WO2003090649A1 - Artificial disc replacements with natural kinematics - Google Patents

Artificial disc replacements with natural kinematics

Info

Publication number
WO2003090649A1
WO2003090649A1 PCT/US2003/012500 US0312500W WO03090649A1 WO 2003090649 A1 WO2003090649 A1 WO 2003090649A1 US 0312500 W US0312500 W US 0312500W WO 03090649 A1 WO03090649 A1 WO 03090649A1
Authority
WO
WIPO (PCT)
Prior art keywords
adr
rotation
posterior
anterior
centers
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US2003/012500
Other languages
English (en)
French (fr)
Other versions
WO2003090649A9 (en
Inventor
Bret A. Ferree
David Tompkins
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
SPINCORE Inc
Original Assignee
SPINCORE Inc
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
Priority to AT03726417T priority Critical patent/ATE462382T1/de
Priority to AU2003228655A priority patent/AU2003228655B9/en
Priority to DE60331900T priority patent/DE60331900D1/de
Priority to JP2003587290A priority patent/JP4382501B2/ja
Priority to CA002483226A priority patent/CA2483226C/en
Priority to EP03726417A priority patent/EP1496818B1/en
Priority to US10/512,515 priority patent/US8366772B2/en
Application filed by SPINCORE Inc filed Critical SPINCORE Inc
Publication of WO2003090649A1 publication Critical patent/WO2003090649A1/en
Publication of WO2003090649A9 publication Critical patent/WO2003090649A9/en
Anticipated expiration legal-status Critical
Priority to US13/737,500 priority patent/US8784492B2/en
Priority to US14/308,201 priority patent/US9168146B2/en
Priority to US14/881,879 priority patent/US9572679B2/en
Priority to US15/402,610 priority patent/US9877841B2/en
Priority to US15/840,630 priority patent/US10299933B2/en
Priority to US16/385,703 priority patent/US20190307575A1/en
Ceased legal-status Critical Current

Links

Classifications

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    • A61F2/442—Intervertebral or spinal discs, e.g. resilient
    • A61F2/4425—Intervertebral or spinal discs, e.g. resilient made of articulated components
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    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
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Definitions

  • This invention relates generally to artificial disc replacements (ADRs) and, more particularly, to ADRs facilitating more natural kinematics.
  • ADR artificial disc replacement
  • ADR designs do not attempt to limit the pressure across the facet joints or facet joint motion. Indeed, prior art ADRs generally do not restrict motion. For example, some ADR designs place bags of hydrogel into the disc space which do not limit motion in any direction. In fact, ADRs of this kind may not, by themselves, provide sufficient distraction across the disc space. ADR designs with metal plates and polyethylene spacers may restrict translation but they do not limit the other motions mentioned above. The articular surface of the poly spacer is generally convex in all directions. Some ADR designs limit motion translation by attaching the ADR halves at a hinge. One of the most important features of an artificial disc replacement (ADR) is its ability to replicate the kinematics of a natural disc.
  • ADR artificial disc replacement
  • ADRs that replicate the kinematics of a normal disc are less likely to transfer additional forces above and below the replaced disc.
  • ADRs with natural kinematics are less likely to stress the facet joints and the annulus fibrosus (AF) at the level of the disc replacement. Replicating the movements of the natural disc also decreases the risk of separation of the ADR from the vertebrae above and below the ADR.
  • ADR The kinematics of ADRs are governed by the range of motion (ROM), the location of the center of rotation (COR) and the presence (or absence) of a variable center of rotation (VCOR).
  • ROM range of motion
  • COR center of rotation
  • VCOR variable center of rotation
  • ROM is limited by the facet joints and the AF.
  • a natural disc has a VCOR, that is, the COR varies as the spine bends forward (flexion) and backward (extension).
  • the vertebra above a natural disc translates forward l-2mm as the spine is flexed.
  • TDR total disc replacements
  • This invention improves upon prior art TDRs by more closely replicating the kinematics of a natural disc.
  • the preferred embodiments feature two or more fixed centers of rotation (CORs) and an optional variable COR (VCOR) as the ADR translates from a fixed posterior COR to a more anterior COR.
  • the multiple CORs permit a TDR with a posterior COR that lies posterior to the COR of the TDR to facilitate normal disc motion.
  • the use of two or more CORs allow more flexion and more extension than permitted by the facet joints and the AF.
  • Artificial facet joint-like components may also be incorporated into the design to restrict excessive translation, rotation, and/or lateral bending.
  • FIGURE 1 is a sagittal cross section of a total disc replacement (TDR) according to the invention having three fixed centers of rotation (CORs);
  • FIGURE 2 is a sagittal cross section of the TDR of Figure 1 extended 5 degrees, more or less;
  • FIGURE 3 is a sagittal cross section of the TDR of Figure 1 showing various degrees of flexion
  • FIGURE 4 is a sagittal cross section of another embodiment of a TDR having an anterior COR and a posterior COR;
  • FIGURE 5 is a sagittal cross section of the TDR of Figure 4 in a flexed position
  • FIGURES 6Aand 6B are drawings that show the articulating surfaces of the TDR drawn in Figure 4;
  • FIGURE 7 is a sagittal cross section of another embodiment having an anterior and a posterior COR;
  • FIGURE 8 is a sagittal cross section of the TDR of Figure 7 in a more flexed position
  • FIGURE 9 is a view of the articulating surfaces of the TDR of Figure 7;
  • FIGURE 10 is an oblique view of the assembled TDR drawn in Figure 7;
  • FIGURE 11A is a view of the anterior side of a cervical embodiment of the TDR of Figure 7;
  • FIGURE 1 IB is a view of the lateral side of the TDR of Figure 11 A
  • FIGURE 11C is a view of the interior of the TDR drawn in Figure 11 A;
  • FIGURE 12A is a sagittal cross section of yet a further embodiment of an artificial disc replacement according to the invention.
  • FIGURE 12B is a sagittal cross section of the embodiment of the ADR of Figure 12 A;
  • FIGURE 12C is a view of the side of the ADR of Figure 12A;
  • FIGURE 13 A is a view of the side of the ADR of Figure 12A including modular shims.
  • FIGURE 13B is an exploded view of the embodiment of the ADR shown in Figure 13 A.
  • ADRs artificial disc replacements
  • Wedge or trapezoid-shaped ADRs are also presented to preserve lordosis.
  • Fasteners may be used to fix the ADR to upper and lower vertebrae.
  • An optional lip may additionally be provided to prevent the trapping of soft tissue during the movement from a flexion to neutral position.
  • the present invention extends such teachings through total disc replacements
  • TDRs that more closely replicate the kinematics of a natural disc.
  • the preferred embodiments feature two or more fixed centers of rotation (CORs) and an optional variable COR (VCOR) as the ADR translates from a fixed posterior COR to a more anterior COR.
  • CORs fixed centers of rotation
  • VCOR variable COR
  • the multiple CORs permit a TDR with a posterior COR that lies posterior to the COR of the TDR to facilitate normal disc motion.
  • the use of two or more CORs allow more flexion and more extension than permitted by the facet joints and the AF.
  • Artificial facet joint-like components may also be incorporated into the design to restrict excessive translation, rotation, and/or lateral bending.
  • Figure 1 is a sagittal cross section of a TDR according to the invention having three fixed CORs. Articulation occurs at the posterior COR when the spine is in a neutral to extended position.
  • Figure 2 is a sagittal cross section of the TDR drawn in Figure 1 with the ADR extended 5 degrees, more or less.
  • Figure 3 is a sagittal cross section of the TDR drawn in Figure 1 in various degrees of flexion. As illustrated in the figure, the COR migrates anteriorly from a more posterior COR to a more anterior COR as the TDR is flexed.
  • Figure 4 is a sagittal cross section of another embodiment of the invention having an anterior COR and a posterior COR.
  • the TDR articulates at the posterior COR with the TDR in neutral to extended position.
  • Figure 5 is a sagittal cross section of the TDR drawn in Figure 4 in a flexed position.
  • the superior TDR endplate translates forward from the posterior COR to the anterior COR as the ADR moves from a neutral or extended position to a flexed position.
  • Figures 6Aand 6 B are a view of the articulating surfaces of the TDR drawn in Figure 4.
  • the inferior TDR endplate is shown in Figure 6A, and the inferior surface of the superior TDR endplate is shown in Figure 6B.
  • Figure 7 is a sagittal cross section of a further embodiment of the invention, including an anterior and a posterior COR.
  • the design also includes novel artificial facet joint-like components that prevent excessive translation, rotation, or lateral bending.
  • Figure 8 is a sagittal cross section of the TDR drawn in Figure 7 in a more flexed position. The drawing illustrates a gap between the artificial facet joint-like portions of the device.
  • Figure 9 is a view of the articulating surfaces of the TDR drawn in Figure 7. The superior surface of the inferior TDR endplate is drawn on the left.
  • Figure 10 is an oblique view of the assembled TDR drawn in Figure 7.
  • FIG. 11 A is a view of the anterior side of a cervical embodiment of the TDR drawn in Figure 7. Screws can be inserted through the holes in the TDR to attach the TDR to the vertebrae. A reversible locking mechanism can be used to prevent the screws from backing out of the vertebrae.
  • Figure 1 IB is a view of the lateral side of the TDR drawn in Figure 11 A.
  • Figure 11C is a view of the interior of the TDR drawn in Figure 11 A. The superior surface of the inferior component of the TDR is drawn on the left.
  • Figure 12A is a sagittal cross section of another embodiment wherein, in contrast to the embodiment of Figure 7, the articulating surfaces of the anterior and/or the posterior CORs are not congruent.
  • the use of non-congruent articulating surfaces uncouples translation from rotation.
  • ADRs with non-congruent joint surfaces allow greater spinal flexion and extension without corresponding subluxation of the vertebrae.
  • the spherical projections from the upper and lower ADR endplates can cooperate to prevent the upper ADR endplate from translating posteriorly over the inferior ADR endplate.
  • the drawing illustrates the different radius of curvature of the components forming the joint in the posterior aspect of the ADR.
  • Figure 12B is a sagittal cross section of the embodiment of the ADR drawn in Figure 12A in a flexed position.
  • the drawing illustrates the different radius of curvature of the components forming the joint in the anterior aspect of the ADR.
  • Figure 12C is a view of the side of the ADR drawn in Figure 12A.
  • Artificial facet joint-like components similar to those drawn in Figure 7, prevent excessive forward translation of the upper ADR endplate relative to the lower ADR endplate.
  • the artificial facet joint-like components can also limit axial rotation and lateral bending.
  • Figure 13A is a view of the side of the ADR drawn in Figure 12A, with modular sims. Modular shims can be used to increase the lordosis, or wedge shape, of the ADR.
  • the modular shims can be attached to the top of the superior ADR endplate and/or the bottom of the inferior ADR endplate.
  • the shims could fasten to the keels of the ADR.
  • the shims could attach to another part of the ADR endplates.
  • the shims could simply lay on the ADR endplates.
  • the shim inventory would include shims with different thickness and different angles.
  • Figure 13B is an exploded view of the embodiment of the ADR drawn in 13 A.
  • a concave surface may have a radius of curvature that is larger than the radius of curvature of an articulating convex surface such that the two surfaces are not in direct or intimate contact at all times.
  • Both symmetrical and asymmetrical joints may also be used.
  • a portion of the back of the posterior joint may be removed to move the posterior COR further posterior and to increase the surface area of the posterior joint by increasing the radius of the surface.
  • the articulating surface may be formed by a toroidal region and a spherical region, in this and other embodiments non-spherical surfaces may also be used to permit translation, rotation or other movements between more controlled articulations.
  • TDRs according to the invention may be used in the cervical, thoracic, or lumbar spine.
  • ADR/TDRs according to this invention may also be composed of various materials.
  • the components may be constructed of a metal such as chrome cobalt or a ceramic such as aluminum oxide.
  • the novel TDR can also be made of a metal or ceramic coated with a harder or softer second material. That is, one or both of the components may be a metal coated with a ceramic, or a metal or ceramic coated with a diamond-like material or other hardened surface. Alternatively, one or both of the components may be coated with a polymeric (i.e., polyethylene) surface or liner.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
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  • Orthopedic Medicine & Surgery (AREA)
  • Neurology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Oral & Maxillofacial Surgery (AREA)
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  • Cardiology (AREA)
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PCT/US2003/012500 2002-04-23 2003-04-23 Artificial disc replacements with natural kinematics Ceased WO2003090649A1 (en)

Priority Applications (13)

Application Number Priority Date Filing Date Title
AT03726417T ATE462382T1 (de) 2002-04-23 2003-04-23 Künstlicher bandscheibenersatz mit natürlicher kinematik
AU2003228655A AU2003228655B9 (en) 2002-04-23 2003-04-23 Artificial disc replacements with natural kinematics
DE60331900T DE60331900D1 (de) 2002-04-23 2003-04-23 Künstlicher bandscheibenersatz mit natürlicher kinematik
JP2003587290A JP4382501B2 (ja) 2002-04-23 2003-04-23 自然な運動機能を有する代替人工椎間板
CA002483226A CA2483226C (en) 2002-04-23 2003-04-23 Artificial disc replacements with natural kinematics
EP03726417A EP1496818B1 (en) 2002-04-23 2003-04-23 Artificial disc replacements with natural kinematics
US10/512,515 US8366772B2 (en) 2002-04-23 2003-04-23 Artificial disc replacements with natural kinematics
US13/737,500 US8784492B2 (en) 2002-04-23 2013-01-09 Artificial disc replacements with natural kinematics
US14/308,201 US9168146B2 (en) 2002-04-23 2014-06-18 Artificial disc replacements with natural kinematics
US14/881,879 US9572679B2 (en) 2002-04-23 2015-10-13 Artificial disc replacements with natural kinematics
US15/402,610 US9877841B2 (en) 2002-04-23 2017-01-10 Artificial disc replacements with natural kinematics
US15/840,630 US10299933B2 (en) 2002-04-23 2017-12-13 Artificial disc replacements with natural kinematics
US16/385,703 US20190307575A1 (en) 2002-04-23 2019-04-16 Artificial Disc Replacements With Natural Kinematics

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US37474702P 2002-04-23 2002-04-23
US60/374,747 2002-04-23
US44595803P 2003-02-07 2003-02-07
US60/445,958 2003-02-07
US44964203P 2003-02-24 2003-02-24
US60/449,642 2003-02-24
US10/420,423 US6706068B2 (en) 2002-04-23 2003-04-22 Artificial disc replacements with natural kinematics
US10/420,423 2003-04-22
US10/512,515 US8366772B2 (en) 2002-04-23 2003-04-23 Artificial disc replacements with natural kinematics

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US10512515 A-371-Of-International 2003-04-23
US10/512,515 A-371-Of-International US8366772B2 (en) 2002-04-23 2003-04-23 Artificial disc replacements with natural kinematics
US13/737,500 Continuation US8784492B2 (en) 2002-04-23 2013-01-09 Artificial disc replacements with natural kinematics

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EP (2) EP1496818B1 (enExample)
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US6706068B2 (en) 2004-03-16
WO2003090649A9 (en) 2004-06-03
JP2005523109A (ja) 2005-08-04
US20050228497A1 (en) 2005-10-13
US20030199981A1 (en) 2003-10-23
CA2483226C (en) 2008-07-08
JP4382501B2 (ja) 2009-12-16
EP1496818A4 (en) 2007-01-03
US9168146B2 (en) 2015-10-27
AU2003228655B2 (en) 2007-09-13
US8366772B2 (en) 2013-02-05
EP2184037A1 (en) 2010-05-12
EP1496818A1 (en) 2005-01-19
CA2483226A1 (en) 2003-11-06
EP2184037B1 (en) 2011-10-19
AU2003228655A1 (en) 2003-11-10
US9572679B2 (en) 2017-02-21
EP1496818B1 (en) 2010-03-31
US20130131813A1 (en) 2013-05-23
US20180116820A1 (en) 2018-05-03
US20190307575A1 (en) 2019-10-10
AU2003228655B9 (en) 2008-03-13
US20160030193A1 (en) 2016-02-04
US20170119545A1 (en) 2017-05-04
US20140303735A1 (en) 2014-10-09
US8784492B2 (en) 2014-07-22
US10299933B2 (en) 2019-05-28
US9877841B2 (en) 2018-01-30

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