WO2012062272A2

WO2012062272A2 - Instrument set for minimally invasive surgery in spinal fusion performed on the human or animal body

Info

Publication number: WO2012062272A2
Application number: PCT/DE2011/001893
Authority: WO
Inventors: Igor Nikiforov
Original assignee: Igor Nikiforov
Priority date: 2010-10-22
Filing date: 2011-10-18
Publication date: 2012-05-18
Also published as: DE102010049455A1; WO2012062272A3

Abstract

The invention relates to an instrument set for minimally invasive surgery in spinal fusion performed on the human or animal body, wherein the instrument set (1) comprises a guide instrument (2) for inserting further instruments (3) of the instrument set (1) into the human or animal body, wherein the guide instrument (2) has an instrument insertion channel (4) oriented in the longitudinal direction, and wherein the instrument set (1) comprises a guide wire (5) for guiding the instruments (3) of the instrument set (1) into the intervertebral space, which guide wire (5) can be guided through the instrument insertion channel (4), wherein the guide wire (5) is designed, at the distal end (6) thereof, in the form of a hook-shaped spike (7), and the guide wire (5) has a cross-sectional widening (8) before the hook-shaped spike (7), and the instruments (3) of the instrument set (1) have a passage (9) extending right through them in the longitudinal direction of the instruments (3) in order to receive the guide wire (5).

Description

Instruments for minimally invasive surgery in the field of spinal fusion on the

human or animal body

The invention relates to a set of instruments for minimally invasive surgery in the field of

Spinal fusion in the human or animal body.

In certain diseases of the spine, a stiffening of the affected spinal area (spinal fusion) is unavoidable despite conservative therapy. To stiffen the vertebral body segment-bridging screws and rods are attached to the back of the vertebral body and thus the vertebrae together

stabilized. In this technique, special screws (pedicle screws) are inserted through the vertebral arcs into the vertebrae, which are to be stiffened. The screws are connected longitudinally with rods, whereby two or more vertebrae are linked together. The real one

Stiffening, in the sense of a bony fusion of a

Spine segment, is a task of the body and takes place in the following months after a Spondylodese operation in which the stabilized spinal column sections bony merge together.

As a rule, in such pathological

Changes in the spine also degenerate

Disc be removed. Instead of the intervertebral disc, an intervertebral disc prosthesis, also referred to as a "cage", is implanted into the intervertebral space to stabilize the intervertebral disc space and restore intervertebral disc height.

The surgical methods used distinguish between the ALIF (Anterior Lumbar Intersegmental Fusion) -, PLIF (Posterior Lumbar Intersegmental Fusion) - or TLIF (Transforaminal Lumbar Intersegmental Fusion) method. Side access to the surgical field is referred to as XLIF (Extreme Lateral Interbody Fusion).

A disadvantage of the known surgical methods is that the spine over a distance of 15 to 20 cm

and the wound is kept open for a long time. This is a big one

Infection risk with concomitant large blood loss due to the size of the wound given. Since these methods are performed under general anesthesia, there is an additional risk to the patient due to the

Side effects and risks that cause general anesthesia.

Due to the intensity of the procedure, correspondingly long recovery times of up to several weeks result for the patient.

In recent years, therefore, surgical methods and corresponding instruments have been developed that only require minimally invasive procedures on the patient.

In the minimally invasive procedures, it is possible to anesthetize the patient only locally during the procedure, so that it is constantly responsive during the operation. As a result, immediate checks are possible

Nerve contacts possible. A minimally invasive procedure is far more pleasant and gentler for those affected than conventional methods. As a rule, patients can get up after just a few hours and often leave the clinic on the same day.

Instruments for minimally invasive surgery in the

Area of spinal fusion is known in the art. This is done through secure access to the spinal canal under endoscopic image control of the herniated disc (prolapse) removed. The forceps and gripping elements are pushed through a guide tube of the endoscope under X-ray control in the operation area. This will not hurt any nerves

Intervertebral disc with special milling instruments

extended. The operation progress is controlled by a camera integrated in the endoscope and a picture display system. A gentle removal of the spinal disc tissue is thus ensured.

After the removal of the prolapse and the associated decompression of the spinal canal, the preparation and preparation of the affected intervertebral space for the implantation of the intervertebral disc prosthesis takes place. In this section of surgery, the remaining disc material remaining in the disc space is removed, as well as the

Vortex body and cover plates refreshed. Thereafter, the disc space for further decompression of

Spinal canal spread and introduced the disc prosthesis in the correct position under X-ray control.

Disadvantageous to the known for the minimally invasive

Instrumentation developed is that. The safe guidance of the instruments of an instrument due to the endoscopic guide tube is ensured only to the intervertebral disc space, but not beyond into the intervertebral space. The guidance and positioning of the instruments in the disc space is therefore dependent on the skill and experience of the surgeon. By

However, improper handling of the instruments can easily cause injury to the vertebral body or the

Vertebral occlusal plate, which may adversely affect the healing process and the lasting stability of the spinal fusion. At worst, The fibrous ring (annulus fibrosus) of the intervertebral disc can be pierced and penetrated into the spinal canal, which in the worst case can lead to permanent damage to the spinal nerves.

It is therefore an object to provide an instrument for the minimally invasive procedure in the field of spinal fusion in the human or animal body, with which injuries to the aforementioned form are avoided.

To solve the problem, a set of tools for the minimally invasive surgical procedure in the field of spinal fusion on the human or animal body is specified, which is a management tool for introducing other instruments of the instrumentation in the

human or animal body as well as one

Guidewire for guiding the instruments of the

Instrumentation in the intervertebral space comprises. The guide instrument has a longitudinal direction

equipped instrument insertion channel. Of the

Guide wire is passed through the instrument insertion channel and is formed at its distal end in the form of a hook-shaped mandrel. Before the hook-shaped mandrel, the guide wire has a cross-sectional widening. Furthermore, the instrumentation is characterized by the fact that the other instruments of the instrumentation for receiving the guide wire in the longitudinal direction of the instruments are cannulated throughout.

The guidewire serves to guide the instruments into the intervertebral space. For this purpose, the guide wire is inserted through the Instrumenteinführkanal the guide instrument in the intervertebral space or in the disc space and with its hook-shaped mandrel in The fibrous ring (annulus fibrosus) of the intervertebral disc compartment or hooked into one of the vertebral bands.

The cross-sectional widening of the guide wire in front of the hook-shaped mandrel serves as a stopper, with the result that only the mandrel of the guide wire can penetrate the fiber ring. Preferably, the cross-sectional widening extends radially around the guide wire. With this configuration is prevented, the fiber ring or the vortex band with the guide wire too far

puncture and, if necessary, the spinal canal

hurt. After completion of the surgical procedures, the mandrel can be easily released from the entanglement and the

Guide wire are pulled out of the intervertebral space.

The instrument of the invention comprises several

Instruments with which the preparation and preparation of the intervertebral space for the implantation of a

Intervertebral disc prosthesis, in particular a Cages, can be made. All instruments according to the invention are characterized in that they are cannulated continuously for receiving the guide wire in the longitudinal direction or a cannulation for receiving and guiding the

Having guidewire. The surgical technique that can be performed with the instrumentation according to the invention is preferably under the assistance of an optical control of the surgical field via an endoscope

carried out .

The cannulation can be designed in the form of a straight bore, which is guided continuously in the longitudinal direction of the instrument, or as a guide tube arranged in the longitudinal direction of the instrument, at least on a partial region of the outer sheath. The guidewire is passed through the Cannulated and can slide in this, so that the cannulated instrument on the guide wire can be performed as on a string along. Since the guide wire is hooked to the mandrel in the fiber ring or the vortex band, the instruments along the guide wire can be accurately and accurately inserted into the intervertebral space.

Advantageously, the cross-sectional widening in front of the mandrel of the guide wire is a material thickening of the

Guidewire and / or a firmly connectable to the guide wire means for generating a

Cross-sectional enlargement, which is a firmly connected to the guide wire cannulated body, preferably a

cannulated bullet or a cannulated disc, can be.

In a particular embodiment, the maximum

Cross-sectional diameter of the cross-sectional extension of the guidewire greater than the cross-sectional diameter of the cannulation of the instrument instruments.

An advantage of this design is that the

Instruments along the guidewire only up to the

Cross-sectional expansion of the guidewire can be performed, but not beyond. The

Cross-sectional enlargement serves in this embodiment additionally as a stopper for guided on the guide wire instruments. With this special

A sufficient spacing of the instrument to the fiber ring of the intervertebral disc space or to the vertebral ligaments is ensured and a violation of the

Fiber rings or vertebral bands avoided by direct contact with the instrument used. The avoidance of direct contact between the fiber ring and the instrument is of great importance in particular for cutting or milling instruments, because of the sharp-edged Characteristics of these instruments there is a great risk of perforation of the intact area of the fiber ring or the vertebral ligaments.

In a particular embodiment, that is

Guiding instrument in the form of a longitudinal direction

elongated guide sleeve is formed. This

allows rigid instruments through the

Instrumenteneinführkanal through to the

Introduce whirl space.

In a further embodiment it is provided that the instrumentation at least one cutting and / or

Milling instrument for processing located in the intervertebral space tissue material comprises, which is equipped at its distal end with a cutting and / or milling element. The cutting and / or milling element can with a

Guide rod or guide sleeve, preferably releasably connected. The cutting and / or milling instrument can be inserted into the instrument insertion channel of the guide instrument and rotated in the instrument insertion channel. The rotation occurs around the guidewire.

The guiding of the cutting and / or milling instrument through the instrument insertion channel ensures a safe approach of the instrument to the surgical field. Through the cannulated guide over the guide wire, the cutting and / or milling element of the cutting and / or

Milling instruments beyond the Instrumenteinführungskanal out are inserted target and exact position in the intervertebral space.

The cutting and / or milling instrument is used to remove tissue remnants after removal of the

Disc cartilage remained in the intervertebral space. Turning the cutting and / or Fräsinstruments is the preferably rigidly connected to the cutting and / or milling instrument cutting and / or cutting element in

Vertebral space rotates, whereby tissue materials such as cartilage residues or bone can be debrided by cutting and removed from the intervertebral space.

The instrumentation can several cutting and / or

Milling instrument of the same type include, but differ in the size of the cutting and / or milling element. The size is defined by the length and / or the radial extent of the cutting and / or milling element.

The debridement of tissue material is preferably in the first step with the smallest cutting and / or

Milling element performed. In the subsequent steps, one cutting and / or milling element of the next size is used in stages. By the layers

Debridieren the Gewerbereste the intervertebral space is gently cleared while avoiding injury or even erosion of the uppermost bone layer of the vertebral plate or the vortex ground.

To facilitate rotation, the cutting and / or milling instrument may be provided with a handle at its proximal end.

In a particular embodiment, the cutting and / or milling element of at least one cutting and / or Fräsinstruments two symmetrical to the longitudinal axis of the

Cutting and / or milled cutter blades arranged in the longitudinal direction of the cutting and / or milling element equidistant from the longitudinal axis of the cutting and / or milled element and offset by 180 ° to the longitudinal axis to each other. Preferably, the blades have

on both sides a cutting edge to a debridement of the Fabric both clockwise and anticlockwise

to be able to.

In an alternative embodiment, the cutting and / or milling element of at least one cutting and / or Fräsinstruments arranged in the longitudinal direction of the cutting and / or milling element, in the radial direction to the longitudinal axis of the cutting and / or milling flexible flexible blade blades have.

Due to the flexibility of the flexible blade blades is achieved that this is the respective, usually uneven formation of the surface of the

Vertebral body or the vertebral body plate can optimally adapt and thus a uniform removal of the subchondral plate to the top

Bone layer of the intervertebral space limiting vertebra can be made without irreversibly damaging the top bone layer. A removal of the. uppermost bone layer is mandatory to avoid, to maintain the stability of the stiffened vertebrae.

The degree of bending of the blade blades to accommodate the intervertebral space is in a particular

Execution form of the cutting and / or milled element of the cutting and / or FräsInstruments adjustable and

fixable. For this purpose, the cutting and / or Fräsinstruments has a locking mechanism that can be operated by the surgeon from the outside to spread the flexibly flexible blade blades in the radial direction to the longitudinal axis of the cutting and / or milling element and in

to fix the desired degree of bending of the blade blades.

In a preferred form of locking mechanism, the flexibly flexible blade blades are at the distal end firmly with the cutting and / or cutting element and on

proximal end of the cutting and / or milling element with a on the guide rod of the cutting and / or

Milling instrument longitudinally slidably mounted ring or sleeve connected. The spreading of the blades is achieved by pushing the ring or the sleeve towards the distal end of the cutting and / or milling instrument, whereby the blade leaves are arched outwards like a balloon. The blade blades become

preferably spread to surface contact with the surfaces of the vertebral body plate and the vertebral body, wherein the blade leaves to the

Create surface structure of the vertebral body plates.

After the tissue materials have been removed from the intervertebral space and the subchondral plates of the vertebral surfaces have been removed in preparation for the implantation of the cage, the intervertebral space is to be expanded in order to further relieve the spinal canal by tensioning the vertebral ligament or the fiber ring and to remedy its compression on the other hand, to create space for introducing further preparative instruments.

For spreading the vortex gap includes the

Instrumentarium therefore at least one dilator Repositeur, at its distal end with a

Reduction element is equipped. The dilator repositor is insertable into the instrument insertion channel of the guide instrument and can be rotated therein. The rotation occurs around the guidewire.

The rotational ability of the dilator repositor in the

Instrument insertion channel is necessary to learn about the movement of the respective Repositionselements in

Whirl space to determine its expansion. If the intervertebral space is widened to such an extent that the fiber ring or the vertebral bands are under optimum tension, a resistance becomes noticeable during the rotation of the reduction element, in the form that the

Reduction element is difficult or impossible to rotate.

The reduction element can be connected to a guide rod or guide sleeve, preferably releasably.

The instrumentation may include multiple dilator repositories that differ in size and / or design of the reduction element. The size is defined by the length and / or the radial extent of the

Repositionselements. To facilitate rotation, the dilator repositories may be provided with a handle at their proximal end.

The vertebral body plate and the vertebral body are slightly concave. To be optimal

To achieve spreading of the intervertebral space, are therefore in a particular embodiment of the

Reduction elements at least two opposite, extending in the longitudinal direction portions of the lateral surfaces of the Repositionselements convex. The degree of spatial curvature of these sections may vary from

Repositioning element to reposition element vary. The connecting the said convex sheath sections

Sheath sections of the reduction element are designed as a planar surface. By this configuration of the

Reduction elements is achieved that the distance between the planar surfaces is less than the maximum determinable distance between the convex shell sections. This embodiment allows easy insertion of the reduction element in the

Intervertebral space. By turning the dilator Repositeurs then become the convex

Sheath sections simultaneously against both

Vertebral body and as well against the

Vertebral ceiling plate pushed, causing the

Vertebrae are pressed apart.

After sufficient expansion of the intervertebral space with concomitant decompression of the spinal canal, the uppermost bone layer of the vertebral body and / or the vertebral body plate is prepared for the implantation of the cage.

In order to improve the ingrowth of the cage implant, small defects are placed in the uppermost bone layer, which lead to the body's own cells from the

Invade vertebral body into the intervertebral space or

Bleeding. The immigration of the body's own bone and / or cartilage cells is primarily used to colonize a possibly uninoculated cage implant with these cells. This form of preparation of

Vertebral plate is called microfracturing.

To carry out this operation step, the

Instrumentation therefore comprise at least one instrument, which at its distal end with a reamer for

Processing of the vertebral body and

Vertebral cover plate, which is the intervertebral space

limit, is equipped. The reamer is in the

Instrumenteinführungskanal the guide instrument inserted and can be rotated in it. The rotation occurs around the guidewire.

The reamer can be used with a guide rod or

Guide sleeve, preferably releasably connected.

Preferably, the reamer has blades or blades that rotate spirally around the body of the reamer. By rotation of the reamer are by means of the invention Blade or cut the desired defects into the topmost bone layer by scratching them. To facilitate rotation, the instrument may be provided with reamer at its proximal end with a handle.

To obtain a uniform microfracture of the concave

To achieve vertebral plates, the reamer is formed in a preferred embodiment substantially ellipsoid. The distal and / or proximal end of the

Reamer can adapt to the shape of the

Whirled intervertebral be flattened.

After completion of the microfracturing principle, the implant (intervertebral disc prosthesis, especially cage) can be used in the intervertebral space. It is more advantageous, however, the vortex gap before the onset of

To fill up implants with autologous bone tissue and / or a biocompatible synthetic implant material in order to positively influence the healing process and the lasting stability of the spinal fusion.

For introducing autologous bone tissue and / or. A biocompatible synthetic implant material, the instrumentation in a particular embodiment therefore comprises an instrument having at the distal end a syringe which is insertable into the instrument insertion channel of the guide instrument and preferably can be rotated therein. The syringe is equipped with a stamp that the surgeon from outside through the

Instrument introduction channel can be operated through. Preferably, the syringe has a curved cannula for uniformly occluding the autologous bone tissue and / or the biocompatible synthetic implant material

Distribute intervertebral space. The instrumentation according to the invention will now be described with reference to FIGS

1: Schematic representation of the instrument,

Fig. 2: Schematic representation of a cutting and / or

Milling instrument with a first embodiment of a cutting and / or milling element,

Fig. 3: Schematic representation of a cutting and / or

Milling instrument with a second embodiment of a cutting and / or milling element,

4: Schematic representation of a dilator

Repositories with two alternative embodiments of the reduction element,

5: Schematic representation of an instrument with a reamer according to the invention,

6: Schematic representation of an instrument with a syringe according to the invention,

7: Schematic representation (top view) of an instrument introduced into the intervertebral space,

Fig. 8: Schematic representation (side view) of an introduced into the intervertebral space instrument explained in more detail.

FIG. 1 shows a set of instruments for minimally invasive surgery in the field of

Spinal fusion in the human or animal body. The instrumentation 1 comprises a plurality of instruments 3 and a guide instrument 2 for inserting the

Instruments 3 in the human or animal body. The guide instrument 2 has a longitudinal direction equipped Instrumenteinführkanal 4. Furthermore, the instrumentation 1 comprises a guide wire 5 for guiding the instruments 3 of the instrumentation 1 into the intervertebral space. The guide wire 5 is passed through the instrument insertion channel 4 and is characterized by a hook-shaped pin 7 formed at its distal end 6. Before the hook-shaped mandrel 1 of the guide wire 5 in the form of a

Cross-sectional enlargement 8 thickened designed. The

Cross-sectional enlargement 8 is by a on the

Guidewire 5 wound up and firmly connected to the guide wire 5 ball 10 is formed. To record the

Guidewire 5 are the instruments 3, exemplified for all other instruments 3 shown on a single instrument, in the longitudinal direction of the instruments 3 continuously cannulated. 9

FIG. 2 shows a cutting and / or milling instrument 11 for processing tissue material located in the intervertebral space, which is equipped with a cutting and / or milling element 12 at its distal end. FIG. 2 includes a view A-A of the cutting and / or milling element 12.

The cutting and / or milling element 12 is provided with a

Guidance bar connected and with two symmetrical to

Longitudinal axis of the cutting and / or milling 12th

arranged blades 13 equipped. The blades 13 have on both sides cutting. The blades are in

The longitudinal direction of the cutting and / or milling element 12 and are equidistantly offset from each other to the longitudinal axis of the cutting and / or milling element 12 and at an angle of 180 "to each other.A handle on the proximal end of the cutting and / or Fräsinstruments 11 easier handling, especially for turning, the Instruments 11 attached. The cannulation 9, through which the guide wire 5 is guided, runs straight in

Longitudinal through the instrument 11th

3 shows an alternative embodiment of a cutting and / or Fräsinstruments 11 with a cutting and / or cutting element 12, the four arranged in the longitudinal direction of the cutting and / or milling element 12, in the radial direction to the longitudinal axis of the cutting and / or Milling elements 12 flexibly flexible blade blades 14 has. Figure 3 includes a view B-B of the cutting and / or

Milling elements 12.

The flexibly flexible blade blades 14 are fixed at the distal end to the cutting and / or milling element 11 and at the proximal end of the cutting and / or milling element 11 with a on the guide rod of the cutting and / or

Milling instruments 11 longitudinally slidably mounted ring connected. The spreading of the blades is achieved by pushing the ring in the direction of the distal end of the cutting and / or milling instrument 11, causing the blade blades 14 to bulge outward like a balloon.

FIG. 4 shows a dilator repository 15 of the instrumentation 1 for spreading the intervertebral space, which is equipped with a reduction element 16 at its distal end. FIG. 4 comprises cross-sectional views C-C of two alternative embodiments of the invention

Reduction element 16.

The reduction element 16 is in two opposite, longitudinal sections of the

Sheath surfaces 17 convex. The convex Mantelabschni te 17 connecting jacket portions of the reduction element are formed as a planar surface. The dilator repository 15 is longitudinal

continuously cannulated 9 formed.

FIG. 5 shows an instrument 18, which is continuously cannulated 9 and at its distal end with a reamer 19 for processing the vertebral body and vertebral body cover plate, which surrounds the intervertebral space

limit, is equipped. The reamer 19 is in

Essentially formed ellipsoidal, 19 blades are arranged on the body of the reamer, which rotate around the body of the reamer 19 spirally. By rotation of the reamer 19, the desired defects are placed in the uppermost bone layer by means of the blades or cutting according to the invention by being scratched. To facilitate the rotation of the instrument 18 with

Reamer 19 equipped with a handle at its proximal end.

FIG. 6 shows an instrument 20 of the instrumentation 1, which at its distal end is provided with a syringe 21 for

Insertion of autologous bone tissue and / or a biocompatible synthetic implant material. This instrument 18 also has a cannulation 9 in the longitudinal direction, through which the guide wire 5 is guided.

FIG. 7 shows a schematic illustration

(Plan view) of a vertebral body 22 with a in the

Vertebral space 23 inserted instrument 3, here a dilator repositor 15 with a reduction element in 16. The dilator repository 15 is through the

Instrument insertion channel 4 of the guide instrument 2, which is designed as a guide sleeve, guided and mounted on the guide wire 5. The guide wire 5 is inserted through the instrument insertion channel 4 of the guide instrument 2 in FIG introduced the intervertebral space 23 and hooked with its hook-shaped mandrel 7 in the fiber ring (annulus fibrosus) 24 of the disc compartment.

The cross-sectional widening 8 of the guide wire 5, which is shaped in the shape of a ball 10, serves as a stopper in front of the hook-shaped mandrel 7, with the result that only the mandrel 7 of the guide wire 5 can penetrate the fiber ring 24. This prevents the

Fiber ring 24 with the guide wire 5 pierced too far and the vertebral body is injured. The ball 10 also serves as a stopper for the guided on the guide wire 5 reduction element 16. This achieves a sufficient spacing of the reduction element 16 to the fiber ring 24 of the disc space and a

Injury of the fiber ring 24 avoided by direct contact with the instrument 15.

FIG. 8 shows a schematic representation

(Side view) of one of the vertebral body base 25 and the vertebral body plate 26 limited vertebral space 23. In the intervertebral space 23 is a Dilatatoren- Repositeur 15 with a reduction element in the 16th

introduced. The reduction element 16 is in two

opposite, running in the longitudinal direction

Convex portions of the lateral surfaces 17, which are adapted to the concave configuration of the vertebral body plates 25, 26. The jacket sections of the reduction element 16 connecting the convex jacket sections 17 are formed as a planar surface (dashed lines). The dilator repository 15 is longitudinal

continuously cannulated 9 formed. The dilator repository 15 is through the instrument insertion channel 4 of the guide instrument 2, as a guide sleeve

is formed, guided and stored on the guide wire 5. The guide wire 5 is through the Instrument insertion channel 4 of the guide instrument 2 inserted into the intervertebral space 23 and hooked with its hook-shaped mandrel 7 in the fiber ring (annulus fibrosus) 24 of the disc compartment. The ball 10 also serves to secure the guide wire 5 in and to the spacing of the reduction element 16 from the fiber ring

Claims

claims:

1. Instrumentation for the minimally invasive

Surgical intervention in the field of

Spinal fusion on the human or

animal body, wherein the instrumentation (1) is a guide instrument (2) for introducing further

Instruments (3) of the instrumentation (1) in the human or animal body, wherein the guide instrument (2) has a longitudinal direction

equipped instrument insertion channel {4), and wherein the instrumentation (1) a guide wire (5) for guiding the instruments (3) of the

Instrumentation (1) in the intervertebral space, which is feasible through the instrument insertion channel (4), characterized in that the guide wire (5) at its distal end (6) in the form of a

hook-shaped mandrel (7) is formed and the guide wire (5) in front of the hook-shaped

formed mandrel (7) has a cross - sectional widening (8) and the instruments (3) of the

Instrumentation (1) for receiving the guide wire (5) in the longitudinal direction of the instruments (3) are continuously cannulated (9).

2. Instrumentarium according to claim 1, characterized

in that the cross-sectional widening (8) is a thickening of the material and / or a means (8) which can be fixedly connected to the guide wire (5) to produce a cross-sectional widening (10).

3. Instrumentarium according to claim 2, characterized

in that the means for producing a cross-sectional widening (10) has a cannulated body firmly connectable to the guide wire (5), preferably a cannulated ball or a cannulated disc, is.

4. Instrumentarium according to one of claims 1 to 3,

characterized in that the maximum

Cross-sectional diameter of the cross-sectional widening (8) of the guide wire (5) larger than that

Cross - sectional diameter of cannulation (9)

Instruments (3) of the instrument {1).

5. Instrumentation according to one of claims 1 to 4,

characterized in that the guide instrument (2) is designed in the form of a longitudinally elongated guide sleeve.

6. Instrumentarium according to one of claims 1 to 5,

characterized in that the instrumentation (1) comprises at least one cutting and / or milling instrument (11) for processing tissue material located in the intervertebral space, which at its distal end is provided with a cutting and / or milling element (12).

and wherein the cutting and / or milling instrument (11) is insertable into the instrument insertion channel (4) of the guide instrument (2) and rotatable in the instrument insertion channel (4).

7. instrument according to claim 6, characterized

characterized in that the cutting and / or milling element (12) at least one cutting and / or

Milling instruments (11) has two symmetrically to the longitudinal axis of the cutting and / or milled member (12) arranged blades (13), wherein the blades (13) in the longitudinal direction of the cutting and / or milled member (12) equidistant from the longitudinal axis of the cutting - and / or milled elements (12) and offset by 180 ° to the longitudinal axis are arranged to each other.

8. Instrumentarium according to claim 6, characterized in that the cutting and / or cutting element (12) at least one cutting and / or

Milling instruments (11) a plurality of longitudinally of the cutting and / or milled member (12) arranged in the radial direction to the longitudinal axis of the cutting and / or milled member (12) flexibly flexible blade blades

(14).

9. instrument according to claim 8, characterized

characterized in that the degree of bending of the

Blade blades (14) for adaptation to the

Vertebral space is adjustable and fixable.

10. Instrumentarium according to one of claims 1 to 9,

characterized in that the instrumentation (1) at least one dilators repositeur (15) for

Spreading of the intervertebral space, which is equipped at its distal end with a reduction element (16), wherein the dilator Repositeur

(15) into the instrument introduction channel (4) of the

Guide instrument (2) is insertable and rotatable therein.

11. Instrumentarium according to claim 10, characterized

characterized in that at least two

opposite, running in the longitudinal direction

Sections of the mantle surfaces (17) of the

Reduction elements (16) are convex.

12. Instrumentarium according to one of claims 1 to 11,

characterized in that the instrumentation (1) comprises at least one instrument (18) equipped at its distal end with a reamer (19) for machining the base of the vertebral body and the vertebral disc covering the intervertebral space, wherein the reamer (19} in the

Instrument introduction channel (4) of the

Guide instrument (2) is insertable and rotatable therein.

13. Instrumentarium according to claim 12, characterized

characterized in that the reamer (19) is formed substantially ellipsoid.

14. Instrumentarium according to one of claims 1 to 13, characterized in that the instrumentation (1) comprises an instrument (20) at its distal end with a syringe (21) for insertion of

autologous bone tissue and / or a biocompatible synthetic implant material, wherein the syringe (21) in the

Instrument introduction channel (4) of the

Guide instrument (2) insertable and preferably rotatable therein.