WO1998048717A1 - Apparatus for interlocking two contiguous, in particular lumbar, vertebrae - Google Patents

Apparatus for interlocking two contiguous, in particular lumbar, vertebrae

Info

Publication number
WO1998048717A1
WO1998048717A1 PCT/FR1998/000880 FR9800880W WO9848717A1 WO 1998048717 A1 WO1998048717 A1 WO 1998048717A1 FR 9800880 W FR9800880 W FR 9800880W WO 9848717 A1 WO9848717 A1 WO 9848717A1
Authority
WO
Grant status
Application
Patent type
Prior art keywords
screw
implant
caract
ris
ball
Prior art date
Application number
PCT/FR1998/000880
Other languages
French (fr)
Inventor
Jean Taylor
Bernard Villaret
Harmodio Herrera
Original Assignee
Jean Taylor
Bernard Villaret
Harmodio Herrera
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

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7062Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
    • A61B17/7064Devices acting on, attached to, or simulating the effect of, vertebral facets; Tools therefor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • 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
    • A61B17/1757Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7032Screws or hooks with U-shaped head or back through which longitudinal rods pass
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7035Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
    • A61B17/704Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other the longitudinal element passing through a ball-joint in the screw head
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, E.G. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/4405Joints for the spine, e.g. vertebrae, spinal discs for apophyseal or facet joints, i.e. between adjacent spinous or transverse processes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B2017/7073Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant with intervertebral connecting element crossing an imaginary spinal median surface
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, E.G. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/4455Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
    • 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
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30476Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
    • A61F2002/30507Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism using a threaded locking member, e.g. a locking screw or a set screw
    • 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
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30537Special structural features of bone or joint prostheses not otherwise provided for adjustable
    • A61F2002/30538Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting angular orientation
    • 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
    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • 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
    • A61F2250/00Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0004Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
    • A61F2250/0006Special 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

Abstract

The disclosed device comprises means for joining two contiguous vertebrae at their respective pedicular and laminar facets. The invention specifically comprises, for each pair of articular facets, a pedicular implant (1) consisting of a screw (2) with a head (3) containing an inset ball-and-socket joint (5) rotating in the horizontal and frontal planes. The device further comprises a translaminar implant (4) which extends from the cord (22) of the vertebra (L4) through the plate; the end (7) of said implant (4) is inserted into the entire length of a threaded bore (11) completely intersecting the rotating ball-and-socket joint (5). The mechanical locking of the two implants thereby ensures that the two articular facets are joined, and are homologous due to the predetermined position of the ball-and-socket joint and the translaminar implant (4). The paired device allows the procedure to be restricted to only the pedicles of the vertebra concerned by the monosegmental immobilization, thereby ensuring rotatory as well as translatory immobilization. In other words, rotation is neutralized by the two translaminar screws, while translation is secured by the pedicular axis.

Description

DEVICE FOR join two VERTEBRAE CONΗGUES INCLUDING LOWER BACK

The present invention relates to a ostéosyn- t esis spinal device for securing two adjacent vertebrae, lumbar particular, in view of their bone fusion, comprising means for securing the vertebrae at their respective pedicle and laminar facets.

We know that a healthy intervertebral disc is a viscoelastic joint unit. It allows a mobility about a longitudinal axis and rotational movements are guided back by the facet joints, biplanar lumbar. The mobility in the sagittal plane occurs particularly during flexion. Its control in fact involves, in addition the disc viscoélasti- city, limiting the mechanical action of the antero-medial portion and frontalisée facet joint, thus opposing the interbody shear forces. The posterolateral portion and sagittalisée facet occurs, meanwhile, during lateral movements, achieved in the frontal plane.

Ultimately, each lumbar mobility segment is presented as a complex interrelationship triarticulaire. This fact involves complex, taking the L4-L5 segment by way of example: the L4-L5 disc, the superior articular facet of vertebra L5 underlying and inferior articular facets of the overlying vertebra. The superior facets are directly appendues subsequently vertebral pedicle L5, part of the functional complex. The lower facets graft distal to the infero-lateral portion L4 blades. Their mean plane is orthogonal to the axis lamina.

These elements constitute a functional pair assembly disposed symmetrically on either side of the mid-sagittal plane. This set includes successive elements: disc, pedicle, upper and lower articular - blade. The posterior arch of the vertebra locks behind the rotary mobility of the anterior segment of the underlying vertebra. The upper pedicular-joint assembly has the function of opposing the anterior translation of the posterior arch. In some anatomical and pathological situations, a release happens these "locks". Private segmental mobility of self-control beyond its physiological context. A reaction process attempts to remedy this failure. In bankruptcy, the need for surgery becomes an alternative analgesic required.

In a first type of proposed solution, there is provided a posterior fixation of the spinal segment considered by using a series of pedicle screws interconnected by rods or plates, this solution being imposed in the lumbar arthrodesis posterior directions side. The immobilization of the joints of the fixed segment to facilitate fusion induced by a complementary bone graft. This synthesis monoplanar neutralizes the only frontal plane.

It is actually a variant of posterior osteosynthesis designed initially for corrections of scoliosis using rods, anchors were Fiabi lises.

These pedicle implants are in the sagittal plane. The cephalic screw assembly are inserted into vertebral pedicles belonging to the functional segment adjacent the neutralization, which are thereby unnecessarily deteriorated, which is a significant disadvantage of this type of device.

Another disadvantage of these accomplishments lies in the frequent problems of neo-hinge they induce, particularly because of the facet degradation above the merged level, caused by the osteosynthesis material.

Furthermore stabilization obtained is relative, because the assembly acts as a buttress. The addition of international pedicle transverse extra-osseous elements stiffens the assembly by securing implants, preventing phenomena "wiper". The Registry of inter-laminar articulo site is reduced because it is occupied by the plates or rods. Moreover, the radiological monitoring of the merger is difficult given the overlays. Finally learning a reliable pedicle target is deemed difficult. According to a second type of proposed solution is secured facet joint by means of short transfixing screw.

This system, the mechanical weakness is obvious, has been improved by inserting longer screws, from the base of the spinous through the blade, then inter-facet, leading to the front edge of the cross at its junction pedicle.

Such screws have certain advantages: there is thus obtained a very satisfactory stabilizing, controlling mobility about a longitudinal axis. This applies especially in the case of instability of discogenic. Further stabilization is truly mono-segmental neurological risk of the procedure is very low, thanks to the use of a viewfinder, using an intraoperative radiation monitoring is not necessary. The inter-transverse decortication to prepare the graft bed is not mandatory, operative time is reasonable, wise learn- technique is relatively simple, and finally the economic impact of this fixation is reasonable.

However these lumbar translaminar screw fixings have drawbacks.

First a technique first requires that the blades are intact and that the facets were respected during decompression. More booster engages through the base of the transverse process is very short. The translaminar screws do not effectively oppose a translational force, which explains the evolutionary failures. Finally, the application of this technique to second facet arthropathy cases imposes no disorientation of the facet spacing of degenerative origin. This procedure can only be applied where a combined translational hypermobility around the transverse and anteroposterior axes (particularly degenerative spondylolisthesis). Decortication facet is difficult because we must preserve the subchondral bone. The good results of this technique involve compliance with statements that are, moreover, very narrow.

The present invention therefore aims to propose an osteosynthesis device for securing the segment mobility of two adjacent vertebrae, in particular lumbar, avoiding the above disadvantages of both types of known embodiment described.

According to the invention, the spinal osteosynthesis device for securing two adjacent vertebrae comprises, for each pair of pedicle facets and laminar, an implant transpédi- cular, a translaminar implant and locking means for mechanically interlock these two implants so angularly adjustable.

The invention thus realizes a combination of two translamaire implants (or translaminar) pedicle and mechanically connected by an adjustable bolt system in several directions.

According to one advantageous embodiment, the implant is a pedicle screw having a threaded shank and a head containing a rotatable ball joint and adapted to perform the connection with the translaminar implant. Thanks to this system, only the pedicle involved in this monosegmental neutralization are instrumented, which is a first important advantage of the invention.

Moreover the interdependence between the laminae implants (laminar) and pedicle combines the mechanical advantages of the two systems, namely rotary and translational neutralization.

The pedicle implant reinforces the anchoring in the anterior portion of the mobility segment, which is thus reinforced and exerts a counter-support. Finally a fault (defect) or laminar joint secondary to a broader liberation movement does not prevent the use of this fixation procedure. The invention also relates to a arthroplasty device between two facet joint of two adjacent vertebrae L4, L5, one of the facets being in the extension of a pedicle of a vertebra L5 and the other facet is adjacent to a blade of the other vertebra L4.

According to the invention, this device comprises a pedicular implant secured to a concave artificial facet, and a translaminar implant secured to a convex artificial facet joint.

Other features and advantages of the invention appear from the following description with reference to the accompanying drawings which illustrate several embodiments by way of non-limiting examples.

Figure 1 is a side elevational view in a sagittal plane, substantially enlarged scale of a spinal segment consisting of two lumbar vertebrae, with a first embodiment of the osteosynthesis device covered by the invention. FIG 2 is a view of the osteosynthesis device of Figure 1 in a horizontal plane, that is to say a plane transverse to that of Figure 1.

Figure 3 is a view of the spinal segment of Figures 1 and 2 and its osteosynthesis device in a posterior frontal plane. Figure 4 is an enlarged longitudinal sectional enlarged view of a pedicle screw and its swivel ball joint forming part of the osteosynthesis device of Figures 1 to 3.

Figure 5 is a cross-sectional view of the 5/5 Figure 4. Figure 6 is a partial cross-sectional view of a second embodiment of the osteosynthesis device according to the invention. Figure 7 is a sectional and partial elevation of a third embodiment of the osteosynthesis device according to the invention.

Figure 8 is a schematic top view of a fourth embodiment of the device according to the invention. Figure 9 is an elevational enlarged partial enlarged sectional view of a fourth embodiment of the spinal osteosynthesis device according to the invention.

Figure 10 is an elevational and partial sectional view in a horizontal plane of a complete peer device, including that of Figure 9 and implanted in a vertebra.

Figure 11 is an elevational view in a frontal plane, on a reduced scale, of the device of Figure 10.

Figure 12 is an elevation and partial sectional view of a translaminar viewfinder for performing aiming for laying the translaminar implant.

13A and 13B are views in partial schematic elevation of two variants of the viewfinder 12 of FIG.

The spinal osteosynthesis device illustrated in the drawings is intended to mechanically secure the two adjacent vertebrae, in particular two lumbar vertebrae L4 and L5 (Figure 1) at their articular facets F (Fig.2), and respective pedicle laminar to for subsequent bone fusion.

This device comprises, for each pair of facet joints, a transpedicular implant 1 comprises a screw having a threaded shank 2 and a head 3, a translamaire implant (or translaminar) consisting of a screw 4, and means for allow a mechanical connection between the screw 4 and translaminar the pedicle screw 1, such that a ball 5 orientable pierced from side to side, housed in the head 3, as well as means for hanging the upper portion of the screw 4 on the slide, namely a cylindrical head 9 or more preferably a washer 65 with barbs 66 and a compression nut 70 (figures 9-10). The head 3 is tubular, provided at its end with a part

18 set at the factory; in its wall is arranged a lateral opening 6 can be penetrated by one end 7 to trocar tip of the threaded rod of the translaminar screw 4. This insertion of the end 7 allows screwing it in a diametral bore 11 of the patella 5, which is extended by a tubular portion 12 coaxial to its diametral bore 11. the latter is dimensioned to receive the threaded end 7 of the corresponding screw 4 after suitable angular orientation of the ball 5, which is supported on a spherical seat 13 provided in the head 3. the seat 13 extends to the base of the unthreaded smooth inner wall 3a of the head 3, as well as about an axial hole formed in the threaded shaft 2. This hole is shaped, e.g. polygonally (6 sections) in order to receive a not shown tool of screwing the implant 1 into the pedicle of the vertebra L5.

The head 3 is equipped with a ball 5 of the blocking means in a predetermined angular orientation. In the example shown, this means is constituted by a threaded plug 15 in which is arranged a profiled hole 16 screwed by means of a not shown tool.

The cap 15 can be screwed into the threaded tubular wall 17 (bounded on one side by the opening 6) until the face of the stopper 15 facing the ball 5 comes into locking support thereon. Advantageously, the side vis-à-vis the ball 5, the plug 15 has a conical profile 18 ending in a conical or spherical bearing

19 bearing on the surface of the ball 5.

The ball 5 with its lateral section 12 is adjustable in a horizontal plane PH which is that of Figures 2 and 4, between a frontal plane and a sagittal plane PF PS with a predetermined angular displacement A of the OX axis of its bore 11. on the other hand the ball joint 5 is also adjustable in the frontal plane PF (the plane of FIGS 3 and 5) between the horizontal plane PH and the sagittal plane PS with a predetermined angular displacement B of the OX axis. The limits of angular displacement A correspond to the abutment, in the PH plane of the wall of the tubular portion 12 against the conical profile 18 of plug 15, these pieces being of course adequately dimensioned.

The angular operating range A in the horizontal plane PH may be 33 °, while the angular movement in the frontal plane PF can be 65 °. The amplitude of these angular displacements is determined by the dimensions of the opening 6 of the head 3 in the horizontal and frontal planes, by the thickness of the wall of the section 12 and the insertion depth of the pin 14 in the head 3.

The edge of the opening 6 adjacent to the threaded spindle 2 is delimited by an angular sector 21 of the clamping screw 1, for example hexagonal, the distance between the upper side of sector 21 and the center O of the ball 5 may be about 2mm, this value is not limiting.

The establishment by the surgeon of this system combining a pedicular implant 1, a translaminar implant 4 and ensuring interlamino-locking pedicle through the swivel ball joint 5, is carried out as follows.

Of course, the surgeon removes the prior articular facet mass of the vertebra L5 to allow to stay in its place the head 3 of the screw 1. a) pedicular implant 1 is implemented according to a codified technique, Read cathétérisant the pedicle of the vertebra L5 from the junction isthmo-articulo-transverse. b) The surgeon inserts through the opening 6 the ball joint 5 with its section 12, which takes place just before the junction fronto sagittal upper facet belonging to the segment to be instrumented. c) A viewfinder comes to fit over the ball joint 5 and to automatically guide the introduction of the implant translamaire 4 through the spinous 22 of the vertebra L4. This guiding occurs until the end 7 can be screwed into the bore 11 of the ball joint 5 previously oriented properly in the horizontal and frontal planes, according to angles within the above values. d) The second implant 4 enters at the junction of the blade 23 and the spinous process 22 to move in the direction of the blade, forward, outward and downward, guided in this by an unillustrated ancillary specific, towards the center of the bottom side of the posterior arch of this segment mobility. The implant 4 joins automatically adjustable ball 5 into the bore 11 from which it enters. e) The bolt consisting of the patella system 5 is then actuated, interconnecting the two implants 1 and 4. f) The same process is taken from the contra-lateral side, to set up the second pair of implants 1 and 4 (Figure 2).

According to a second possible embodiment, illustrated in Figure 6, the device is adapted to allow to perform osteosynthesis by a spinal rod 24. For this purpose the pedicular implant 1 comprises a cage 25 which may be screwed onto a flange 26 a stopper 15 formed in the part 18 and the pin 14. a cylindrical part 27 to the inner cage 25 is provided with a pin 28 adapted to be inserted into the blind hole 50 of the plug 15 and has a recess semi- cylindrical receiving the spinal rod 24.

The component 27 is inserted, free to rotate around its axis of revolution, above the plug 15.

The device is completed by a second cylindrical part 30 having a semi-cylindrical recess enabling it to cap the rod 24, above the part 27 and inside the cage 25. The part 30 is provided with a pivot 29 passing through a hole of the bottom 31 of the cage 25, and thus ensuring a bond between the latter and the part 30.

This pivot connection allows automatic positioning of the two parts 25 and 30 over the rod 24 during assembly. The cage 25 is screwed onto the upper flange of the stopper 15, thereby locking the positioning rod 24 within the assembly. The portion of the embodiment of Figure 4 to that of Figure 6 involves changing the plug 15, but retaining the mounting translamaire already in place.

A pathological event can lead to revision surgery for osteosynthesis extend by using the screw 1 implanted in the pedicles of adjacent vertebrae; these screws are connected by, in particular, the rods 24, lying in a posterior plane to translaminar implants. Under these conditions, and without removing the implant 4, the head of the pedicle screw 1 is capped with the cage 25 by extender board and the cap 15 replaced so that the pin 24 comes to rest before being blocked . This adaptability of the invention allow the possible use of pedicular implants whose properly intraspongieuse portion may be subjected to proper surface treatment reliable anchoring through an osteogenic induction.

The embodiment of Figure 7 includes an extension 40 that can cover the head 3 of the screw 1. This extension 40 is made up of three parts: a nut 43 which is screwed onto the external thread 17 of the head 3, a body 44 engaged by its base in a floating manner, freely rotatable in the nut 43, and a threaded pin 33 for attaching the spinal rod 24 into a channel 45 U-shaped body 44. This assembly makes it possible to properly orient the body 44 at the end tightening the nut 43.

8 illustrates another possible embodiment of the invention. Whereas the pedicle axis orthogonally supports an upper articular facet, concave, which is articulated with a lower, convex articular facet, the vertebral lamina 32 constitutes the axis orthogonal to the support, the same principles in the art can be adopted for consider preparing a prosthetic facet arthroplasty.

The pedicle implant 34 comprises in this embodiment (Fig.8) a threaded shaft not surmounted with a head, but a concave facet prosthesis 35. The implant transiaminaire 4 receives at its end a convex facet 36, prosthetic, instead of the locked portion in the ball joint 5. This mounting is carried out on the two pairs of facets, natural facets having previously been removed as shown in the left part of figure 8.

The two prosthetic facets 35, 36 are adapted to the carrier (or rod), respectively transpedicular 34 and translaminar 4, once in place in the manner of a sphere cephalic adapted on a prosthetic femoral stem. The joining may be achieved for example by clipping of the facets 35, 36 on respective pins 37, 38 of the implants, which fits into conjugated holes 39, 41 of the facets 35, 36. In the embodiment illustrated in Figures 9 11, the spinal osteosynthesis device comprises a pedicle screw 51 having a conventional thread adapted to the pedicle P, and its head 52 is provided with a seat 53 formed with a projecting collar allowing the screw 51 to be supported optimum based on the pedicle P of the vertebra. Above the seat 53, the head 52 is extended by a polygonal footprint 54, for example hexagonal, which is in turn extended by a tubular part 55 containing the ball joint 5. The end 55 of the tubular part 55 is threaded and can be capped with a nut 56 to protect the screw 51. If necessary, the nut 56 can be removed in order to substitute one element for mounting, if necessary, an adapter may receive interpédiculaires mounting studs.

The ball 5 can be blocked by a threaded plug 57 which is screwed into the corresponding threaded opening of the tubular part 55. The ball 5 is pierced right through by a threaded hole 58 diametrically extended by an outer barrel 59 oriented in a side opening 61, of elongated shape, arranged in the tubular part 55. a second opening 60 of oblong shape is also formed in a location diametrically opposite that of the opening 61. Thus the translamaire screw 62 can traverse from side to side the ball joint 5 and the barrel 59, and the opposed openings 61 and 60, so that its end 63 formed by a trocar tip, can be anchored distally into the vertebra at the transverse junction joint-pedicle solid.

Translamaire the screws (or translaminar) 62 is constituted by a threaded shaft along its entire length, the opposite end to its tip trocar 63 has a contoured cavity 64, for example hexagonal (6 sides), serving to hold the screw through an unrepresented specific instrument, ensuring its penetration through the blade. The end 64 is also provided with a washer 65 with barbs 66 that can be slid along the threaded shaft 62 to engage the posterior aspect of the spinous. The end of the screw 62 has been completed by a nut 65 for locking, which when the screw 62 translamaire is implemented (Figures 10 and 11) comes to bear on the washer 65 and lock the screw 62 in place, exercising if needed booster effect.

The ancillary instrumentation for placement of the osteosynthesis device according to the invention, in particular that of Figures 9 to 11, is partially illustrated in Figures 12, 13A and 13B. The instrumentation includes a viewfinder transiaminaire 67 which comprises: a) a handle 68, T, to tubular body 80, extended by a sleeve 69 adapted to oversee the head 55 and the hexagonal recess 54 of the pedicle screw; the handle 68 is removably mounted on the body 80; b) an arm 71 hinged to the handle 68, the distal free end 72 is provided with a sleeve 79 adapted to withstand the implant translaminar 62 and enable its introduction into the barrel 59 of the ball joint 5 through a lumen elongated 73 arranged in the wall of the jacket 69 (Figure 13A). Light 73 extends parallel to the axis of the pedicle screw 51, so as to enable the barrel 59 of the ball 5 to be directed around its mobility plan, front, with its end which passes through the light 73 , while the end of the jacket 69 rests on the seat 53. the height of the light 73 may vary, as shown in Figure 13B which shows a variant 74 of the light is shorter than the light 73, in the 75 shirt.

The arm 71 includes a proximal portion 76 attached to the handle 68, pivoted on the distal portion 72 about an axis 77 and to which is attached a tip 78 dimensioned to be able to contact the upper edge of the vertebral lamina.

The orientation in the horizontal plane, the barrel 59 can be realized by rotating the pedicle screw 51 about its axis, through the removable handle 68 which may be refitted if necessary, over the jacket 69. The articulation about the axis 77 of the arm 71 makes it possible, thanks to the mobility of the sheath 79, through which the threaded shaft translamaire 62, engaged in the barrel 59, to follow the orientation given to the threaded barrel 59 according to the anatomical topography of the laminar referred.

The distal portion 72 is properly positioned when the tip 78 has built on the upper edge of the vertebral lamina. Translamaire the screw 62 can then be introduced into the barrel 59, the ball joint 5 and through the opposed apertures 61, 60 and an elongate slot 81 formed in the sleeve 69 opposite to the light 73 to come file into the vertebra. The angle made by the threaded bushing 59 is automatically adapted, so that there is a match based on the particular type of adjustment by the sheath 79 to the barrel 59. The tip 78 pendent on the proximal portion 76 prevents passage of the blade in the root canal space waning of the translaminar referred. The latter is done with a threaded spindle, by the drill bushing 59.

The translaminar screw 62 passes through the side portion of the vertebra to ensure a better rooting. Its threaded shaft is cut flush with the clamping nut 65, so that this assembly provides a perfect blocking of the axial mobility of the vertebral segment and cancels in the horizontal plane. Both translaminar screws 62 (Figures 10 and 11) join the pedicle screw 51 seen from behind by the head. Figure 11 shows the blocking effect that also operates in the frontal plane. Both translaminar screws 62 are thus secured to the pedicle through the pedicular implant 51. The latter is implemented by means of a screwdriver (not shown), which adapts to the viewfinder 68, 69 and can come to slide inside the vertical portion (tubular body 80) of the viewfinder.

The invention is susceptible of various alternative embodiments. Thus the attachment of the ball 5 with the implant 1 and 4 may be accomplished by any equivalent means to the screw cap 15, which can be achieved in different ways from that shown. Similarly, in the device of Figure 4, the cap 15 may be crimped onto the ball 5, the recess 16 being deleted. The angular fixing of the ball 5 can then be obtained by a screw axis in the solid plug 15, through a tapped bore (Figure 4).

Claims

1. A device for spinal ostéosynthèse for bone fusion of two vertèbres contiguës, including lumbar (L4, L5), comprising means for securing the vertèbres at their facets (F) and respective pédiculaires laminar caractérisé in that it comprises, for each pair of facets pédiculaire and laminar, a transpédiculaire implant (1), a transiaminaire implant ( 4) and locking means (5, 15 ...) for securing mécaniquement these two implants manière réglable angularly.
2. Device according to claim 1, caractérisé transpédiculaire in that the implant is a screw (1) having a filetée rod (2), and a tête (3) containing a ball (5) swiveling and adaptée réaliser for binding with translaminar implant (4).
3. Device according to claim 2, caractérisé in that the tête (3) is tubular and in its wall is a agencée latérale opening
(6) which can pénétrer a extrémité (7) of the translaminar implant (4) for être solidarisée with the ball (5) in logée the tête of the screw (4).
4. Device according to claim 3, caract├⌐ris├⌐ in that the ball (5) pr├⌐sente a al├⌐sage diam├⌐tral taraud├⌐ (11) for receiving the adapt├⌐ extr├ ⌐mit├⌐ filet├⌐e (7) of a screw (4) forming the translaminar implant, and t├¬te (3) of the p├⌐diculaire screw (1) is ├⌐quip├⌐e one of the ball holding means in a d├⌐termin├⌐e angular orientation, e.g. filet├⌐ pin (14) which ├¬tre viss├⌐ in t├¬te (3) screws ( 1) and come to bear on the ball (5).
5. Device according to claim 4, caractérisé in that the ball (5) is a tubular prolongée tronçon diamétral (12), coaxial à its tap alésage é (11).
6. Device according to claims 4 and 5, caractérisé in that the ball (5) is pivotable on the one hand in a horizontal plane (PH) between a frontal plane (PF) and a sagittal plane (PS ) with an angular débattement prédéterminé (a) of the axis of its alésage (11), and secondly in a frontal plane (PF) between the horizontal plane (PH) and the sagittal plane (SP) with a prédéterminé débattement (B) of the axis of its alésage the débattement (a) in the plane horizontal étant e.g. about 33 degrés while débattement (B) in the frontal plane is approximately 65 degrés, the amplitude of these angular débattements étant d éterminée by the dimensions of the opening (6) of the tête (3) of the screw (1) in the horizontal plane and in the frontal plane.
7. Device according to one of claims 2 à 6 caractérisé in that the ball (5) is supported on a sphérique siège (13) in the threaded rod formé ée (2), and tête (3) comprises a screw ia profilée form (21) adaptée order to receive a screwing tool.
8. Device according to one of Claims 4 à 7 caractérisé in that it comprises an extension élément (25) covering the tête (3) of the screw p édiculaire (1) and can être traversé ostéosynthèse by a spinal rod (24), this extension étant fixé on a stopper (15) blocking and containing pièces (27, 30) for positioning the rod.
9. Device according to one of Claims 4 à 7 caractérisé in that it comprises an extension élément (40) capping the tête (3) of the screw pédiculaire (1), and présentant réception a U-shaped channel of a vertébrale rod (24) fixée in this channel, this extension comprising a body (44) Mt. é floating on a écrou (43) for fixing the à tête (3) of the pédiculaire screw (1).
10. Device according to claim 4, caractérisé in that the screw-in côté à towards the ball (5), the pin (14) in a pi vissé èce (18) and is provided with a conical profile by a terminé portée sphérique or conical (19) for locking support on the patella.
11. The device arthroplasty between two articular facets of two vertèbres contiguës (L4, L5) one of the facets being in the extension of a pédicule a vertèbre (L5 ) while the other side is adjacent à a blade (32) of the other vertèbre (L4), caractérisé in that it comprises a pédiculaire implant (34) integral a concave artificial facet (35), and a translaminar implant (4) integral with a convex artificial articular surface (36), the securing of the facets with implants étant réalisée for example by clipping .
12. Device according to claim 3, caract├⌐ris├⌐ in that in the wall of the tubular t├¬te (55) is agenc├⌐e lat├⌐rale one second opening (60), oblong, can ├ ¬tre travers├⌐e in m├¬me premi├¿re time as the opening (61) by a extr├⌐mit├⌐ (63) of the translaminar implant (62).
13. Device according to claim 12, caract├⌐ris├⌐ in that the translaminar screw (62) is form├⌐e by a filet├⌐ axis including a extr├⌐mit├⌐ pr├⌐sente a footprint profil├ ⌐e (64) for maintaining said screw by a sp├⌐cifique tool, and this extr├⌐mit├⌐ is provided with a washer (65) and a ├⌐crou (70) for locking , the washer can ├¬tre provided with spikes (66) for anchoring in the post├⌐rieure opposite the ├⌐pineuse, the second extr├⌐mit├⌐ screw ├⌐tant constitu├⌐e of a trocar tip (63) distal anchor in a vert├¿bre.
14. Instrumentation ancillary destinée à laying of ostéosynthèse device according to any one of claims 1 à 13 caractérisée in that it comprises a viewfinder translaminar which comprises: a) a tubular poignée (68, 80) prolongée by a jacket (69) to oversee the adaptée tête (55) of the screw pédiculaire ( 51) and on which the poignée montée is removably manière, b) an arm (71) on the articulé poignée, the free distal extrémité (72) is adaptée to withstand the translaminar implant (62) and enable its introduction into a barrel (59) of the ball (5) through a à lumière
(73) of the jacket.
15. Instrumentation according to claim 14, caractérisée in that the arm (71) articulé viewfinder has a proximal portion (76) fixée à the poignée (68) articulée on the distal portion (72) and which is à fixée a tip (78) dimensionnée to be able to contact the edge of the supérieur vertébrale blade.
16. Instrumentation according to claim 15, caractérisée in that it further comprises a screwdriver can être introduced in the translation à intérieur poignée of the tubular (68) viewfinder après that the jacket (69) of the latter has the coiffé tête (53) of the pédiculaire screw (51) to screw said screw.
PCT/FR1998/000880 1997-04-30 1998-04-30 Apparatus for interlocking two contiguous, in particular lumbar, vertebrae WO1998048717A1 (en)

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Applications Claiming Priority (1)

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EP19980922912 EP0996383A1 (en) 1997-04-30 1998-04-30 Apparatus for interlocking two contiguous, in particular lumbar, vertebrae

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