WO2016144150A1 - Système extensible pour fusion intersomatique et procédé d'utilisation - Google Patents

Système extensible pour fusion intersomatique et procédé d'utilisation Download PDF

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Publication number
WO2016144150A1
WO2016144150A1 PCT/MX2015/000037 MX2015000037W WO2016144150A1 WO 2016144150 A1 WO2016144150 A1 WO 2016144150A1 MX 2015000037 W MX2015000037 W MX 2015000037W WO 2016144150 A1 WO2016144150 A1 WO 2016144150A1
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WO
WIPO (PCT)
Prior art keywords
box
platform
clamp
lateral
gates
Prior art date
Application number
PCT/MX2015/000037
Other languages
English (en)
Spanish (es)
Inventor
Salvador José MARIN
Original Assignee
Marin Salvador José
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 Marin Salvador José filed Critical Marin Salvador José
Priority to PCT/MX2015/000037 priority Critical patent/WO2016144150A1/fr
Publication of WO2016144150A1 publication Critical patent/WO2016144150A1/fr

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Classifications

    • 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
    • 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor

Definitions

  • the present invention relates in general to an expandable system for intersomatic fusion and more specifically to a system consisting of an expandable box, a positioning device and a forceps for expansion that allow to locate within the intervertebral space, easily and with ease. a minimum invasion, the expandable box, said box being able to be later expanded to immobilize the adjacent vertebrae.
  • Surgical fusion of the spine is a method widely used for the treatment of painful segmental instability associated or not, to root compression; Its objective is to eliminate this instability and, in this way, reduce the pain and disability that this causes. It can be done through different surgical techniques, within them, those that include the use of internal fixation (instrumentation) have improved the fusion rates and clinical results, and that is, they have avoided the need to use a rigid external support after Surgery.
  • FPL posterolateral fusion
  • the circumferential fusion was developed to provide a solid fixation of the segments to be fused, maintaining at the same time, the capacity to support weight and the height of the intervertebral space.
  • Xa FPL the placement of the graft in the vertebral body, subjecting the graft to compressive forces, improving bone fusion by the law of olf; the vertebral body receives greater vascular supplementation than the posterior elements and this will further enhance the potential fusion; by restoring the height of the disc space improves the sagittal alignment and achieves an indirect foraminal decompression, decreasing the pain caused by the preexisting lesion; more disc is dried, facilitating the formation of bone healing tissue, thus favoring intervertebral fusion ⁇
  • Among its disadvantages is the higher requirement - technique, the higher initial cost and the higher rate of complications, such as dural damage, neurogenic damage and device migration.
  • intersomatic fusion ⁇ FI ⁇ provides the surgeon with multiple options regarding the approach, the graft used and the internal fixation devices.
  • the intersomatic device titanium, carbon fiber, PEEK, or iliac crest structural graft can be used; of these, the iliac crest structural graft has poor support capacity and is associated with high rates of postoperative displacement or collapse.
  • the first of these groups is formed by the rigid boxes, which have pre-established dimensions so, to be implanted, they require means that separate the space between vertebrae to allow their correct placement, being its greater disadvantage the increase of the risk of damages caused by an excessive application of force in order to introduce the device and / or an excessive opening of the intersomatic space;
  • the second group consists of the expandable boxes, whose common characteristic is that they can vary their height dimensions, thus allowing them to be admitted into the intersynceric space without the need to apply large forces nor being required to perform a preliminary separation between the vertebrae .
  • US Patent 8308804 B2 discloses a spinal fusion device comprising a first end plate configured to fit within a disc space and engage a first vertebra and a second end plate configured to fit within the disc space and engage with a second vertebra, the two plates being separated by a single spacer that is located between the first end plate and the second end plate and maintains a predetermined distance between the first and second plate.
  • the disadvantage of the device described is that the elevation is not made uniformly when introducing the spacer, since said element is wedge-shaped and first raises the portion closest to the entry site, making it difficult to place it correctly.
  • great care must be taken when entering the separator since it is an independent piece of the device, if it is not entered in the correct angle, it avoids the firm fixation of the device.
  • OS 6159244 A discloses an expandable intervertebral fusion implant that includes a pair of semi-cylindrical shells having coupling surfaces that resist change when the parts are assembled.
  • the shells have pillars provided with teeth that allow to ratchet between the shells after they have been placed between the vertebral elements.
  • the pillars are curved and extend from their shells at a non-perpendicular angle, so that the resulting implant narrows to accommodate between non-parallel medullary end plates, maintaining the curvature of the spine.
  • This implant has the disadvantage of requiring the previous piercing of a channel on the surface of the vertebrae to avoid lateral movements thereof and also, by having multiple teeth on the pillars, it can be the case that if not carried out correctly the elevation of the device, this one is uneven because the teeth of the four pillars do not align correctly.
  • Patent US 6332895 Bl protects an expandable intervertebral implant that includes two separate shells having corrugated collecting surfaces that resist compression and displacement when the parts are distended with a special installation tool.
  • the shells include two flat wings that provide a large support area against the adjacent vertebral endplates to prevent the implant from sinking into the cancellous bone.
  • the disadvantage of this implant is that it is necessary to carry out a groove through the walls of the two vertebrae adjacent to the implant in order to accommodate the central arched part of both housings.
  • the implant also has the problem that there are no mechanisms to prevent horizontal movement between the two housings, so if this occurs, the device would be misplaced and the load of the vertebrae would not be distributed evenly.
  • US patent 7828849 B2 protects an intervertebrai spacer device consisting of three members forming a closed box, with two perations at one of its ends and a third bore at the tip of the opposite end.
  • the operation of said device is based on the sliding of the central member by a laterally applied force, which causes the angled sections of the first and third member to be separated from each other, necessitating a securing bolt to keep the device in an extended position.
  • the previous configuration of elements allows the device to be removed, since when pressing the bolt the mechanism is released, collapsing the members; however, the presence of a controlling race resort bolt Xa increases complexity of the device and if it loses its rigidity, the device collapses uncontrollably causing serious spinal injuries.
  • the present invention has for its object to provide a compact and easy placement that can be located within small spaces
  • a particular objective of the present invention is to provide a system for intersoratal fusion that has an expanding box with means to prevent horizontal sliding between the components of the same.
  • Another objective of the present invention is to provide an intersoratal box with elements that ensure the elevation thereof and that at the same time prevent the collapse of the height achieved.
  • Another objective of the present invention is to provide a positioning system for the intersomatic box, which is easy to operate and has a small number of elements.
  • Figure 1 is a perspective view of the lower platform of the expander box.
  • Figure 2 is a perspective view of the upper platform of the expanding box.
  • Figure 3 is a perspective view of the lower platform ⁇ e and the expanding box showing the location of the gates or windows in an oblique position.
  • Figure 4 is a perspective view of the lower platform of the expanding box showing the location of the doors or windows in vertical position.
  • Figure 5 is a perspective view of the ventral region of the expanding box showing the use of the threaded hole and the bolts or screws.
  • Figure 6 is a perspective view of the holding pin 2 without the guide rod and the threaded handle.
  • Figure 7 is a perspective view of the holding part with the guide rod and the threaded handle.
  • Figure 8 is a perspective view of the clamp for expansion in the closed position.
  • Figure 9 is a perspective view of the clamp for expansion in the open position.
  • Figure 10 is a perspective view of the expandable box with the guide rod engaged.
  • Figure 11 is a perspective view of the expanding box with the clamping piece engaged on the guide rod without the threaded handle.
  • Figure 12 is a perspective view of the expandable box coupled to the clamping piece secured with the threaded handle.
  • Figure 13 shows the placement of the system for intersomatic fusion in the intervertebral space using the clamping piece.
  • Figure 14 shows the collapsed expandable box attached to the guide rod located in the intervertebral space
  • Figure 15 shows the insertion of the clamp for expansion in the space between the platforms of the box S expandable.
  • Figure 16 shows the expansion of the expandable box through the thrust caused by the blades of the expansion clamp
  • Figure 17 shows the expandable box with the gates raised and fixed in the intervertebral space still coupled to the guide rod.
  • Figure 18 shows the expandable box placed correctly in the intervertebral space
  • Figure 19 is a perspective view of the lower platform of the mode with four gates, with the gates in an oblique position.
  • Figure 20 is a perspective view of the lower platform of the four-gauge mode, with the gates in vertical position.
  • Figure 21 shows a section of the expandable box of the four-gauge mode, with the gates in an oblique position.
  • Figure 22 shows a section d expandable box of the mode with four gates, with the gates in verticai position,
  • Figure 23 is a perspective view of the central piece in the form of "double ⁇ " of the expandable box in its modality that increases both in height and width,
  • Figure 24 is a top view of the lower platform of the expandable box showing the modality increasing both in height and width.
  • Figure 25 is a perspective view of the clamp for lateral expansion in the closed position.
  • Figure 26 is a perspective view of the clamp for side panel in open position.
  • Figure 28 shows the box expanded in width of the modality that increases both in height and width.
  • the objective technological development of the present invention consists of a system for intersomatic fusion comprising an expandable box of reduced height in its folded mode, with means preventing lateral displacements between its contact surfaces. Also, the present invention relates to a series of devices for facilitating the placement and elevation of the expandable box within the intersomatic space.
  • the system for intersomatic fusion of the present invention comprises an expandable intersomatic box ⁇ A ⁇ , a clamping piece (B) and a clamp for expansion (C).
  • the box AS in turn comprises a lower platform 1 which is a piece of shape substantially adapted to adapt to the contours of the vertebrae ⁇ such as rectangular, oval, kidney-shaped, etc.), compact and with a window or orifice central (2), with the lower surface of said platform ⁇ 15 being rough, to come into contact with the cartilaginous terminal plate of the lower vertebra of the intervertebral space, the upper surface of the platform ⁇ 1 ⁇ is smooth and from it four are raised hollow cylinders ⁇ 3) perpendicular, one in each corner, arranged to receive four cylinders of smaller diameter protruding from an upper platform (5) and, slots ⁇ 4 ⁇ adjacent to said cylinders.
  • the upper platform (5) is a piece substantially the same as that of the lower platform (1), compact and with a central window or hole ⁇ 6 ⁇ , with a rough upper surface, to come into contact with the terminal plate cartilaginous of the superior vertebra of the intervertebral space and, a smooth lower surface from which protrude four cylinders (7) perpendicular to it, one at each corner, arranged to disengage within the four hollow cylinders (3) of greater diameter that rise of the lower platform (i), to allow the gearing of both platforms (upper and lower) avoiding the horizontal displacements between them, said cylinders (?), slots (8) adjacent to them and; gates or windows (9) having they are compact rectangular structures, with a central hole also rectangular, arranged horizontally opposite each other and perpendicular to the greater diameter of the lower platform, said components being located at the oblique ends of two lateral projections ⁇ 10 ⁇ of the upper surface of the lower platform (1) in the direction of its major axis, so that the box (A) to be in contracted position, has windows
  • the box ⁇ &) on its ventral face (which is the face that will correspond to the ventral side of the spine, once placed), has aligned in its central part a hole with thread ⁇ 11 ⁇ located on the platform top ⁇ 5) and two bolts or screws ⁇ 12 ⁇ located on the lower platform (1).
  • the clamping piece ⁇ 8 ⁇ comprises a hollow upper rod (13) through which a rod or guide (14) runs, two lower rods ⁇ 15 ⁇ , two parallel frame pieces (16) through which the rod runs ( 13) as the two rods (15) and, a threaded handle (17) which is placed in one of the distal ends of the guide (14), in such a way that the rod (14) when being threaded in the hole (11) ⁇ of the box (A), serves as a guide for the insertion of the hollow rod (13), allowing to align the lower rods (155 with each of the bolts ⁇ 12 ⁇ of the lower platform (15 of the box (A)) .
  • the clamp for expansion ⁇ C ⁇ comprises a hollow rod ⁇ 18 ⁇ supported by a piece with two rings (19) located on the upper surface of an axis (20), which serves as a pivot point of two arms ⁇ 21 ⁇ That they continue at their distal end, towards the hollow rod (18), with two blades (22) that open in response to the approach of the arms (21).
  • Said clamp (C) also has an insurance system (23) in the form of a crosshead that limits the opening of the blades (22).
  • both the lower and upper platform of the box (A) are oval in shape, said box having at least 4 windows, two on each side of the box, which in each case One of its upper ends has lateral grooves to receive a double V- shaped structure "(25) that allows to coordinate the displacement of each two windows in order to expand the box in a controlled and uniform manner. Increase the effective area of the expanded box and resist higher compression forces such as those that occur when the box is placed in the lumbar region.
  • each of the platforms of the expandable ca is manufactured in two lateral segments joined by a central segment in the form of "double T" (26) that has a pair of slides through which the two lateral segments slide ( right and left), said segments travel equivalent distances until they face each other in the middle line or center of each of the center-segments (26).
  • the lateral projection (10) of the ventral face is also divided into two sections, each of which has a bolt or screw (12) associated with it.
  • the expansion clamp (C) is inserted through the same channel used for the insertion of the box on the guide (14), in this way it is allowed to introduce correctly the two blades (22) in the space that is between the lower platform (!) and the upper (5) of the box.
  • the expansion clamp ⁇ C ⁇ is correctly positioned, it is applied to the two arms ⁇ 21 ⁇ bringing them closer to each other, this moves the two blades away ⁇ 22 ⁇ by raising the gates, so that the box expands in height and sits firmly between the surfaces of the adjacent vertebrae.
  • the box In the modality in which the box also increases its width, before carrying out the lifting of the gates it is necessary to introduce a prism or the modified clamp for lateral expansion ⁇ D ⁇ .
  • the two hollow tubular pieces ⁇ 24 ⁇ are applied or coupled on the two bolts ⁇ 12 ⁇ of each of the sections of the lateral projection ⁇ 10 ⁇ ⁇ as shown in figure 27 ⁇ , once placed the clamp in the correct position, force is applied to the arms (215) in order to bring them closer together, thereby causing the separation of the two tubular pieces ⁇ 24 ⁇ and the lateral segments (left and right) of the platforms.
  • the box (A) thereby increasing the total width of the intersomatic box (Figure 285 ⁇

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Cardiology (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Neurology (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un système pour la fusion intersomatique avec des mécanismes pour éviter les déplacements latéraux indésirables entre ses composants, et qui comprend une boîte extensible présentant deux plateformes entre lesquelles se situent des fenêtres qui sont élevées au moyen d'une pince pour l'extension en hauteur, ladite boîte étant placée dans l'espace intervertébral à l'aide d'une pièce de fixation qui comprend un guide fileté et une série de tiges creuses qui permettent le contrôle total de mouvements de la boîte.
PCT/MX2015/000037 2015-03-06 2015-03-06 Système extensible pour fusion intersomatique et procédé d'utilisation WO2016144150A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/MX2015/000037 WO2016144150A1 (fr) 2015-03-06 2015-03-06 Système extensible pour fusion intersomatique et procédé d'utilisation

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/MX2015/000037 WO2016144150A1 (fr) 2015-03-06 2015-03-06 Système extensible pour fusion intersomatique et procédé d'utilisation

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WO2016144150A1 true WO2016144150A1 (fr) 2016-09-15

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Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1998014142A1 (fr) * 1996-10-01 1998-04-09 Surgical Dynamics, Inc. Implant de fusion spinale et son procede d'insertion
WO2009064787A2 (fr) * 2007-11-12 2009-05-22 Synthes (U.S.A.) Implant intervertebral a hauteur reglable
WO2009114381A1 (fr) * 2008-03-07 2009-09-17 Synthes Usa, Llc Dispositif d'espaceur intervertébral expansible
US20100016970A1 (en) * 2008-07-17 2010-01-21 John Kapitan Spinal interbody spacers
US20110130835A1 (en) * 2008-12-10 2011-06-02 Innvotec Surgical, Inc. Adjustable Distraction Cage With Linked Locking Mechanisms
WO2013184946A1 (fr) * 2012-06-06 2013-12-12 Medivest, Llc Implants d'élément d'espacement de tissu extensible et son procédé d'utilisation
US20140249629A1 (en) * 2005-04-12 2014-09-04 Ahmnon D. Moskowitz Zero-profile expandable intervertebral spacer devices for distraction and spinal fusion and a universal tool for their placement and expansion

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1998014142A1 (fr) * 1996-10-01 1998-04-09 Surgical Dynamics, Inc. Implant de fusion spinale et son procede d'insertion
US20140249629A1 (en) * 2005-04-12 2014-09-04 Ahmnon D. Moskowitz Zero-profile expandable intervertebral spacer devices for distraction and spinal fusion and a universal tool for their placement and expansion
WO2009064787A2 (fr) * 2007-11-12 2009-05-22 Synthes (U.S.A.) Implant intervertebral a hauteur reglable
WO2009114381A1 (fr) * 2008-03-07 2009-09-17 Synthes Usa, Llc Dispositif d'espaceur intervertébral expansible
US20100016970A1 (en) * 2008-07-17 2010-01-21 John Kapitan Spinal interbody spacers
US20110130835A1 (en) * 2008-12-10 2011-06-02 Innvotec Surgical, Inc. Adjustable Distraction Cage With Linked Locking Mechanisms
WO2013184946A1 (fr) * 2012-06-06 2013-12-12 Medivest, Llc Implants d'élément d'espacement de tissu extensible et son procédé d'utilisation

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