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WO1999011203A1 - Prosthesis of the spinal column - Google Patents

Prosthesis of the spinal column

Info

Publication number
WO1999011203A1
WO1999011203A1 PCT/AT1998/000201 AT9800201W WO9911203A1 WO 1999011203 A1 WO1999011203 A1 WO 1999011203A1 AT 9800201 W AT9800201 W AT 9800201W WO 9911203 A1 WO9911203 A1 WO 9911203A1
Authority
WO
Grant status
Application
Patent type
Prior art keywords
prosthesis
vertebral
implant
body
surface
Prior art date
Application number
PCT/AT1998/000201
Other languages
German (de)
French (fr)
Inventor
Ronald J. Sabitzer
Franz K. Fuss
Original Assignee
Sabitzer Ronald J
Fuss Franz K
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
    • 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
    • A61F2/442Intervertebral or spinal discs, e.g. resilient
    • 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
    • A61F2/30767Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes, grooves
    • 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
    • A61F2002/30108Shapes
    • A61F2002/30199Three-dimensional shapes
    • A61F2002/30224Three-dimensional shapes cylindrical
    • 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
    • A61F2002/30108Shapes
    • A61F2002/30199Three-dimensional shapes
    • A61F2002/30242Three-dimensional shapes spherical
    • A61F2002/30245Partial spheres
    • 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
    • A61F2002/30108Shapes
    • A61F2002/30199Three-dimensional shapes
    • A61F2002/30252Three-dimensional shapes quadric-shaped
    • A61F2002/30253Three-dimensional shapes quadric-shaped ellipsoidal or ovoid
    • 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
    • A61F2002/30108Shapes
    • A61F2002/30199Three-dimensional shapes
    • A61F2002/30301Three-dimensional shapes saddle-shaped
    • 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
    • A61F2002/30331Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30354Cylindrically-shaped protrusion and recess, e.g. cylinder of circular basis
    • 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
    • A61F2002/30405Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves
    • 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
    • A61F2/30767Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes, grooves
    • A61F2002/30878Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes, grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • 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
    • A61F2/30767Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes, grooves
    • A61F2002/30904Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes, grooves serrated profile, i.e. saw-toothed
    • 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
    • A61F2002/4631Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor the prosthesis being specially adapted for being cemented
    • 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
    • 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
    • A61F2220/0033Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
    • 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
    • A61F2230/0069Three-dimensional shapes cylindrical
    • 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
    • A61F2230/0071Three-dimensional shapes spherical
    • 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
    • A61F2230/0073Quadric-shaped
    • A61F2230/0076Quadric-shaped ellipsoidal or ovoid
    • 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
    • A61F2230/0095Saddle-shaped

Abstract

In a spinal column prosthesis for insertion into the intervertebral space of the spinal column after surgical removal of the intervertebral disk, it is provided that the prosthesis (6), which in the inserted state is designed in a single piece, has a curved surface (9) at its top side, is movable relative to the cranial vertebra (1) and is fixed to the caudal vertebra (3) by anchoring and connecting means (11) arranged on the bottom side (10) of the prosthesis. The axis of rotation (7) between adjacent vertebrae (1, 3) when bending forwards and backwards (5) lies in the caudal vertebra (3). This makes it possible to preserve the natural mobility between adjacent vertebrae (1, 3) and to keep the natural centre of rotation in its physiological position.

Description

SPINAL PROSTHESIS

The invention relates to a spinal prosthesis for introduction into the intervertebral gap of the spinal column after surgical removal of the disc.

The intervertebral disc (intervertebral disc, intervertebral disc) has two tasks: ensuring the mobility of two vertebrae to each other and shock absorber effect. From various medical reasons, removal of the discus may be (the disc) is necessary. Said in advance, there is no standard surgical therapy for or after Discusent- fernung. As an operative way generally three surgical methods are used: A: Fusion, B: neither Discus substitute or merger, C: disk replacements (there are only in the lumbar spine).

In fusion, two adjacent vertebral bodies are connected to each other by means of various Verblockungsmöglichkeiten that both the mobility and the shock absorber effect will be lost.

Neither disk replacements nor fusion lead to abnormal motility with missing Bumper St obtaining.

The following prosthesis or implant types (only for the lumbar spine) that are intended for introduction into the intervertebral space (Intervertebralspalt):

a) The implant consists of a single piece which may have elastic properties and is not connected with the vertebral bodies. These implants provide a reduced mobility and possibly a certain shock effect. The fulcrum of these implants is in the implant itself and not in the lower vertebral body, as physiologically is the case. aa) no elastic properties: The implant is installed a steel ball (Fernstrom ball-bearing prothesis)

ab) elastic properties: tentnummern implants with the following patent: WO 94/23671, WO 93/16664, DE 37 41 493 Al, US-A

4,874,382, US-A 5,047,055, US-A 5,108,438, US-A 5,192,326, EP-A 0,304,305, US-A 5,320,644.

b) The implant consists of a single piece, which consists of hard cover plates and an elastic core. The cover plates may have connection or anchor itself against the vertebral bodies. These implants provide a reduced mobility and a certain shock effect. The fulcrum of this import implants is in the implant itself and not in the lower vertebral body, as physiologically is the case. This relates to implants with the following patent numbers: CH 671 691 A5, WO 90/11740, US-A 4,911,718, US-A 5,071,437, US-A 5,171,281, EP 0346269 A2, EP 0310837 Al.

c) The implant is fixedly connected to the two vertebral bodies and consists of at least two parts which are movably connected with each other as is apparent, for example, FR-A 2,718,635. Each part is a body integral with a vortex. Between these parts elastic elements can be installed. These two parts ensure reduced mobility and possibly a certain shock effect. The fulcrum of these implants is in the implant itself or at the edge of the implant and not - as usually - on the lower vertebrae. The term "edge" is to be understood: top of the implant (= bottom side of the upper vertebra; WO 93/10725), the underside of the implant (= top of the lower vertebra; US-A 5,314,477), rear side of the implant (US-A 4 759769).

ca) no elastic properties: implants with the following patent numbers: US-A 5,314,477, EP 0,560,141 Al, US-A 5,258,031, US-A 5,246,458, EP-A 0,177,728, DE 35 29 761 AI WHERE 93/10725.

cb) elastic properties: Implants tentnummern with the following patent: WO 94/26213, EP 0566810 Al, DE 41 09 941 AI,

DE 42 13 771 Cl, US-A 4,309,777, US-A 5,002,576, US-A 4,759,769, US-A 4,946,378, US-A 4,873,477.

In all of these types of implants according to the above reasonable led prior art is generated within the mobility of the prosthesis; only in the Fernstrom ball-bearing prothesis movement between the implant and the two vertebral bodies occurs. There is no implant, which is movable and immovable relative to the other against a vertebral body.

The problems arising after surgical treatment are:

a) the mobility is repealed: Thereby, the neighboring segments (adjacent intervertebral discs) are charged insofar as they must mitübernehmen the lost motion.

b) the shock absorber effect is eliminated: this does not lead to pollution of the neighboring segments because there are other structures that take on this shock effect (ligaments, muscles); Also there is no as a shock absorber acting facilities at the major joints of the lower extremity (hip, knee, ankle).

c) a mobility is present, and the implant is not connected to the vertebrae: The pivot point is here in the wrong places and that the middle of the implant. This leads to an unnatural stress of the other facilities of the spine (ligaments, joints, muscles) and pain in these structures so that they can no longer function optimally. Furthermore, it comes through the false view fulcrum to shear forces that can crowd out the implant from the intervertebral gap.

d) a mobility is present, and the implant is firmly connected to two vertebrae: The pivot point is located chops! in the wrong place, in the implant or on the edge. Characterized in that parts of the implant are rigidly connected to the vertebrae, writes the (non-physiological) kinematics of the implant to the vertebrae prior to the kinematics. This in turn leads to an unnatural stress of the other facilities of the spine (ligaments, joints, muscles) and shear forces between the implant and vertebrae. The firm connection of the implant with two vertebrae, the implant can not be forced out of the intervertebral gap now by the unnatural kinematics. Thus, the fastener and the bone are overused, so the risk of implant loosening is. This is the only way the bone to respond to the unnatural kinematics, because it has through the firm connection without any further possibility of adjustment.

Other disadvantages result from the fact that implants which consist of two or more parts which can not be fitted on the cervical spine due to the small size.

The object of the invention relates to a prosthesis that maintains the physiological or natural flexibility and preserves the motion rotation center in its physiological location. To achieve this object, the spinal prosthesis of the invention is substantially characterized in that the integrally formed in the installed state, the prosthesis has a curved surface on the prosthetic top and is movable relative to the cranial vertebral body that the prosthesis been established through anchoring and connecting means is connected immovably to the denture-bottom with the caudal vertebral body and that the axis of rotation between the adjacent vertebral bodies in back and forth bending at the caudal vertebral body lies. The prosthesis is in operations in which the Discus (disc) is removed to introduce into the intervertebral space. The implant or the prosthesis is constructed of invention according to so that the cranial (upper [the standing human]) vertebral body is movable relative to the integral prosthesis, and the prosthesis relative to the caudal (bottom) vertebral body is not movable. The inventive design of the spinal prosthesis succeeds not only a reliable anchoring of the prosthesis in the caudal vertebral body, but it may by the same according to the invention intended mobility of the integral in the installed state prosthesis physiological or natural mobility of the neighboring vertebral bodies by providing the axis of rotation between the adjacent vertebral bodies in the caudal vertebral body, as this corresponds to the natural axis of rotation between adjacent vertebral bodies can be maintained.

For the case of confined spaces is provided according to a preferred embodiment is that the prosthesis consists of two equally large, substantially symmetrical, assemblable together parts, whereby, however, also in this embodiment in the installed state a one lumpy prosthesis results, which relative to the cranial vertebral body along the curved surface is movable while the prosthesis according to the invention is anchored fixedly in the caudal vertebral bodies.

In order to obtain a corresponding number of freedom degrees of movement between the adjacent Wirbelkörpe for installation of the prosthesis according to the invention is also provided according to another preferred embodiment that the facing to the cranial vertebral body, domed upper surface of the prosthesis in at least one of a ball Schnittanischt , ellipsoidal, saddle or cylinder surface is formed, it being possible to achieve different degrees of freedom of movement between the adjacent vertebral bodies by appropriate choice of the curved surface and a corresponding orientation of the installation of the prosthesis. A different selection of degrees of freedom can be hiebei achieved in that the curved upper surface along two substantially normal to each stationary cutting lines having a different curvature or curvature, as a preferred execution form of the prosthesis according to the invention corresponds.

For proper anchoring of the prosthesis in the lower or caudal vertebral body according to the invention preferably provided that the anchoring and connecting means are formed by at least one web or projection, which in particular has a granular, porous, ribbed, toothed or roughened surface. For adaptation to different purposes or for use of different anchoring or connecting means having a main body of the prosthesis darübherinaus is preferably provided that the connecting and anchoring means of the prosthesis via a plug-in or threaded connection are detachably fixed.

The advantages of the invention result from the fact that a) the implant (in all spinal segments cervical, thoracic and lumbar spine) may be used, as it can be taken into account individual kinematics of each section and produced in any required size; b) it can be installed from the anterior (front) and posterior (rear); c) there is (a part or installation reasons of two parts, left and right part), which is only connected to the lower vertebral body; d) it ensures due to its shape up to three degrees of freedom of movement and the physiological axes of movement in their natural position preserves, wherein especially the pivot point is at ante and retroversion is located in the central region of the caudal vertebral body; e) the cranial vertebral body is movable relative to the prosthesis so that the bone tissue of the prosthesis can adapt by physiological remodeling; and f) due to the points d) and e) the motion segment associated structures (belts, joints, muscles) are not overloaded.

The invention is described below in detail with reference to the accompanying drawing with reference to ones shown, schematically presented embodiments, wherein:

FIG. 1 is an intact segment of the spine in a side view;

Fig. 2 is a spinal motion segment from the side with an inventive spinal prosthesis (kinematic spinal prosthesis) shows;

. (Seen sectional area of ​​the page) Figure 3 shows a sagittal section through an embodiment of a prosthesis according to the invention; (See sectional area from the front ge-) and Fig. 4 is a frontal sectional view of further modified embodiments of the prosthesis according to the invention with different curvature of the surface according to the arrows IV of FIG. 2 and 3, where Fig. 3 is a view in the direction of arrow III is the Fig. 4.

A natural, intact spinal motion segment (Fig. 1) from the side (front left, rear right, standing man) consists of the cranial (upper) vertebral body 1, the caudal (bottom) vertebral body 3 and the intervening Discus ( 2, disc). The direction of motion 5 of the upper vertebra 1 by forward and reverse bending (Ante / retro version) takes place about a pivot point 4, which is located in the lower vertebra. 3

During the operation, the prosthesis or the implant 6 (Fig. 2) inserted between the vertebral bodies 1, 3. The direction of motion 5) of upper vertebra 1 by forward and reverse bending (Ante / retro version) now takes place about a pivot point 7, which is located in the lower vertebrae 3 and is determined by the prosthesis shape and substantially the natural pivot point 4 of FIG . 1 corresponds.

The integral prosthesis 6 (Fig. 3) is divided into a top 8 and a bottom 10. At the top 8 is relevant to the movement surface 9. The curvature of the surface determines the pivot point 7 (for forward and reverse bending center of curvature = rotation center in circular geometry). are located on the underside 10 of the anchoring and connecting means 11 for the anchoring of the prosthesis 6 in the lower vertebral body 3, so that the rigidity of the prosthesis is ensured 6 relative to the lower vertebral body. 3 In Fig. 3 and also in Fig. 2 is a sinking of the prosthesis 6 is drawn as anchoring means in the lower vertebral body 3.

In the frontal section (section area viewed from the front) through the prosthesis (Fig. 4) show themselves modified EMBODIMENTS possible different curvatures of the surface of the prosthesis 6: ball surface 9a, ellipsoidal surface 9b, semi-surface 9c cylinder surface 9d.

When using a prosthesis 6 result for the movable friendliness following conditions:

-A) The top 8 has a curved surface 9. The curvature is the kinematics in the direction of motion 5 of the upper or cranial vertebral body before. In the supply and return diffraction (Ante and retroversion) of the spinal column of the pivot point 7 is the movement in the lower vertebral body. 3

The center of curvature of the prosthesis (in sagittal cut prosthesis seen sectional area from the side; Fig. 3), therefore, must be at the same location. Corresponds to the curvature of the circular geometry, the center of curvature is equal to the fulcrum 7 (center of rotation). the implant is viewed from the front (frontal section, section area viewed from the front; Fig. 4), then the curvature can be different. Is the curvature of a side view 9 identical to the front view of 9a corresponds to the upper side of the prosthesis of the circular geometry. therefore the prosthesis ensures three degrees of freedom:

-a) forward / backward bending about a horizontal axis -b) side bending a sagittal axis, and c) rotating about a vertical axis.

Is not the curvature of a side view 9 identical to the curvature of front view but either the same direction curved 9b oppositely curved or 9c, then the top of the prosthesis either the ellipsoid geometry or the saddle geometry corresponds. The prosthesis 6 warranty then provides only two degrees of freedom of movement: -a) forward / backward bending about a horizontal axis b) Side Bend a sagittal axis

Is the curvature of a side view 9 not identical to the latter in front view and is not curved 9b, the upper side corresponds to the prosthesis of the cylinder geometry. The prosthesis ensured only one degree of freedom of movement: -a) forward / backward bending about a horizontal axis

The different curvatures of the surfaces of front view (Fig. 4) are necessary to account for the different movement behavior of the individual functional sections of the spine bill.

B) The bottom side 10 of the one piece prosthesis 6 must be such that a movement of the same (relative to the lower or caudal vertebral bodies 3 either rotation or translation) is excluded. The rigidity is given by the anchoring and connecting means. 11 This can be: one or more ridges or projections 11 which are sunk into the lower vertebral body 3; a granular, porous, ribbed, toothed or roughened lower surface 13, into which the bone tissue can grow; Bone cement for connecting the prosthesis and bone. The connecting means need not necessarily be permanently associated with the prosthesis, but may be attached to the prosthesis by means of plug-in connection or screw also contact lighter installation, as is indicated in Fig. 4 by a releasable connection 14.

-C) As a variant, the prosthesis also consist of two equal parts exist (right part and left part), as is indicated in Fig. 4 in the formation of the prosthesis with the curvature 9a by the parts 6 and 6 ', whereby the division takes place along the cut line 12 substantially. This is the case when tightly dimensioned surgi- cal access routes for easier insertion of the prosthesis (here: smaller parts of the prosthesis) require. The composition of the components in the intervertebral space, however, the single piece shape of the prosthesis 6 as described above results in the installed state. The advantage in this case is that the prosthesis can be installed in particular in the lumbar spine and from the back (dorsal).

Claims

P atentanspr ├╝ che
1. Wirbels├ñulen prosthesis for introduction into the intervertebral gap of the Wirbels├ñule after surgical removal of the disc, characterized in that the einst├╝ckig formed in the installed state prosthesis (6) da├ƒ a gew├╢lbte Oberfl├ñche ( 9, 9a, 9b, 9c, 9d having) on ​​the prosthesis top (8) and the cranial gegen├╝ber Wirbelk├╢rper (1) is movable, the prosthesis (6) da├ƒ by anchoring and connection means ( (11) on the prosthesis lower side 10) is immovably connected to the caudal Wirbelk├╢rper (3) and da├ƒ the axis of rotation (7) between the adjacent Wirbelk├╢rpem (1, 3) in pre- and Zur├ ╝ckbeugen (5) is in the caudal Wirbelk├╢rper (3).
2. Wirbelsäulen prosthesis according to claim 1, characterized in that daß the prosthesis (6) of two equal großen consists essentially symmetrical to each other assemblable parts.
3. Wirbelsäulen prosthesis according to claim 1 or 2, characterized in that the daß for cranial Wirbelkörper (1) facing, gewölbte Oberfläche the prosthesis (6) in at least one cross-sectional view of a ball - (9a), ellipsoidal (9b), saddle (9c) or cylinder Oberfläche (9d) is formed.
4. are Wirbelsäulen prosthesis according to claim 1, 2 or 3, characterized in that daß the anchoring and connection means of at least one web or projection (11) is formed, which in particular a körnige, poröse , ribbed, toothed or roughened Oberfläche (13).
5. Wirbelsäulen prosthesis according to one of the Ansprüche 1 to 4, characterized in that daß the connecting and anchoring agent (11) to the prosthesis (6) über a plug-in or threaded connection (14 ) are fixed lösbar.
6. Wirbelsäulen prosthesis according to one of the Ansprüche 1 to 5, characterized in that the daß gewölbte Oberfläche (9, 9a, 9b, 9c, 9d) along two substantially normal to each other standing cut lines a different environment or have Wöl- Krümmung.
PCT/AT1998/000201 1997-08-28 1998-08-26 Prosthesis of the spinal column WO1999011203A1 (en)

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FR2799116A1 (en) * 1999-09-30 2001-04-06 Euros Sa Intervertebral implant comprises pure or alloyed pyrocarbon and is placed between two vertebrae and interacts by means of friction with at least one of them
US6679915B1 (en) * 1998-04-23 2004-01-20 Sdgi Holdings, Inc. Articulating spinal implant
US6824565B2 (en) 2000-09-08 2004-11-30 Nabil L. Muhanna System and methods for inserting a vertebral spacer
DE10339170A1 (en) * 2003-08-22 2005-03-24 Aesculap Ag & Co. Kg Intervertebral implant useful as replacement for intervertebral disk, includes upper and lower support bodies that are supported pivotably in relation to one another via saddle joint
EP1523962A1 (en) * 2003-10-17 2005-04-20 Cervitech, Inc. Set of cervical intervertebral prostheses
WO2005046533A1 (en) 2003-10-17 2005-05-26 Cervitech, Inc. Set of cervical intervertebral prostheses
US6936070B1 (en) 2001-01-17 2005-08-30 Nabil L. Muhanna Intervertebral disc prosthesis and methods of implantation
WO2005117765A1 (en) * 2004-05-28 2005-12-15 Sdgi Holdings, Inc. Prosthetic facet joint and nucleus supplement
US6981989B1 (en) 2003-04-22 2006-01-03 X-Pantu-Flex Drd Limited Liability Company Rotatable and reversibly expandable spinal hydraulic prosthetic device
US7419505B2 (en) 2003-04-22 2008-09-02 Fleischmann Lewis W Collapsible, rotatable, and tiltable hydraulic spinal disc prosthesis system with selectable modular components
EP2184037A1 (en) * 2002-04-23 2010-05-12 SpineCore, Inc. Artificial disc replacements with natural kinematics
KR101051264B1 (en) * 2003-10-17 2011-07-21 서비텍, 인크. Set between the cervical prostheses
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US9233011B2 (en) 2006-09-15 2016-01-12 Pioneer Surgical Technology, Inc. Systems and apparatuses for inserting an implant in intervertebral space
US9241807B2 (en) 2011-12-23 2016-01-26 Pioneer Surgical Technology, Inc. Systems and methods for inserting a spinal device
US9351852B2 (en) 2002-05-23 2016-05-31 Pioneer Surgical Technology, Inc. Artificial disc device
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US6679915B1 (en) * 1998-04-23 2004-01-20 Sdgi Holdings, Inc. Articulating spinal implant
US6846328B2 (en) 1998-04-23 2005-01-25 Sdgi Holdings, Inc. Articulating spinal implant
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US8628575B2 (en) 2000-08-29 2014-01-14 Nabil L. Muhanna Vertebral body replacement and method of use
US9468539B2 (en) 2000-08-29 2016-10-18 Nabil L. Muhanna, M.D. Vertebral body replacement and method of use
US6824565B2 (en) 2000-09-08 2004-11-30 Nabil L. Muhanna System and methods for inserting a vertebral spacer
US6936070B1 (en) 2001-01-17 2005-08-30 Nabil L. Muhanna Intervertebral disc prosthesis and methods of implantation
EP2184037A1 (en) * 2002-04-23 2010-05-12 SpineCore, Inc. Artificial disc replacements with natural kinematics
US9168146B2 (en) 2002-04-23 2015-10-27 Spinecore, Inc. Artificial disc replacements with natural kinematics
US9572679B2 (en) 2002-04-23 2017-02-21 Spinecore, Inc. Artificial disc replacements with natural kinematics
US9877841B2 (en) 2002-04-23 2018-01-30 Spinecore, Inc. Artificial disc replacements with natural kinematics
US8262731B2 (en) 2002-05-23 2012-09-11 Pioneer Surgical Technology, Inc. Artificial disc device
US9351852B2 (en) 2002-05-23 2016-05-31 Pioneer Surgical Technology, Inc. Artificial disc device
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DE10339170A1 (en) * 2003-08-22 2005-03-24 Aesculap Ag & Co. Kg Intervertebral implant useful as replacement for intervertebral disk, includes upper and lower support bodies that are supported pivotably in relation to one another via saddle joint
EP1523962A1 (en) * 2003-10-17 2005-04-20 Cervitech, Inc. Set of cervical intervertebral prostheses
WO2005046533A1 (en) 2003-10-17 2005-05-26 Cervitech, Inc. Set of cervical intervertebral prostheses
KR101051264B1 (en) * 2003-10-17 2011-07-21 서비텍, 인크. Set between the cervical prostheses
US7628813B2 (en) 2003-10-20 2009-12-08 Cervitech, Inc. Cervical intervertebral prosthesis system
US8062369B2 (en) 2003-10-20 2011-11-22 Cervitech, Inc. Cervical intervertebral prosthesis system
US9445916B2 (en) 2003-10-22 2016-09-20 Pioneer Surgical Technology, Inc. Joint arthroplasty devices having articulating members
US8066773B2 (en) * 2004-01-28 2011-11-29 F3 Technologies, Llc Artificial intervertebral disc
WO2005117765A1 (en) * 2004-05-28 2005-12-15 Sdgi Holdings, Inc. Prosthetic facet joint and nucleus supplement
US9233011B2 (en) 2006-09-15 2016-01-12 Pioneer Surgical Technology, Inc. Systems and apparatuses for inserting an implant in intervertebral space
US9693872B2 (en) 2006-09-15 2017-07-04 Pioneer Surgical Technology, Inc. Intervertebral disc implant
US8029569B2 (en) 2006-11-20 2011-10-04 International Spinal Innovations, Llc Implantable spinal disk
US9241807B2 (en) 2011-12-23 2016-01-26 Pioneer Surgical Technology, Inc. Systems and methods for inserting a spinal device
EP2907481A1 (en) * 2014-02-12 2015-08-19 HO-MED Handelsgesellschaft m.b.H. Implant for insertion between vertebrae of the spine and construction kit for making such an implant

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