WO1992001428A1 - Prothese vertebrale - Google Patents

Prothese vertebrale 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
vertebral
vertebral prosthesis
prosthesis according
rail
rails
Prior art date
Application number
PCT/AT1991/000090
Other languages
German (de)
English (en)
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
Application filed by Mohamed Ibrahim Rasheed filed Critical Mohamed Ibrahim Rasheed
Publication of WO1992001428A1 publication Critical patent/WO1992001428A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7059—Cortical plates
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
    • A61B17/8009—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones the plate having a ratchet
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30433—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels, rivets or washers e.g. connecting screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30476—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
    • A61F2002/30487—Circumferential cooperating grooves and beads on cooperating lateral surfaces of a mainly longitudinal connection
    • A—HUMAN NECESSITIES
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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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30476—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
    • A61F2002/30507—Connections 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
    • A—HUMAN NECESSITIES
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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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30518—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements with possibility of relative movement between the prosthetic parts
    • A61F2002/3052—Connections 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30518—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements with possibility of relative movement between the prosthetic parts
    • A61F2002/3052—Connections 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
    • A61F2002/30522—Connections 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The 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
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30537—Special structural features of bone or joint prostheses not otherwise provided for adjustable
    • A61F2002/3055—Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting length
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The 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
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30565—Special structural features of bone or joint prostheses not otherwise provided for having spring elements
    • A61F2002/30571—Leaf springs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A61F2002/30774—Apertures or holes, e.g. of circular cross section internally-threaded
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A61F2002/30777—Oblong apertures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A61F2002/30784—Plurality of holes
    • A61F2002/30785—Plurality of holes parallel
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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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30841—Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes
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    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A—HUMAN NECESSITIES
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    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0041—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws

Definitions

  • the present invention relates to a vertebral prosthesis for insertion instead of one or more destroyed vertebral bodies, with two support plates for bearing against the end faces of adjacent stable vertebral bodies, the support plates having anchoring means for anchoring in these vertebral bodies and by at least one in length adjustable spacers are connected.
  • the invention relates to a device for handling this vertebral prosthesis.
  • one or more diseased or destroyed vertebral bodies have to be removed from the spine, be it that the vertebral bodies are affected by metastases, be it because of epidural vertebral canal metastases or because of functional instability of the spine, it has previously been necessary to remove the diseased or disrupted spine disturbed vertebral bodies to remove completely from the spine and insert a prosthesis between the remaining healthy vertebral bodies of the spine.
  • the vertebral prosthesis can be individually manufactured during the operation, as in the case of the alloplastic vertebral body replacement described in DD-PS 235 416.
  • a disadvantage of this, however, is that this vertebral body replacement is only anchored in the adjacent healthy vertebral bodies with a screw and a wire pin.
  • the cylindrical sheet metal jacket shown in EP-A 0 268 115, likewise individually manufactured during the operation, with openings in the jacket wall, the filled with bone back and / or bone cement has the disadvantage that the bone cement reaches local temperatures during hardening, which can lead to necrosis of the surrounding tissue.
  • vertebral prostheses are also known, the length of which can be adjusted by various means. Vertebral prostheses adjustable in length are described in US Pat. No. 4,657,550, US Pat. No. 4,553,273 and DE-OS 37 29 600. These are always arrangements in which the distance between two support bodies can be adjusted by means of a central spindle drive.
  • the block-shaped support bodies described in US Pat. No. 4,553,273, on which the spindle drive is supported are sunk into preferably polygonal recesses to be created in the adjacent vertebral bodies. A disadvantage of this is therefore also that the recesses have to be created during the operation, which necessitates a time-consuming and complicated procedure.
  • the recesses must be cut into the adjacent vertebral bodies precisely according to the dimensions of the support bodies, since otherwise there is no secure attachment.
  • the angular support bodies described in DE-OS 37 29 600 are screwed to the end faces of the vertebral bodies with these only laterally by means of bone screws.
  • Another possibility of fastening the support bodies is described in US Pat. No. 4,657,550, namely anchoring by means of spikes in the adjacent vertebral bodies.
  • all these designs have in common the disadvantage that no implant can be used if a central length-adjustable spacer is provided.
  • DE-Al 30 23 942 describes a spacer for prosthetic vertebral body replacement and a tool for inserting the same.
  • the tool consists of a forceps-like device with specially designed forceps legs and a locking device for holding its spread position.
  • the spacer is arranged eccentrically with respect to the longitudinal axis of the vertebral prosthesis defined by the center point of the support plates, a free receiving space for receiving an implant made of natural and / or artificial material being left between the support plates.
  • the eccentric arrangement of the spacer makes it possible to insert an implant in the case of a stable prosthesis that can be adjusted to different lengths.
  • the prosthesis construction can be relieved considerably, since the implant can also absorb a considerable part of the pressure on the spine.
  • any suitable artificial replacement piece can form the implant.
  • preference is given to a natural bone implant, best taken from the body's own bone, or a bone implant made from bone parts and bone cement. In any case, the amount of to be inserted into the patient's body gewebsfremden material to a minimum can then be restricted with the • present invention.
  • anchoring means are spikes. After insertion of the vertebral prosthesis and removal of the stretching of the patient's spine necessary for the operation, these automatically penetrate into the neighboring vertebral bodies.
  • a support plate with at least one opening enables the bone material to grow together naturally within the spine through the support plates when using a bone implant. If there are several such perforations, the prosthesis is particularly firmly held after the overgrowth. In addition, this also ensures the possibility of only partial removal of vertebral bodies and the secure connection with the remaining stable vertebral body parts. It is furthermore advantageous if the openings are circular, since this facilitates their manufacture.
  • connecting pieces which have at least one opening for a bone screw penetrating laterally into the adjacent vertebral body are connected to the support plates.
  • the bone screw can be chosen so long that it extends into the vertebral arch of the vertebral body in question. This provides a secure fixation in addition to the spikes penetrating the stable vertebral body. It is also easily possible to only partially remove a sick or destroyed vertebral body.
  • the spikes provided for anchoring in the adjacent vertebral bodies must of course be arranged in such a way that the bone screw can be screwed between them.
  • the fact that these connecting pieces are in an approximate continuation of the spacer also makes it possible to keep the wound as small as possible, because then access to the screws of the connecting pieces and to the adjusting mechanism of the spacer is from the same side and only slightly offset in height he follows.
  • DE-OS 37 29 600 only describes a connection piece to the vertebral body in the form of the vertical part of an angular support body with an opening for a bone screw.
  • a reliable connection between the vertebral body and the rotating forces is not opposed, since the end face of the vertebral body is not also directly connected to the horizontal '.1 of the angular support body.
  • connecting pieces are offset to the outside relative to the spacer and are connected to the support plates via connecting sections. This ensures that the adjacent vertebral body is held securely and the off-center spacer thus moves somewhat below the end face of the adjacent vertebra, which is desirable for structural reasons. Nevertheless, there is enough space for an implant.
  • the connecting pieces which have at least one opening for a bone screw penetrating laterally into the adjacent vertebral body, are connected to the support plates on the side of the support plates opposite the spacer.
  • the receiving space for the implant is thus accessible to the surgeon from the same side for any corrections, even when the prosthesis is inserted, as is the screw connection to the adjacent vertebral bodies.
  • a longitudinal adjustment must then, however, be made and fixed with the insertion, or access to it must be through a hole through the implant if the wound is to be kept small.
  • connection pieces each have two openings arranged off-center for two bone screws penetrating laterally into the adjacent vertebral body.
  • mandrels in the edge region of the support plate which prevent the bone screws from penetrating into the vertebral body can be omitted.
  • Mandrels are preferably provided on the support plates in the receiving space for anchoring the implant.
  • bone cement palacos
  • temperatures of up to 95 ° C. occur during the hardening of bone cement, which leads to the burning of the surrounding tissue structures.
  • the spikes provided according to the invention ensure permanent fixation of the implant, in particular a bone implant, without using bone cement.
  • the mandrels are arranged in continuation of the mandrels provided for anchoring on the adjacent stable vertebral bodies.
  • the manufacture of the vertebral prosthesis is thereby considerably simplified since the mandrels in the form of double cones can be pressed into bores provided for this purpose in the support plates.
  • the mandrels are arranged radially outside of openings in the support plates.
  • the mandrels preferably extend in one piece above and below the respective support plate and are arranged symmetrically, for example at the corner points of an imaginary hexagon.
  • the openings (which are known per se from DE-OS 37 29 600) are then within the side edges of the hexagon.
  • the conical mandrels preferably have a length of 3 to 50 mm. Since the vertebral prosthesis can be used in patients of all ages and in all areas of the spine, it is advantageous to provide the size of the vertebral prosthesis and thus also the mandrels in a few different dimensions adapted to these different purposes. In the case of small children, a smaller dimension of the vertebral prosthesis and the mandrels will accordingly be chosen in accordance with the size of the adjacent vertebral bodies and the implant to be inserted than in adults. When replacing a cervical vertebra, for example, a different dimension of the vertebral prosthesis will be selected than when replacing a lumbar vertebra.
  • the mandrels are expediently at least so long that they can penetrate the approximately 3 mm thick hard layer that closes off the end of the vertebral body.
  • the length of the mandrels is practically unlimited, they can penetrate the adjacent healthy vertebral body completely and even penetrate into the next vertebral body. However, this then leads to a restricted mobility of the vertebral pillar.
  • the length of the mandrels should therefore not exceed the height of the adjacent vertebral body unless otherwise intended for any reason.
  • support plates are circular, their manufacture is considerably simplified by turning. A hexagonal shape is also stable and easy to manufacture.
  • the off-center spacer is adjustable in length in a ratchet-like manner.
  • a ratchet-like adjustment mechanism of the spacer ensures a quick and precise adaptation of the vertebral prosthesis to the distance to be bridged between the two remaining healthy vertebral bodies.
  • the expression "ratchet-like" as used here means that the spacer of the vertebral prosthesis can be adjusted in one direction, preferably by pushing it together, while movement in the opposite direction is blocked by locking devices, as a result of which the length in the inserted state can be readjusted after opening ⁇ the stretching of the patient's spine can be increased more or less automatically in the sense of shortening the prosthesis.
  • the procedure for the operation with adjustment of the prosthesis proceeds approximately as follows: The surgeon selects the appropriate dimension of the prosthesis based on data from previous examinations, X-ray images and empirical values.
  • the patient's spine is stretched and the destroyed vertebral body (parts) is (are) removed.
  • the length and the shape of the implant to be inserted between the support plates of the prosthesis are determined and the intended or removed implant is brought to the required dimension.
  • the implant is inserted outside the patient's body into the receiving space of the wide-open prosthesis and the prosthesis is pushed together manually, the spikes arranged on the inside of the support plates already penetrating into the implant and fixing it.
  • the prosthesis is then placed between the remaining adjacent healthy vertebral bodies and the patient's spine is not stretched.
  • the mandrels on the inside of the support plates penetrate further into the implant and the spacer pushes further together or at one He locks the ratchet together "tooth for tooth”.
  • the spikes provided on the outside of the support plates penetrate into the end faces of the adjacent vertebral bodies. If the support plates lie against the end faces of the adjacent vertebral bodies and the implant, bone screws are optionally screwed through the openings in the connecting pieces for additional security.
  • the off-center spacer (formed like a ratchet or not) is formed by two rails which are detachably connected to one another and are each firmly connected to a support plate. This appears to be the simplest and safest construction.
  • At least one of the rails has a guide for the longitudinal displacement of the other rail. This prevents the two rails from tilting during longitudinal displacement.
  • the guide is provided in the end region of the rails opposite the support plates. This arrangement ensures safe guidance of the two rails even with maximum opening.
  • the guide is formed by a bracket spanning the other rail. This bracket represents a measure to hold the other rail practically captive, even if the two rails are loosely connected.
  • the guide is formed in that the one rail is bent or angled like a flange with the longitudinal edges at least over part of its length. Such a guide ensures that the two rails are exactly aligned in a loose connection.
  • the rails of the spacer are convexly curved in relation to this axis in a section transverse to the longitudinal axis of the vertebral prosthesis.
  • Such a shape which is regarded as particularly advantageous, gives the prosthesis greater strength in the longitudinal direction.
  • the connecting pieces are also convexly curved in a section transverse to the longitudinal axis of the vertebral prosthesis with respect to this axis. This also makes it easier to adapt the connecting pieces to the adjacent given body. If this shape is combined with circular support plates, the entire vertebral prosthesis can be produced simply by turning.
  • the rails are provided with interlocking teeth on the sides facing one another. As a result, a certain fixation of the spacer is given in each case when a tooth snaps into place on a tray in the corresponding recess on the other tray.
  • flanks of the teeth on the side facing the support plate firmly connected to the rail are vertical and on the side facing the other support plate, they slope away. Teeth formed in this way on the rails have the effect that the spacer can be pushed together, but inadvertent removal is prevented by the vertical flanks of the teeth resting against one another.
  • each rail of the spacer is provided with teeth only in the edge regions adjoining the two longitudinal edges.
  • This embodiment is particularly advantageous if the rails of the spacer are convexly curved in a section transverse to their longitudinal axis with respect to the longitudinal axis of the vertebral prosthesis.
  • the two rails are fastened by means of a releasable fastening means, e.g. a pin or a screw, are interconnected.
  • a releasable fastening means e.g. a pin or a screw
  • the fastening means is loose, the two rails are thus easily adjustable.
  • the fastening means is simply tightened or closed and thereby presses the two rails of the spacer firmly against one another. An undesired adjustment of the length of the prosthesis is practically impossible.
  • fastening means are held captive. This can be achieved in the case of a screw, for example, in that after it has been inserted, it rivets flat at its end facing away from the head. is pressed. Since this screw is relatively small and is only loosely attached when the prosthesis is inserted, there is a possibility that it and / or a possible lock nut in the patient's body will be lost. This will prevent this.
  • another fastening means for example a pin
  • it can be firmly connected to one of the rails, in any case extends through the other rail and can, for example, have a thread on the projecting section, onto which a nut is screwed. The end of the pin can then also be pressed flat like a rivet in order to keep the nut captive here.
  • the rails are loosened by a spring located under the screw head, e.g. a leaf spring, resiliently pressed against one another, which at the same time forms a securing means for the screw.
  • a spring located under the screw head, e.g. a leaf spring, resiliently pressed against one another, which at the same time forms a securing means for the screw.
  • the spring can be provided, for example, in the form of a helical spring or a curved leaf spring.
  • a threaded bore is provided in the rail closer to the longitudinal axis of the vertebral prosthesis for receiving the connecting screw. Since the connecting screw used has to be small due to the dimensions of the prosthesis and it should only be tightened when the prosthesis with the inserted implant has been brought to its final length at the location of the patient's spine to be prosthesized, there is a threaded hole more advantageous than a lock nut. Tightening the screw is easier since no special measure is required to hold the nut.
  • a longitudinal slot penetrated by the connecting screw can then advantageously be provided.
  • This longitudinal slot enables the spacer to be adjusted simply, quickly and practically continuously (as far as it can be “continuously” by the teeth).
  • the head of the connecting screw is provided recessed. This enables a smooth outer side of the spacer to be achieved, which is favorable with regard to possible damage to the surrounding tissue.
  • the rails of the spacer are held together in a springy manner. In this way, they can be adjusted in length outside the patient's body without slipping when inserted.
  • the type of teeth provided on the rails means that the splints can only slide together until the implant lies against the support plates. Although it is here too. Additional protection by an additional fastening means, ie a screw, is possible, but is not absolutely necessary if the spring is designed accordingly.
  • the rails can be held together by one or more C-shaped spring clamps encompassing them on the outside.
  • Such spring clips are easy to put on and remove, which makes it easy to open the prosthesis, e.g. if an incorrectly dimensioned implant is inserted.
  • these are preferably provided on the longitudinal edges of the rails and engage in the longitudinal grooves provided on the outer surface of the outer rail and the inner surface of the inner rail with respect to the longitudinal axis of the vertebral prosthesis, thereby preventing them from slipping and loosening are secured and protruding parts can also be avoided.
  • a spring-loaded spacer is provided between the rails, which can be lowered into a recess provided on the inside of the outer rail and which can be adjusted transversely to the recess in the extended cell.
  • a spacer which can possibly snap into a second, less high recess, enables the vertebral prosthesis to be opened in its extended position, for example in the case of a placed incorrectly dimensioned implant without removing the spring clips. The spacer then presses the two rails and the teeth thereon so far apart against the spring action of the clamps that the teeth no longer interlock.
  • the spacer can be formed by the web of a T-shaped insert, the legs of which protrude outwards through a bore provided in the outer rail. This makes it easy to adjust the spacer, both when the prosthesis is inserted and outside the patient's body, using a suitably designed tool, for example a suitable key.
  • walls are provided which are directed vertically towards one another and preferably adjoining one another to at least partially limit the receiving space provided between the support plates, wherein a wall can also be formed by a rail.
  • a wall can also be formed by a rail.
  • the receiving space is provided with walls, since then these pieces of bone without prior shaping only have to be filled into the receiving space and connected to one another with bone cement.
  • the connection through the bone cement can take place either with the prosthesis disassembled or with the prosthesis already adapted to the length of the gap to be bridged through openings provided for this purpose.
  • These walls correspond most simply to the shape of the support plates, so that a hollow cylindrical wall for delimiting the receiving space can also be provided, for example, in the case of circular support plates.
  • a support plate forms an integral unit with the rail firmly connected to it and the connecting piece. This reduces the number of parts of the spinal prosthesis. This enables simple and quick assembly of the prosthesis before use.
  • the unit can then be made from one piece. Specifically the manufacture of a prosthesis with round support plates and curved rails and connecting pieces can then be made by turning from a blank. This ensures a secure and firm construction of the unit, without subsequent welding, riveting or screwing. Compounds of this type cannot corrode and form weak spots in the patient's body through the formation of a local element.
  • a suitable piece for example made of a special steel, for example made of (A) FM138 steel (US standard), can be used as the blank.
  • Another object of the present invention is to provide a device for handling the vortex prosthesis described above.
  • a device comprising two mutually parallel arms with inserts as working parts, at least one guide device and one adjusting device is used, the arms of the device being guided parallel to one another by the guide device when being adjusted in one plane and the adjusting device enables a controlled adjustment of the distance between the two arms.
  • the insertion, spreading and, if appropriate, the removal of the generally relatively small vertebral prosthesis according to the invention is considerably simplified if an insert is used for fastening a vertebral prosthesis. Inserts for other purposes, for example for piercing the holes for the spikes, further facilitate the operation.
  • the thread enables simple and stepless adjustment of the distance between the arms. It is also possible to carry out the adjustment by means of two counter-rotating threads on a rod, the two counter-rotating thread sections of this rod then engaging in corresponding threads in the arms.
  • the guide device is formed by two parallel rods, expediently on both sides of the adjusting device.
  • a measuring device for determining the distance between the two arms is also provided. This simplifies the selection of the size of the spinal prosthesis and also the prefabrication of the implant the distance between the remaining vertebral bodies can be determined quickly and precisely by the surgeon.
  • the vertebral prosthesis can be connected by screws to the inserts for holding them in such a way that the screws protrude through bores in the inserts and rest in threads which are here in the bores of the connector ⁇ end pieces of the vertebral prosthesis are provided.
  • the use of screws to attach the vertebral prosthesis to the inserts enables a secure and easily detachable connection.
  • the side of the inserts facing the vertebral prosthesis which is intended to hold it is adapted to the outer shape of the connecting pieces of the vertebral prosthesis and the inserts on the arms are preferably held non-rotatably.
  • Figure 1 is an axonometric view of a vertebral prosthesis in an exploded view.
  • FIG. 2 shows a bottom view of the outer half of this vertebral prosthesis of FIG. 1, which is outer with respect to the longitudinal axis of the vertebral prosthesis;
  • FIG. 3 shows a vertebral prosthesis according to an embodiment with springs in the assembled state in an axonometric view
  • FIG. 4 is a top view of the upper (inner) half of the vertebral prosthesis of FIG. 3 in FIG. 3;
  • FIG. 5 shows a plan view of a lower (outer) vertebral prosthesis half in an embodiment according to FIGS. 3 and 4;
  • Fig. 6 is a plan and elevation of a spacer for the spinal prosthesis of Fig. 5;
  • FIG. 7 shows another vertebral prosthesis with a circular support surface in an axonometric view
  • 8 shows a partial view of a modified lower (outer) half of a vertebral prosthesis according to a further embodiment
  • FIG. 9 shows an axionometric view of a modified upper (inner) vertebral prosthesis half
  • FIG. 10 shows a schematic side view of an inserted vertebral prosthesis according to FIG. 1 with an inserted implant
  • FIG. 11 shows a vertebral prosthesis according to a further embodiment with a complete conversion of the receiving space for the implant in the assembled state in an axonometric view
  • FIG. 11 Fig.! _. a top view of the upper half of the vertebral prosthesis in FIG. 11;
  • FIG. 13 is a top view of the lower half of the vertebral prosthesis in FIG. 11;
  • FIG. 14 shows a spinal prosthesis in accordance with yet another embodiment in the assembled state in an axonometric view
  • FIG. 15 shows an axionometric view of a further modified upper (inner) vertebral prosthesis half
  • FIG. 16 is an axionometric view of yet another modified lower (outer) vertebral prosthesis half
  • Figure 17 is a plan view of a detail of Figure 16;
  • FIG. 18 shows a side view of a device for handling the vertebral prosthesis
  • Fig. 19 is a top view of the device of Fig. 18.
  • a spinal prosthesis 1 is illustrated, which essentially consists of two parts or halves, each of which forms an integral unit 2, 3.
  • Each of these units 2, 3 essentially consists of, for example, a hexagonal support plate 4 (any other shape is also possible), which is connected via a connecting section 5 to a connector 6 which is preferably arranged at right angles thereto.
  • a rail 7 or 8 preferably extends perpendicularly away from the latter, the two rails 7, 8 forming a length-adjustable spacer 9 with one another, as will be explained in more detail below.
  • the support plates 4 form a receiving space for the implant, which is only partially delimited laterally by the rails 7 and 8 and for which the support plates 4 form the top and bottom surfaces.
  • the length of this receiving space can be varied by moving the rails against each other.
  • the support plates 4 offset somewhat inward from the edge or from the corners, have mandrels 10 extending in both directions for anchoring in adjacent vertebral bodies (not shown) or mandrels 11 for anchoring an inserted implant (likewise not shown) ) on.
  • the mandrels 10 and 11 can of course be offset and provided at other locations, just as they can also have other shapes in view and cross section.
  • the mandrels 11 projecting into the receiving space are not absolutely necessary, and in fact are not expedient in the case of particularly hard implants.
  • openings 12 are provided in the support plates 4 in order to allow the implant located between the support plates 4 to grow together with the adjacent vertebral bodies. Such breakthroughs are advantageous since full growth is desired.
  • the number and design of these openings can vary as desired, but in order to achieve regrowth for the purpose of more firmly anchoring the prosthesis, it is advisable to provide at least two openings.
  • Bores 13 are provided in the connecting pieces 6, through which bone screws (not shown) can be screwed into the adjacent vertebral bodies from the side. These holes can also be threaded.
  • Such connecting pieces do not have to be provided at all, because even a stable connection can be established with the spikes 10 alone. But they contribute to further stabilization.
  • the two rails 7, 8 of the length-adjustable spacer 9 are provided on the mutually facing sides with teeth 14, the flanks of which are vertical on the side facing the support plate 4 connected to the rails 7 and 8, respectively fall diagonally on the other side.
  • outer rail 8 is a longitudinal slot 15 and in the inner rail 7 there is a threaded bore
  • the longitudinal slot 15 is dimensioned such that the shaft of a connecting screw 17 can be displaced therein in the longitudinal direction.
  • the rail 8 of the outer integral unit 3 has a shoulder or shoulder 19 in the edge region of the longitudinal slot 15, on which the leaf spring 18 and the underside of the head of the connecting screw 17 rest. whereby the head is sunk against the bottom or outside of the rail 8.
  • the vertebral prosthesis 1 shown in FIG. 3 essentially consists of the same parts as the vertebral prosthesis shown in FIG. 1.
  • the detachable connection of the two rails 7, 8 of the two halves 2, 3 of the vertebral prosthesis 1 provided with teeth 14 differs here.
  • longitudinal grooves 20 are provided adjacent to the longitudinal edges, engage in the two C-shaped spring clips 21 in order to be supported in them and thus press the rails 7, 8 together.
  • the rails 7, 8 do not have to be connected by a connecting screw 17.
  • FIG. 4 shows the upper integral unit 2 of the vertebral prosthesis 1 according to FIG. 3, the connection piece 6 of which in the region of the bone screw bore 13 has a countersink 22 (shown in dashed lines) for the recessed attachment ⁇ ._r through the bore 13 Has bone screw (not shown).
  • the bore of the unit 3 also has a similar design.
  • the lower integral unit 3 shown in FIG. 5 additionally has two mutually perpendicular, intersecting rectangular recesses 23, 23 'on the upper side of the lower (outer) rail 8 provided with the teeth 14 and a bore 24 provided at the intersection of the two recesses.
  • the two depressions 23, 23 ' are of different depths.
  • the recess 23 'lying parallel to the longitudinal axis of the unit is so deep that it can accommodate the web 25 (shown in broken lines) of a spacer 26 which is T-shaped in view (see FIG. 6), so that when the prosthesis is assembled, the teeth 14 of the two closely abutting rails 7, 8 can interlock, whereas the recess 23 is considerably shallower.
  • FIG. 6 shows in detail in plan and plan view the spacer 26 used in FIG. 5 with the web 25 and a leg 27 with a hexagonal recess 28 in its end face.
  • the leg 27 then projects through the bore 24 when the prosthesis is assembled and can be easily rotated from the outside with a suitable key.
  • FIG. 7 shows a further embodiment, in which the support plates 4 of the two units 2, 3 of the vertebral prosthesis 1 are circular. This design facilitates the working out of the units 2, 3 from one piece, for example by turning. Otherwise, the spinal prosthesis 1 from FIG. 7 corresponds to that according to FIG. 1.
  • FIG. 8 shows a partial view of a modification of the rails 7 and 8 (here: the rail 8) of the spinal prosthesis 1, the teeth 14 being provided only in the two longitudinal edge regions 29, 30 of the rails. Furthermore, the rails are in one Section transversely curved to the longitudinal axis of the vertebral prosthesis. For easier manufacture by turning, the center of curvature of the rail lies in the center of the support plates.
  • FIG. 9 shows a further modification of the integral unit 2 of the vertebral prosthesis 1, the upper or inner splint 7 being bent or angled over several sections of its length in the direction of the splint 8 of the integral unit 3 (not shown) Parts 31 ', which form a guide for the other, lower rail 8.
  • FIG. 10 shows a schematic side view of a vertebral prosthesis 1, here that according to FIG. 1, in the inserted state, the bow-like configuration of the vertebral prosthesis 1 being evident. Furthermore, an implant 32 located between the support plates 4 and two bone screws 33 screwed laterally into the adjacent healthy vertebral bodies (e.g. 34) through the holes 13 in the connecting pieces 6 can be seen. Likewise, the mandrels 10 and 11 penetrating into the vertebral bodies 34 or into the implant 32 are shown in broken lines.
  • the vertebral prosthesis 1 shown in FIG. 11 essentially consists of the same parts as the vertebral prosthesis 1 shown in FIG. 1.
  • the walls 4 ′ and 4 that are directed toward and adjoin one another from the support plates 4 are different here ", which form two nestable boxes that enclose the receiving space for the implant.
  • FIGS. 12 and 13 show the two halves 2 and 3 of the vertebral prosthesis 1 from FIG. 12 with the walls 4 'and 4 "in view.
  • the vertebral prosthesis 1 shown in FIG. 14 also consists essentially of the same parts as the vertebral prosthesis 1 shown in FIG. 1, but here the connecting pieces 6 are arranged on the side of the support plates 4 opposite the spacer 9. Furthermore, the support plates 4 are round and the rails 7, 8 of the spacer 9 and the connecting pieces 6 are convexly curved in a section transverse to the longitudinal axis with respect to the longitudinal axis of the vertebral prosthesis, namely with a radius of curvature, the center point of which corresponds to the center points of the support plates 4 coincides. At the same time, these rails form part walls of the receiving space. In this embodiment, only one bore for a screw shaft is shown as a fastening means in the outer rail (here 7).
  • both rails 7 and 8 provided part of the fastening means, such as the screw head or a nut on the lower (not visible) side of the rail 8 are preferably sunk.
  • the implant must be drilled through in order to be able to pass a tool, such as a key.
  • the projections 31a here form a lateral guide for the other, lower rail 8.
  • the rail 8, not shown can of course also have such projections 31a.
  • the projections 31a can also have hook-like extensions at their ends for engaging behind the rail 8.
  • the bracket 31b arranged in the end region of the outer rail 8, which in the assembled state, the other rail 7 with play (um a "ratcheting" of the teeth of the rails 7, 8 in the longitudinal adjustment to allow one to lie).
  • the bracket 31b also has the purpose of better holding the two integral units 3 that make up the vertebral prosthesis together in the not yet fixed state.
  • the unit 3 also has a modified connecting piece 6 with two lateral openings 13 for receiving two bone screws (not shown) in two laterally projecting tongues.
  • the mandrels 10 which protrude outward and prevent the penetration of these bone screws are omitted here (cf. also FIG. 17).
  • FIG. 18 shows a device 35 which is used during the operation in connection with the vertebral prosthesis 1 (not shown).
  • the device 35 consists of two arms 36 and 37 lying parallel to one another in one plane, which are connected to one another by two parallel guide rods 40 and an adjusting rod 41 preferably lying in the same plane.
  • the end portions of the arms 36 and 37 each have Threaded bores 46 for fastening interchangeable inserts 38, 39 by means of screws 47.
  • These two inserts in turn each have a bore 48 for the recessed receiving of the screw 47, as well as a bore 43 for receiving screws 42 for fastening the vertebral prosthesis 1 (not shown here) via its connecting pieces 6.
  • the guide rods 40 are in bores pressed into arm 36 and displaceable in bores 49 in arm 37.
  • the guide rods 40 have stops 50 at their ends.
  • the adjusting rod 41 has a pressed-on knurled disk 52, a shoulder 51 and a threaded section 44, which threaded section engages in a threaded bore 53 in the arm 37.
  • the section between the shoulder 51 and the knurled disk 52 can be freely rotated in a bore 54 in the arm 36.
  • the knurled screw 52 is rotated, the two arms 36 and 37 are then pushed apart or pushed together parallel to one another, depending on the direction of rotation, as a result of which, when the vertebral prosthesis is screwed on, the spacer 9 of the (not shown) vertebral prosthesis 1 is opened or closed .
  • a scale 45 for reading the distance of the two arms 36 and 37 from one another or the required size of the spinal prosthesis or the implant is attached to one of the guide rods 40.
  • a large number of variants are available for training the leadership.
  • the simplest is just a rotating rod that also carries the thread for the adjustment device. If the overall height is large enough, the guide rods do not have to protrude. Also, no rods have to be used - for example, a slotted plate, in the slot of which the threaded rod is rotatably arranged, is a possible alternative.
  • the adjusting device can also be designed differently.
  • inserts can be attached to the arms of the device in any way, for example also by dovetail tongue and groove. If one dispenses with the other applications and only wants to hold the spinal prosthesis, the inserts shown in FIGS. 18 and 19 can also be integrally connected to the arms. A variation of these inserts is advantageous, however, because of the possibility of using an insert according to Fig. 20. Further practical inserts can be used, e.g. Measuring inserts in connection with a scale between them and the like.
  • the distance to be bridged by the vertebral prosthesis is achieved by inserting the device 35 into the spine, spreading the device 35 by turning the knurled screw 52 until the outsides of the inserts 38 and 39 abut the end faces of adjacent vertebral bodies and reading the distance A on the scale 45 detected.
  • the device 35 is then removed from the spine again and a suitable vertebral prosthesis 1 is selected on the basis of the now known distance A.
  • the inserts for the outer mandrels in the adjacent vertebral body surfaces can now be pre-pierced with inserts according to FIG. 20.
  • the spinal prosthesis 1 is now connected to the device 35 in a partially pushed-together state by means of the screws 42 engaging in the openings 13 (here designed as threaded bores) of the connecting pieces 6, inserted into the spine by means of the device 35 and there except for the spread right length. It is even more advantageous to attach the vertebral prosthesis to the inserts for holding it in the measured length. The prosthesis can thus be securely anchored in the spine immediately with little effort. After the device 35 has been removed from the surgical wound, bone screws can then be screwed through the openings 13 in the connecting pieces 6 and the length can be finally fixed.
  • the most preferred embodiment of the vertebral prosthesis 1 is that according to FIG. 7, in which, however, the convex curved rails according to FIG.
  • the two parts 2 and 3 of the vertebral prosthesis 1 are turned from one piece and the double mandrels 10, 11, which are also turned, are inserted subsequently.

Abstract

Il est décrit une prothèse vertébrale destinée à être appliquée à la place d'une ou de plusieurs vertèbres fracturées, présentant deux plaques d'appui prévues pour reposer sur les faces frontales de vertèbres stables voisines, lesdites plaques d'appui présentant des pointes assurant un ancrage dans lesdites vertèbres voisines et étant reliées par une pièce d'écartement réglable en longueur, prothèse dans laquelle la pièce d'écartement (9) est montée excentrée par rapport à l'axe longitudinal de la prothèse (1) défini par les centres des plaques d'appui (4), et présente deux barres (7, 8) munies de dents (14) qui s'engrènent les unes avec les autres, sur les faces opposées, lesdites barres (7, 8) étant reliées entre elles au moyen d'une vis (17), cependant qu'il est prévu entre les plaques d'appui (4), un espace libre destiné à recevoir un implant (32) en un matériau naturel et/ou synthétique. En outre, il est décrit un dispositif pour la manipulation et, en particulier, la mise en place de cette prothèse.
PCT/AT1991/000090 1990-07-24 1991-07-24 Prothese vertebrale WO1992001428A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
AT0155790A AT394307B (de) 1990-07-24 1990-07-24 Wirbelprothese
ATA1557/90 1990-07-24

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

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EP (1) EP0540559A1 (fr)
JP (1) JPH06500711A (fr)
AT (1) AT394307B (fr)
AU (1) AU8098091A (fr)
CA (1) CA2088066A1 (fr)
WO (1) WO1992001428A1 (fr)

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EP0639351A2 (fr) * 1993-08-20 1995-02-22 ULRICH, Heinrich Implant pour le remplacement d'une vertèbre et/ou stabilisation de la colonne vertébrale
WO1995025485A1 (fr) * 1994-03-23 1995-09-28 Schnorrenberg Chirurgiemechanik Gmbh Dispositif de positionnement et de soutien pour la colonne vertebrale
WO1998046173A1 (fr) * 1997-04-15 1998-10-22 Synthes Ag Chur Prothese de vertebre telescopique
WO1999038460A1 (fr) * 1998-01-30 1999-08-05 Königsee Implantate und Instrumente zur Ostheosynthese GmbH Implant pour corps vertebral, ajustable en hauteur
FR2774280A1 (fr) * 1998-01-30 1999-08-06 Dimso Sa Implant pour remplacer une vertebre
WO1999039665A1 (fr) * 1998-02-06 1999-08-12 Biedermann Motech Gmbh Espaceur a longueur axiale reglable
WO1999063913A2 (fr) * 1998-06-05 1999-12-16 Surgicraft Limited Implant chirurgical
WO2000049977A1 (fr) * 1999-02-26 2000-08-31 Williams Lytton A Procede et appareil d'ancrage d'implant intervertebral
EP1080703A2 (fr) 1999-09-02 2001-03-07 Howmedica Osteonics Corp. Implant vertébral
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AT394307B (de) 1992-03-10
JPH06500711A (ja) 1994-01-27
ATA155790A (de) 1991-09-15
EP0540559A1 (fr) 1993-05-12
CA2088066A1 (fr) 1992-01-25
AU8098091A (en) 1992-02-18

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