WO2014076084A1 - Prothèse d'articulation à facettes - Google Patents

Prothèse d'articulation à facettes Download PDF

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Publication number
WO2014076084A1
WO2014076084A1 PCT/EP2013/073628 EP2013073628W WO2014076084A1 WO 2014076084 A1 WO2014076084 A1 WO 2014076084A1 EP 2013073628 W EP2013073628 W EP 2013073628W WO 2014076084 A1 WO2014076084 A1 WO 2014076084A1
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WO
WIPO (PCT)
Prior art keywords
facet joint
joint prosthesis
vertebra
joint body
prosthesis according
Prior art date
Application number
PCT/EP2013/073628
Other languages
German (de)
English (en)
Inventor
Mark Heyland
Manav MEHTA
Patrick Strube
Georg Duda
Original Assignee
Charité - Universitätsmedizin Berlin
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 Charité - Universitätsmedizin Berlin filed Critical Charité - Universitätsmedizin Berlin
Priority to EP13789793.0A priority Critical patent/EP2919716A1/fr
Publication of WO2014076084A1 publication Critical patent/WO2014076084A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
    • A61B17/7025—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other with a sliding joint
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
    • A61B17/7031—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other made wholly or partly of flexible material
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
    • A61B17/7064—Devices acting on, attached to, or simulating the effect of, vertebral facets; Tools therefor
    • 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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/4405—Joints for the spine, e.g. vertebrae, spinal discs for apophyseal or facet joints, i.e. between adjacent spinous or transverse processes
    • 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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30205—Three-dimensional shapes conical
    • A61F2002/3021—Three-dimensional shapes conical frustoconical
    • 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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30205—Three-dimensional shapes conical
    • A61F2002/30212—Half-cones
    • 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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30224—Three-dimensional shapes cylindrical
    • A61F2002/30232—Half-cylinders
    • 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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30383—Connections 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
    • A61F2002/3039—Connections 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
    • A61F2002/30398—Sliding
    • 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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30383—Connections 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
    • A61F2002/3039—Connections 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
    • A61F2002/30398—Sliding
    • A61F2002/304—Sliding with additional means for limiting said sliding
    • 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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30476—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
    • A61F2002/3049—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism using a slidable sleeve covering the connection
    • 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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The 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
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30563—Special structural features of bone or joint prostheses not otherwise provided for having elastic means or damping means, different from springs, e.g. including an elastomeric core or shock absorbers
    • 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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30721—Accessories
    • A61F2/30734—Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
    • A61F2002/30738—Sleeves

Definitions

  • Facet joint prosthesis The invention relates to a facet joint prosthesis for vertebrae of a spinal column.
  • Two adjacent vertebrae of a spinal column are connected to one another via an intervertebral disc arranged between the two vertebral bodies.
  • This articulation permits complex movement of the two vertebrae with respect to one another, which involves a rotational movement about a longitudinal axis of the vertebrae, a tilting movement about different axes, which are arranged approximately in a transverse plane (flexion), and a sliding movement in an approximately transversal plane (extension ).
  • additional facet joints are formed on the articular processes of the vertebrae which protrude from the vertebral arch. These are also called vertebral arch joints.
  • the facet joints form a joint between a downward pointing articular process (processus articularis inferior) of the upper vertebra and an upwardly pointing articular process (processus articularis superior) of a lower vertebra.
  • a downward pointing articular process processus articularis inferior
  • an upwardly pointing articular process processus articularis superior
  • two of these facet joints are always formed in pairs and approximately mirror-symmetrical to a sagittal mid-plane of the spine.
  • Facet joint prostheses for vertebrae of a spinal column are known.
  • DE 10 2007 038 996 A1 shows a facet joint prosthesis for two vertebrae of a spinal column with a first joint body, which has a fastening means for fixed connection to an upper vertebra and a convex, first joint surface and with a second joint body, which is a fastening means for having a fixed connection with a lower vertebra and a concave second articulation surface for guiding the first articular surface.
  • the facet joint prosthesis comprises two first joint bodies and two second joint bodies, which are each arranged in pairs, wherein the first joint body and the second joint body are each firmly connected to one another via a transverse connection.
  • This facet joint prosthesis has a complicated structure and allows only a bilateral application, so that an implantation of this facet joint prosthesis requires a relatively complicated surgical procedure.
  • Further bilaterally implantable facet joint prostheses are furthermore known, for example, from US Pat. No. 8,034,078 B2, US 2010/0312283 A1 or WO 2010/065277 A1.
  • the invention has for its object to provide a facet joint prosthesis of the generic type, which is characterized by a simple structure, easy to apply and auditable and largely simulates the behavior of the natural facet joint. According to the invention this object is achieved by a facet joint prosthesis for vertebrae of a spinal column with the features mentioned in claim 1.
  • the facet joint prosthesis comprises a first joint body, which comprises a fastening means for non-positive and / or positive connection with a first vertebra, a second joint body, the fastening means for non-positive and / or positive connection with a second vortex adjacent to the first vertebra and comprising a connection arrangement coupling the first joint body to the second joint body along a parting plane, wherein the connection arrangement comprises a first connection element connected to the first joint body and a second connection element connected to the second joint body, the connection elements being correspondingly contactable along a parting plane Having sliding surfaces and the connecting elements are coupled to each other via at least one elastic element, it is advantageously possible to provide a simply constructed facet joint prosthesis, by their modular Structure is variably applicable and the behavior of a natural facet joint including joint capsule largely replicates. In particular, it is possible to apply the facet joint prosthesis only unilaterally, so that only a minimal invasive procedure is required.
  • the facet joint prosthesis according to the invention makes it possible, as in the case of the known bilateral facet joint prostheses, in particular to limit the rotation of a vertebra of the spinal column, without substantially limiting the other directions of movement.
  • the corresponding sliding surfaces of the connecting elements extend vertically. Due to the dividing plane defined here, the flexion and extension can take place almost unhindered.
  • the elastic element coupling the connecting elements leads only to a small resistance to the flexion and extension.
  • the sliding surfaces are formed on overlapping portions of the connecting elements. This advantageously makes it possible to form the connection arrangement in a simple, in particular also easy to apply design.
  • the overlapping portions of the connecting elements thus define the parting plane of the facet joint prosthesis. Because the sliding surfaces of the itself overlapping portions of the connecting elements are formed, the natural facet joint can be replicated in a particularly simple manner.
  • the at least one elastic element is arranged in the region of the overlapping sections of the connecting elements, wherein preferably the overlapping sections have a guide groove for the at least one elastic element.
  • the at least one elastic element is an elastic ring, whose inner diameter is less than idle at rest than an Au - prepare for preparation. This advantageously ensures that a particularly secure fit of the elastic element is achieved.
  • the positioning of the elastic element is effected by an elastic widening, wherein subsequently a self-aligning arrangement of the elastic element takes place in the guide groove.
  • a further preferred embodiment of the invention provides that between see the sliding surfaces of the connecting elements at least one damping element is arranged, which is preferably formed by an elastic intermediate layer.
  • an attenuation of the axial rotation of the joint prosthesis can be achieved, wherein the axial rotation of the facet joint prosthesis can be influenced depending on a thickness of the at least one damping element and a modulus of elasticity of the damping element.
  • the sliding surfaces merge into a vertical movement of the connecting elements to each other limiting stop surfaces.
  • a different, almost any extension limitation can be fixed here in a simple manner.
  • a resilience of the facet joint prosthesis is adjustable via an elasticity of the at least one elastic element.
  • the fastening means are multi-axial pedicle screws. This advantageously makes it possible to securely connect the facet joint prosthesis by means of per se known pedicle screws positively and / or positively with the vertebrae of the spine, without relaxation being expected during the intended use of the prosthesis.
  • the facet joint prosthesis according to the invention provides a modular, unilateral or bilateral, lumbar posterior, facet joint prosthesis.
  • the modular design allows by appropriate selection of the available modules an adaptation in a simple manner to an actually required medical indication.
  • the facet joint prosthesis is of small construction and can therefore be applied minimally invasively. Despite this small modular design, the behavior of a natural facet joint including joint capsule is largely reproducible.
  • the facet joint prosthesis according to the invention has two separate bone fasteners at the top and bottom (eg pedicle screws) which are each coupled to two connecting elements (eg rods). These separate parts may be in the parting plane z. B. interact along overlapping surfaces and in turn are coupled to an elastic element.
  • This has the advantage that the pedicle screws can be used separately and can be aligned separately. For pedicle screws with a movable head can so even with difficult geometry of the anatomy or with a small access path, ie minimally invasive, and with fully or partially existing facet joints, the pedicle screw shafts are placed relatively freely.
  • the pedicle screw heads can be aligned in such a way that the two connecting elements (eg rods) are in line, ie aligned. Then the parting plane can also be customized, z. B. on the basis of the remaining facet joint can be adjusted by the two rod parts are used so that the projection of the parting plane in the plane of joint articulation of the facet joint is. The position and orientation of the parting plane can be changed and adjusted by the surgeon or by the surgical technique.
  • the two connecting elements eg rods
  • z. B. on the basis of the remaining facet joint can be adjusted by the two rod parts are used so that the projection of the parting plane in the plane of joint articulation of the facet joint is.
  • the position and orientation of the parting plane can be changed and adjusted by the surgeon or by the surgical technique.
  • a facet joint prosthesis for vertebrae of a spinal column with the features mentioned in claim 13.
  • the facet joint prosthesis has a joint body, which comprises a fastening means for non-positive and / or positive connection with a first vertebra of a spinal column, and connected to the joint body connecting element, wherein the connecting element and a first vortex adjacent second vortex along a parting plane having sliding surfaces that can be brought into contact and the connecting element and the second vertebra are coupled to one another via at least one elastic element, it is advantageously possible to provide a facet joint prosthesis which has only one joint body that together with a natural joint extension of an adjacent vertebra forms the facet joint prosthesis.
  • an undamaged joint extension can be obtained with only partially damaged facet joint and this can be coupled with a connected to the adjacent vertebra prosthesis.
  • Required for this purpose is in the undamaged joint extension on or bring a sliding surface, which is coupled to the sliding surface of the connecting element of the artificial joint body of the facet joint prosthesis.
  • FIG. 1 shows a schematic perspective view of vertebrae of a spinal column with a facet joint prosthesis
  • Figure 2 is a schematic exploded view of the facet joint prosthesis
  • Figures 3a-3c different views of connecting elements of the facet joint prosthesis.
  • Figure 1 shows a generally designated 10 facet joint prosthesis, which is implanted between two adjacent vertebrae 12 and 14 of a spine.
  • the facet joint prosthesis 10 is implanted unilaterally in the area of a facet joint 16 of the spinal column.
  • the natural facet joint 16 includes a downwardly facing articular process 18 of the upper vertebra 12 and an upwardly protruding articular process 20 of the lower vertebra 14.
  • FIG. 2 shows an exploded perspective view of the facet joint prosthesis 10.
  • the facet joint prosthesis 10 comprises a first joint body 22 and a second joint body 24.
  • the joint body 22, 24 are each connected via fasteners non-positively and / or positively connected to the vertebrae 12 and 14 respectively.
  • the fastening means 26 are formed, for example, by known multiaxial pedicle screws, which are positively and materially insertable into corresponding previously created screw channels in the vertebrae 12 and 14, respectively, with or without bone cement.
  • the joint body 22 or 24 and the fastening means 26 may also be designed together as a pedicle screw.
  • the facet joint prosthesis 10 comprises a connection arrangement 28, which is formed by a first connection element 30 and a second connection element 32.
  • the connecting element 30 is connected to the joint body 22 and the connecting element 32 to the joint body 24. This connection can be made with screw connections, clamp connections or other suitable connections not shown here in detail.
  • the connection arrangement 28 further comprises an elastic element 36.
  • the joint body 22 and 24 are fastened with the fastening means 26 to the vertebrae 12 and 14, respectively. Since the fastening means 26 are formed by multiaxial pedicle screws, an alignment of the joint bodies 22 and 24 in the degrees of freedom predetermined by the pedicle screws is possible here. In this way, consideration can be given to different configurations of the vertebrae 12 and 14, respectively.
  • the alignment of the joint body 22 or 24 takes place in such a way that the grooves 38 and 40 formed in the joint bodies 22, 24 are aligned with one another.
  • the connecting elements 32 and 34 are brought into contact with their sliding surfaces (explanations on this are given in FIGS. 3 a to 3 c).
  • the elastic member 36 is then striped over the contacted fasteners 30 and 32 so that the fasteners 30 and 32 are captively coupled together.
  • the assembly of the elastic element 36 can also take place in such a way that it is at first stripped from the sliding surface side only via a connecting element (into the groove). As a result, it hardly needs to be stretched at all or not at all. Then push the second connecting member 32 with the sliding surfaces in contact with the first connecting member 30, so that the elastic ring has to expand slightly and slips into the groove of the second connecting member 32.
  • This assembly also allows for stiff rings and does not damage the rings by overstretching.
  • the elastic element 36 is formed by an elastic ring whose inner diameter in the unassembled state is less than an outer diameter of a guide groove of the connecting elements 30 and 32. This results in a more firmly defined seat of the elastic element 36 around the connecting elements 30 and 32, respectively.
  • the mutually coupled connecting elements 30 and 32 are then introduced into the grooves 38 and 40 of the joint body 22 and 24 and fixed there, so that the arrangement shown schematically in Figure 1 is achieved.
  • Both the joint bodies 22 and 24 and the connecting elements 30 and 32 and the elastic element 36 thus form individual modules of the facet joint prosthesis 10.
  • the facet joint prosthesis 10 can be adapted by selecting correspondingly required modules.
  • This applies in particular to the elastic element 36 which can be provided with different moduli of elasticity.
  • the connecting elements 30 and 32 are explained in more detail. 3a shows a perspective view of the connecting elements 30 and 32.
  • the connecting elements 30 and 32 form a parting plane 42, wherein each of the connecting elements 30 and 32 in the region of the parting plane 42 has a sliding surface 44 and 46, as the side view in Figure 3b illustrates.
  • the sliding surfaces 44 and 46 are in contact with each other along an overlapping portion 48 of the connecting members 30 and 32.
  • the connecting elements 30 and 32 each have a base body 50 or 52. In the region of the overlapping portion 48 of the base body 50 and 52 forms the sliding surfaces 44 and 46, respectively.
  • the sliding surface 44 passes via a stop surface 54 in the base body 50 and the sliding surface 46 via a stop surface 56 in the base body 52 via.
  • FIG. 3c shows the connecting element 30 in an enlarged side view.
  • the connecting elements 30 and 32 are identical in their construction and mirror images of one another, insofar the following explanations also apply to the connecting element 32. Recognizable is the body 50 extending portion 48 on which the sliding surface 44 and the annular groove 58 are formed. The sliding surface 44 merges into the abutment surface 54 at an angle ⁇ .
  • the angle ⁇ has a size of> 90 °, in particular between 1 10 ° and 150 °, preferably between 130 ° and 140 °, or on the example shown by 135 °.
  • An end region 60 of the section 48 has a frustoconical tip 62, wherein a conical surface 64 extends at an angle ⁇ to a longitudinal axis 66 of the connecting element 30.
  • the longitudinal axis 66 coincides with the parting plane 42 (FIG. 3a).
  • the angle ⁇ is a complementary angle to the angle a, that is, the sum of the angles ⁇ and ⁇ is 180 °.
  • the sliding surface 44 extends between a starting point 68 and an end point 70. In the end point 70, the sliding surface 44 merges into the abutment surface 54. At the starting point 68, the sliding surface 44 merges into the conical surface 64. It is clear from FIG. 3b that a distance a remains between the starting point 68 of the connecting element 30 and the end point 70 of the connecting element 32. This distance a thus defines the distance of the conical surface 64 from the stop surface 54.
  • This displacement brings about an approach of the conical surface 64 of the one connecting element 30 or 32 to the abutment surface 54 or 56 of the respective other connecting element 30 or 32.
  • the maximum displacement is determined by the distance a. give. This distance a thus represents a limitation of the extension of the facet joint prosthesis 10.
  • the at least one damping element 72 also leads to a reduction in wear of the superimposed sliding surfaces 44 and 46 of the connecting elements 30 and 32.
  • Titanium or cobalt-chromium alloys are suitable as materials for the connecting elements 30 and 32, for example.
  • the material for the elastic member 36 and the at least one damping element 72 are elastic polymers, such as silicone.
  • the facet joint prosthesis 10 By means of the facet joint prosthesis 10 according to the invention, by selecting the dimensioning and the choice of material of the connecting elements 30 and 32 and the elastic element 36 of the at least one damping element 72, a flexion, extension and lateral inclination of about 80% of the normal physiological range of motion and an axial rotation of 85 to 97% of normal rotation can be achieved.
  • the band stiffness of the elastic element 36 which may, for example, be between 20 and 50 MPa (megapascals), has a significant influence on this.
  • the inventive facet joint prosthesis 10 represents an implant which can be used unilaterally to obtain a facet joint or bilaterally with an intact disc or an artificial intervertebral disc, resulting in almost physiological range of motion and physiological loading of the remaining spinal structures.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Neurology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • General Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Public Health (AREA)
  • Animal Behavior & Ethology (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Vascular Medicine (AREA)
  • Prostheses (AREA)

Abstract

L'invention concerne une prothèse d'articulation à facettes (10) pour vertèbres d'une colonne vertébrale, comprenant un premier corps d'articulation (22) qui comprend un moyen de fixation (26) pour la liaison à force et/ou par complémentarité de forme avec une première vertèbre (12), un deuxième corps d'articulation (24) qui comprend un moyen de fixation (26) pour la liaison à force et/ou par complémentarité de forme avec une deuxième vertèbre (14) voisine de la première vertèbre (12) ainsi qu'un dispositif de liaison (28) accouplant le premier corps d'articulation (22) au deuxième corps d'articulation (24) le long d'un plan de séparation. Selon l'invention, le dispositif de liaison (28) comprend un premier élément de liaison (30) relié au premier corps d'articulation (22), le dispositif de liaison (28) comprend un deuxième élément de liaison (32) relié au deuxième corps d'articulation (24), les éléments de liaison (30, 32) présentent des surfaces de glissement (44, 46) correspondantes pouvant être mises en contact le long d'un plan de séparation (42) et les éléments de liaison (30, 32) sont accouplés l'un à l'autre par l'intermédiaire d'au moins un élément élastique (36).
PCT/EP2013/073628 2012-11-14 2013-11-12 Prothèse d'articulation à facettes WO2014076084A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
EP13789793.0A EP2919716A1 (fr) 2012-11-14 2013-11-12 Prothèse d'articulation à facettes

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102012220808.9A DE102012220808A1 (de) 2012-11-14 2012-11-14 Facettengelenkprothese
DE102012220808.9 2012-11-14

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WO2014076084A1 true WO2014076084A1 (fr) 2014-05-22

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EP (1) EP2919716A1 (fr)
DE (1) DE102012220808A1 (fr)
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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20050240266A1 (en) * 2004-04-22 2005-10-27 Kuiper Mark K Crossbar spinal prosthesis having a modular design and related implantation methods
US20050256578A1 (en) * 2004-05-11 2005-11-17 Geoffrey Blatt Artificial spinal disc, insertion tool, and method of insertion
WO2007124249A1 (fr) * 2006-04-20 2007-11-01 Warsaw Orthopedic, Inc Stabilisateur vertébral

Family Cites Families (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7896906B2 (en) 2004-12-30 2011-03-01 Depuy Spine, Inc. Artificial facet joint
US7776090B2 (en) * 2004-12-13 2010-08-17 Warsaw Orthopedic, Inc. Inter-cervical facet implant and method
US8034078B2 (en) 2008-05-30 2011-10-11 Globus Medical, Inc. System and method for replacement of spinal motion segment
DE102007038996B4 (de) 2007-08-17 2015-03-19 Burkhard Rischke Facettengelenk-Prothese
WO2010065277A1 (fr) 2008-11-25 2010-06-10 Synthes Usa, Llc Implant viscoélastique pour articulation facettaire

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20050240266A1 (en) * 2004-04-22 2005-10-27 Kuiper Mark K Crossbar spinal prosthesis having a modular design and related implantation methods
US20050256578A1 (en) * 2004-05-11 2005-11-17 Geoffrey Blatt Artificial spinal disc, insertion tool, and method of insertion
WO2007124249A1 (fr) * 2006-04-20 2007-11-01 Warsaw Orthopedic, Inc Stabilisateur vertébral

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EP2919716A1 (fr) 2015-09-23
DE102012220808A1 (de) 2014-05-15

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