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WO2000074605A1 - Intervertebral implant and assembly for setting same - Google Patents

Intervertebral implant and assembly for setting same

Info

Publication number
WO2000074605A1
WO2000074605A1 PCT/FR2000/001444 FR0001444W WO0074605A1 WO 2000074605 A1 WO2000074605 A1 WO 2000074605A1 FR 0001444 W FR0001444 W FR 0001444W WO 0074605 A1 WO0074605 A1 WO 0074605A1
Authority
WO
Grant status
Application
Patent type
Prior art keywords
implant
shells
core
end
provided
Prior art date
Application number
PCT/FR2000/001444
Other languages
French (fr)
Inventor
Henry Graf
Original Assignee
Henry Graf
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date

Links

Classifications

    • AHUMAN NECESSITIES
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    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/4611Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of spinal prostheses
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    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • 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
    • A61F2/446Joints 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 having a circular or elliptical cross-section substantially parallel to the axis of the spine, e.g. cylinders or frustocones
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    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
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    • 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
    • A61F2002/30884Fins or wings, e.g. longitudinal wings for preventing rotation within the bone cavity
    • AHUMAN NECESSITIES
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    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • 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
    • A61F2002/30891Plurality of protrusions
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    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
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    • A61F2/3094Designing or manufacturing processes
    • A61F2002/30975Designing or manufacturing processes made of two halves
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    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
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    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4625Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use
    • A61F2002/4627Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
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    • 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
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    • A61F2230/0006Rounded shapes, e.g. with rounded corners circular
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    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
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    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
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    • A61F2230/0017Angular shapes
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    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
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    • AHUMAN NECESSITIES
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    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, E.G. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • 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
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    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, E.G. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys
    • A61F2310/00023Titanium or titanium-based alloys, e.g. Ti-Ni alloys

Abstract

The invention concerns an implant (2) comprising, over part of its periphery, two rigid linings (16) designed to be in contact with two neighbouring vertebrae respectively, the vertical dimension of the set implant increasing towards the front part thereof and varying between a minimum dimension and a maximum dimension. Said implant further comprises a removable core (4), provided with two upper and lower peripheral contact zones (6) with each lining, the vertical distance separating the two peripheral zones (6) increasing towards the front part of the implant, and the two linings (16) are shells capable of adopting an intermediate configuration wherein the vertical spacing between their outer surfaces is substantially constant or decreasing towards the front, said shells (16) forming, in said intermediate configuration, an internal volume adapted to receive said removable core (4).

Description

INTERVERTEBRAL IMPLANT AND ASSEMBLY INSTALLATION OF SUCH IMPLANT

The invention relates to an intervertebral implant and a set of poses for such an implant.

Usually, such an implant, which can be partial or total, is intended to replace part or all of an intervertebral disc, when it was destroyed by surgery or disease.

Known from OA-97/31517, an intervertebral implant formed by a rigid body of frustoconical shape, whose transverse dimensions increasing towards the anterior portion of the implant, with reference to the latter once placed between the vertebrae . This implant is provided with two threaded coatings in the form of a circular arc, intended to come into contact with each of the vertebrae. The spacing between these two coatings, that is to say the greatest distance therebetween, in cross-section varies continuously from the rear of the implant, toward the front thereof.

This known implant, however, has drawbacks. Since, for anatomical reasons, its front longitudinal end has greater transverse dimensions, it is difficult to insert the implant from the rear of the spine. Indeed, it is first necessary to provide, in the vertebral bone, a housing whose dimensions correspond to the maximum spacing between the coatings, at the anterior part of the prosthesis. This is primarily the cause of destructive surgery, detrimental to the patient's physical integrity. Furthermore, this implant has a high risk of being ejected from the intervertebral space, since, once in place, the implant is placed in a housing whose transverse dimensions are greater than those of the majority of the implant itself, particularly in the vicinity of the rear end of the latter. Such an implant can not be set up successfully, since the front of the spine, which involves the implementation of a particularly delicate surgery.

To overcome the disadvantages of the prior art discussed above, the invention proposes to provide an intervertebral implant which, while possessing an advantageous conformation of a physiological point of view, can be easily inserted from the rear of a vertebra, for the implementation of a relatively destructive surgery, and has a satisfactory stability once in place within the intervertebral space. For this purpose, it relates to an intervertebral implant for insertion between two adjacent vertebrae, said implant comprising on a portion of its periphery, two rigid coatings intended to come into contact respectively with the two adjacent vertebrae, the vertical dimension implant placed increasing towards the anterior portion of the implant and varying between a minimum size and a maximum size, characterized in that said implant further comprises a removable core, provided with two upper and lower peripheral regions of contact with each coating, the vertical distance between the two peripheral areas increasing towards the anterior portion of the implant, and in that the two coatings are clean shells adopting an intermediate configuration in which the vertical distance between their outer surfaces is substantially constant or descending forwardly, said shells forming in said intermediate configuration, an inner volume adapted to receive said removable core.

The invention also proposes to produce a set of poses for the implant as defined above on it, which ensures easy installation of the latter and that preserves the integrity of the various organs in the vicinity of which this set is moved during all laying operations. To this end, the invention also relates to a set of poses for the implant as defined above, characterized in that it comprises means for forming a second interior volume in communication with the interior volume formed by said shells in said intermediate pattern. The invention is described below with reference to the accompanying drawings, given solely by way of nonlimiting example and in which:

- Figure 1 is a perspective view of the various components of an implant according to a first embodiment of the invention;

- Figure 2 is an exploded perspective view of the various components of a set of poses for the implant of Figure 1; - Figure 3 is a longitudinal sectional view of the two coatings of the prosthesis of Figure 1, made integral with a positioning insert of Figure 2;

- Figure 4 is a longitudinal sectional view illustrating the insertion phase of the core of the implant into the interior volume defined by the two coatings of the implant of Figure 1;

- Figure 5 is a longitudinal sectional view of the implant of Figure 1, once installed in the intervertebral space; and - Figure 6 is a perspective view illustrating the one hand the various components of an intervertebral implant conform to a second embodiment of the invention and, on the other hand, one of the elements belonging to a set installation for this implant. Figure 1 shows, seen in perspective, an intervertebral implant according to a first embodiment of the invention, generally designated by reference 2. This implant comprises a core 4 made of a substantially rigid biocompatible material, such that a metal, eg titanium, or even a polymer. This core can also be made of a bone substitute material or comprise a hollow metal frame and whose surface is pierced with orifices.

The cross section of the core 4 is composed of two end portions 6 whose outer periphery describes an arc of a circle and which are connected by two flat surfaces 8 forming a middle portion 10.

The transverse dimension or width of the end portions 6 is substantially constant throughout the implant 2, whereas the height of the flat portions 8 increases forwardly of the implant, with reference thereto a once established in the intervertebral space. Each end portion 6 is hollowed out two grooves

12, the depth of which decreases continuously towards the rear of the prosthesis, this depth being zero at the rear longitudinal end of the implant. The core 4 is also formed with a central longitudinal bore which is passing through. The vertical spacing between the two end portions

6, with reference to a standing patient is between of, at the rear portion of the prosthesis, and D ', at the front portion thereof.

The implant 2 also comprises two coatings 16, 16 'forming shells which are movable both relative to each other and relative to the core 4.

Each shell 16, 16 'includes a central cap 18, 18' cylindrical, intended to come into contact with the core 4. This cap is connected to a surrounding cover 20, 20 'having, in cross section, an arc shape circle. The outer surface of these caps is provided with a thread 22, 22 ', to facilitate implantation of the prosthesis.

The connecting region between each cap 18, 18 'and its adjacent cap 20, 20' is hollowed a through longitudinal opening 24, 24 'in the shape of a circular arc, for the tongues of housing a set of pose, as explained in the following figures.

Each shell 16, 16 'is provided with two radial notches 26, 26', projecting inwardly from the front end of each cap 18, 18 '. It should be noted that these notches extend only over a small portion of the longitudinal dimension of the shells 16, 16 '. The respective positions of the notches 26, 26 'and grooves 12 allows them to cooperate, by sliding of these notches in the grooves.

Each shell 16, 16 'is provided with two side skirts 28, 28', 30, 30 'extending in the direction of the opposite shell, from the ends of each cap 18, 18', substantially perpendicular to the main axis of the prosthesis. These skirts have, side views, a profile almost sinusoidal. The skirts 28, 30 or 28 ', 30' of the same shell 16, 16 'are asymmetrically arranged with respect to one another. However, the skirt facing 28, 28 'or 30, 30' of the shells 16, 16 'have conjugate shapes, so that they are able to bear one on the other by their respective edges. For this purpose, the latter may be provided with male-female elements, not shown, for example of the type with tenon-mortise, to prevent relative translation of the two shells, in directions both longitudinal and transverse.

Each shell is provided with a front flap 32, 32 respective. These flaps are longitudinally offset relative to each other and, as shown in Figure 3, extend along the main dimensions such that they overlap, when the shells are pressed against one another . The flap 32 'adjacent to the notches 26, 26' is further provided with a threaded through hole 34 ', intended to cooperate with a threaded rod, as will be explained in what follows. Can be provided that the other part 32 is provided with a similar hole. The shell 16 is further provided with a terminal lug 35 forming, with the flap 32 ', housing 35' U-shaped in which is received the flap 32.

Each shell 16, 16 'is formed with a notch 36, 36' extending over a portion of the longitudinal dimension of the shell, at the radial center portion thereof. An elastic tab 38, 38 'terminated at its front part by a tip 40, 40' protruding outwards, is hinged on the front wall of each notch 36, 36 '. The dimensions of the tip 40, 40 'are such that it does not protrude beyond the outer surface of the cap when the core 4 is not in contact with the latter (Figure 4). In contrast, as shown in particular in Figure 5, once the implant is in place, that is to say the core 4 in contact with the shells 16, 16 ', each pin 40, 40' protrudes through relative to the outer surface of these shells, so as to form an anchoring means of the implant in the corresponding vertebra.

2 shows the different elements of a set of insertion of the implant 2, designated as a whole by the reference 42. The assembly includes an insert 44, which consists, in cross section, two end portions 46, the outer periphery of an arc of a circle and which are connected by two flat surfaces 48 forming a middle portion 50. It should be noted that the vertical spacing between these end portions is constant along this insert and is substantially equal to the distance d 'between the end portions 6 of the core 4, at the rear portion thereof.

Each end portion 46 of one insert 44 is hollowed three longitudinal grooves, namely a central groove 52 and two outer slots 54. The depth of these grooves is substantially constant along the prosthesis. The outer grooves 54 are arranged such that they cooperate, by sliding, with the notches 26, 26 'of the shells 16, 16'. The outer groove 54 is arranged such that one insert 44, when secured to the shells 16, 16 ', as shown in Figure 3, does not induce formatting projecting tabs 38, 38' relative at the outer periphery of the shells 16, 16 '. The insert 44 is hollowed with a central longitudinal bore which is passing through. It should be noted that the longitudinal dimensions of the insert 44 are larger than those of the shells 16, 16 '.

The laying assembly 42 also includes a tool 58 having a handle 60 extended by two tongues 62, 62 'in form of a circular arc. These latter have dimensions such that they are capable of penetrating into the openings 24, 24 'formed in the shells 16, 16'. Each tongue 62, 62 'is provided with a radially inner recess 64, 64' defining a distal tapered portion 66, 66 'of this tab. Each distal portion 66, 66 'is further recessed with a longitudinal slot 68, 68', avoiding all contact between the tongues 62, 62 'and the tips 40, 40', as shown in particular in Figure 3.

The laying assembly 42 finally comprises a rod 70 whose one end 72 is threaded.

We will now describe the implementation of the implant 2 by means of the laying assembly 42, with reference to Figures 1 to 5.

first placing the two shells 16, 16 'around 1 insert 44. For this purpose, it is reported the inner surface of the caps 18, 18' against the end portions 46 of this insert, the notches 26, 26 'penetrating the outer grooves 54. One end of this insert is abutted against the shutter 32', while the other end of this insert projects longitudinally relative to the corresponding end of the shells 16, 16 ' . When the shells are disposed around one insert

44, the edges of adjacent skirts 28, 28 'and 30, 30' of these shells are in mutual support.

the rod 70 is then inserted through the central hole 56 of the insert 44 and then secures the rod relative to the shells, by cooperation of the threaded end 72 of the rod 70 with the threaded hole 34 'of the flap 32' .

Then puts the distal tapered portion 66, 66 'of each tab 62, 62' in the openings 24, 24 ', until the recesses 64, 64' abut against the rear wall of the shells. In this configuration, the inner surface of the caps 18, 18 'and the tabs 62, 62' are continuous.

The two shells 16, 16 'thus form an intermediate implant I, whose transverse dimensions are substantially constant and are close to the smallest transverse dimension of the final implant.

The establishment of the intermediate implant, which is generally cylindrical in the intervertebral space is first of all as to provide, in the latter, a housing whose transverse dimensions correspond to those of this intermediate implant. Then introduced this implant by screwing, by means of the handle 60 of the running tool 58. The threads 22, 22 'which are provided with the shells are advantageous in respect of this operation. In addition, the outer surface of the tongues 62, 62 'is preferably smooth, allowing easy removal of the tongues once the intermediate implant in place. When the shells occupy the position that they must adopt, once the final implant formed, the handle 60 is removed from the tool 58, which is removable with respect to the tongues 62, 62 ', the distal portion 66, 66 'remains in place in the openings 24, 24'. then removed one insert 44 of the inner volume V of the shells 16, 16 ', taking advantage of the fact that the insert 44 has significant longitudinal dimensions.

is then introduced, as shown in Figure 4, the core 4 in the interior volume V of the tongues 62, 62 '. The core 4 is introduced by its front end, larger in size, which has the effect of mutually separate the tongues and the edges opposite the skirts 28, 30 and 28 ', 30' of the shells. The shutter 32 'has a certain elasticity to compensate for this distance. Then, it advances the core 4 towards the inner volume V of the shells 16, 16 '. To this end, is secured with respect to the tongues 62, 62 ', a ground plate 74 with a central hole 76 threaded. The latter cooperates with a tubular member 78 disposed around the threaded rod 70 and whose outer surface is threaded. One of the ends of this tubular member 78 is provided with an operating knob 80 while its opposite end receives ball, a disk-shaped piston which bears against the rear face of the core 4.

When operating the operating button 80, the tubular member moves relative to the plate 74 in the direction of the shells 16, 16 ', which has the effect of bringing the core 4 of the latter. At some point in this operation, the notches 26, 26 'of the shells 16, 16' penetrate into the longitudinal grooves 12 of the core 4. It is then possible to désoli- dariser the threaded rod 70 with respect to the flaps 32, 32 ', then to withdraw the rod out of the interior volumes of the shells 16, 16' and tabs 62, 62 '.

Alternatively, one can also remove the threaded rod 70 together with one insert 44, taking advantage of the fact that the caps can not move longitudinally with respect to one another, the flap 32 being received in the housing 35 'in U. by continuing to operate the operating button 80, the core

4 proceeds along the inner surface of the caps 18, 18 ', while the notches 26, 26' slide in the grooves 12. Since the end portions 6 of the core 4 are devoid of central grooves, like 52 those of one insert 44, the movement of the core with respect to the shells 16, 16 'contributes to swing the elastic tabs 38, 38' outwardly of the shells, until the tips 40 , 40 'adopt a projecting position, as illustrated in Figure 5. at the end of movement of the core 4 with respect to the shells

16, 16 ', the front wall of the core 4 abuts against the flap 32', while the notches 26, 26 'bear against the rear face of the core 4. Since the grooves 12 have zero depth in the vicinity of this rear end, the notches 26, 26 'prevent any longitudinal movement of the core 4 with respect to the shells 16, 16' in a first direction, such a longitudinal displacement is prevented in the other direction, due the presence of the rear flap 32.

Once the implant 2 in position, the opposed skirts 28, 30 'and 28', 30 of the caps, namely a skirt of a cap and the skirt of the other cap, generally symmetrical to the first skirt relative to the longitudinal axis of the implant have, in cross section, an overlap area. This reduces the lateral shear to which is subjected the implant. The height or vertical dimension of the implant, once laid, increases from a value at the rear of the implant to a value D at the front thereof.

Figure 6 shows the various tive constitutional elements of an implant according to a second embodiment of the invention, designated as a whole by the reference 102.

This implant comprises a core 104, whose cross section consists of two end portions 106, connected by two walls 108, perpendicular to these end portions 106, so as to form a middle portion 110.

The transverse dimension or width of the core 104 is substantially constant all along the latter, whereas the height or vertical dimension of the core increases toward the front thereof, by reference to the implant once implemented in the intervertebral space. The core 104 is hollowed out of four side grooves 112, namely two pairs of respectively upper and lower grooves extending parallel to the end portion 106 in which they are adjacent. The core 104 is also pierced by a central longitudinal bore 114, which is passing through.

The implant 102 also includes two shells 116, 116 'which are movable both relative to each other and relative to the core 104. Each shell has a U-shape and has a core 118, 118 ', intended to come into contact with the end portions 106, and two wings 120, 120' intended to bear against the flat surfaces 108. the core 118, 118 'is formed with a longitudinal opening 124, 124 ', and a notch 136, 136', the walls of which receive a lug not shown, similar to 38, 38 'described with reference to previous figures. The outer surface of the core is further provided with pins 137, 137 'intended to penetrate into a corresponding vertebra. The inner wall of the wings 120, 120 'is provided with longitudinal ribs 138, 138' adapted to cooperate with the grooves 112 of the core 104. Each shell is provided at its front end flaps, of which only one 132 is shown, similar to those described with reference to figures 3 to 5. the installation of the implant 102 is achieved by means of a laying assembly comprising an insert 144, of rectangular cross section, constant throughout the insert. The latter is provided with six grooves, namely two grooves 152, 152 ', respectively top and bottom, and four lateral grooves 154 adapted to cooperate with the ribs 138, 138'. The grooves 152, 152 'allow the free passage of the spring anchoring lug in the vertebra. The placement of the implant 102 is carried out as follows. Is firstly secures the insert 144 relative to the shells 116, 116 ', by cooperation of the ribs 138, 138' with the lateral grooves 154 then secures the two shells by means of a not shown threaded stem, analogously to what has been described with reference to the previous embodiment. In this configuration, the wings 120, 120 'opposite the two shells are in mutual contact.

This forms an intermediate implant that is inserted into the intervertebral space by impaction. then sets up tabs similar to those 62, 62 ', in the openings 124, 124' of the shells 116, 116 '. Then introduced the core 104 into the interior volume defined by the tabs not shown, and then is introduced the core 104 into the interior of the shells 116, 116 ', by impaction, by means of a not shown tool. withdrawal operations one insert 144, the threaded rod and unrepresented tabs operate analogously to what has been described with reference to previous figures. The invention allows to achieve the objectives mentioned above. The two shells, movable with respect to the core, which is provided with the implant of the invention allow the realization of an implant through a small transverse dimension, adapted to be introduced into the intervertebral space by providing a housing small size, which is advantageous for the patient's physical integrity.

This intermediate implant has good stability with respect to the vertebral bone and constitutes a lever arm for insertion of the core into the interior of the shells. Furthermore, given the small size of the housing formed initially, the final implant has a very satisfactory stability, once established.

The implant of the invention is also advantageous in that it allows the production of preliminary tests, with only partial introduction of the soul into the interior of the cap. In this way, it is possible to withdraw the core, in the event that its conformation is not beneficial for the patient, so as to replace it with another core, of suitable profile.

It should be noted that the realization of a small-sized housing does not allow the introduction of a one-piece implant of the prior art. Indeed, if we try to introduce the implant, holding the walls of a housing, there occurs a collapse of the vertebral bones, in which the invention eliminates the use of intermediate implant comprising the two shells.

Claims

1. An intervertebral implant (2; 102), for insertion between two adjacent vertebrae, said implant comprising on a portion of its periphery, two rigid coatings (16; 116) intended to come into contact respectively with the two adjacent vertebrae, the vertical dimension of the placed implant increasing towards the anterior portion of the implant and varying between a minimum dimension (d) and a maximum dimension (D), characterized in that said implant further comprises a removable core (4; 104 ), provided with two upper and lower peripheral regions (6; 106) contact with each coating, the vertical distance between the two peripheral areas (6; 106) increasing towards the anterior portion of the implant, and in that the two coatings (16; 116) are of clean shells to adopt an intermediate configuration (I) wherein the vertical spacing between their outer surfaces is substantially constant or decreases towards the av ant, said shells (16; 116) forming, in said intermediate configuration (I), an interior volume (V) suitable for receiving said removable core (4; 104).
2. Implant according to claim 1, characterized in that, in said intermediate configuration, the spacing between the shells (16; 116) is close to the minimum spacing (d) of said intervertebral implant.
3. Implant according to claim 2, characterized in that, in said intermediate configuration, the adjacent ends (28, 28 'and 30, 30') of said shells (16) are in mutual contact.
4. Implant according to claim 3, characterized in that it comprises fastening means in translation of said shells (16; 116) in said intermediate pattern.
5. Implant according to one of claims 1 to 4, characterized in that, in said intermediate configuration (I), said shells (16; 116) are adapted to receive said removable core (4; 104) by sliding, and that there is provided means (12, 26; 112, 138) for securing said shells in rotation (16; 116) relative to said core (4; 104) during said sliding.
6. Implant according to one of claims 1 to 5, characterizes in that it comprises means (26, 32 ') of longitudinal translation in joining, according to two opposite directions, said shells (16) relative to said core (4).
7. Implant according to one of claims 1 to 6, characterized in that said implant is provided with means (28, 28 ', 30, 30') for reducing lateral shearing.
8. Implant according to Claim 7, characterized in that the means for reducing lateral shearing comprise at least first (28, 28 ') and second (30, 30') opposite lateral skirts, which are provided with shells respectively ( 16), said opposed skirts having an overlap area.
9. Implant according to any one of the preceding claims, characterized in that it comprises anchoring means (40) said shells (16) to said vertebrae, movable between a retracted position, when the core (4) No is not in contact with said peripheral areas (6), and a projecting position where said peripheral regions (6) of the core (4) are in contact with said coatings (6).
10. Installation for the implant assembly according to quelcon- that of the preceding claims, characterized in that it comprises means (62) for forming a second interior volume (V) in communication with the interior volume (V) formed by said shells (16; 116), in said intermediate configuration (I).
11. An assembly according to claim 10, characterized in that the means (62) for forming a second interior volume (V) have a continuous inner surface with the inner surface of said shells (16; 116), in said intermediate configuration ( I).
12. An assembly according to claim 10 or 11, characterized in that the means for forming a second interior volume (V) comprise tongues (62) adapted to be engaged partially into the openings (24; 124) longitudinal which are provided with shells (16; 116).
13. laying assembly according to one of Claims 10 to 12, characterized in that it comprises means (44; 144) for stabilizing said shells (16; 116) in said intermediate configuration (I), adapted to be engaged within the interior volume (V) of said shells.
PCT/FR2000/001444 1999-06-02 2000-05-26 Intervertebral implant and assembly for setting same WO2000074605A1 (en)

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