penetrate after insertion of the prosthesis and canceling the necessary during the operation of the stretching of the patient itself in the adjacent vertebral bodies the spine.

The preferred application of a support plate having at least one aperture allows the use of a Knochenim¬ plantats the natural coalescence of bone material in¬ nerhalb the spine through the support plates therethrough. If several such openings exist, a beson¬ DERS settled denture retention results after the coalescence. Zusätz¬ Lich this ensures the possibility of only partial Entfer¬ voltage of vertebral bodies and a secure link with the ver¬ lasting stable vertebral body parts. It is furthermore suitable if the perforations are formed circular, since thereby the production is facilitated thereof.

According to a preferred embodiment of the invention it is provided that are connected in approximate continuation of the eccentric spacer connecting pieces having at least one opening for laterally entering into the adjacent vertebral bone screw with the support plates. The bone screw can be chosen so long that in to the vertebral arch of the corresponding vertebra it ranges. This is given in addition to the stable vertebra ein¬ urgent thorns secure fixation. It is also easily possible to remove a diseased or destroyed by Wirbelkör¬ only partially. When using a long Kno¬ chenschraube the intended mandrels belkörpern for anchoring in the adjacent Wir¬ must of course be arranged in such a way ange¬ that the bone screw can be threaded between these hindurch¬. That these connectors are in approximate continuation of the spacer allows the Wun¬ de as low as possible to keep because of the access to the screws of the fittings and adjustment of Ab¬ stood holder of the same side and höhenver¬ just something sets takes place.

The use of connectors in the design of prostheses is known per se. Thus, in U.S. Patent No. 4,599,086, in DE-OS 23 65 873 and in EP 179 695 Anschlu߬ pieces at prostheses described fixed length, while 37 29 600 Connector pieces are provided by angular support body according to the DE-OS which are in turn connected by a central length-adjustable spacer. The connectors described in DE-OS 23 65 873 are arranged along a large part of the periphery of the support plate, thus in¬ sequence of several penetrating into the vertebral body Knochen¬ screws to tension, outbreaks and chipping in Kno¬ surfaces can come. Also, a large wound opening has created wer¬ to order the fittings .to about ben to only fasten the vertebral body. In DE-OS 37 29 600, only a Anschlu߬ the other hand piece to the vertebral body in the form of the vertical part of an angular support body described with an opening for a bone screw. In one embodiment of this type, a reliable connection αar vertebral body with respect to rotational forces is not, however gege _ since the end face of the fluidized body is not directly connected to the horizontal '.1 of angular supporting body.

It is favorable if the connecting pieces relative to the Ab¬ spacers offset to the outside and are connected to the support plates by connecting portions. This is given a secure mounting of the adjacent vertebral body and thus the außer¬ central spacer moves slightly below the face of the adjacent vertebrae, which is worth wünschens¬ for structural reasons. Nevertheless remains enough space for a possible implant.

According to another embodiment of the invention the connecting pieces having at least one opening for laterally entering into the adjacent vertebral bone screw, on the opposite side of the spacer support plates connected to the support plates. The receiving space for the implant is thereby accessible for any corrections such as the screw connection with the adjacent vertebral bodies even with the prosthesis in place for the surgeon from the same side. A longitudinal adjustment must then, however, be with the onset vorgenom¬ men and fixed, or the access to this must be done via a hole through the implant, wants to keep the wound further small.

In a further preferred embodiment, see vorge that the Ansσhlußstücke two eccentrically arranged perforations for two seit¬ in the adjacent vertebral bodies having Lich penetrating bone screws. obstructive mandrels in the edge region of the Stütz¬ plate may be omitted in this approximate shape Ausfüh¬ if necessary, the penetration of the bone screws into the vertebral body.

Preferably, pins are provided for anchoring the implant on the support plates directed into the receiving space. Da¬ through can largely on the use of bone cement (Palacos) be dispensed with for fixing, for sheathing and filling interspaces. When curing Knochenze¬ ment temperatures are known to occur up to 95 ° C, resulting in the burning of surrounding tissue structures. In contrast, the Erfin dung provided according thorns secure a permanent fixation of the implant, in particular a bone implant, without the use of bone cement.

In the above embodiment it is favorable if the mandrels may be arranged in continuation of the provided for anchorage to the adjacent vertebral bodies stable mandrels. The preparation of the intervertebral prosthesis is fanned characterized verein¬ considerably as the mandrels in the form of a double cone in therefor provided in the support plates bores can be pressed.

It is advantageous if the mandrels are arranged radially outside of the openings of the support plates. The mandrels preferably extend in one piece above and below the respective support plate and are symmetrical, for example, arranged at the vertices of an imaginary hexagon. The perforations (which are known per se from DE-OS 37 29 600) then lie inside the side edges of the hexagon. These perforations, for example in the form of bores or slots er¬ possible coalescence of the adjacent vertebral body with the intervertebral prosthesis and the firmly anchored by the mandrels Im¬ Plantat, whereas the Durch¬ described in DE-OS 37 29 600 perforations only ingrowth body, allowing the bone substance of the fluidized in the prosthesis as these prosthesis having no Mög¬ friendliness for receiving an implant, in particular a Kno¬ chenimplantats.

Preferably, the tapered mandrels have a length of 3 to 50 mm. Because the prosthesis can be used in patients of all Alters¬ levels and in all areas of the spine, it is advantageous to the size of the prosthesis and therefore also the pins in, matched these different application purposes to provide a number of different dimensions. In infants is body according to the size of the adjacent fluidized and the implant to be inserted accordingly a smaller dimension of the prosthesis and the mandrels are selected as in adults. Also, the prosthesis will be chosen as a substitute in a lumbar vertebra, for example for replacement of a Halswir¬ bels another dimension. The mandrels are preferably at least as long that they thickness about 3 mm, can penetrate the end face final hard layer the vertebral body. The length of the spikes is virtually unlimited, they can penetrate the an¬ adjacent healthy vertebral body and completely and penetrate even into the next vertebra. However, this then leads to restricted mobility of the spinal column. The length of the spikes should therefore, if no intention of irgend¬ reason otherwise, shall not exceed the height of the adjacent vertebral body.

When the supporting plates are circular, their production is considerably simplified by turning. A hexagonal shape is also stable and easy to manufacture.

After a favorable embodiment of the eccentric spacer is ratchet-like adjustable in length. Mostly, what exact length of the prosthesis is needed is not known prior to surgery. By a ratchet-like adjustment of the spacer fast and accurate adaptation of the prosthesis to be bridging distance between the bei¬ the remaining healthy vertebral bodies is guaranteed. The Aus¬ pressure "ratchet-like" as used herein means that the Ab¬ spacers of the prosthesis in one direction, preferably along sliding, is adjustable while a movement is blocked in the opposite direction by means of locking devices, which allow readjustment of the length in the inserted state to On ¬ annulment of the extension of the patient's spine in terms of shortening the prosthesis can more or less take place automatically.

The operation at the operation with adaptation of the prosthesis runs approximately as follows: Using data from previous studies, X-rays and experience of the surgeon selects the appropriate dimension of the prosthesis. The patient's spine will be stretched and the (s) destroyed (s) fluidized body (parts) is (are) removed. The length and shape of the employed between the support plates of the prosthesis implant is determined, and the proposed or taken implant is brought to the required dimension. The implant is inserted außer¬ half of the patient's body in the receiving space of the widely opened ge prosthesis and the prosthesis is pushed manually quantitative zusam¬, wherein the ange¬ arranged on the inside of the support plates mandrels already penetrate into the implant and fix it. Then the prosthesis is inserted between the remaining adjacent healthy vertebral bodies and canceled the extension of the patient's spine. Since this resulting in a considerable pressure on the vertebrae, the spikes on the inside of the support plates penetrate further into the implant and the spacer pushes on together or with a ratchet it snaps "tooth for tooth" together. At the same time provided for at the outer side of the support plates mandrels penetrate into the end surfaces of the adjacent vertebral bodies. When the supporting plates rest against the front surfaces of the adjacent vertebral bodies and of the implant, bone screws are screwed optionally for additional securing by the perforations of the Anschlu߬ pieces.

According to a preferred embodiment of the außer¬ central spacer (formed ratchet-like or not) formed by two releasably connected to each other rails, which are each fixedly connected to a support plate. This appears to be the easiest and safest design.

It is also advantageous if at least one of the rails has a guide for the longitudinal displacement of the other rail. Tilting of the two rails for the longitudinal displacement is thereby prevented.

It is advantageous if the guide is provided in the support plates ge genüberliegenden end portion of the rails. This arrangement ensures a reliable guidance of the two rails, even at maximum aperture.

Furthermore, is advantageous when the guide is formed by a the other rail spanning bracket. This temple is a measure for virtually captive holding the other rail even with loose connection between the two rails.

According to a preferred embodiment, the guide is formed by a rail flange is bent, or to the longitudinal edges on at least part of its length is angled. Such a guide insures that the two rails are accurately guided in line with loose connection.

it is low, even if the rails of the spacer are curved in a section transverse to the longitudinal axis of the prosthesis with respect to this axis convex. By such a particularly advantageous Viewed form a higher strength of the prosthesis is placed in the longitudinal direction.

It is also advantageous if the Anschlu߬ pieces in a section transverse to the longitudinal axis of the prosthesis are convexly curved with respect to this axis. This allows the connectors to the adjacent WIR is given belkörper also ei¬ got a better adjustment. Are still combined plates with circular Stütz¬ this form, ka _n the entire prosthesis be prepared simply by turning.

It is also advantageous if the rails are provided on the other ein¬ facing sides with interlocking teeth. Thereby, a certain degree of fixing of the spacer is given in each case engages a tooth on a Schiese in the corresponding recess on the other rail.

It is favorable if the flanks of the teeth are perpendicular at each rail on the side facing the rail firmly connected to the support plate and sloped on the side facing the other supporting plate. Such teeth formed on the rails cause the Abstandhal¬ ter Although collapsible, but unintentional off by abutment of the vertical flanks of the teeth is an¬ each other is prevented.

It is also advantageous if each rail of the Abstand¬ holder is provided only in the subsequent to the two longitudinal edges Rand¬ areas with teeth. This embodiment is particularly advantageous if the rails of the spacer is curved transversely to its longitudinal axis with respect to the longitudinal axis of the prosthesis in a convex section are formed. By omitting the teeth in the inner region of the rails, the Fe¬ derwirkung is amplified in connecting the rails, since over the entire rail width extending teeth Radial¬ an increased stiffness of the rails is provided.

Furthermore, it is preferably provided that the two rails are interconnected by means of a releasable fastener such as a pin or a screw. If any are loose Be¬ fastening means the two rails are slightly verstell¬ bar. If the prosthesis is then set to its final length, the implant is inserted, the fastening means is simply tightened or closed, thereby pressing the two rails of the spacer against each other firmly. An undesirable shifting of the prosthesis in the length is practically unmög¬ Lich.

it is also preferable if all parts of the Befesti¬ are branching agent held captive. This can be at a bolt about be achieved that this set according to their Ein¬ at its end facing away from the head end rivet-like is pressed flat. Since this screw is relatively small and only loosely attached to the insertion of the prosthesis, there is a possibility that it passes and / or a possible counter-nut in the body of Pati¬ ducks lost. This is thus prevented. In Verwen¬ dung other fastener such as a pin, it can be fixedly connected to one of the rails, extends through at least the other rail, and may, for example, on the outstanding portion having a thread on wel¬ ches a nut is screwed. The end of the pin can be flattened rivet-like then also to keep here the Mut¬ ter captive.

Preferably, the rails are in loose screw resiliently aneinandergedrück by an arranged under the screw head spring, eg a Blatt¬ spring, which simultaneously forms a backup for the screw. Thus, the rails of the Abstandhal¬ ters are pressed together even at loose screw in some degree, thereby facilitating precise longitudinal adjustment of the prosthesis and a "rattling" of the rails is prevented. At the same time an unwanted loosening of the screw is prevented by the action of the spring. The spring can be provided, for example in the form of a coil spring or a bent leaf spring.

it is low, even if a threaded bore is provided for receiving the connecting screw in the side closer to the longitudinal axis of the prosthesis rail. Since the Verbin¬ used dung screw due to the dimensions of the prosthesis must be small and they should only be tightened when the prosthesis with an inserted implant placed at the site to prothesierenden place of the patient's spine to its final length wur¬ de is a threaded hole advantageous than a lock nut. The tightening of the screw is easier because there is no specific measure to hold the mother is required.

Advantageously, may then be a connection screw of the Ver¬ interspersed longitudinal slot provided in the located farther away from the longitudinal axis of the prosthesis rail. Die¬ ser longitudinal slot enables a simple, rapid and practical continuously variable (where it can be through his teeth "infinitely") adjustment of the spacer. In itself, however, it is also possible to provide in one or two rails in the longitudinal direction a plurality of bores at intervals side by side. The length adjustment er¬ then follows in that a screw is screwed into aligned bores, respectively. However, this solution is ver¬ inhibited in the production of the prosthesis with significant overhead because all the bores of the inboard = m rail with Innen¬ must be provided threads and also άϊr tooth spacing to the spacing of holes coordinated Werder ISS to a vollständ¬ sodium superposition of the two drilling to ensure ^ s.

It is also advantageous if αer head of the screw Verbindungs¬ sunk provided. This can achieve a smooth Außen¬ side of the spacer, which is favorable in view of a possible violation of the surrounding tissue.

According to a further embodiment, the rails of the spacer are held together resiliently. They can be exclusively adjusted serhalb the patient's body in the length thereby without slipping occurs during insertion. After insertion of the prosthesis, the rails can then slide together only until the implant inen applied to the support plates by the type of rails provided on the teeth. While it is here also that too. DITIONAL protection by an additional Befesti¬ restriction means, ie a screw, it is possible but not necessarily required with an appropriate design of the spring.

In particular, the rails may be held together by one or a number of them embracing the outside C-shaped spring clip (s). Such spring brackets can be easily put on and remove, whereby a simple opening of the prosthesis, for example, upon insertion of an incorrectly sized graft is possible.

In this case, these are preferably provided on the longitudinal edges of the rails with the use of two spring brackets and engage in each case on the respect to the longitudinal axis of the Wirbelpro¬ synthesis outer surface of the outer rail and the inner surface of the inner rail provided longitudinal grooves a, thereby to prevent slipping and loosening are secured and projecting parts can be avoided also.

It is favorable if between the rails a laid down in a ~ hiene on the inside of the outer recess S ver¬ lowerable, is provided in the extended ^ cellung transversely to the recess ein¬ stellbares spring loaded spacer. A der¬-like spacer which can optionally engage in a second recess less high, allowing in its ausgefahren¬ en position opening the prosthesis, such as a single-set incorrectly dimensioned implant without removing the Federklam¬ numbers. The spacer then presses the two rail slat NEN and the teeth against the spring action of the brackets located on it so far apart that the teeth no longer dergreifen ineinan¬.

In this case, the spacer may be formed by the web of a T-shaped insert, the legs projecting through a provided in the outer rail hole to the outside. This allows easy adjustment of the spacer, both in and outside the prosthesis in the patient's body, by a correspondingly formed tool, for example by a passenen key is given.

It is also advantageous if directed perpendicular to the Stütz¬ plates to one another and preferably adjoining one another walls for at least partially limiting the zwi¬ rule intended receiving space are provided the support plates, wherein a wall can also be formed by a rail. Especially when a sufficiently large body's own bone implant is available, the surgeon is often forced to use several smaller pieces of bone and connect them with bone cement. It is often advantageous if the receiving space with walls is provided because then filled these pieces of bone without vorheri¬ ger shape only in the receiving space and have to be connected with chenzement Kno¬. The connection through the bone cement can thereby already done Ungen to the length of the gap überbrücken¬ adapted prosthesis by Hiezu provided Durchbrech¬ either auseinandergenom¬ mener prosthesis or when. The simplest these walls correspond to the shape of the support plates, so that approximately even with circular support plates a hollow cylindrical wall for limiting the receiving space can be provided.

According to a preferred embodiment of the present invention forms each have a support plate with the with it firmly ver¬-bound rail and the connecting piece form an integral unit. The number of parts of the intervertebral prosthesis is thereby reduced. Thus a simple and rapid assembly of the prosthesis prior to use is possible.

In this case, the unit can then be machined from a single piece. Specifically, the production of a prosthesis with circular support plates and curved rails and connection pieces can then be effected by turning from a blank. Da¬ by a safe and tight construction of the unit gewährleist¬ et, .beta. without subsequent pivoting, rivet or screw connection. Compounds of this type can not be corroded by formation of a local cell and form weak points in the body of the patient. As a blank, a suitable piece, for example, a special steel, for example, of (A) FM138 steel (US standard), are used.

Another object of the present invention is to provide an apparatus for handling the above-described Wirbelpro¬ synthesis. For this purpose, a device comprising two parallel arms with inserts as working parts, mindes¬ applies ver¬ least one guide device and an adjusting device, wherein the arms of the device processing in parallel by the Führungseinrich¬ during an adjustment in one plane to one another and ge leads are the adjusting device allows a controlled Ein¬ provide to each other the distance between the two arms. With such a device inserting, spreading, and optionally removing the invention, relatively small in general, intervertebral prosthesis is substantially simplified when an insert for securing a prosthesis is used. Ein¬ sets for other purposes, for example for preparing the holes for the spikes, further facilitate the surgery.

Most simply, the guide means and the steeply Ver¬ means each by rods and the adjusting device there by a thread on a rod may be formed. The Ge winch facilitates simple and infinite adjustment of the distance between the arms. It is also possible that Ver¬ position by two opposing thread on a rod take vorzu¬, wherein the two opposing threaded sections of this rod then engage in corresponding threaded in the arms.

For stable guide even at high loads, it is advantageous when the guide means by means of two mutually parallel rods, advantageously to both sides of the VerStell¬ formed.

According to another preferred embodiment of a measuring device for determining the distance of the two arms is also additionally provided. This simplifies the selection of the size of the prosthesis and the pre-fabrication of the implant, since the distance between the remaining vertebrae by the surgeon can be determined rapidly and accurately.

In an intervertebral prosthesis with connectors and Durch¬ interruptions in these connection pieces, the prosthesis by means of screws with the inserts on their supports be such ver¬ prevented that the screws extend through bores in the inserts and rest in threads which here in the holes of the to ¬ tailpieces of the prosthesis are provided. The use of screws to attach the prosthesis on the inserts ensures a secure, easily detachable connection.

In a further preferred embodiment of the Vor¬ direction facing the intervertebral prosthesis side of specific to its holder inserts is connected to the outer shape of the pieces of the prosthesis adapted Anschlu߬ and preferably the Ein¬ are sets to the arms non-rotatably held. This allows for in these inserts on the arms of the device fixed fluidized prosthesis precise guidance of the parts of the prosthesis during expansion of the device and avoided a possible tilting of the spacer of the prosthesis.

The invention is explained below by means of calculations in the Zeich¬ illustrated preferred embodiments, yet wei¬ ter.

Show it:

Fig. 1 is an axonometric view of a prosthesis in exploded form;

. Fig. 2 is a bottom view of the longitudinal axis of the prosthesis outer lower half of Figure 1 this fluidized prosthesis of FIG. 1;

3 shows a prosthesis according to an embodiment with springs in an assembled condition in axonometric view An¬.

Figure 4 is a plan view of the upper in Fig 3 (inner) half of the intervertebral prosthesis of Figure 3...;

Figure 5 is a plan view of a lower (outer) fluidized prosthesis half, in one embodiment according to the Fig. 3 and 4.

Figure 6 is a plan and elevation of a spacer for the intervertebral prosthesis of FIG. 5.

Figure 7 shows another prosthesis having a circular support surface in an axonometric view. Fig. 8 is a partial view of a modified lower (outer) half of a prosthesis according to a further exemplary form;

Figure 9 is an axonometric view of a modified upper (inner) vertebral prosthesis half.

Figure 10 is a schematic side view of a einge¬ translated intervertebral prosthesis of Figure 1 with an inserted implant..;

Figure 11 shows a prosthesis according to a further embodiment with a complete walling of the receiving space for the implant in the assembled condition in axonometric view.

_ Fig.!. a plan view of the upper in Figure 11 is half of the intervertebral prosthesis.

13 is a plan view of the lower half in Figure 11 of the prosthesis..;

Figure 14 shows a prosthesis according to still another embodiment in an assembled state in axonometric view.

FIG. 15 is an axonometric view of a further modi¬ fied upper (inner) vertebral prosthesis half;

Figure 16 is an axonometric view of yet another modified lower (outer) vertebral prosthesis half.

Fig. 17 is a plan view of a detail of Fig. 16;

FIG. 18 is a side view of an apparatus for Hand¬ dling of the prosthesis;

19 is a plan view of the device of Fig. 18.; and

Fig. 20 with another insert.

In Fig. 1, a prosthesis 1 is illustrated, which consists essentially of two parts or halves, which each form an integral unit 2, 3. Each of these units 2, 3 substantially consists of a, for example hexagonal support plate 4 (also any other shapes are possible), the extension section via a Verbin¬ 5 is connected to a preferably perpendicular thereto arranged connection piece. 6 On the other side of the connecting portion 5 preferably extends senk¬ right away from this one rail 7 or 8, wherein the two rails 7, 8 together form a longitudinally adjustable spacer 9, as will be explained in more detail below. Between the support plates 4, a receiving space for the implant is gebil¬ det, which is laterally only partially defined by the rails 7 and 8 and for the support plates 4 form the top and bottom surfaces. The length of this receiving space can be varied by mutual displacement of the rails. When mounting the two rails 7 and 8 to each other whose size is determined and held sta¬ bil.

The support plates 4 are offset slightly inward from the edge or from the corners extending in both directions mandrels 10 to be anchored in adjacent vertebral bodies (not shown ge) also or pins 11 for anchoring a Implan¬ used tats (not shown ) on. The mandrels 10 and 11 can of course be added and provided at other locations as well can have as they cut other shapes in elevation and Quer¬. Especially with artificial implants which projects into the receiving space mandrels 11 are not necessarily erfor¬ sary, even in particularly hard implants also not appropriate.

Furthermore, in the support plates 4 openings 12 are provided in order to allow coalescence of the implant located between the support plates 4 with the adjacent vertebral bodies. After a through waxing is desired, such perforations are advantageous. The number and design of these openings can be varied as desired, but it is expedient to Er¬ livering a Umwachsung order firmer anchoring of the prosthesis to provide at least two openings.

In the connecting pieces 6 holes 13 are provided which can be screwed through the (not shown) bone screws from the side into the adjacent vertebral bodies. These holes can be provided with threads. Such fittings must not be provided because even own a stable connection her¬ already with thorns 10 is adjustable. but they contribute to further stabilization.

The two bars 7, 8 of the adjustable-length Abstand¬ holder 9 are provided on the mutually facing sides with teeth 14 whose edges each on the side facing the associated with the rail 7 and 8, the support plate 4, senk¬ are fairly and sloped on the other side. In the be¬ züglich the - through the centers of support plates 4 defined - longitudinal axis of the prosthesis 1 is a longitudinal outer rail 8 slot 15 un 'in the inner rail 7 has a threaded bore

16. The Läi; gsschlitz 15 is dimensioned so that the stem of a connecting screw 17 ver¬ longitudinally therein can be pushed. In assembling the prosthesis 1 therethrough pushed through the longitudinal slot 15 connecting bolt is

17 screwed against the spring action, arranged between the rail 8 and the head of the screw 17 leaf spring 18 having rounded edges, drilling in the provided in the rail 7 Gewinde¬ sixteenth The outstanding out of the threaded bore 16 of the end may then be flattened rivet-like and be captively held in the rails. Although it would be possible inside smooth rails to use 7 and 8, but this is a much higher demand on the fasteners. Also, any other shaped interlocking projections and recesses may be provided on the corresponding surfaces of the rails 7 and 8, however, provide a series of teeth optimum.

As is apparent from Fig. 2, the rail 8 of the outer integral unit 3 in the edge region of the longitudinal slot 15 a shoulder or shoulder 19, on which or 18 and the underside of the head of the Verbindungs¬ screw 17 bear the leaf spring, whereby the head is arranged sunk in relation to the lower or outer side of the rail. 8

The intervertebral prosthesis 1 shown in Fig. 3 consists we¬ sentlichen of the same parts as those in Fig. 1 shown intervertebral prosthesis. Different here is the detachable connection of the two rails 7 provided with teeth 14, 8 of the two halves 2, 3 of the prosthesis 1. On the upper side of the upper rail 7 and the underside of the lower rail 8 are disclosed benach¬ the longitudinal edges of the longitudinal grooves 20 are provided, engage with the two C-shaped spring clips 21 to be stored therein and then the rails 7 to compress. 8 In the Wir¬ belprothese 1 of FIG. 3 must therefore (not shown) after insertion of the Im¬ plantats no connecting together of the rails 7, 8 are made by a connecting screw 17.

Fig. 4 shows the upper integral unit 2 of the synthesis Wirbelpro¬ 1 according to Fig. 3, the connecting piece 6 in the region of the bore-Kno¬ chenschrauben a nsenkung 22 (shown in phantom) 13 for sunken installation ^ ._r penetrating through the bore 13 bone screw (not shown). A similar Aus¬ formation also includes the bore of the unit. 3

The lower integral unit 3 shown in Figure 5. Has, in addition to the provided with the teeth 14 top of the lower (outer) rail 8 two mutually perpendicular, intersecting rectangular recesses 23, 23 'and provided at the intersection of both wells bore 24. the bei¬ the recesses 23, 23 'are different depths. can in vor¬ present case, the recess extending parallel to the longitudinal axis of the unit is for example 23 'so deep that the (dashed lines drawn) web 25 of a T-shaped in view Distanz¬ piece 26 (see Fig. 6) accommodate in its entirety, so that when zu¬ sammengebauter prosthesis, the teeth 14 of the two closely abutting rails 7, 8 can mesh, while the recess 23 is considerably shallow. If the web 25 of the discontinuously dance piece 26 (Fig. 6) from the outside against the action of cling Feder¬ 21 inwardly toward the other rail 7, ge suppressed and is rotated 90 ° so that the web 25 in the seichte¬ ren recess 23 comes to rest, the teeth 14 are of an¬ the rail 7 on the web 25 and can no longer engage the teeth 14 of the rail. 8 As a result, an opening of the fluidized prosthesis 1 without removal of the C-shaped spring clips 21 mög¬ Lich and the two bars 7, 8 can be slid over each other.

Fig. 6 shows in detail construction and in plan view, the spacer 26 5 used in Fig. 25 with the web 27 and a leg area with a hexagonal recess 28 in its Stirn¬. The leg 27 then extends in an assembled prosthesis through the bore 24 and can be easily rotated with a suitable key from outside.

In Fig. 7 a further embodiment is shown in which the support plates 4 of the two units 2, 3 of the synthesis Wirbelpro¬ 1 are formed circular. This training makes it easier to work out the units 2, 3 in one piece, beispiels¬ example by turning. Moreover, the prosthesis 1 of FIG. 7 corresponds to that according to Fig. 1.

Fig. 8 shows in partial view of a modification of the rail slat NEN 7 and 8 (in this case the rail 8) of the prosthesis 1, wherein the teeth 14 are provided only in the two longitudinal edge portions 29, 30 of the rails. Furthermore, the rails are curved in a convex section transverse to the longitudinal axis ge of the intervertebral prosthesis. For ease of manufacture by means of rotation of the curva- is mungsmittelpunκt the rail at the center of the support plates.

In Fig. 9 shows a further modification of the integral Ein¬ is unit 2 of the prosthesis 1 shown, in detail, the upper or inner rail 7 to a plurality of portions of its length in the direction of the rail 8 of the integral unit 3 (: ot shown) bent or angled members 31 'which form a guide for the other lower rail. 8

Fig. 10 shows in a schematic side view of a fluidized prosthesis 1, that is Lich herein according to Fig. 1, in the inserted state, wherein the stirrup-like configuration of the prosthesis 1 ersicht¬. Furthermore, a be¬ between the support plates 4 find pending implant 32 and two body through the holes 13 in the connection pieces 6 laterally into the adjacent fluidized healthy (eg 34) are screwed in the bone screw 33 can be seen. Also, the penetrating into the vertebral body 34 and into the implant 32 mandrels 10 and 11 in dashed lines.

The intervertebral prosthesis 1 shown in Fig. 11 consists we¬ sentlichen of the same parts as those in FIG 1. Unlike the intervertebral prosthesis shown 1 are here to be directed from the plates Stütz¬ 4 to each other and together anschließen¬ the walls 4 'and 4. "forming two telescoping boxes which enclose the receiving space for the implant.

Fig. 12 and Fig. 13, the two halves 2 and 3 show the intervertebral prosthesis 1 of Fig. 12 with the walls 4 'and 4 "in view.

The intervertebral prosthesis 1 shown in Fig. 14 is likewise appropriate, essentially of the same parts as the prosthesis 1 shown in Fig. 1, however, the connecting pieces 6 are here arranged on the spacer 9 opposite side of Stütz¬ plates 4. Furthermore, the support plates 4 are round and the rails 7, 8 of Äbstandhalters 9 and the connecting pieces 6 are in one section transverse to _rer longitudinal axis with respect to the longitudinal axis of the prosthesis is curved convexly formed and that with a radius of curvature telpunkten its center with the Mit¬ of the backing plates 4 coincide. These rails bil¬ the same part of the walls of the receiving space. is guide die in this Aus¬ in the outer rail (7 here), only a hole for a screw shaft shown as a fastening means. Here, the movable and provided for loosening the connection of the two longitudinal rails 7 and 8 of the fastening means, such as the screw head or a nut at the bottom (not visible) side of the rail 8 are preferably sunk. you want but then reach a fixation or loosening in the implant is inserted, the implant must be drilled to a tool, like a key, to round lead.

In Fig. 15 a variation of the integral unit 2 of the prosthesis 1 is also shown, in which case each comprises, for example, the upper or inner rail 7 in the support plate 4 gegenüber¬ end region on both longitudinal sides a lateral projection 31a downwardly toward the rail 8 of the integral unit 3 (not shown) extend or are bent. The projections 31a thereby form here a lateral guide for the other lower rail 8. At the same time, and of course the rail, not shown, may have from 8 provide such projections 31a auf¬. Also, the protrusions 31a may have at their ends hook-like projections for engaging behind the rail. 8

Fig. 16 shows a further embodiment of the integral unit 3 of the prosthesis 1, wherein the guide is formed for the other rail 7 through a arranged in the end region of the outer rail 8 bracket 31b here that (the other rail 7 in the assembled condition with play to "ratchets" a superposition of the teeth of the rails 7, 8 loan during the longitudinal adjustment to enable 1) engages. The bracket 31b is apart from the guidance function better hold in the unfixed state the purpose of the two integral units 3 that make up the prosthesis.

The unit 3 also has here-circuit piece 6 with two lateral apertures 13 for receiving two bone screws (not shown) in two laterally projecting tongues vor¬ a modified An¬. The ben for the penetration of these Knochenschrau¬ obstructive outwardly projecting pins 10 are here wegge¬ blank (see. Also FIG. 17).

In Fig. 18 there is shown apparatus 35, the moment during the operation in connection with the prosthesis 1 (not shown ge) is used. The device 35 consists of two in a plane lying parallel arms 36 and 37 which verbun¬ together by two parallel guide bars 40 and a lie vor¬ preferably in the same plane are the recliner rod 41. The end portions of the arms 36 and 37 each have threaded holes 46 for the attachment of replaceable inserts 38, 39 by means of screws 47. These two inserts have in turn both a bore 48 to the recessed socket of the screw 47, and a bore 43 for receiving screws 42 for securing the prosthesis 1 (not ge shows) through its connecting pieces 6. The guide rods in each case 40 are in bores press-fitted in the arm 36 and slidable in holes 49 in the arm 37th Furthermore, the guide bars 40 at their ends have stops 50th The shift rod 41 has a pressed-on thumb wheel 52, a shoulder 51 and a threaded portion 44, which threaded portion engages in a threaded bore 53 in the arm 37th The portion between the shoulder 51 and the Rändel¬ disc 52 is freely rotatable in a bore 54 in the arm 36th Upon rotation of the thumb screw 52 are then depending on Drehrich¬ tung the two arms 36 and 37 apart parallel to each other or pushed together, thereby opening 9 of the subsequently at aufge¬ screwed prosthesis of the spacers (not gezeig¬ th) vertebral prosthesis 1 or closed , Furthermore, a scale 45 is attached to each other or the benötig¬ th size of the intervertebral prosthesis or implant for reading the distance between the two arms 36 and 37 on one of the guide rods 40th

a variety of options are available for the training of leadership. The simplest is just a rotatable rod supporting the thread for the adjusting device simultaneously. If the height is large enough, a projection of the guide bars is not required. Also, no rods should be verwen¬ det - it is approximately a slotted plate in the slot of the threaded rod is rotatably disposed, a possible alternative. The adjusting device may be designed differently.

In Fig. 19 it can be seen that the prosthesis 1-facing side of the inserts 38 and 39 is adapted to the round shape of the connecting pieces 6 of FIG. 14. A different form of adjustment could be achieved for instance by a corresponding recess in the insert front surface. Furthermore, in the end region of the arm 36 a groove 55 for receiving a projection 56 on the insert 38 is clearly er¬, which as an example of an additional fixing against rotation relative to the arm (here 36) of many possibilities Möglich¬ is considered. Fig. 20 shows another insert which is formed analogous to a support plate 4 with external spines. It is used for Ein¬ sting of the holes in the adjacent vertebral bodies to Vorbe¬ reitung the use of the prosthesis.

These inserts can be mounted on any area on the arms of the device, including through dovetail groove and pen. to dispense with the other applications and want to keep only the prosthesis, the inserts shown in FIGS. 18 and 19 can also be integrally connected to the arms. but a variation of these inserts is advantageous because of the possibility of using an insert according to FIG. 20. Further practical inserts can be used, eg Meßein¬ rates in conjunction with a scale between and derglei¬ chen them.

The device is now used in the operation as follows:

The to be bridged by the intervertebral prosthesis distance 52 to the outer sides of the inserts 38 and 39 abut by inserting the device 35 into the spine, struts of the device 35 by turning the knurled screw on the end surfaces of adjacent vertebral bodies and reading of the distance A on the scaling 45 detected. Then, the device 35 removed from the spinal column and a suitable fluidized prosthesis 1 is now selected based on the known distance A. It is now the holes for the outer pins in the adjacent vertebrae surfaces are prearranged with inserts according to Fig. 20. The prosthesis 1 is now eingreif¬ screws 42 are connected in partially zusammenge¬ schobenem state by means of the (set forth herein as threaded holes) into the through holes 13 of the fittings 6 with the device 35, is introduced into the spine by means of the device 35 and thence to the right length apart. Is even more advantageous to secure the disc prosthesis equal in the measured length of the inserts to its holder is. The prosthesis can thus be securely anchored with little effort once in the spine. After removing the device 35 from the surgical wound bone screw can then be screwed 6 and the final fixation of the length is carried out through the apertures 13 of the connecting pieces. The most preferred embodiment of the Wirbelpro¬ Proposition 1 is that according to Fig. 7, but in which, instead of the cited therein flat rails 7 and 8, the convexly curved rails according to Fig. 8 can be used. Here, the focus is Krümmungs¬ these rails at the center of the respective Stütz¬ plate 4. The two parts 2 and 3 of the prosthesis 1 are rotated in one piece and also the twisted pair of mandrels 10, 11 are inserted subsequently.

Claims

Ü patent claims CHE:
1. intervertebral prosthesis for insertion in place of one or more of destroyed vertebral body, with two supporting plates (4) to bear against the end surfaces of adjacent stable vortex body, said support plates anchoring means (10) for anchoring in these vertebral bodies, and (by at least one length-adjustable spacer 9 are connected), is characterized gekenn¬ characterized in that the spacer (9) axis eccentrically with respect to the longitudinal defined (by the center points of the support plates 4) of the prosthesis (1) is arranged, in which (between the support plates 4) a free receiving space for receiving a Im¬ plantats (32) from natural and / or artificial material is be¬ blank.
2. intervertebral prosthesis according to claim 1, characterized in that the anchoring means (10) are pins.
3. intervertebral prosthesis according to claim 1 or 2, characterized gekenn¬ characterized in that the support plate (4) has at least one opening (12).
4. intervertebral prosthesis according to claim 3, characterized in that the through opening (12) is circular.
5. intervertebral prosthesis according to any one of claims 1 to 4, characterized in that in approximate continuation of the off-center spacer (9), connecting pieces (6), the refractive least one Durch¬ (13) for a laterally penetrating into the adjacent vertebral bone screw (33) have, with the support plates (4) are connected.
6. intervertebral prosthesis according to claim 5, characterized in that the connecting pieces (6) offset from the spacer (9) to the outside and with the support plates (4) on schnitfte Connection termination (5) are connected.
7. intervertebral prosthesis according to any one of claims 1 to 4, characterized in that connecting pieces (6) having at least one opening (13) for a laterally penetrating into the adjacent vertebral bone screw (33) on which the spacer (9) opposite side of the support plates (4) with the support plates (4) are connected.
8. intervertebral prosthesis according to any one of claims 5 to 7, characterized in that the connecting pieces (6) aufwei¬ two eccentrically arranged through-holes (13) for two laterally penetrating the adjacent vertebral body bone screws (33) sen.
9. intervertebral prosthesis according to any one of claims 1 to 8, characterized in that on the support plates (4) directed into the receiving space mandrels (11) for anchoring the implant (32) are seen vorge.
10. intervertebral prosthesis according to claim 9, characterized in that the mandrels (11) are arranged in continuation of intended for anchoring to the adjacent vertebral bodies stable mandrels (10).
11. intervertebral prosthesis according to claim 9 or 10, characterized gekenn¬ characterized in that the mandrels (10, 11) radially outside interruptions Durch¬ (12) of the support plates (4) are arranged.
12. intervertebral prosthesis according to any one of claims 9 to 11, characterized in that the mandrels (10, 11) have a length of 3 to 50 mm.
13. Intervertebral prosthesis according to one of claims 1 to 12, characterized in that the support plates (4) are circular or square sechs¬ formed.
14. intervertebral prosthesis according to any one of claims 1 to 13, characterized in that the off-center spacer (9) is ratschen¬ manner adjustable in length.
15. intervertebral prosthesis according to any one of claims 1 to 14, characterized in that the off-center spacer (9) by two mutually detachably connected rails (7, 8) is formed, each with a support plate (4) are firmly connected.
16. intervertebral prosthesis according to claim 15, characterized in that at least one of the rails (7 or 8) a guide (31, 31a, 31b) for the longitudinal displacement of the other rail (8 or 7).
17. intervertebral prosthesis according to claim 16, characterized in that the guide (31a, 31b) in the support plates (4) gegenüber¬ end region of the rails (7 or 8) is provided.
18. intervertebral prosthesis according to claim 16 or 17, characterized gekenn¬ characterized in that the guide (31a) by the other rail (8 or 7) spanning bracket (31b) is formed.
19. intervertebral prosthesis according to claim 16 or 17, characterized gekenn¬ characterized in that the guide (31) is formed by a rail (7 or 8) is a flange or bent with the longitudinal edges at least on a part of its length is angled.
20. intervertebral prosthesis according to any one of claims 15 to 19, da¬ characterized by that the rails (7, 8) of the spacer (9) in a section transverse to the longitudinal axis of the prosthesis (1) are convexly curved with respect to this axis.
21 intervertebral prosthesis according to claim 20, characterized in that the connecting pieces (6) transversely to the longitudinal axis in a section of the prosthesis (1) are curved convexly ge with respect to this axis.
22 intervertebral prosthesis according to any one of claims 15 to 21, da¬ by in that the rails (7, 8) are provided at the sides facing each other with interlocking teeth (14).
23 intervertebral prosthesis according to claim 22, characterized in that, for each rail (7, 8), the flanks of the teeth (14) on the side facing the with the rail fixed to the support plate (4) which are perpendicular and on the side facing the other supporting plate (4), sloped.
24. intervertebral prosthesis according to claim 22 or 23, gekenn¬ characterized characterized in that each rail (7, 8) of the spacer (9) only in the subsequent to the two longitudinal edges of the edge areas (29, 30) with teeth (14) is provided.
25 intervertebral prosthesis according to any one of claims 15 to 24, da¬ by in that the two rails (7, 8) by means of a releasable fastener such as a pin or a screw (17) are connected together.
26 intervertebral prosthesis according to claim 25, characterized in that all parts of the fastening means are captively retained.
27 intervertebral prosthesis according to claim 25 or 26, gekenn¬ characterized characterized in that the rails (7, 8) for bulk screw (17) are pressed together resiliently by means disposed under the screw head spring, eg a Blatt¬ spring (18) also forms a backup for the screw (17).
28 intervertebral prosthesis according to any one of claims 25 to 27, da¬ by in that the closer to the longitudinal axis of the prosthesis (1) located rail (7) is provided a threaded bore (16) for receiving the connecting screw (17).
29 intervertebral prosthesis according to any one of claims 25 to 28, da¬ by in that in the further from the longitudinal axis of the prosthesis (1) away located rail (8) is an extension bolt from the Verbin¬ (17) by modifying the longitudinal slot (15) is provided ,
15 to 29, characterized by da¬ 30 intervertebral prosthesis according to any of claims, that the head of the connecting screw (17). is countersunk provided.
31 intervertebral prosthesis according to any one of claims 15 to 24, da¬ by in that the rails (7, 8) of the spacer (9) are held together resiliently.
32. intervertebral prosthesis according to claim 31, characterized in that the rails (7, 8) by one or more they Fende C-shaped spring clips (21) are held together outside umgrei¬.
33. intervertebral prosthesis according to claim 32, characterized in that two spring clips (21) are seen vor¬ on the longitudinal edges of the rails, which in each case at the relative to the longitudinal axis of the prosthesis (1) outer surface of the outer rail (8) and the inner surface of the inner rail (7) provided longitudinal grooves
(20) engage.
34. intervertebral prosthesis according to any one of claims 31 to 33, da¬ by in that between the rails (7, 8) into an opening provided on the inner side of the outer rail recess (23 ') retractable transversely (in the extended position to the recess 23 ') is provided adjustable spring loaded spacer (26).
hindurch¬ 35. intervertebral prosthesis according to claim 34, characterized in that the distance piece (26) through the web (25) of a T-shaped insert is formed, the legs (27) by a provided in the outer rail bore (24) to the outside protrudes.
36. intervertebral prosthesis according to any one of claims 1 to 35, characterized in that perpendicularly of the support plates (4) aufeinan¬ to be directed and preferably adjoining one another walls (4 ', 4 ") for at least partially limiting the between the support plates (4) provided the receiving space are provided, wherein a wall can also be formed by a rail (7, 8).
37. intervertebral prosthesis according to any one of claims 15 to 36, da¬ by in that a respective support plate (4) with the fixed rail associated with it (7 or 8) and the connecting piece (6) (an integral unit 2 or 3 ) forms.
38. intervertebral prosthesis according to claim 37, characterized in that the unit (2 or 3) is machined out of one piece. - -
39. The apparatus for handling the disc prosthesis according to one of claims 1 to 38, comprising two parallel arms (36, 37) with inserts (38, 39) as working parts, at least one guide means (40) and an adjusting device (41), wherein the arms (36, 37) of the device by the guide device
(40) results in an adjustment in a plane parallel to one another and ge the adjusting device (41) a controlled setting of the distance between the two arms (36, 37) to each other enables er¬.
40. Apparatus according to claim 39, characterized in that the guide means (40) and the adjusting device (41) respectively by rods and the adjusting device (41) thereby by a thread (44, 44 ') is formed at a bar.
41. Apparatus according to claim 40, characterized in that the guide means (40) by two parallel rods expediently on both sides of the adjustment device
(41) is formed.
42. Device according to one of claims 39 to 41, characterized in that in addition a measuring device (45) for determining the distance of the two arms (36, 37) is provided.
43. Device according to one of claims 39 to 43 for Hand¬ the intervertebral prosthesis of the prosthesis (1) these by screws (42) dling according to one of claims 5 to 38, characterized in that, with inserts (38, 39) for actuating Befes¬ with the inserts (38, 39), said coil (42) through bores (43) in the inserts (38, 39) protrude and rest in threads which pieces in a respective one of the aperture (13) of the Anschlu߬ ( 6) of the prosthesis (1) are provided.
44. Device according to one of claims 39 to 43 for Wir¬ belprothesen according to any one of claims 5 to 38, characterized gekenn¬ in that with inserts (38, 39) for fixing the prosthesis fluidized (1) on this side facing the inserts (38, 39) to the outer shape of the connecting pieces (6) of the prosthesis (1) adapted and preferably the inserts (38, 39) on the arms (36, 37) are held non-rotatably.
PCT/AT1991/000090 1990-07-24 1991-07-24 Artificial vertebra WO1992001428A1 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
ATA1557/90 1990-07-24
AT155790A AT394307B (en) 1990-07-24 1990-07-24 prosthesis

Publications (1)

Publication Number Publication Date
WO1992001428A1 true WO1992001428A1 (en) 1992-02-06

Family

ID=3515968

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/AT1991/000090 WO1992001428A1 (en) 1990-07-24 1991-07-24 Artificial vertebra

Country Status (6)

Country Link
EP (1) EP0540559A1 (en)
JP (1) JPH06500711A (en)
AT (1) AT394307B (en)
AU (1) AU8098091A (en)
CA (1) CA2088066A1 (en)
WO (1) WO1992001428A1 (en)

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EP0540559A1 (en) 1993-05-12
AU8098091A (en) 1992-02-18

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