WO1998010722A1 - Cage d'osteosynthese expansive - Google Patents

Cage d'osteosynthese expansive Download PDF

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Publication number
WO1998010722A1
WO1998010722A1 PCT/FR1997/001617 FR9701617W WO9810722A1 WO 1998010722 A1 WO1998010722 A1 WO 1998010722A1 FR 9701617 W FR9701617 W FR 9701617W WO 9810722 A1 WO9810722 A1 WO 9810722A1
Authority
WO
WIPO (PCT)
Prior art keywords
branches
cage
implant according
wedge
base
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/FR1997/001617
Other languages
English (en)
French (fr)
Inventor
Jean-Luc Chauvin
David Attali
David Attia
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Osteoimplant Technology Inc
Original Assignee
Cage Concepts LLC
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
Family has litigation
First worldwide family litigation filed litigation Critical https://patents.darts-ip.com/?family=9495900&utm_source=google_patent&utm_medium=platform_link&utm_campaign=public_patent_search&patent=WO1998010722(A1) "Global patent litigation dataset” by Darts-ip is licensed under a Creative Commons Attribution 4.0 International License.
Priority to PL97332161A priority Critical patent/PL185352B1/pl
Priority to BR9712820-1A priority patent/BR9712820A/pt
Priority to US09/117,469 priority patent/US6129763A/en
Priority to DE69730360T priority patent/DE69730360T2/de
Priority to IL12869597A priority patent/IL128695A/en
Priority to AU43055/97A priority patent/AU715283B2/en
Priority to CA002266126A priority patent/CA2266126C/fr
Priority to AT97919092T priority patent/ATE273674T1/de
Priority to EP97919092A priority patent/EP1014899B1/fr
Application filed by Cage Concepts LLC filed Critical Cage Concepts LLC
Priority to JP51332698A priority patent/JP4107397B2/ja
Publication of WO1998010722A1 publication Critical patent/WO1998010722A1/fr
Priority to NO19991228A priority patent/NO314121B1/no
Anticipated expiration legal-status Critical
Priority to US09/951,751 priority patent/US20020040243A1/en
Priority to US10/124,044 priority patent/US7828848B2/en
Priority to US12/887,283 priority patent/US8435299B2/en
Priority to US13/863,964 priority patent/US8790407B2/en
Priority to US13/863,857 priority patent/US8992621B2/en
Priority to US14/629,648 priority patent/US20150230934A1/en
Ceased legal-status Critical Current

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    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0073—Quadric-shaped
    • A61F2230/0076—Quadric-shaped ellipsoidal or ovoid
    • 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0004—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
    • A61F2250/0006—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting angular orientation

Definitions

  • the subject of the present invention is an expansive osteosynthesis cage.
  • the technical sector of the invention is the field of implantable bone implants or prostheses and the surgical methods for their implementation.
  • the main application of the invention is the production of implants intended to be slipped or inserted posteriorly between the vertebral plates of two consecutive vertebrae to maintain a given distance between them and restore the stability of the spine, for example to a failure of the corresponding joint, making the two vertebrae integral.
  • implants are mainly used, also called “cages”, some of which are hollow, rigid and monobloc, with internal-external communication lights, to house a bone graft which ensures, through said lights, the fusion subsequent of said graft with the adjacent vertebrae on either side: one can cite in this area the application for b revet WO 96/08205 published March 21, 1996 on a "Cone intervertebral fusion cage” and EP 637 440 published on February 8, 1995 on an “Interbody implant for spine”; these types of cages, however, have fixed and given external dimensions, while the distances between two vertebrae are not constant; in addition, the inclination of the intervertebral plates to which we want to restore a given angular position, does not allow the use of rigid boxes posteriorly; they can only be introduced by the anterior route.
  • cages comprising two substantially parallel branches and connected to a rigid body through which one can rotate, a worm screw system which then brings a corner, screwed onto said screw and initially placed from the side of the distal ends of the branches, towards their connection body, which separates the two branches angularly: one can then introduce such a cage of initial flattened shape between the vertebrae, then by screwing the axis of operation of the corner, one adjusts and a desired angle is imposed between the branches from a posterior access.
  • the problem is therefore to be able to have implants or cages allowing both to combine the geometry of a conventional rigid cage, on the one hand to facilitate their implantation and on the other hand to offer a large interior volume, and the possibility of increasing to a given value the diameter of the distal end of the cage relative to the end located on the side of its point of surgical insertion, once in place, and corresponds to the posterior face vertebrae, while having the least mechanical elements.
  • an expansive osteosynthesis implant comprising branches connected at one of their ends to a base pierced with an orifice, such that said branches and the base constitute a hollow cage whose, in the "resting" position ",
  • the general external shape is a cylinder or quasi-cylinder whose generator which generates it by turning around its axis of symmetry is either a straight line or has in its middle part a portion of curve such as a convex arc of a large radius and whose directrix on which the generator rests , which is also the cross section of the cylinder, is almost circular: we thus obtain a cylinder, either regular in revolution, or which we will qualify in this description as “ovoid” or “oval” and that l 'we will designate under the term cylinder or quasi-cylinder; at least part of the interior volume of the cage towards the distal ends of the branches, is in the form of a truncated cone almost of revolution whose largest base is on the side of said base, which implant comprises at least three branches
  • the position at “rest” is in fact the position of the implant before it is put in place and during it, that is to say without the shim positioned between its branches inside the cage which therefore has a cylindrical external volume of constant section; while the so-called “active” position is the final position of the implant, for example between two vertebrae, the branches being separated by the wedge placed in its final adjustment position, the general external shape of the cage then being almost frustoconical, s flaring from the base corresponding to the end of the implant located on the side of its point of surgical insertion towards the distal end placed most in the interior between the vertebrae.
  • the external surface of said branches is either knurled, or grooved, or threaded according to a profile of a net with projecting edges, or the like.
  • the base at least of the implant if not even the sides of the branches comprise at least two flat or not parallel flats, and each arranged symmetrically with respect to the axis of the implant between two successive branches; these flats, possibly supplemented by the general ovoid shape of the cage, allow better support after expansion by reducing the risks of rotation of the implant.
  • said ovoid shape can allow, better than if the external generator of the shape of the base cylinder of the cage at rest is a straight line, to return after expansion to a conical external profile without curvature and therefore to provide better support. distributed over the vertebral body and a good bone graft intake.
  • the orifice of said base is capable of receiving a closure cap for the interior volume of the cage: the latter can be screwed, for example, into said orifice, then also threaded; in all cases, this plug prevents the bone material from coming out and, depending on its material, it also stiffens the cage.
  • the result is new expansive osteosynthesis implants responding to the problem posed, in particular for the main application defined above.
  • the presence of at least four branches and possibly four to eight makes it possible to have a bilateral expansion, from where a better blocking on the walls of the two vertebral plates face to face, and the absence of rod or connecting piece, between the now hold said expansion and the orifice or plug of the end cap, ensures a large internal volume allowing to receive a significant amount of bone material, which improves consolidation and fusion junction in particular between the vertebrae that the we want to maintain; said filling being all the easier since there is a large orifice at the rear end of the cage in said base.
  • said orifice allows the vertebral endplates to be curetted through grooves located on the lower and upper faces of the cage between each branch.
  • the expansion system thus defined is very simple since it only comprises two parts which are, on the one hand, the end cage to which a plug and possibly an intermediate shim are added, as indicated below, but with no connecting member remaining after installation, since any rod or pin making it possible to position said shims and said plug is then removed.
  • the present invention therefore provides numerous advantages over existing implants and cages, such as those already mentioned which could be supplemented by others but which already show enough of them to prove their novelty and interest.
  • Figure 1 is a perspective view of an example of an implant in the "rest" position and with its different parts aligned along the same axis XX 'of implementation.
  • Figure 2 is a perspective view of the implant of Figure 1, in the "active" position, with the three previous parts assembled.
  • FIGS. 3A, 4A and 5A are respectively a sectional view, and two lateral axial views, one along the front face and the other along the rear face of a cage of another embodiment of an implant according to the invention in the "rest" position.
  • FIGS 3B, 4B and 5B show in the same views, the same cage with its complementary elements assembled as that shown in Figures 3A, 4A and 5A, but in the "active" position.
  • Figure 3C is a side view perpendicular to the axis of the implant of the embodiment of Figures 3, 4 and 5 in the "active" position.
  • FIGs 6, 7 and 8 are figures showing details of embodiment of the implant cage according to the invention.
  • Figures 9, 10 and 1 1 are respectively a partial side sectional view, and axial views along the front and rear sides of the embodiment of the implant shown in perspective in Figures 1 and 2.
  • Figures 12 , 13 and 14 represent a front view and a sectional view respectively of a non-screwed end block for the embodiments of Figures 1, 2, 9, 10 and 11, an end block and / or intermediate screwed of an embodiment according to Figures 3, 4 and 5 and of a closure plug of any of the embodiments according to the invention.
  • the expansive osteosynthesis implant comprises in a known manner branches 5 connected at one of their ends to a base 7 pierced with an orifice 8; according to an essential characteristic of the invention, said branches 5 and the base 7 constitute a hollow cage 1 of which, in the "rest" position, as shown according to the embodiments of FIGS. 1, 3A, 4A and 5A and of FIGS.
  • the general external shape is a cylinder or a quasi-cylinder whose cross section which is also the director of said cylinder, is circular or quasi circular, and whose generatrix which is supported on said director and which generates the cylinder or quasi-cylinder by turning around its axis of symmetry XX ', is either a straight line or an arc of a convex circle of large radius: we thus obtain either a regular cylinder of revolution as shown in lines solid 20j in FIG.
  • the length 1 of the threaded part of the branches 5 can be from 13 to 16 millimeters with a thread pitch p of 1.5 to 2 millimeters, an external diameter D of the cage revolution cylinder from 9 to 16 millimeters and a thread tooth height llj of the order of 0.7 to 0.9 millimeters for an opening angle ⁇ between each tooth of approximately 60 ° and a profile 11 2 internal thread with a radius of the order of 0.4 millimeter; said rounded shape of the profile reducing maximum stress concentrations and thus making it possible to withstand significant forces and shocks.
  • Such an external thread with protruding edges thus allows for easier positioning since it is not traumatic since there is no impact shock to insert said implant which is thus screwed into a prior drill hole using any tool compatible with the orifice 8 of the implant and on the other hand, such a thread ensures, after installation, anchoring in the bone, avoiding any subsequent migration.
  • the base 7 may comprise at least two flat areas 6 parallel or slightly inclined relative to one another to better adapt to the profile of the vertebrae, each arranged between two successive branches 5 as shown in the embodiments of the figures 1, 2, 9, 10 and 1 1; also, the base 7 may have four flats forming a square or pseudo-square section, as shown in the embodiments of Figures 3, 4 and 5; in addition to the base, the branches 5 themselves, especially if the section of the implant is almost circular, may also have a flat in the extension of at least those of the base, as shown in the exemplary embodiments of the figures 3 to 5, or not have any flat area at all, as in the example of FIGS. 1, 2 and 9 to 1 1; such flats can be replaced or at least supplemented by a longitudinal section of the implant of slightly oval or ovoid shape as mentioned above.
  • the orifice 8 of the base 7 can be threaded along a thread profile 15 as shown by way of example in FIG. 6, along a rounded thread pitch, both at the top and at the bottom of the groove with, for example, for the dimensional examples given above, an opening 8 with an internal diameter d of 7 to 10 millimeters, a pitch p 'of 1 to 1.5 millimeters, a thread height of about 0.6 millimeters and an angle ⁇ between the walls of the thread grooves on the order of 30 °.
  • a plug 3 for closing the interior volume 9 is then screwed into said orifice 8, either to serve as an anchoring point for a rod for placing the implant, or after the positioning of the latter and the branches opened by the end shim 2 to close the internal volume 9, in order on the one hand to stiffen the cage and on the other hand to prevent the bone material which can be implanted in the cage, from coming out through this posterior end.
  • Such a plug 3 is shown seen from the front in FIG. 14A and seen in profile in FIG. 14B, with a thread 15 2 of the type of that shown in FIG. 6 and a central orifice 17 of polygonal shape, either square, hexagonal, etc .. or replaced by any means to block the end of a rod having a compatible end so that it can be screwed or unscrewed.
  • said cage 1 comprises four slots 10 forming the inter-branch space as shown in FIG. 8 in view 8 of FIG. 9 for example: such slots allow on the one hand better fusion of the bone graft that can be accommodated in the internal volume 9 relative to the adjacent intervertebral discs, and on the other hand better deformation of the branches 5 during the positioning of the implant, the section of the branches in this part there being indeed weaker than at their end; moreover, such openings can be oblong in shape with the end, situated towards that of the distal ends of the arms 5, narrower than the other end as shown in FIG.
  • the internal surface of the branches 5 delimiting the internal volume 9 of the cage 1 is smooth, which volume then comprises at its distal end an axial housing 12 capable of receiving said shim 2 2 as shown in FIG. 12, and in maintaining it by a shoulder 13 of diameter larger than that of the internal volume 9 of the cage in the "active" position, as shown in FIG. 2.
  • Said shim 2 2 comprises a threaded axial bore 14, capable of receiving a rod, at least the end of which is also threaded and compatible for the positioning of the wedge by simple pushing and displacement in translation, said positioning rod then being removable.
  • the latter may comprise at least two fins 18 or other means, symmetrical with respect to the axis XX 'of the implant; either such a wedge is positioned in the cage 1 before the implantation is put in place, by threading it on the side of the branches, or the base 7 comprises at least two grooves 19 compatible, in which can slip during the placing in place of said wedge 2, if we want to introduce it after the cage, the two said fins 18, these having a thickness e at most equal to the distance and the spacing between the ends of the distal branches of the two 5 adjacent branches.
  • branches do not deform after their expansion, such as an outer ring housed in a groove at their ends and deformable by them.
  • the interior surface of the arms 5 defining the interior volume 9 of the cage 1 is threaded at a pitch equivalent to that of the orifice 8 of the base 7 as shown in Figure 6 for example, and said shim 2 ⁇ is also compatible, as shown in Figures 13A and 13B.
  • said cage 1 can also include at least one other intermediate wedge 4, threaded like that of the end 2, and which can be screwed behind the latter in order on the one hand to compress the bone material that would have been inserted into the space delimited between these two wedges, and on the other hand to stiffen the central part of the cage.
  • Said end wedges 2 and intermediate 4 have an axial orifice 16 of polygonal shape, capable of receiving a removable rod having a male-shaped end compatible to ensure their screwing and their establishment.
  • the truncated cone shape of the interior volume 9 of the cage 1 can be of a half-angle of slope oc of between 6 and 9 degrees for example.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Transplantation (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Cardiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Neurology (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)
  • Materials For Medical Uses (AREA)
  • Food-Manufacturing Devices (AREA)
  • Biological Depolymerization Polymers (AREA)
  • Developing Agents For Electrophotography (AREA)
PCT/FR1997/001617 1996-09-13 1997-09-12 Cage d'osteosynthese expansive Ceased WO1998010722A1 (fr)

Priority Applications (17)

Application Number Priority Date Filing Date Title
AT97919092T ATE273674T1 (de) 1996-09-13 1997-09-12 Expandierbarer osteosynthesekäfig
JP51332698A JP4107397B2 (ja) 1996-09-13 1997-09-12 伸長可能な骨接合用ケージ
US09/117,469 US6129763A (en) 1996-09-13 1997-09-12 Expandable osteosynthesis cage
DE69730360T DE69730360T2 (de) 1996-09-13 1997-09-12 Expandierbarer osteosynthesekäfig
IL12869597A IL128695A (en) 1996-09-13 1997-09-12 Cage expands for osteosynthesis
AU43055/97A AU715283B2 (en) 1996-09-13 1997-09-12 An expandable osteosynthesis cage
CA002266126A CA2266126C (fr) 1996-09-13 1997-09-12 Cage d'osteosynthese expansive
BR9712820-1A BR9712820A (pt) 1996-09-13 1997-09-12 Envoltório de osteossìntese expansivo
EP97919092A EP1014899B1 (fr) 1996-09-13 1997-09-12 Cage d'osteosynthese expansive
PL97332161A PL185352B1 (pl) 1996-09-13 1997-09-12 Implant do osteosyntezy
NO19991228A NO314121B1 (no) 1996-09-13 1999-03-12 Ekspanderbar osteosynteseholder
US09/951,751 US20020040243A1 (en) 1996-09-13 2001-09-14 Method and apparatus for providing proper vertebral spacing
US10/124,044 US7828848B2 (en) 1996-09-13 2002-04-16 Expandable osteosynthesis cage
US12/887,283 US8435299B2 (en) 1996-09-13 2010-09-21 Expandable osteosynthesis cage
US13/863,857 US8992621B2 (en) 1996-09-13 2013-04-16 Expandable osteosynthesis cage
US13/863,964 US8790407B2 (en) 1996-09-13 2013-04-16 Expandable osteosynthesis cage
US14/629,648 US20150230934A1 (en) 1996-09-13 2015-02-24 Expandable Osteosynthesis Cage

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR96/11452 1996-09-13
FR9611452A FR2753368B1 (fr) 1996-09-13 1996-09-13 Cage d'osteosynthese expansive

Related Child Applications (3)

Application Number Title Priority Date Filing Date
US09117469 A-371-Of-International 1997-09-12
US09/117,469 A-371-Of-International US6129763A (en) 1996-09-13 1997-09-12 Expandable osteosynthesis cage
US09/587,596 Continuation US6371989B1 (en) 1996-09-13 2000-06-05 Method of providing proper vertebral spacing

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WO1998010722A1 true WO1998010722A1 (fr) 1998-03-19

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US (9) US6129763A (https=)
EP (1) EP1014899B1 (https=)
JP (1) JP4107397B2 (https=)
KR (1) KR100532548B1 (https=)
CN (1) CN1158979C (https=)
AT (1) ATE273674T1 (https=)
AU (1) AU715283B2 (https=)
BR (1) BR9712820A (https=)
CA (1) CA2266126C (https=)
CZ (1) CZ290106B6 (https=)
DE (1) DE69730360T2 (https=)
ES (1) ES2225964T3 (https=)
FR (1) FR2753368B1 (https=)
IL (1) IL128695A (https=)
NO (1) NO314121B1 (https=)
PL (1) PL185352B1 (https=)
PT (1) PT1014899E (https=)
RU (1) RU2195894C2 (https=)
TR (1) TR199900545T2 (https=)
WO (1) WO1998010722A1 (https=)

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IL128695A0 (en) 2000-01-31
FR2753368B1 (fr) 1999-01-08
US20130310940A1 (en) 2013-11-21
DE69730360D1 (en) 2004-09-23
AU4305597A (en) 1998-04-02
BR9712820A (pt) 1999-11-23
ES2225964T3 (es) 2005-03-16
CZ89399A3 (cs) 1999-06-16
NO991228L (no) 1999-05-12
KR100532548B1 (ko) 2005-12-02
JP2001505081A (ja) 2001-04-17
US20020116066A1 (en) 2002-08-22
US20130310941A1 (en) 2013-11-21
EP1014899A1 (fr) 2000-07-05
AU715283B2 (en) 2000-01-20
ATE273674T1 (de) 2004-09-15
US20060241774A1 (en) 2006-10-26
US20020040243A1 (en) 2002-04-04
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US8790407B2 (en) 2014-07-29
CZ290106B6 (cs) 2002-05-15
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CN1158979C (zh) 2004-07-28
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US8992621B2 (en) 2015-03-31
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NO991228D0 (no) 1999-03-12
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IL128695A (en) 2004-12-15
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US6129763A (en) 2000-10-10
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US7828848B2 (en) 2010-11-09
US20110009972A1 (en) 2011-01-13

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