WO2012056119A1 - Cervical cage and plate system - Google Patents

Cervical cage and plate system Download PDF

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Publication number
WO2012056119A1
WO2012056119A1 PCT/FR2011/000540 FR2011000540W WO2012056119A1 WO 2012056119 A1 WO2012056119 A1 WO 2012056119A1 FR 2011000540 W FR2011000540 W FR 2011000540W WO 2012056119 A1 WO2012056119 A1 WO 2012056119A1
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WO
WIPO (PCT)
Prior art keywords
plate
cage
characterized
upper
system according
Prior art date
Application number
PCT/FR2011/000540
Other languages
French (fr)
Inventor
Gilles Dubois
Jacques Flageollet
Nicolas Guena
Alain Lerch
Original Assignee
Kasios
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 FR1004266 priority Critical
Priority to FR1004266A priority patent/FR2966720B1/en
Application filed by Kasios filed Critical Kasios
Publication of WO2012056119A1 publication Critical patent/WO2012056119A1/en

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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
    • A61F2/4455Joints 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
    • A61F2/447Joints 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
    • 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
    • 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7059Cortical plates
    • 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
    • A61F2002/30383Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
    • A61F2002/30387Dovetail connection
    • 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
    • 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
    • A61F2002/30383Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
    • A61F2002/3039Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove with possibility of relative movement of the rib within the groove
    • A61F2002/30397Limited lateral translation of the rib within a larger groove
    • 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
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    • 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
    • A61F2002/30383Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
    • A61F2002/3039Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove with possibility of relative movement of the rib within the groove
    • A61F2002/30398Sliding
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30576Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs
    • A61F2002/30578Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs having apertures, e.g. for receiving fixation screws
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30604Special structural features of bone or joint prostheses not otherwise provided for modular
    • 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 or bone-contacting surfaces, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surfaces, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/3082Grooves
    • 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
    • A61F2002/4475Joints for the spine, e.g. vertebrae, spinal discs hollow
    • 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
    • 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
    • A61F2002/4629Special 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 connected to the endoprosthesis or implant via a threaded connection
    • 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

Abstract

System for support and intersomatic fusion of the vertebrae, consisting of an intersomatic cage (1) with a continuous hole extending through it in a vertical direction and opening out at the upper and lower faces (7, 8) of the cage, and of a plate (27), which is fixed to the cage and protrudes from both the lower and upper sides of the cage, the plate being designed to be anchored to an upper vertebra and to a lower vertebra, characterized in that the plate is fixed to the cage while at the same time being able to slide relative to the cage between at least two different positions of anchoring of the plate to lower and upper vertebrae.

Description

cage system and cervical plate.

The present invention relates to a cervical cage system and plate being positioned on two cervical vertebrae, in particular successive, and to promote the melting of these vertebrae therebetween (called interbody fusion). Several systems of this kind can especially be stacked on several levels of the cervical vertebrae, including adjacent.

Known such systems comprise an intervertebral cage and a plate disposed substantially perpendicular to the general plane of the cage and provided at the two free ends which protrude from the upper side and the lower side of the respective securing means of cage in the one of the vertebrae, including fastening means in the form of a hole and a screw.

The intersomatic cage is pierced centrally in opening at its upper side and its underside by two upper and lower openings. It is intended to receive the spongy bone and to be interposed between two vertebrae to allow the establishment of a bone graft or a fusion promoting material between the two vertebrae, the bone graft passing through the cage and from grafting by melting both of the vertebrae on either side of the cage.

These prior art systems have the disadvantage that it is difficult to attach two such systems, either side of the same vertebrae between respectively the following vertebra (upwardly in the direction of the column spinal going from bottom to top) and the preceding vertebra (downwardly in the direction of the spinal column from bottom to top) of said vertebra. Indeed, in such a case, there appears an interference between the upper end of the lower plate of the system and the lower free end of the plate of the upper system and it is difficult or impossible to fix these two free ends, namely respectively the lower end of the plate associated with the upper cage and the upper end of the plate associated with the lower cage, unless we accept that these two ends share the same or anchor points on the vertebra, which is a problem, especially tends to diminish the strength of the vertebra.

It has already been thought in the prior art to solve this problem by providing a plate which can be pivoted relative to the anteroposterior axis of the cage to thus allow to arrange two successive plates in the height direction along the spinal column in a staggered arrangement. These plates systems inclined staggered in the lengthwise direction of the spine, however, have also disadvantages. On the one hand, mutual maintenance of the vertebrae is not as good as when the plates are arranged vertically. On the other hand, the fastening system and the pivot plate relative to the cage to ensure a rotation of the plate with respect to the anteroposterior axis of the cage is of complex structure. In addition, although offering more possibilities than the plate fixedly mounted perpendicular to the cage, these staggered arrangements however do not allow to choose between several mounting positions of each plate to the vertebrae, independently of each other , the inclined position of the plate of the lower cage largely determining the inclined position of the plate of the next higher crate.

To documents FR 2747034, WO 2005/077039, US 2008/0312742, US 2010/0057206 and EP 1103236, the plate can be anchored to two neighboring vertebrae top and bottom in only one relative position of the cage and plate. The document US 2008/0051890, there is disclosed a cage plate system in which the plate can be secured to the cage in a number of relative positions. However, the plate can not slide relative to the housing between positions while remaining attached to the cage.

The present invention aims to overcome the drawbacks of the prior art by providing a system of the kind mentioned cage and associated plate although also very simple structure makes available a large number of possible positions of two successive plates without that they do not interfere with each other as regards their anchorages to the same vertebra, it many .de anchoring positions of each plate to the vertebrae for selecting a positioning these anchorages such as maintaining vertebrae from each other is made as stable as possible and in particular is much more stable than in the case of the prior art systems. In addition, the present invention provides a cage plate system in several relative positions of the plate and the cage having a great ease of use, especially to move from one position relative to another.

According to the invention, a compression system and interbody fusion of the vertebrae is as defined in claim 1. Further developments are defined in the subclaims.

According to a preferred embodiment of the invention, the plate is slidably mounted relative to the shaft in the mediolateral direction.

Preferably, the plate is an elongated piece, particularly a rectangular shape and the longitudinal axis of the plate is perpendicular to the plane of the upper sides and / or bottom of .the cage.

In particular, according to a preferred embodiment, the plate is an elongated piece, particularly a rectangular shape and the longitudinal axis of the plate is inclined relative to the plane of the upper sides and / or bottom of the cage while being in the plane defined by the vertical axis and the medio-lateral axis.

According to a preferred embodiment of the invention, at each free end of the plate there are provided means for anchoring the plate to a respective vertebra of the two vertebrae between which is intended to be arranged the cage, including a hole intended to cooperate with an associated screw.

According to a preferred embodiment of the invention, the plate is slidably mounted relative to the cage such that the two elements, the cage and the plate, are not detachable from each other.

According to a preferred embodiment of the invention, the cage comprises at least a recessed guide groove in a top side and / or bottom of the cage, preferably two guide grooves formed respectively in the upper face of the cage and underside of the cage and into which respectively a guide pin to allow the sliding of the plate relative to the cage.

Thus, in particular, according to a particularly preferred embodiment, the cage comprises two upper and lower grooves each extending between two end walls and the plate has a C-shaped hook which each. free end is trapped in a respective groove, the sliding of the plate relative to the cage thereby between two extreme positions left and right without the plate can be detached from the cage.

According to a preferred embodiment, the cage comprises at least one groove in which is received an end rib of the plate, the rib being slidably guided by the groove, in particular the cage comprises two upper and lower grooves and the plate comprises two ribs having a tenon-shaped end that are each received in one of the grooves.

Preferably cross-section the two ribs, the two pins and the portion of the plate between the two ribs have the shape of a C-shaped clamp which clings to the cage by two studs which penetrate into a respective groove and slide it.

Preferably, the system comprises an instrument shaft to put it down. In particular, according to an improvement, the instrument shaft comprises a cylindrical body with an upper or distal end of which extend a complementarily shaped lug with a through hole formed in the plate and at least one lug, preferably two lugs disposed ( s) either side of the pad at a distance therefrom, by protruding from the body of the stem of a greater height than the stud.

The height of the lugs is greater than the height of the stud so that the stud does not project beyond the plate and does not penetrate into the hole of the cage, while the lugs themselves, penetrate between the two headlands plates to thereby prevent rotation but however allow a medio-lateral sliding.

According to a preferred embodiment of the invention, a flat head is formed at the upper end of the rod, the stud projecting from a central portion of the side surface of the head while the at least one lug, of preferably the two pins, is (are) projected from a side portion of the side surface of the head, including the side edges of the left and right side surface of the head.

According to a preferred embodiment of the invention there is formed two left and right steps on the upper surface of the head, so as to form a central open channel having a width substantially corresponding to the width of the plate, to thereby allow the plate to be locked in the channel when the pin has entered the corresponding hole formed in the plate. Preferably, at least the end of the stud has a thread and the associated through hole formed in the stud comprises a corresponding internal thread, so that by screwing the end of the stud into the hole of the plate, a fastening is ensured the plate to the rod.

Preferably, the pad comprises a rod in which is received in a well through-formed in the cylindrical body of the rod, the relative movement of the sub rod relative to the rod being effected by screwing, in particular the inner wall the well being threaded and the sub shaft having an associated thread.

The present invention also relates to an instrument shaft to ask a cage plate system according to the invention.

now described, for example, a preferred embodiment of the invention referring to the drawings:

Figure 1 is a perspective view of an intervertebral cage of a system according to the invention;

Figure 2 is a top view of the cage of Figure 1;

Figure 3 is a sectional view along the line III-III of Figure 2;

Figure 4 is a perspective view of a plate of a cage and plate system according to the invention adapted to cooperate with a cage as shown in Figures 1 to 3; Figure 5 is a top view of the plate of Figure 4;

Figure 6 is a sectional view along line VI-VI of Figure 5;

Figure 7 is a perspective view of a cage and plate system, the plate being slidably mounted with respect to the cage of a non-detachable manner;

Figure 8 is a perspective view of the system of Figure 7, when the latter a- been turned through 180 ° to allow viewing of its lower portion which is here facing upwards;

FIG '-9 is a sectional view and perspective view of the cage and plate system des- Figures 7 and 8, the sectional plane being vertical anteroposterior plane;

10 shows, seen from the rear side, three cages and three plates arranged on the spine of which four vertebrae are shown, a stack of three levels;

Figure 11 shows in perspective the whole cage- plate wherein the plate has been shifted to the left by sliding, with respect to its central position shown in Figures 7 to 9;

Figure 12 shows in perspective the whole cage- plate wherein the plate was shifted to the right by sliding, with respect to its central position shown in Figures 7 to 9; 13 shows a cage plate in perspective with the plate in its central position in which the holes 60 and 24 are in register;

Figure 14 is a perspective view of an instrument shaft for positioning the cage-plate between two vertebrae;

Figure 15 is a front view of the instrument shaft of Figure 14;

Figure 16 is a side view of the instrument stem of Figures 14 and 15;

Figure 17 is an enlarged view of an upper part of the. FIG 16;

Figure 18 is a sectional view following the line AA of Figure 17;

FIG 19 is a view substantially identical side in Figure 15, but on a larger scale an upper portion of the instrument shaft;

Figure 20 is a view of a cage-plate according to the invention and an instrument shaft in the position in which can be inserted between two vertebrae together cage plate with the instrument stem, view being substantially perspective from above; and

Figure 21 is a perspective view of the assembly and the rod of Figure 20 according to another viewing axis. In Figure 1, the cage 1 is of generally parallelepipedal shape having a front side outer face 2, a rear side outer side 3, two lateral outer faces 4 and 5, right and left, an upper outer face 7 and a lower outer face 8. The cage is drilled centrally with a hole 9 of substantially circular section which opens to the upper and lower faces by two upper and lower openings. The housing defines around the hole 9 of an annular shape comprised of a front section 10, a rear section 11 and two sections 12 and 13 right and left.

Of bone material or bone substitute can thus pass through the cage through the hole 9, to promote fusion between the - two vertebrae between which the cage has been inserted.

Of the rear face 3, two plates 14 and 15 forming promontories, upper and lower respectively, protrude from the rear face 3. These two plates are spaced from each other in the vertical direction (the direction of the spine). They are moreover each also slightly recessed with respect to the respectively upper and lower faces.

In the upper face of the upper plate 14, there is formed a longitudinal groove 16 in the mediolateral direction and in the underside of the bottom plate 15, there is formed a longitudinal groove 17 in the mediolateral direction. Each of these grooves is delimited by a longitudinal wall 18, the rear face 3 of the cage and by two walls 19 and 20 of left and right end.

The system also includes a plate 27 shown in isolation in Figures 4 to 6. This plate 27 has an elongated shape, substantially rectangular, having a width dimension (in the direction perpendicular to the plane of Figure 6) and a length dimension (in the vertical direction in Figure 6). The plate comprises at its two free ends of the holes 28 intended to allow the passage of screws (not shown in the figures), for screwing. each end of the plate to an associated vertebra. The hole in the upper end in Figures 5 and 6 is intended to assist in anchoring the plate to a vertebra located above the cage 1 while the hole 28 of the lower end in Figures 5 or 6 is intended to allow the anchoring of the plate to -the lower vertebra located below the cage 1.

Of one of the faces of the plate (the front side), project two ribs 30 and 31 which extend over the entire width of the plate. Both ribs 30 and 31 are spaced from each other and comprise at their respective free end two pins 40, 41 which project laterally of the ribs. The two pins 40 and 41 are directed towards each other, so that the distance by which they are separated is less than the greatest distance (measured in the direction perpendicular to the ribs) between the ribs.

In longitudinal section, as shown in Figure 6, the two ribs and the portion of the plate extending between them and have the C-shape (inverted in Fig 6).

The distance between the two plates 14 and 15 promontories (the underside of the bottom plate to the upper face of the upper plate) is substantially equal (however, while being very slightly less than) the distance between the two inner faces of the two ribs 30 and 31. the two ribs 30 and 31 are thus surround the two plates and the two pins 40 and 41 of end ribs are received in the respective grooves 16 and 17 and thereby prevent the detachment of the plate cage. At the same time, however, the two pins can slide in the grooves to thereby allow sliding of the plate relative to the cage in the mediolateral direction. This sliding is limited to left and right by the two end walls 19 and 20.

At the junction between the left and right walls and the longitudinal wall 18 of each groove, there are formed recesses 50 which increase the width dimension of each groove in the levels of the ends and which allow, by a link rocking action with the elasticity of the material (typically a thermoplastic material or a biocompatible metal) forming the ribs to secure the plate to the cage or to remove it.

Two semicircular cutouts are formed in the upper surface 15 lower plate and the lower surface of the top plate to form a sort of virtual hole in which is received a sleeve 60 circular for receiving a tool for laying of cage. This is a classic feature of interbody cages and is not described in detail here. The sleeve 60 has in particular a thread or milling.

In addition, the plate 17 comprises at its center, between the two ribs 30 and 31, a hole 24 intended to come into correspondence with the virtual hole to allow the passage of a running tool of the assembly.

In Figure 9, -voit in a sectional view in the plane defined by the anteroposterior axis and the vertical axis and in perspective the assembly constituted by the frame 1 and a plate 27 as shown in Figures 7 and 8.

As can be seen in this Figure 9, the face 62 than the upper 30 rib, when the lug 40 is received in the groove 16, is substantially flush with the upper outer face 7 of the housing, while the face 61 lower the lower rib 31, when the lug 41 is received in the groove 17, is substantially flush with the outer lower face 8 of the cage. To facilitate the establishment of a cage plate and between two vertebrae, it is important that these two faces 62 and 61 does not exceed, respectively upwards and downwards, respectively upper face 7 and bottom 8 of the cage.

When, for example as shown in Figure 10, is desired to have between four vertebrae VI, V2, V3 and V4 of the spine, three cages, namely a lower linf cage, an intermediate lint cage and an upper ISUP cage, one fixed plate 27 of the cage lsup to both the upper VI vertebra and the upper intermediate V2 vertebra, the plate 27 of the intermediate shaft to both the upper intermediate V2 vertebra and the lower intermediate V3 vertebra and the plate 27 of the lower cage at a time to the intermediate vertebrae V3 and lower than the lower vertebra V4.

As is well .voit in Figure, two plates should be fixed on each intermediate vertebra V2 and V3. If the installed together with the relative positions of the cage. and .the plate as shown in Figures 7 and 8, that is to say with the plate positioned substantially in the middle of the grooves 16 and 17, there would be interference between the two plates to be attached to the same vertebra. According to the invention, thanks to the fact that the slide plate relative to the cage, one can shift the two plates attached to one vertebra by sliding each in an opposite direction, respectively left (as also shown in Figure 11) and right (as also shown in Figure 12), relative to the central position shown in figures 7 to 9 and 13 (in which the two holes 60 and 14 are in register), so that they are thus fixed to the vertebra being side by side without interfering with one another.

Furthermore, with this slide, which has a large range of movement, there are many possible relative positions between the two plates, which allows to choose the position which gives the greatest stability, particularly as shown in Figure 10 wherein two plates fixed to the same vertebra are respectively shifted to the left and to the right by the same distance relative to the central position.

To Figures 14-19, there is shown an instrument shaft-shaped laying for mating with the cage plate assembly to enable one insertion between two vertebrae in particular.

This instrument consists of a main body 100 shaped substantially circular cylinder at the upper end of which protrudes a head 101 of larger width dimension. The upper surface of the head 101 includes a central planar face 102 which protrudes a circular cylindrical stud 103 of smaller size than that of the planar surface 102. Further, two shoulders 104 and 105 are formed right and left on this surface 102, the two shoulders 104 and 105 thereby forming two lateral steps or steps on the right and left sides respectively.

upper faces of the two steps 104 and 105 side protrude two pins 106 and 107.

To install the cage plate, shown for example in Figures 9 and 11 to 13, we take the instrument shaft 100 and inserting the pin 103 into the hole 24 formed in the plate. The relative dimensions of hole 24 and the stud 103 are such that the pin 103 can enter the hole 24, preferably having substantially the same dimensions and form-fitting. The longitudinal extension, that is to say in the longitudinal direction of the rod, the stud 103 is however such that it does not extend into the hole 60 of the cage to thereby does not prevent the plate to slide in the mediolateral direction of sliding. At the same time the stud 103 enters the hole 24, the two pins 106 and 107 penetrate them in the groove formed between the two plates 14 and 15 in the form of the cage promontory to thereby block any possibility of rotation of the rod instrument and the plate relative to the cage.

Once the central pin 103 inserted into the hole 60 and the pins disposed within the groove formed between the two plates 14 and 15, is pushed with the rod plate assembly and cage between two vertebrae. The cooperation between the rod and the plate is such that the rod and the plate are fixed in displacement, so that once the cage inserted between two vertebrae, it is then possible by displacement of the rod sliding the plate relative to the cage for disposing exactly in the position in which it is desired to fix the vertebrae. Thus, the width dimension of the central face 102, between the two shoulders 104 and 105 substantially corresponds to the width of the plate or in any case is greater than the width of the plate so that it can be received between the shoulders.

It is seen in Figures 20 and 21, when the instrument shaft is brought into cooperation with the cage plate assembly, the lugs 106 and 107 penetrate into the groove formed between the two plates 14 and 15 and thus provide a locking in rotation by relative to the own axis of the rod and guide in sliding translation in the medio-lateral direction displacement plate assembly and the instrument shaft.

The hole 24 in the plate 27 has an internal thread.

The pad 103 is constituted by a sub rod which can move within a well 109 formed inside the rod 100.

A distal end portion of the stud 103 is threaded so as to be screwed into the tapping hole 24 and thus securing the rod to the plate.

The well 109 is threaded and at least a section of the rod is threaded in to permit displacement by screwing in the stem relative to the stem. This threaded portion is different from the threaded distal end portion.

The shapes and dimensions of the pad, and cage plate as well as their corresponding tapping and thread are formed so that the free end of pad 103 does not exceed the surface of the plate on the side of the cage and in particular does not penetrate into the hole 60 does not prevent the mediolateral displacement of the plate relative to the cage. In particular, the end of the pin 103 is flush with the face of the plate. According to an improvement, can be provided in the hole 24, a flange at the face of the plate on the side of the cage which locks the rod and prevents it from being screwed any further. Of course, other locking means can be considered and it is also possible within the scope of the present invention does not provide for such locking means. For example, provision may be made in its distal portion under the pad or pin is threaded only over a distance corresponding to the depth of the hole in the plate, an adjacent section of the distal portion of the sub rod is not threaded .

In Figure 10, there is shown three systems cage- plate identical to that of Figures 7 to 9.

Cage plate system of the top of the figure (between Vi and V 2) is anchored to Vi and V 2 in a first relative position of the cage and. plate. The system cage- middle plate of FIG (between V 2 and V 3) is anchored to V 2 and V 3 in a second relative position of the cage and the plate different from the first position.

The system cage plate from the bottom of the figure (between V 3 and V 4) is anchored to V 3 and V 4 in a third relative position of the cage and the plate which is here identical to the first position, but could, if desired, be different from the first, for example be shifted to the left. As can be seen, it is possible to slide the plate relative to the cage between a plurality of different relative positions of the cage and the plate in which the cage plate system can be anchored to two neighboring vertebrae top and bottom by intermediate anchoring means (hole 28 and corresponding screw) carried by the plate.

Claims

CLAIMS ION
Contention system and interbody fusion of the vertebrae, comprising a cage (1) interbody pierced with a through hole which extends in a vertical direction and which opens to the faces (7, 8) top and bottom of the cage and a plate (27) attached to the shaft protruding on both sides top and bottom of the cage, the plate being intended to be anchored to an upper vertebra and a lower vertebra, characterized in that the plate (27) is secured to the cage while being slidable relative to the cage (1) between at least two different positions of the anchor plate to upper and lower vertebrae.
System according to Claim 1, characterized in that the plate (27) is slidably mounted with respect to the cage (1) in the medio-lateral direction.
System according to Claim 1 or 2, characterized in that the plate (27) is an elongated part, in particular of rectangular shape and the longitudinal axis of the plate is perpendicular to the plane faces (7, 8) upper and / or lower of the
System according to Claim 1 or 2, characterized in that the plate (27) is an elongated part, in particular of rectangular shape and the longitudinal axis of the plate is inclined relative to the plane of the upper sides and / or bottom of the cage while being in the plane defined by the vertical axis and the medio-lateral axis.
System according to one of claims 1 to 4, characterized in that each free end of the plate there are provided means (28) for anchoring the plate to a respective vertebra of the two vertebrae between which "is intended to be arranged the cage, including a TRDU intended to cooperate with an associated screw.
System according to one of the preceding claims, characterized in that the cage (1) comprises at least one groove (16, 17) in which is received a rib (30, 31) end of the plate, as the guided rib slidably by the groove.
System according to Claim 6, characterized in- that the cage comprises two grooves (16, 17) and the upper and lower plate comprises two ribs (30, 31) having a tenon-shaped end (40, 41) which are each received in one of the grooves.
System according to Claim 7, characterized in that in section the two ribs (30, 31), the two pins (40, 41) and the portion of the plate (27) between the two ribs have the shape of a clamp C-shaped that clings to the cage by two studs which penetrate into a groove (16, 17) and respective slide therein. System according to one of claims 6 characterized in that the rib or ribs (30, not exceed the outer surfaces
top and / or bottom of the cage.
System according to one of the preceding claims, characterized in that the plate (27) has a hole (24) therethrough and there is provided an instrument shaft (100) to move the cage plate system, the instrument shaft "comprising a body cylindrical with an upper or distal end of which extends a lug (103) of complementary shape of the through hole formed in the plate and at least one lug, preferably -two lugs (106, 107) arranged (s) on both the other of the pad at a distance therefrom, by protruding from the body of the stem of a greater height than the stud.
11. System according to claim 10, characterized in that the hole (24) passing through is threaded and the distal end of the stud (103) is threaded correspondingly.
System according to Claim 11, characterized in that the stud (103) is slidably mounted relative to the shaft (100), including being in the form of a slot rod received in a well (109) of the rod.
PCT/FR2011/000540 2010-10-29 2011-10-04 Cervical cage and plate system WO2012056119A1 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
FR1004266 2010-10-29
FR1004266A FR2966720B1 (en) 2010-10-29 2010-10-29 System cage and cervical plate.

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
EP11771215.8A EP2632391A1 (en) 2010-10-29 2011-10-04 Cervical cage and plate system
BR112013010019A BR112013010019A2 (en) 2010-10-29 2011-10-04 system necklace and cervical plate

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WO2012056119A1 true WO2012056119A1 (en) 2012-05-03

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EP (1) EP2632391A1 (en)
BR (1) BR112013010019A2 (en)
FR (1) FR2966720B1 (en)
WO (1) WO2012056119A1 (en)

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US10182921B2 (en) 2012-11-09 2019-01-22 DePuy Synthes Products, Inc. Interbody device with opening to allow packing graft and other biologics
US10070970B2 (en) 2013-03-14 2018-09-11 Pinnacle Spine Group, Llc Interbody implants and graft delivery systems
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JP2016531634A (en) * 2013-10-07 2016-10-13 ウォーソー・オーソペディック・インコーポレーテッド The spinal implant system and method
EP3054899A4 (en) * 2013-10-07 2017-06-14 Warsaw Orthopedic, Inc. Spinal implant system and method
US20170049579A1 (en) * 2015-08-19 2017-02-23 Raymond J. Quinlan Spinal Fusion Device And Method Of Using Same

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EP2632391A1 (en) 2013-09-04
FR2966720B1 (en) 2013-04-19
BR112013010019A2 (en) 2016-08-02
FR2966720A1 (en) 2012-05-04

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