WO2019016303A1 - Distracteur d'articulation pour la colonne vertébrale - Google Patents

Distracteur d'articulation pour la colonne vertébrale Download PDF

Info

Publication number
WO2019016303A1
WO2019016303A1 PCT/EP2018/069603 EP2018069603W WO2019016303A1 WO 2019016303 A1 WO2019016303 A1 WO 2019016303A1 EP 2018069603 W EP2018069603 W EP 2018069603W WO 2019016303 A1 WO2019016303 A1 WO 2019016303A1
Authority
WO
WIPO (PCT)
Prior art keywords
bone anchor
joint distractor
longitudinal element
forward longitudinal
joint
Prior art date
Application number
PCT/EP2018/069603
Other languages
English (en)
Inventor
Dirk Leonard Marinus OTERDOOM
Josephus Marie André KUIJLEN
Erik DE KROSSE
Roelof Jan NEUTEL
Original Assignee
Rijksuniversiteit Groningen
Academisch Ziekenhuis Groningen
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 Rijksuniversiteit Groningen, Academisch Ziekenhuis Groningen filed Critical Rijksuniversiteit Groningen
Publication of WO2019016303A1 publication Critical patent/WO2019016303A1/fr

Links

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
    • A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
    • A61B17/7076—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation
    • A61B17/7077—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation for moving bone anchors attached to vertebrae, thereby displacing the vertebrae
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • 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
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8866—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices for gripping or pushing bones, e.g. approximators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • A61B2017/0256—Joint distractors for the spine

Definitions

  • the present invention relates to a joint distractor for the spine, in particular a joint distractor suitable for the procedure transforaminal lumbar interbody fusion and fixation, in short TLIFF.
  • TLIFF A technical difficult part of TLIFF is to decompress the neural structures by drilling or chiselling the unilateral facet joint away. When this joint is removed the disc space can be entered and the interbody spacer can be placed. Because of the technical difficulty there is a risk that neural structures are damaged. Also, insufficient height can be obtained between the vertebral bodies. Distraction over the facet joint facilitates the removal of the unilateral facet joint and the placement of the interbody spacer.
  • An example of an orthopaedic device that can be used for compression or distraction of bone parts is known from US 2014/0163575 Al .
  • the orthopaedic device utilizes elongated pins as fasteners for compression or distraction of bone parts.
  • the "Elongated pins" are K-wires, used for fixating bone parts or providing anchors.
  • the orthopaedic device distracts bone parts that are secured to the first and second arm members by K-wires.
  • the K-wires are locked into the elongated pin receiving bores (also collets) of the locking sleeves.
  • a nut threadably engages the collets for locking the K-wire received in the elongated pin receiving bore. After the bone parts are secured, the movable second arm member can be moved in compression direction or distraction direction. The nut and the threaded connection to the locking sleeve are bulk and compromise visualization and working space.
  • WO 2005/079684 Al relates to devices and methods for treating bones and associated soft-tissue support structures suffering from fractures and/or diseases.
  • WO 2005/079684 Al is an example of a device that uses pedicle screws as best shown in FIGs. 6 and 7, wherein a cannulated threaded screw is advanced over the K-wire and the distal, threaded tip of each screw is advanced through the target pedicles and secured into the vertebral bones.
  • US 2016/183995 Al relates to drill and/or guide wire guides for surgical implant drill bits, guide wires and/or cannulated screws and methods of using said guides.
  • This publication is another example of a device that uses pedicle screws, as is shown in FIG. 6A and 6B wherein the screw, or the distal tip of the screw, has been partially screwed into the bone.
  • the present invention seeks to provide a joint distractor for the spine wherein working space is improved and view for a surgeon is less obstructed.
  • the present invention seeks to provide a joint distractor for the spine wherein a problem with a known joint distractor for the spine is at least partly solved.
  • the present invention seeks to provide an alternative joint distractor for the spine.
  • joint distractor for the spine
  • joint distractor comprises a bone anchor for attaching the joint distractor to a vertebrae, in particular a pedicle of the vertebrae
  • the bone anchor comprises a forward longitudinal element having a smooth outer surface and comprises a passage for receiving a Kirschner wire in a sliding manner.
  • the bone anchor comprising a forward longitudinal element having a smooth outer surface and comprising a passage for receiving a Kirschner wire in a sliding manner enables to push the bone anchor in the vertebrae while making use of guidance given by the Kirschner wire.
  • the bone anchor has a compact construction seen in a pushing direction which assures that the working space is improved and view for a surgeon is less obstructed.
  • the bone anchor can be pushed into the vertebrae in any suitable manner, like for example hammering or vibrating.
  • the smooth outer surface of the forward longitudinal element of the bone anchor is secured to the vertebrea by friction only. No threaded connection between the bone anchor and the vertebrae is required nor present. Therefore, no rotation about a longitudinal axis of the bone anchor is required which facilitates coupling of the bone anchor to an arm.
  • the joint distractor according to the invention attaches to the vertebrea by friction between the vertebrea and the smooth outer surface of the forward longitudinal element of the bone anchor.
  • the outer surface of the forward longitudinal element being smooth means that the forward longitudinal element has a continuous even outer surface that secures to the vertebrea by friction only. In other words, the forward longitudinal element has a smooth outer surface configured to secure to the vertebrea by friction only.
  • the forward longitudinal element has a cylindrical shape. This facilitates the introduction of the bone anchor into the vertebrae even more.
  • the cylindrical shaped forward longitudinal element has a diameter between about 1.8 and about 5 mm. This assures the forward longitudinal element can withstand a pushing force or a distracting force without buckle and the damage to the vertebrae is minimized.
  • the length of the forward longitudinal element is configured such that the forward longitudinal element can extend between 10 and 25 mm into a vertebrae. This overlap between the forward longitudinal element and the vertebrae minimizes the chance to damage the vertebrea.
  • the length of the forward longitudinal element is between 15 and 25 mm. This helps in dealing with size differences between patients, and vertebraes.
  • the forward longitudinal element has a pointy tip for facilitating introduction of the forward longitudinal element into a vertebrae.
  • the passage is centrally arranged with respect to the forward longitudinal element. This is an optimal arrangement with respect to mechanical strength of the bone anchor.
  • the bone anchor comprises a lateral exit in communication with the passage to guide the Kirschner wire sidewards with respect to a longitudinal axis of the bone anchor. This even more improves working space and view for a surgeon.
  • the bone anchor comprises a rear end remote from the forward longitudinal element, wherein the rear end comprises a protrusion that extends transversal with respect to a longitudinal axis of the bone anchor.
  • the protrusion extending transversal facilitates exerting both pushing force and distracting force to the bone anchor while limitation of view and working space is kept minimal.
  • the passage extends continuous through the entire bone anchor. This enables the Kirschner wire to exit the bone anchor as far away from the patient as possible. This all the more improves working space and view for a surgeon.
  • the bone anchor comprises a midsection arranging the rear end remote from the forward longitudinal element, wherein optionally the forward longitudinal element is arranged off set with respect to the longitudinal axis of the bone anchor. This enables to improve working space and view for a surgeon even more.
  • the bone anchor has a length between 90 and 130 mm. This makes the joint distractor suitable for minimal invasive spine surgery.
  • the joint distractor comprises a frame member, and at least two arms connected to the frame member for movement of the at least two arms toward or away from each other, wherein each of the at least two arms is connected to a respective bone anchor. Each of the at least two arms is connectable to a vertebrae through a respective bone anchor.
  • the joint distractor comprises a coupling structure to releasably couple the rear end of a bone anchor to a free end of the arm, wherein the coupling structure comprises a pair of stop surfaces that engage the protrusion at opposite sides of the protrusion. This facilitates to exert the distraction force on the bone anchor and enables to couple the bone anchor to the arm by a single movement of the bone anchor.
  • a kit comprising a joint distractor as defined above and a Kirschner wire configured to be received in the passage with a sliding fit.
  • Fig. 1 is a joint distractor according to the invention
  • Fig. 2 is a side view of a first embodiment of a bone anchor
  • Fig. 3 is back view of the bone anchor of fig. 2;
  • Fig. 4 is a side view of a second embodiment of a bone anchor.
  • Fig. 5 is back view of the bone anchor of fig. 4. Description of embodiments
  • Fig. 1 is a joint distractor 1 according to the invention.
  • the joint distractor 1 is suitable for the spine surgery. That is to say, the joint distractor 1 is configured to distract a joint of the spine, in particular by a known procedure of transforaminal lumbar interbody fusion and fixation, in short TLIFF.
  • the joint distractor 1 comprises two arms 12 connected to a frame member 11 for movement of the arm 12 or arms 12 toward or away from each other which is a construction known per se.
  • Each of the two arms 12 is connected to a respective bone anchor 2.
  • one arm 12 is connected to the frame member 11 through a rack 19 and pinion (not shown) mechanism.
  • the rack 19 and pinion mechanism can be manually driven by the grip 20 to distract or compress a spinal joint.
  • the arms 12 are pivotable which is known per se and not described further.
  • the joint distractor 1 comprises two bone anchors 2.
  • a bone anchor 2 has a length between 90 and 130 mm.
  • the bone two bone anchors are 2 are secured each to a respective arm 2.
  • the bone anchors 2 are configured for attaching the joint distractor 1 to a vertebrae which is not shown.
  • the bone anchor 2 is secured in particular to a pedicle of the vertebrae. Therefore, the bone anchor 2 comprises a forward longitudinal element 3.
  • the forward longitudinal element 3 has a smooth outer surface 4.
  • the smooth outer surface 4 enables to slide the forward longitudinal element 3 into the vertebrae by pushing.
  • the forward longitudinal element 3 has a cylindrical shape along the longitudinal axis 9 of the bone anchor 2.
  • the shown cylindrical shaped forward longitudinal element 3 has a diameter of about 4 mm.
  • the length of the forward longitudinal element 3 is configured such that the forward longitudinal element 3 can extend at least 15 mm into a vertebrae. Therefore, the length of the forward longitudinal element 3 is between 15 and 25 mm.
  • the forward longitudinal element 3 has a pointy tip 6.
  • the pointy tip 6 is configured for facilitating introduction of the forward longitudinal element 3 into a vertebrae.
  • the forward longitudinal element 3 of the bone anchor 2 comprises a passage 5 for receiving a Kirschner wire 22 in a sliding manner.
  • the connecting between the passage 5 and the Kirschner wire 22 is a sliding fit or also sliding adjustment.
  • the passage 5 is centrally arranged with respect to the forward longitudinal element 3.
  • the joint distractor comprises a coupling structure 13.
  • the coupling structure 13 is configured to releasably couple the rear end 7 of a bone anchor 2 to a free end 14 of the arm 12.
  • the coupling structure 13 comprises a pair of stop surfaces 16.
  • the pair of stop surfaces 16 engage the bone anchor 2 at opposite sides 15 to exert a distracting force to the bone anchor 2.
  • the pair of stop surfaces 16 is brought into engagement with the bone anchor 2 with a simple movement of the bone anchor 2.
  • the pair of stop surfaces 16 is brought into engagement with the bone anchor 2 with a simple rotation of the bone anchor 2.
  • the rotation movement is defined by a knuckle joint 17, 21 between the arm 12 and the bone anchor 2.
  • the knuckle joint 17, 21 is configured as a pin 17 hole 21 connection.
  • Fig. 2 and 3 show a first embodiment of a bone anchor 2.
  • the bone anchor 2 has a total length between 90 and 130 mm.
  • the bone anchor 2 comprises a rear end 7 remote from the forward longitudinal element 3.
  • the rear end 7 of the bone anchor 2 comprises a protrusion 8.
  • the protrusion 8 extends transversal with respect to a longitudinal axis 9 of the bone anchor 2.
  • the pair of stop surfaces 16 engage the protrusion 8 of the bone anchor 2 at opposite sides 15.
  • a hole 21 is formed in the protrusion 8 that forms the knuckle joint 17, 21.
  • the bone anchor 2 comprises a striking face 18.
  • the striking face 18 is configured for hammering action or hammering impact.
  • the striking face 18 is formed with the protrusion 8.
  • the bone anchor 2 comprises a midsection 10.
  • the midsection 10 arranges or spaces the rear end 7 remote from the forward longitudinal element 3.
  • the forward longitudinal element 3 is arranged off set with respect to the longitudinal axis 9 of the bone anchor 2.
  • the forward longitudinal element 3 of the bone anchor 2 comprises a passage 5 for receiving a Kirschner wire 22 in a sliding manner.
  • the passage 5 is centrally arranged with respect to the forward longitudinal element 3.
  • the passage 5 only extends in the forward longitudinal element 3.
  • a kit is provided comprising a joint distractor as defined above and a Kirschner wire 22 configured to be received in the passage 5 with a sliding fit.
  • the forward longitudinal element 3 has a pointy tip 6.
  • the cone angle a is about 18°.
  • Fig. 4 and 5 show a second embodiment of a bone anchor. Only differences with the first embodiment are described.
  • the passage 5 is centrally arranged with respect to the bone anchor 2.
  • the passage 5 extends along the longitudinal axis 9 of the bone anchor 2.
  • the passage 5 extends continuous through the entire bone anchor 2.
  • the passage 5 extends continuous through the rear end 7, the midsection 10 and the forward longitudinal element 3.
  • Fig. 3 and fig. 5 show a kit comprising a bone anchor 7 of a joint distractor 1 and a Kirschner wire 22 22.
  • the Kirschner wire 22 is configured to be received in the passage 5 with a sliding fit.

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

Abstract

La présente invention concerne un distracteur d'articulation (1) pour la colonne vertébrale, lequel distracteur d'articulation comprend un ancrage osseux (2) pour fixer le distracteur d'articulation à une vertèbre, en particulier un pédicule des vertèbres, l'ancrage osseux comprenant un élément longitudinal avant (3) ayant une surface externe lisse (4) et comprenant un passage (5) pour recevoir un fil de Kirschner d'une manière coulissante. L'ancrage osseux comprenant un élément longitudinal avant ayant une surface externe lisse et comprenant un passage pour recevoir un fil de Kirschner (22) d'une manière coulissante permet de pousser l'ancrage osseux dans les vertèbres tout en utilisant un guidage donné par le fil de Kirschner.
PCT/EP2018/069603 2017-07-20 2018-07-19 Distracteur d'articulation pour la colonne vertébrale WO2019016303A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
EP17182254 2017-07-20
EP17182254.7 2017-07-20

Publications (1)

Publication Number Publication Date
WO2019016303A1 true WO2019016303A1 (fr) 2019-01-24

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PCT/EP2018/069603 WO2019016303A1 (fr) 2017-07-20 2018-07-19 Distracteur d'articulation pour la colonne vertébrale

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WO (1) WO2019016303A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2021042156A1 (fr) * 2019-09-04 2021-03-11 Simplify Medical Pty Limited Distracteur vertébral et systèmes et procédés chirurgicaux

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2005079684A1 (fr) 2004-02-14 2005-09-01 Crosstrees Medical Inc. Procédés et dispositifs de traitement des fractures et des maladies osseuses
US20070093846A1 (en) * 2005-10-12 2007-04-26 Robert Frigg Apparatus and methods for vertebral augmentation
EP1807008A2 (fr) * 2004-09-30 2007-07-18 DePuy Spine, Inc. Instrument et procede destines a l'insertion et a l'alignement d'un implant intervertebral
US20140163575A1 (en) 2012-12-12 2014-06-12 Wright Medical Technology, Inc. Orthopedic compression/distraction device
US20140228899A1 (en) * 2012-12-12 2014-08-14 Wright Medical Technology, Inc. Orthopedic compression/distraction device
US20160183995A1 (en) 2013-08-02 2016-06-30 Flower Orthopedics Corporation Drill and/or Guide Wire Guides For Surgical Drill Bits, Guide Wires and/or Screws and Methods of Using Said Guides

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2005079684A1 (fr) 2004-02-14 2005-09-01 Crosstrees Medical Inc. Procédés et dispositifs de traitement des fractures et des maladies osseuses
EP1807008A2 (fr) * 2004-09-30 2007-07-18 DePuy Spine, Inc. Instrument et procede destines a l'insertion et a l'alignement d'un implant intervertebral
US20070093846A1 (en) * 2005-10-12 2007-04-26 Robert Frigg Apparatus and methods for vertebral augmentation
US20140163575A1 (en) 2012-12-12 2014-06-12 Wright Medical Technology, Inc. Orthopedic compression/distraction device
US20140228899A1 (en) * 2012-12-12 2014-08-14 Wright Medical Technology, Inc. Orthopedic compression/distraction device
US20160183995A1 (en) 2013-08-02 2016-06-30 Flower Orthopedics Corporation Drill and/or Guide Wire Guides For Surgical Drill Bits, Guide Wires and/or Screws and Methods of Using Said Guides

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2021042156A1 (fr) * 2019-09-04 2021-03-11 Simplify Medical Pty Limited Distracteur vertébral et systèmes et procédés chirurgicaux

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