WO1996022747A1 - Interbody cavity type implant, and instrumentation and method for positioning same - Google Patents

Interbody cavity type implant, and instrumentation and method for positioning same

Info

Publication number
WO1996022747A1
WO1996022747A1 PCT/FR1996/000108 FR9600108W WO9622747A1 WO 1996022747 A1 WO1996022747 A1 WO 1996022747A1 FR 9600108 W FR9600108 W FR 9600108W WO 9622747 A1 WO9622747 A1 WO 9622747A1
Authority
WO
Grant status
Application
Patent type
Prior art keywords
implant
tool
end
instrument
body
Prior art date
Application number
PCT/FR1996/000108
Other languages
French (fr)
Inventor
Gilles Gagna
Pierre Antonietti
Original Assignee
Stryker Corporation
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

Links

Classifications

    • AHUMAN NECESSITIES
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    • 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
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/4611Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of spinal prostheses
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    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1671Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
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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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    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
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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
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4629Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof connected to the endoprosthesis or implant via a threaded connection
    • 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
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4681Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor by applying mechanical shocks, e.g. by hammering
    • 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
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4687Mechanical guides for implantation instruments
    • 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
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0004Rounded shapes, e.g. with rounded corners
    • 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
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0017Angular shapes
    • A61F2230/0021Angular shapes square
    • 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
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0017Angular shapes
    • A61F2230/0026Angular shapes trapezoidal
    • 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
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0028Shapes in the form of latin or greek characters
    • 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
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063Three-dimensional shapes
    • A61F2230/0082Three-dimensional shapes parallelepipedal

Abstract

An interbody cavity type implant (10) for insertion into a hole provided in a region separating two adjacent vertebral bodies. The implant includes an elongate rigid body and has a generally non-circular cross-section. Said implant is designed to be inserted into a generally cylindrical hole and its front end comprises a plurality of sharp ridges (16a) forming gouges which, by impaction, can shape the hole according to the cross-section of the implant. Instrumentation for positioning the implant is also disclosed.

Description

IMPLANT TYPE INTERSOMATIC CAGE AND INSTRUMENTS AND METHOD FOR INSTALLATION

The present invention relates generally the interbody implants used in spinal trauma.

It relates more particularly to a novel rigid interbody fusion cage and a tooling and a method for its installation.

Conventionally, such an implant is in the form of a cylindrical body in biocompatible metal or metal alloy. A cylindrical hole is formed by means of a rotary tool in the intervertebral space and the implant is positioned in the hole, using a relatively crude ancillary. This implant and method for laying however suffer from a number of drawbacks

First, because of the circular shape of the implant, the stability of the position of the latter is not guaranteed. In addition, its installation using a non-specific ancillary is extremely difficult and tedious, in particular inasmuch as it is necessary to prepare the hole for the implant and implant placement, to maintain body vertebral properly discarded. Practically, it is common that after a setting operation of an interbody cage, it takes the game is moving and no longer fulfills its function.

already known by OA-89 09035 cylindrical implants with the aforementioned drawbacks. The same document also discloses a square implant, inadequate section to a cylindrical bore, and the preparation work of the hole becomes much more tedious.

The present invention aims to overcome the disadvantages of the prior art. Thus the present invention provides firstly u cage-type intervertebral implant, of the type for andR received in a hole formed in a region between two adjacent vertebral corp, and comprising an elongated body rigige whose section is non-circular overall shape , characterized in that it is intended to be received in a generally circular tro and in that it comprises at front end so a plurality of sharp edges forman gouges allow by impaction, to shape the next hole section of 'implant.

Preferred, but not limiting of this implant are:

- the cross section of the implant is of generally square form with rounded corners and in that its front side is generally concave, to thereby form four sharp edges forming gouges and for driving bone debris torn by the edges when impaction.

- the upper and lower faces of the implant each include a detent for self-stabilization of the implant in its housing.

- top, bottom and side of the implant faces have a slightly concave profile.

- the implant comprises in the region of its rear fac means for the soil idar isat ion u instrument for its installation in its housing by a posterior approach.

- the securing means comprise a threaded hole centrally formed in said rear face. - the implant further comprises in the region of its rear face means for indexing in the axial direction and rotation of the implant relative to said instrument. - the indexing means comprise a groove formed in said rear face and the bottom of which is formed the tapped hole.

- the implant comprises in the region of its front face means for securing an instrument for its implementation in its housing by an anterior approach.

- the securing means comprise a threaded bore formed centrally in said front face. - the implant comprises a through-hole extending between its upper and lower faces.

- the upper and lower faces of the implant are oriented parallel.

- upper and lower faces of the implant are slightly inclined with respect to one another, so as to treat the case of a lordosis.

According to a second aspect of the invention there is provided a combination of a cage-type intervertebral implant and instrumentation for its installation posteriorly in a region between two vertebral bodies, characterized in that the implant comprises an elongate body rigige having a non-circular overall shape of section and having at its front end a plurality of sharp edges forming gouges, the implant also having at its front end and a threaded means forms a complementary indexing means and further characterized in that one instrumentation comprises:

- a first elongated tool for distraction of the adjacent vertebral bodies between which the implant is to be placed; - a tubular guide instrument to be half in place around the first tool and comprising means intended to be anchored in the vertebral bodies to handle to maintain their spacing after distraction, and handle retaining said guide instrument in a position reference,

- a second tool reamer to be CERs in the guide instrument and to form by rotation u cylindrical hole of revolution between the vertebral bodies and

- a third tool in place of the implant impaction pa, having at one end thread means for co-operating with the thread means of the implant and u indexing means intended to cooperate with the indexing of moye implant and intended to be engaged ave the implant in the guide instrument.

Preferably the first tool comprises a corp having at one end a portion of distraction of elongated section, and at the other end a removable grip.

Particularly advantageously, the tubular guide instrumen has an inner section that can tell engaged practically without play but ave rotatably about the first tool. According to a preferred embodiment, the tubular guide instrumen comprises at one end two pin intended to be engaged by impaction in both vertebral corp. Also preferably, the instrumentation further comprises a tool impaction blind cooperating with the end of the guide instrument opposite to the pins passing around the homologous end of the first tool, which overflows said guide instrument, and via which impacts can be applied to the guide instrument.

According to an advantageous characteristic, the second tool comprises a body capable of being engaged substantially without clearance, but with the possibility of rotation in the tubular guide instrument at a first end of the body section being provided a reamer appetizers all equal or smaller than the body, and at a second end of the body being provided a rotary drive handle.

According to another advantageous characteristic, the third tool comprises a hollow body capable of being engaged substantially without clearance, but with the possibility of rotation in the tubular guide instrument, a rod slidably and rotatably mounted in the hollow body and having at one first end of the threaded means in the form of a threaded rod and a second end a drive wheel for rotating the rod, and said hollow body carries at its homologous end of the first end of the rod indexing means cooperating with the indexing means of the implant.

Other aspects, objects and advantages of the present invention will become more apparent from reading the following detailed description of a preferred embodiment thereof, given by way of example and with reference to the accompanying drawings, : Figure 1 is a top view of an intervertebral cage according to the invention, Figure 2 is a sectional view according to line II-II of Figure 1, Figure 3 is a view according to arrow III of Figure 1, Figure 4 is an enlarged elevational view of a detail of the cage of figures 1 to 4, 5a and 5b are two views in side elevation of a portion of a tool used in a first step of laying the cage of figures 1 to 4, Figure 6 is a partial axial sectional view of a portion of the tooling used in a second stage of installation, Figure 7 is a partial axial section a portion of the tooling used in a third step of laying, has 8 is a partial axial sectional view of a portion of the tooling used in a fourth stage of installation, Figure 9a is a side view of a portion of the tooling used in a fifth stage of installation, Figure 9b is an axial sectional view of the horizontal part of the equipment of Figure 9a, Figure 10 is a partial axial section of a portion of the tooling used in a sixth step of laying, FIG 11 is a partial axial sectional view of a portion of the tooling used in a seventh step of laying, and Figure 12 is a schematic view in side elevation of an intervertebral cage according to one embodiment of the invention .

preliminarily Note that, from one figure to another, elements identical or similar parts are designated as far as possible by the same reference signs.

Referring firstly to Figures 1 to 4, there is shown an interbody implant type cage 10 which has the general shape of an elongate body of generally square section with rounded corners. The upper face, bottom and side all have an oriented concavity, intended to promote the angular stability 1'implant.

The upper and lower faces 11a, lib of the cage each have a detent 12 for the stabilization of the implant in position between two vertebral bodies, this latching ensures anchoring in the adjacent bone walls and therefore a good blocking of the implant against movements in axial direction. This detent is shown in detail in Figure 4, with regard to the upper side, and has a series of transverse teeth 12a of symmetrical triangular profile whose vertex angle is designated α.

The end of the implant to the right in Figures 1 and 3 (so-called front end) has a concave face 16, for example sphere-shaped portion.

This concavity to define, at the rounded corners of the implant at the front, four cutting edges which, as discussed below, act as gouges during implant placement. The center of the concave face 16 is provided an axial threaded bore 17, for purposes explained below.

The opposite or rear side of the implant, as shown in Figures 1 to 3, is generally straight. It has over its entire width a transverse groove little prodonde 13 with straight edges, the center of which are practiced a threaded axial bore 14.

Finally, the implant 10 is traversed from side to side, input its upper and lower faces 11a, lib, with an oblong and Stage 15 of constant cross section, in order explained below.

We will indicate below preferred but in no way limiting dimensions for the cage intersomatiqu described above: overall length: 25 mm width: 10.5 mm Width: 10.5 mm radius of curvature of the rounded corners: 2.2 mm radius of curvature of the concavity oriented: 20 mm concave radius of curvature of the face 16: 8 mm apex angle α of the anchoring teeth 90 ° tooth width: 2 mm height of the teeth: 1 mm height groove 13: 5 mm depth of the groove 13: 0.5 mm

will now be described in detail a instrumentation and method for installing the implant described dessu in the space between two vertebral bodies of the human spinal, and the various functions provided by the geometry of the implant.

We first carried out, conventionally, the preparation of the way first. Is then performed, not illustrated faço, partial distraction of the intersomatic spaced from the side of the disc opposite to that o is about to be treated.

Referring now to Figures 5a and 5b, there shown a distraction tool generally designated by 100, which comprises a reference main body 10 cylindrical. At one end of this corp extends axially an intermediate portion 104 having its free end a tool-shaped spatula 106 of oblong profile, for example elliptical.

At the opposite end of the body extends axially on a rod 108 which can be removably mounted, for example clipped, a handle 109 for maneuvering the reference 107 denoting an unlocking member of said handle.

It is observed in Figure 6 that the latching is effected by bringing a groove 108a formed in the stem 108.

The tool 100 as shown in Figures 5a and 5b allows, as a first step of the laying method of the implant, a distraction of the two vertebral bodies CV1 and CV2 between which the implant is to be placed. More specifically, by inserting force the tip 106 into the intervertebral space, and by rotating the tool about a quarter turn according to arrow F5 in Figure 5a, is brought to the two vertebral bodies to deviate from an appropriate distance (Figure 5b). This distance determined by the width of the spatula 106, is preferably slightly less than the height of the intersomatic cage to ask.

Now with reference to Figure 6, there is illustrated the tool 100 held in the position of Figure 5b, the handle 109 has been withdrawn. It then engages the cylindrical body 102 of the tool 100 a tool generally designated 110. This instrument comprises a hollow cylindrical barrel 112 whose inner diameter is slightly smaller than the outer diameter of the body 102 of the tool 100. It was comprises at its end facing the spine two pointed pins 113 arranged diametrically mounted on the shaft via a ring spindle head, and at its opposite end a handle 114 secured to the shaft 112. ^ is furthermore observed on Figure 6 that the two pins 113 of instrument 110 are arranged to be at the right of the two vertebral bodies respectively CV1, CV2. The instrument 110 is intended, in the following installation procedure, to ensure an operating guide defining an axis of reference response, and as will be seen below to maintain the body vertebra properly spaced from the other. It will be noted that after having engaged the guide instrument 110 on the tool 100, some alignment adjustment can be performed inch align with respect to the patient's longitudinal axis.

Now with reference to Figure 7, there is represented the instrument 110, the tool 100 contained inside thereof, and another tool generally indicated by 12 for allowing to apply axial impacts the instrument 110 . This tool 120 has the shape of a blind which you a cylindrical skirt 122 surrounds, av match, the end portion of the tool 100 which projects through the open end of the instrument 110 and which part u peak 124 is located away from the end tool 100. the free edge of the skirt 122, opposite the somm 124, abuts on the hollow cylindrical body 112 of instrument 110 at the handle 114.

Impacts are then applied according to arrow F7 s the top 124 of the tool 120, these impacts are transmitted the guide instrument 110 for placing the two broch 113 in the respective vertebral bodies CV1, CV2, in the manner of a nailing. It will be observed that an operation performed while the first tool 100 remains in place e provides distraction of the two vertebral bodies.

Figure 7 shows the position of the instrument 110 at the end of this operation. Once this is done, the bell 120th withdrawn, the handle 109 is raised and the 100 u traction tool may be exerted on the tool 100 by means of said handle to extract the blade 106 of the intervertebral espa and completely remove the tool 100 of the guide instrument. The instrument 110 then is, for any further operations, a tool guide as we will see below.

Referring now to Figure 8, was inserted into the instrument guide 110 instead of the first tool 100 a second tool 130. The tool 132 comprises a cylindrical body whose diameter is slightly smaller than the inside diameter of the barrel 112, a stem 134 extending axially at one end of body 132 and a reamer 136 provided at the free end of the rod 134.

At its opposite etrémité, the tool 130 includes a fixed or removable handle 138. By rotating the tool 130 using handle 138 and simultaneously exerting pressure on the tool is made in the space between the vertebral bodies a cylindrical bore of revolution. The movement of the tool 130 are symbolized by the arrow F8.

Preferably, the diameter of the reamer 136 is equal to the width and the overall height of the implant 10 described with reference to Figures 1 to 4. These dimensions are chosen to be slightly greater than the height of the interbody space, determined by the width of the spatula 106 of the tool 100. Thus, one reamer removes the disc material, and also a small amount of bone material in the vertebral plates.

Once a suitably deep hole has been formed (this depth can be controlled for example by a stop cooperating between the tool 130 and the guide 110, or by a scale formed on the body 132 of the tool 130) the latter is then extracted from the guide 110.

The following operation consists in mounting the implant on a third tool 10 shown in Figures 9a and 9b. The light 15 of the implant is pre-filled with bone grafts that will be used after installation to establish a bone connection between the two vertebral bodies.

This tool 140 is in two parts, namely an outer part comprising a cylindrical barrel 141 and an inner portion having a cylindrical body 1 can slide and rotate freely, but pratiqueme without play in the shaft 141.

The drum 141 includes at its left front end in Figures 9a and 9b) an extension cylindrical n, more particularly an extension 1 limited by two straight edges whose distance is very slightly less than the distance between the righ edges of the groove 13 of the implant. Near its rear extremi, the outer part of the tool 140 COMPOR two wings 148, for reasons explained below.

The inner part of the tool 140 comport extending axially from body 143 at its front extremi, a threaded rod 144. The threaded rod passes freely through the end of the outside of the tool 140 in which is practiced extension 14 a shoulder 146 formed in the outer shaft 141 limits the axial displacement of the inner portion of the tool.

At its opposite end, the body 143 is severally a knob 145 for rotating it.

The assembly of the implant 10 of the 140 effect tool threadably engaging the threaded rod 144 in the threaded SAFTA 14 of the implant, while the end 142 of the outer part is held in alignment of the groove 13 of the implant. Rotation of the threaded rod 14 is carried out using the dial 145.

After tightening, the implant 10 is secured to the outi 140 both in translation and in rotation, through the cooperation of the screw and complementary form between the formed end 142 of the tool and the groove 13

The assembly thus obtained, shown in Figures 9 and 9B, is engaged in the guide instrument 110.

Referring now to Figure 10, one observes that the shaft 112 of the instrument 110 has at its rear extrémit (right) two notches 112a which are adapted to receive the wings 148 of the tool 140. In this tool the handle 140 can be inserted into the instrument 110 as guided in a specific angular position, which corresponds to a position of the implant 10 wherein the top walls and bottom 11a, lib are vis-à-vis two vertebral bodies. then applied to the tool 140, at the wheel of the 145 axial impacts. These impacts allow the implant to penetrate gradually into the cylindrical bore formed by the reamer (see Figure 8), the four sharp edges 16a of the implant as described above acting as gouges to enlarge in their area the tapped hole by attacking the bone material of the vertebral bodies. It will be observed here that the concavity of the front face 16 of the implant 10 allows, as this machining work progresses, to expel the bone chips that are released ahead of the implant, by accumulating the bottom of the hole . It is the implant itself, according to an important feature of the invention, which acts as a latest tool for its installation. Thus, it is the implant that conforms itself, from a cylindrical pilot hole of revolution, a housing having exactly the same section as the implant, which ensures its stability.

Once the implant is positioned at the desired depth (concretely determined by the abutment of the flanges 148 at the bottom of the grooves 112a), the knob 145 of the tool 140 is rotated to unscrew the threaded shank 144 of the threaded bore 14 and release the tool 140. This movement is symbolized by the arrows Fila. The tool 140 is then extracted from the guide instrument 110, either in one step or in two steps (indoor and outdoor). Reference is made to Figure 11 illustrating the partial withdrawal of the inner part of the tool 140.

Finally, by pulling at the handle 114 (Fllb arrows), the guide instrument 110 is separated from the vertebral bodies CV1, CV2. The two vertebral bodies so naturally tend to approach and grip the implant 10. The serrated surfaces 12 thereof are anchored then in the bone tissue of the vertebral bodies inch further improve the stability of the implant.

vertical light here be observed that 15 formed in the implant and filled grafts before laying perm ensure over time bone cell binding through it between the vertebral bodies over- and underlying. Note in this regard that the self-cutting action of the STAKE during laying ensures a cleaning vis-à-vis faces of two vertebral bodies, to facilitate the socket on the graft.

Thus has been described an instrumentation and a trial pose of an intervertebral cage posteriorly q has a number of advantages. The wo is performed quickly and with great precision and stability of the implant once installed is excellent.

As described with reference to Figures 1 to 3 the implant 10 also has a threaded bore 17 da anteriorly. This bore allows it to be solidari from the front to the tool 140, to allow a pose anterior voi when it is necessitated. In case c, the housing for the implant is at least partielleme preformed by hand. with reference to Figure 12, there is shown an implant alternative embodiment suitable for situati lordosis, that is to say a non-parallelism between the faces vis-à-vis the two vertebral bodies (cases of lumbar vertebrae). In this case, the upper and lower faces 11b li of the implant 10 have a CERTAI skew relative to each other, adapted to the lordosis in this case, the hole with the aid of this reamer a diameter substantially equal to the smallest height 1'implant.

Of course, the present invention is not limited nullemen to the embodiments described and shown but the man of the art can apply any variant o modification within the spirit.

Claims

1. An implant (10) of the intervertebral cage type, of the type intended to be received in a hole formed in a region between two adjacent vertebral bodies (CVI, CV2), and comprising an elongate body rigige whose section is non-circular overall shape characterized in that it is intended to be received in a generally circular hole and in that it comprises at its front end a plurality of sharp edges (16a) forming gouges allow by impaction, to shape the hole according to the section of the implant.
2. Implant according to claim 1, characterized in that its cross section is generally square with rounded corners and in that its front face (16) is generally concave, thereby forming four sharp edges forming gouges (16a) and effecting drive of bone debris torn by the edges during impaction.
3. Implant according to claim 2, characterized in that its upper and lower faces (11a, lib) each comprise a detent (12) for self-stabilization of the implant in its housing.
4. Implant according to one of claims 2 and 3, characterized in that the top, bottom and sides of the implant have a slightly concave profile.
5. Implant according to one of claims 1 to 4, characterized in that it comprises in the region of its rear face means (14) for the fastening of an instrument for its implementation in its housing by a posterior approach.
6. Implant according to claim 5, characterized in that the securing means comprise a threaded tro (14) formed centrally in said rear fac.
7. Implant according to claim 5 or 6, charac in that it further comprises in the region of its rear fac means (13) for indexing in axial directio and rotation of the implant relative audi instrument.
8. Implant according to claims 6 and 7 taken th combination, characterized in that the means of indexatio comprise a groove (13) formed in said rear fac and the bottom of which is formed the tapped tro.
9. Implant according to one of claims 1 to 8 characterized in that it comprises in the region of its front fac means (17) for the u fastening instrument for its implementation in its housing a path pa earlier.
10. Implant according to claim 5, characterized an that the securing means comprise a threaded tro (17) formed centrally in said front face
11. Implant according to one of claims 1 to 10 characterized in that it comprises a light passing through (15) extending between its upper and lower faces.
12. Implant according to one of claims 1 to 11 characterized in that its upper and lower surfaces (lla, 11b) are oriented parallel.
13. Implant according to one of claims 1 to 11 characterized in that its upper and lower faces (11a, lib) are slightly inclined relative one another.
14. A combination of an implant (10) type intersomatic cage and instrumentation for its installation posteriorly in a region between two vertebral bodies (CVI, CV2), characterized in that the implant comprises a body rigige having a non-elongate generally circular section and having at its front end a plurality of sharp edges (16a) forming gouges, the implant also having at its rear end a threaded means (14) and an indexing means (13 ) with complementary shapes, and further characterized in that the instrumentation comprises:
- a first elongated tool (100) for the distraction of the adjacent vertebral bodies between which the implant is to be placed;
- a tubular guide instrument (110) to be placed around the first tool and comprising means (113) intended to be anchored in the vertebral bodies so as to maintain their spacing after distraction, and to retain said instrument guiding in a reference position,
- a second tool (130) reamer to be received in the guide instrument and forming a cylindrical hole by rotation of revolution between the vertebral bodies, and
- a third tool (140) in place of the implant by impaction, having at one end thread means (144) for cooperating with the threaded means of the implant and an indexing means (142) for cooperate with the indexing means of the implant and intended to be engaged with the implant (10) in the guide instrument.
15. The combination of claim 14, characterized in that the first tool (100) comprises a body (102) having at one end a portion of distraction (106) of elongate section, and at the other end a removable handle (109 ).
16. The combination of claim 15 characterized in that the tubular instrument radio control (110) has an inner section as little engaged practically without play but with possibility of rotation about the first tool (100).
17. The combination of claim 16 characterized in that the tubular instrument radio control
(110) has at one end two pins (113) to be engaged by impaction in the two bodies vertébrau (CVI, CV2).
18. The combination of claim 16 or 17 characterized in that the instrumentation comprises outr a tool impaction (120) cooperating with the end of the guide instrument (110) opposite the pin Passan around the homologous end of the first tool (100), that beyond said guide instrument, and the intermediair which impacts can be applied to the guiding of instrument.
19. Combination according to one of claims 16 18, characterized in that the second tool (130) include an a body (132) engageable substantially san game but with possibility of rotation, in the tubular guide instrumen at a first end of the corp being provided a reamer (136) of overall section equal to o lower than the body, and at a second end of the body being provided a handle (138) e rotary drive.
20. Combination according to one of claims 16 19, characterized in that the third tool (140) include an a hollow body (141) engageable pratiquemen snugly, but rotatably, the tubular instrument dan guiding a rod (143) slidably and rotatably mounted in the hollow body and having at one end the screw means (144) in the form of a threaded rod and a second end a knob (145) rotary drive of the stem, and in that said hollow body (141) carries at its homologous end of the first end of the rod of the indexing means (142) cooperating with the indexing means (13) of the implant (10) .
PCT/FR1996/000108 1995-01-24 1996-01-23 Interbody cavity type implant, and instrumentation and method for positioning same WO1996022747A1 (en)

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FR95/00760 1995-01-24
FR9500760A FR2729557B1 (en) 1995-01-24 1995-01-24 cage interbody implant type, and instrumentation and process for its installation

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EP1083829A1 (en) * 1998-06-09 2001-03-21 Infineon Technologies AG Device for preparing a space between adjacent vertebrae to receive an insert
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US6302914B1 (en) 1995-06-07 2001-10-16 Gary Karlin Michelson Lordotic interbody spinal fusion implants
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US6966912B2 (en) 1998-06-09 2005-11-22 Sdgi Holdings, Inc. Device and method for preparing a space between adjacent vertebrae to receive an insert
WO2000024327A3 (en) * 1998-10-28 2000-11-09 Sdgi Holdings Inc Interbody fusion grafts and instrumentation
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US9078768B2 (en) 1999-03-05 2015-07-14 Warsaw Orthopedic, Inc. Arcuate interbody spinal fusion implant having a reduced width and an anatomically conformed trailing end
US8882835B2 (en) 1999-03-05 2014-11-11 Warsaw Orthopedic, Inc. Interbody spinal fusion implant having an anatomically conformed trailing end
US6241770B1 (en) 1999-03-05 2001-06-05 Gary K. Michelson Interbody spinal fusion implant having an anatomically conformed trailing end
US8343220B2 (en) 1999-05-05 2013-01-01 Warsaw Orthopedic, Inc. Nested interbody spinal fusion implants
US7022137B2 (en) 2000-04-19 2006-04-04 Sdgi Holdings, Inc. Bone hemi-lumbar interbody spinal fusion implant having an asymmetrical leading end and method of installation thereof
US8834569B2 (en) 2000-04-19 2014-09-16 Warsaw Orthopedic, Inc. Artificial hemi-lumbar interbody spinal fusion cage having an asymmetrical leading end
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US7156875B2 (en) 2000-04-19 2007-01-02 Warsaw Orthopedic, Inc. Arcuate artificial hemi-lumbar interbody spinal fusion implant having an asymmetrical leading end
US6666890B2 (en) 2000-04-19 2003-12-23 Gary K. Michelson Bone hemi-lumbar interbody spinal implant having an asymmetrical leading end and method of installation thereof
US8323340B2 (en) 2000-04-19 2012-12-04 Warsaw Orthopedic, Inc. Artificial hemi-lumbar interbody spinal implant having an asymmetrical leading end
US6821280B1 (en) 2000-08-03 2004-11-23 Charanpreet S. Bagga Distracting and curetting instrument
US7918855B2 (en) 2000-12-14 2011-04-05 Warsaw Orthopedic, Inc. Spinal interspace shaper
US8377063B2 (en) 2000-12-14 2013-02-19 Warsaw Orthopedic, Inc. Method for preparing a space in the human spine
US7611514B2 (en) 2000-12-14 2009-11-03 Warsaw Orthopedic, Inc. Spinal interspace shaper
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US9463098B2 (en) 2001-04-02 2016-10-11 Warsaw Orthopedic, Inc. Spinal fusion implant with bone screws and a bone screw lock
US6989031B2 (en) 2001-04-02 2006-01-24 Sdgi Holdings, Inc. Hemi-interbody spinal implant manufactured from a major long bone ring or a bone composite
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US9289309B2 (en) 2002-12-19 2016-03-22 DePuy Synthes Products, Inc. Intervertebral implant
US8460380B2 (en) 2004-02-13 2013-06-11 Franz Copf, JR. Intervertebral implant and surgical method for spondylodesis of a lumbar vertebral column
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US8876835B2 (en) 2009-12-28 2014-11-04 Safe Orthopaedics Device for positioning an implant
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