WO2007003437A2 - Cage for the introduction into an intervertebral-disc compartment - Google Patents

Cage for the introduction into an intervertebral-disc compartment Download PDF

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Publication number
WO2007003437A2
WO2007003437A2 PCT/EP2006/006608 EP2006006608W WO2007003437A2 WO 2007003437 A2 WO2007003437 A2 WO 2007003437A2 EP 2006006608 W EP2006006608 W EP 2006006608W WO 2007003437 A2 WO2007003437 A2 WO 2007003437A2
Authority
WO
WIPO (PCT)
Prior art keywords
cage
intervertebral
disc compartment
plate
cover plate
Prior art date
Application number
PCT/EP2006/006608
Other languages
English (en)
French (fr)
Other versions
WO2007003437A3 (en
Inventor
Franz Jun. Copf
Original Assignee
Copf Franz Jun
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
Application filed by Copf Franz Jun filed Critical Copf Franz Jun
Priority to EP06762461A priority Critical patent/EP1919403A2/en
Publication of WO2007003437A2 publication Critical patent/WO2007003437A2/en
Publication of WO2007003437A3 publication Critical patent/WO2007003437A3/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters 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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    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/4455—Joints 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
    • A61F2/447—Joints 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 substantially parallelepipedal, e.g. having a rectangular or trapezoidal cross-section
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    • A61F2/4611—Special 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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    • A61F2/00—Filters 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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special 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
    • A61F2002/4625—Special 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
    • A61F2002/4627—Special 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0091—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements connected by a hinged linkage mechanism, e.g. of the single-bar or multi-bar linkage type
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0004—Rounded shapes, e.g. with rounded corners
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0082—Three-dimensional shapes parallelepipedal
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005—The prosthesis being constructed from a particular material
    • A61F2310/00011—Metals or alloys
    • A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni alloys
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00389—The prosthesis being coated or covered with a particular material
    • A61F2310/00574—Coating or prosthesis-covering structure made of carbon, e.g. of pyrocarbon
    • A61F2310/0058—Coating made of diamond or of diamond-like carbon DLC

Definitions

  • the invention relates to a cage to be introduced into an intervertebral-disc compartment formed between two adja- cent vertobrae .
  • cage is understood to denote a cage-like body that is surgically positioned within an intervertebral- disc compartment, which is formed between two adjacent vertebrae of the human spine.
  • the cage has the task of replacing an intervertebral disc and fixing the spacing between the two adjacent vertebrae by fusing the latter.
  • Most cages have a substantially cylindrical overall shape and are screwed into the intervertebral-disc compartment via a ventral access canal.
  • Cages of such a type are known from US 2003/0045938 Al and DE 199 57 339 C2, for example.
  • These known cages can be introduced into the in- tervertebral-disc compartment via ventral access canals having a relatively small diameter. As a result the risk is small that ventral blood vessels will be damaged during the operation.
  • the vertebrae adjoining the intervertebral-disc compartment are stressed very unevenly by the cylindrical cages, which may result in degradations on these verte- brae. Furthermore, with the cylindrical cages it is difficult to fix the vertebrae delimiting the intervertebral-disc compartment exactly in the desired position.
  • a cage that may, even if it has larger dimensions than known cylindrical cages, be introduced into the intervertebral disc compartment through an access canal having a small diameter. According to a first aspect of this invention this problem is solved by a cage which is assembled from at least two constituent elements which preferably have at least substantially the same size.
  • This construction of the cage permits the two constituent elements to be introduced into the intervertebral disc compartment in succession via a (ventral or ventrolateral) access canal.
  • the cage is not introduced as a whole, but in parts, and it is only completely assem- bled after the introduction of the parts into the intervertebral disc compartment.
  • cages have the longest dimension laterally. Therefore it is advantageous to divide the cage in two constituent elements along a plane of symmetry which runs parallel to the transverse sides of the cage. Such a configuration ensures that both constituent parts have the same lateral dimension that determines the diameter of the access canal.
  • the latter may be provided with guide faces which engage one another when the constituent elements are joined together.
  • the guide faces align the constituent elements relative to each other in at least two orthogonal directions.
  • the guide faces may be de- signed such that it is possible to connect the constituent elements positioned in the intervertebral disc compartment with a sliding movement that can be produced even through a small access canal.
  • constituent elements may be envisaged as well.
  • constituent elements may be connected using screws, brackets or glue.
  • the subdivision of the cage into two (or more) constitu- ent elements that are assembled within the intervertebral disc compartment also makes it possible to implant cages that are significantly larger than those known in the art. Cages having larger base and cover plates are advantageous because they may then completely rest on the hard bone tissue ⁇ substantia compacta) forming the surface of the adjacent vertebrae. In the case of smaller cages used heretofore, significant forces are borne by the softer bone tissue ⁇ substantia spongiosa) in the middle of the vertebrae. This conventional approach entails significant risks of bone degradations caused by excessive forces acting on the substantia spongiosa.
  • a fin On the base plate and/or on the cover plate a fin may be arranged which extends parallel to the transverse sides and which is preferably perpendicular to the plate.
  • the fins are formed by adjacent fin elements provided on each constituent element. Such a fin enables the cage to be fixed in relation to the adjacent vertebrae if, prior to the introduction, a groove for receiving the fin is chiseled into said vertebrae with the aid of a chisel .
  • a corrugation which extends parallel to the longitudinal sides of the plates may furthermore be provided at least partially.
  • the corrugation has the task of increasing the frictional resistance of the cage in relation to the adjacent vertebrae and, in this way, of preventing it from being pressed out. This is particularly useful if the cage has the overall shape of a wedge, or if no fins are provided.
  • the corrugation preferably has a serrated profile with corrugation flanks, the inclines of which in the direction of introduction are smaller than in the opposite direction. In this way, when the cage is being introduced into the intervertebral-disc compartment the corrugation generates a smaller resistance than when it is being pulled out.
  • a cage system comprising a cage and operating means that are separably connectable to the cage.
  • the operating means are configured to rotate the cage when connected thereto upon operation of the operating means .
  • the ventral or lateral access canal must generally have a diameter that is at least as large as the length of the cage.
  • the diameter of the access canal can be considerably reduced. Accordingly, the risk of damage to blood vessels that have to be displaced in the course of creating the access canal is also reduced.
  • the operating means may comprise two rods that are separably connectable to the cage in an articulating manner.
  • the operating means may be separably, but fixedly attached to the cage, and the operating means may then comprise articu- lating members that make it possible to rotate the fixed cage upon actuation of a lever or rotating wheel .
  • FIG. 1 is a perspective representation of a ventral cage according to a first exemplary embodiment of the invention
  • FIG. 2 is a side view of the cage shown in FIG. 1 ;
  • FIG. 3 is a side view of a ventral cage according to a variant of the first exemplary embodiment
  • FIG. 4 is a perspective representation, corresponding to FIG. 1, of a ventral cage according to a second exemplary embodiment of the invention, wherein the cage has been assembled from two constituent elements ;
  • FIG. 5 is a front view of the cage shown in FIG. 4;
  • FIG. 6 is a side view of a constituent element of the cage shown in FIG. 4;
  • FIG. 7 is a perspective representation of a ventral cage according to a third exemplary embodiment of the invention, wherein the cage is capable of being rotated about a vertical axis in the interverte- bral-disc compartment by two operating rods;
  • FIG. 8 is a perspective, merely exemplary representation of a hook connection which is suitable in principle for separable articulation of the operating rods;
  • FIGS. 9a to 9c show the cage of FIG. 7 in a simplified top view in varying rotary positions
  • FIGS. 10a to 10c are representations corresponding to
  • FIGS. 9a to 9c but with other points of articu- lation of the operating rods;
  • FIG. 11 is a perspective view of another embodiment of a cage in accordance with the invention.
  • FIG. 12 is a central cross-section through a plane of symmetry of the cage shown in FIG. 11.
  • FIG. 1 is a perspective view of a ventral cage which is denoted in its entirety by 10.
  • the cage 10 has an upward- pointing cover plate 12 which has a substantially rectangular basic shape.
  • the cover plate 12 has a ventral longitudinal side 14 which is convexly curved and which is oriented ventrally after the introduction of the cage 10 into an intervertebral-disc compartment.
  • On the opposite side the cover plate 12 is bounded by a dorsal longitudinal side 16 which includes a right angle with two transverse sides 18, 20.
  • two window-like openings 22, 24, which define a crosspiece 26 berween them, are provided symmetrically relative to a plane of symmetry which passes perpendicularly through the cover plate 12 and which extends through the vertex of the curved longitudinal side 14.
  • the crosspiece 26 bears a first fin 28 which is trapezoidal and which extends in the aforementioned plane of symmetry of the cage 10.
  • a first fin 28 which is trapezoidal and which extends in the aforementioned plane of symmetry of the cage 10.
  • three bores are provided which are denoted by 30, 32, 34 in the side view of FIG. 2.
  • a base plate 36 which is ronstructed just like the cover plate 12.
  • a second fin 38 Dis- cernible only in the side view of FIG. 2 is a second fin 38 which is borne by a crosspiece 40 between two openings 42, 44 in the base plate 36.
  • ventral longitudinal sides 14 of the cover plate 12 and of the base plate 36 are connected by a front plate 46 which likewise has two window-like openings 48, 50.
  • a front plate 46 which likewise has two window-like openings 48, 50.
  • the cover plate 12 and the base plate 36 are connected to one another via a closed back plate 52 which has no openings.
  • Side plates with opening 53 and 55 extend between the transverse sides of the cover plate 12 and of the base plate 36.
  • the cover plate 12 and the base plate 36 are not parallel but are arranged at a wedge angle ⁇ relative to one another.
  • the longitudinal sides of the cover plate 12 and of the base plate 36 therefore extend parallel to one another, whereas the transverse sides 18, 20 of the cover plate 12 include the wedge angle ⁇ with the transverse sides of the base plate 36.
  • the length 1 of the cage 10 which is the length of the dorsal longitudinal side 16, and also of the quantities indicated in FIG. 2. These quantities are the wedge angle ⁇ , the maximal height h of the cage 10 and the minimal width b.
  • the radius of curvature For the purpose of describing the curvature of the front plate 46, use may be made of the radius of curvature.
  • the entire cage may be manufactured in one piece from a suitable material, for example titanium.
  • a suitable material for example titanium.
  • the cage shown in FIGS. 1 and 2 may be introduced into an intervertebral-disc compartment between two adjacent vertebrae in the following way:
  • the intervertebral-disc compartment, into which the cage is to be introduced via a ventral access canal is surveyed with the aid of biometric methods.
  • recourse may, for example, be taken to imaging methods such as magnetic-resonance imaging, for instance.
  • imaging methods such as magnetic-resonance imaging, for instance.
  • it is possible to determine the width, the depth, the maximal height of the intervertebral-disc compartment and also the angle of the intervertebral-disc compartment.
  • material-abrading manner such as milling the surfaces of the adjacent vertebrae.
  • a cage is now selected having geometrical parameters that come closest to the biometric data ob- tained in the course of surveying the intervertebral-disc compartment.
  • a ventral access canal leading to the intervertebral-disc compartment in question is now created surgically, and the material that is present there, for example an intervertebral disc or a bone graft replacing said disc, is removed.
  • a material-abrading preliminary treatment of the intervertebral-disc compartment is also required in many cases, particularly in the cervical section of the spine.
  • grooves which serve to receive the fins 28, 38 are now chiseled with the aid of a chisel into the two vertebrae that delimit the intervertebral- disc compartment.
  • the selected cage 10 is now introduced into the exposed intervertebral-disc compartment via the access canal in such a way that the back plate 52 points towards the spinal canal .
  • the fins 28, 38 engage the grooves, which were previously chiseled into the vertebrae, and thus fix the cage 10 laterally.
  • a fixing along the direction of introduction is obtained by the friction of the fins 28, 38 within the grooves.
  • the cover plate 12 and the base plate 36 are sup- ported on the hard bone tissue known as substantia com- pacta.
  • forces acting in the longitudinal direction of the vertebral column are optimally transferred between the vertebrae adjacent the int ⁇ rvertebral-disc compartment.
  • the forces acting on the softer central re- gion ⁇ substantia spongiosa) of the vertebrae are kept small .
  • FIG. 3 shows, in a side view corresponding to FIG. 2, a variant of the cage 10 shown in FIGS. 1 and 2, wherein a cover plate 12' and a base plate 36' bear on their out- ward-pointing surface a longitudinal corrugation 60 having an approximately sawtooth-shaped profile.
  • the profile flanks in this case are inclined to a variably strong degree, so that the cage 10, despite the corrugation 60, can be readily introduced by its rear side 52' into the intervertebral-disc compartment but resists a movement in the opposite direction by virtue of the steps 62 which extend approximately ver- tically.
  • FIGS. 4 to 6 show a second embodiment on the basis of a perspective representation corresponding to FIG. 1, a front view of the front face, and a side view of a constituent element of a jointing face, respectively.
  • the essential difference of the cage 110 shown in FIGS. 4 to 6 from the cage 10 shown in FIGS. 1 and 2 consists in the fact that the cage 110 is subdivided along the aforementioned plane of symmetry into two constituent elements 110a, 110b.
  • the peripheral jointing seam between the constituent elements 110a, 110b is denoted by 111.
  • the two constituent elements 110a, 110b are aligned relative to one another via grooves and guide ridges, so that the cage 110 has again a smooth surface.
  • each constituent element 110a, 110b is provided with its own fins 128a, 138a and 128b, 138b, respectively.
  • the fins 128a, 128b and the fins 138a, 138b bear against one another in planar manner, so that only one groove needs to be chiseled into each of the vertebrae delimiting the intervertebral-disc compartment despite the division of the cage 110 into two parts. Nevertheless, each constituent element 110a, 110b is independently secured in the lateral direction against slipping in the groove.
  • FIG. 5 it can further be discerned that in the right- hand constituent element 110b, on the jointing face at the levels of the cover plate 112b and of the base plate 136b, grooves 115 and 117, respectively, of rectangular cross-section have been sunk which, however, as the side view of FIG. 6 shows, do not extend over the entire transverse direction of the cover plate 112b or of the base plate 136b. Rather, the grooves 115, 117 are bounded in the direction towards the back plate 152b by stops 119 and 121, respectively.
  • the left-hand constituent element 110a comprises, on its jointing face at the levels of the cover plate 112a and of the base plate 136a, guide ridges 123 and 125, respectively.
  • the guide ridges 123, 125 take the form of complements of the grooves 115, 117. In particular, this im- plies that the length of the guide ridges 123, 125 coincides with the length of the grooves 115, 117, as can be seen in FIG. 6.
  • the division of the cage 110 into the two constituent elements 110a, 110b permits the following procedure when the cage 110 is being introduced into an intervertebral- disc compartment:
  • the intervertebral-disc compartment is surveyed biometrically, and a cage is selected from a set of prefabricated cages or is produced having dimensions which coincide as well as possible with the biometrically determined dimensions of the intervertebral-disc compart- ment .
  • the intervertebral disc, or a substitute structure that is present in the intervertebral-disc compartment is exposed via a ventral access canal. It should be noted that this access canal may now be significantly smaller than is the case with a one-piece cage.
  • one half of the intervertebral-disc cci- partment is now exposed and is stiffened with a stiffening element.
  • the grooves for the fins 128, 138 are now chiselled into the adjacent vertebrae with the aid of chisel.
  • the constituent element 110a or 110b associated with this side is introduced via the ventral access canal.
  • the two constituent elements 110a, 110b which has been introduced now stiffens the intervertebral-disc compartment, so that the stiffening element that was previously inserted can be removed.
  • the half in which the stiffening element was located is now exposed completely, in order to be able to receive the other half of the cage 110.
  • the guide ridges 123, 125 engage the grooves 115, 117 and finally strike the stops 119, 121.
  • the two constituent elements 110a, 110b are fixed relative to one another in all directions other than the direction of introduction.
  • This procedure has the advantage that the conventional step of taking out a large stiffening element and introducing a cage practically simultaneously is dispensed with. Instead of this, only one half of the interverte- bral-disc compartment is stiffened, so that a constituent element of the cage can be comfortably inserted into the other half of the exposed intervertebral-disc compartment. This constituent element serves as a stiffening element when the stiffening element that was inserted to begin with is removed in order to create room for the other constituent element of the cage.
  • FIG. 7 shows, in a representation similar to FIG. 1, a cage 210 according to a third embodiment. Parts corresponding to those of the cage 10 are denoted by reference numerals augmented by 200, and in some cases will not be elucidated again in detail.
  • the cage 210 differs from the cage 10 shown in FIG. 1 in that operating rods 231, 233 are articulated on the front plate 246 of the cage 210.
  • the joint elements required for this, which cannot be discerned in FIG. 7, for ar- ticulating the operating rods 231, 233 are located on opposite transverse sides of the cage 210 and permit the operating rods 231, 233 to be separably connected to the cage 210 in such a way that the operating rods 231, 233 can be swivelled in a plane which is substantially parallel to the base plate 236.
  • the cage 210 By pulling or pushing the operating rods 231, 233 within this plane, the cage 210 can be rotated about a vertical axis which is denoted by A in FIG. 7.
  • the joint elements - which are not discernible in FIG. 7 - for the operating rods 231, 233 may be short vertically extending pegs 237, such as are shown in an isolated manner in FIG. 8. Together with hooks 235 which are fastened to the ends of the operating rods 231, 233, the pegs 237 form joints that enable the swivelling of the operating rods 231, 233, described above. For the purpose of releasing the connection, the hooks 235 are simply unhooked from the pegs 237.
  • the rotatability of the cage 210 about the vertical axis A using the operating rods 231, 233 allows the cage to be introduced in the longitudinal direction through a narrow ventral access canal, and to be rotated into the definitive transverse position only in, or in the immediate vicinity of, the intervertebral-disc compartment using the operating rods 231, 233.
  • FIGS. 9a to 9c show a simplified top view of the cage 210 and the operating rods 231, 233.
  • the axes of rotation of the fastening elements for the operating rods 231, 233 are indicated in FIGS. 9a to 9c by 239 and 241, respectively .
  • FIG. 9a the cage 210 is shown in its initial position similar to what is illustrated in FIG. 7. Let it be assumed that the cage 210 is to be positioned in the in- tervertebral-disc compartment in this orientation.
  • the back plate 252 of the cage 210 consequently points towards the spinal canal, whereas the convexly curved front plate 246 is aligned ventrally.
  • the cage 210 were to be introduced into a ventral ac- cess canal in this orientation, the diameter d of the access canal must not drop below the length of the cage 210. If forces are now exerted - by hand or with the aid of a manipulator - on the operating rods 231, 233 in the directions indicated by arrows 243 and 245, respectively, the cage 210 rotates in the direction indicated by an arrow 247.
  • the cage 210 appears to be considerably narrower in this rotated orientation.
  • the ventral access canal consequently merely requires a diameter d' which is somewhat larger than the maximal overall width of the cage 210.
  • the diameter d of the ventral access canal is indicated such as would be required in the case of the orientation of the cage 210 shown in FIG. 9a.
  • the cage 210 is now introduced through the ventral access canal until it extends partially into the intervertebral-disc compartment. Forces are now exerted on the operating rods 231, 233, as indicated by arrows 249 and 251, respectively, in FIG. 9b.
  • the cage now rotates within the intervertebral- disc compartment in the direction indicated by an arrow 253 and consequently assumes its desired position in the intervertebral-disc compartment, as shown in FIG. 9c.
  • the operating elements 231, 233 are separated from the cage 210 and guided out of the ventral access canal.
  • the cage 210 is not provided with fins. Sufficient friction may be produced by providing a corrugation 60 on the surface of the base and cover plates as has been described above with reference to FIG. 3.
  • FIGS. 10a to 10c a variant of this embodiment is shown in which joint elements with axes of rotation 239', 241' are provided at points on a cage 210' which are situated diagonally opposite one another.
  • a diagonal arrangement of such a type has the advantage that the cage 210' is able to rotate still further, namely by exactly 90°, about a vertical axis. This can best be discerned in FIG. 10b.
  • FIG. 9b A comparison with FIG. 9b reveals that the ventral access canal needs only to have a diameter d", which corresponds to the maximal width of the cage 210'. The diameter of the ventral access canal can consequently be even smaller than is the case with the cage 210 shown in FIGS. 7 to 9.
  • FIGS. 11 and 12 show another embodiment of a cage 310 in a perspective view similar to FIG. 1 and a central cross- section through a plane of symmetry.
  • the cage 310 has a cover plate 312 comprising at its circumference a plane annular abutment area 370 which may be roughened so as to increase its friction coefficient with respect to bone tissue.
  • a crosspiece 326 extends along an X direction between a ventral longitudinal side 314 and a dorsal longitudinal side 316.
  • the crosspiece 326 separates two openings 322, 324 similar to the embodiment shown in FIG. 1.
  • an outward surface 372 of the crosspiece 326 is convexly curved.
  • the curvature in the XZ plane can be seen best in the cross- section of FIG. 12.
  • the crosspiece 326 is also convexly symmetrical to the middle plane of the crosspiece 326. Due to this curvature, the surface 372 has a vertex 374 at its top.
  • the cross-section shown in FIG. 12 results in a ramp-like shape of the crosspiece 326, having a main flank 376 and a steeper counter flank 378.
  • the shape of the cross-piece thus corresponds significantly, although not completely to the shape of the dome that is formed within the apophyseal ring of the adjacent vertebra.
  • a vertebra 380 is indicated by a dotted line, with its dome 382 formed between the apophyseal ring 384.
  • the crosspiece 326 is more strongly curved than the dome 382.
  • the crosspiece 326 and thus the entire cage 310, can be rotated, preferably by at least 10°, with respect to the vertebra 380 around an axis 390, if the cross-piece 326 gets into contact with the dome 382.
  • the rotation may be initiated with the help of operating rods 231, 233, and/or it may be a result of compression forces produced by ligaments surrounding the vertebrae.
  • the ability to rotate greatly facilitates the correct angular orientation of the cage 310 within the intervertebral disc compartment.
  • a self- centering effect may be observed due to the asymmetric shape of the dome 382 and of the crosspiece 324 so that the adjustment process is less critical for the surgeon.
  • the surface 372 of the crosspiece should have a very low kinetic friction coefficient with respect to the soft bone tissue (substantia spongiosa) which delimits the dome 382.
  • a low kinetic friction coefficient may be achieved by polishing of by the application of a smooth coating to the surface 372, for example.
  • a surface made of diamond-like carbon (DLC) can be applied using ion beam deposition or sputter deposition techniques and is not only biologically compatible, but is very hard and provides a smooth surface with very low friction.
  • An arithmetic roughness Ra of less than 10 ⁇ m or even less than 1 ⁇ m may be easily achieved with such a coating, resulting in a very low kinetic friction coefficient with respect to the adjacent bone material.
  • the shape of the dome 382 generally differs between the different vertebrae, and also from patient to pa- tient, it may be useful for the surgeon to have a supply of cages with different shapes of the crosspiece 324. It is also envisaged to biometrically determine the shape of the dome 382 of the respective vertebra, and to manufacture the cage 310 according to the data obtained in the measurement.
  • the area around the vertex 374 will sink into the soft bone tissue (substantia spongiosa) within the apophyseal ring 384, thereby deforming and displacing this bone tissue to a certain extent, until the plane annular abutment area 370 rests on the hard apophyseal ring 384.
  • the main loads are taken by the annular abutment area 370 and the apophyseal ring 384.
  • the base plate 336 is configured in the same manner. All of the above remarks therefore apply correspondingly to the base plate 336 as well.
PCT/EP2006/006608 2005-07-06 2006-07-06 Cage for the introduction into an intervertebral-disc compartment WO2007003437A2 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
EP06762461A EP1919403A2 (en) 2005-07-06 2006-07-06 Cage for the introduction into an intervertebral-disc compartment

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US69688905P 2005-07-06 2005-07-06
US60/696,889 2005-07-06

Publications (2)

Publication Number Publication Date
WO2007003437A2 true WO2007003437A2 (en) 2007-01-11
WO2007003437A3 WO2007003437A3 (en) 2007-04-19

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JP2019506906A (ja) * 2017-01-31 2019-03-14 ソルコ バイオメディカル カンパニー リミテッド 脊椎間挿入用ケージ挿入装置

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US8083796B1 (en) 2008-02-29 2011-12-27 Nuvasive, Inc. Implants and methods for spinal fusion
US9907672B1 (en) 2008-02-29 2018-03-06 Nuvasive, Inc. Implants and methods for spinal fusion
US10842646B2 (en) 2008-02-29 2020-11-24 Nuvasive, In.C Implants and methods for spinal fusion
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EP3292840A1 (en) * 2016-09-13 2018-03-14 Warsaw Orthopedic, Inc. Interbody spinal fusion device
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JP2019506906A (ja) * 2017-01-31 2019-03-14 ソルコ バイオメディカル カンパニー リミテッド 脊椎間挿入用ケージ挿入装置

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CN101257866A (zh) 2008-09-03
WO2007003437A3 (en) 2007-04-19
ZA200801287B (en) 2010-07-28
EP1919403A2 (en) 2008-05-14

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