US 2003/0163199 A1Application
VARIABLE HEIGHT VERTEBRAL IMPLANT
Publication Date:2003-08-28
•19 Claims
•12 Drawing Sheets
Abstract
The invention relates to a height-variable vertebral body implant having a first, essentially U-shaped or C-shaped cage, as well as vertebral support surfaces formed on said cage, with the first cage being an inner cage, which is embraced and guided in a telescopic manner by a second, outer U-shaped or C-shaped cage. Furthermore, the legs of the inner and the outer cage are aligned in such a manner that a continuous lateral opening is obtained, and the inner and the outer cage is mutually fixed in a predetermined final position.
According to the invention, the inner cage comprises in the zone of that part connecting the legs a longitudinally extending elongated hole having a unilateral toothing. In cooperation with an instrument including a complementary toothing, a relative movement and adjustment may be effected between the cages. In addition, a thread bore is formed in the outer cage in a position below the zone of the elongated hole so as to fix a desired adjustment position.
Metadata
Inventors
- Heinrich Boehm
- Thomas Busch
- Erich Orschler
Application Information
Application Number:US 10/240,268
Filing Date:2003-02-21
Priority Date:2000-03-31
Patent Drawings (12 sheets)
Description
Description
[0001] The invention relates to a height-variable vertebral body implant according to the preamble of claim 1, as well as to an actuating instrument set for same.
[0002] From DE 43 28 062 A1 a supporting bar with laterally slide-on implant bodies is known. In order to enable a sliding-on, the implant bodies are provided with a lateral groove, with a surface structure in the form of a toothing serving to fix the surfaces of the implant bodies to one another and, in addition, to maintain the position with respect to the vertebral body or bodies, respectively.
[0003] Due to the fact that the implant bodies shown therein are pre-manufactured with various heights and can be slid onto the bar, a certain height adaptation can be effected, However, the handling of the implant is extremely difficult, and the manufacturing costs are high.
[0004] From EP 0 302 719 a U-shaped implant is known wherein openings are provided which serve to introduce bone cement. Further openings may be provided for accommodating a screw in order to secure the implant immediately in the vertebra. Carbon-fiber reinforced synthetic material is specified for the shown implant.
[0005] The implant placeholder according to EP 0 268 115 A1 comprises a cylinder jacket element with a plurality of rhomboidal reticulate recesses. A ring provided therein at the upper and lower end of the cylinder jacket element prevents an undesired excessively deep penetration of the implant into the vertebra. An additionally provided base plate serves the same purpose. The cylinder jacket element is closed and has no further openings apart from the rhomboidal openings for the introduction of bone cement, so that in this case, too, there are difficulties in the surgical handling with disadvantages in the injection of bone cement.
[0006] DE 196 15 938 A1 discloses a vertebral column supporting device for carrying out an intersomatic arthrodesis. The supporting device consists of titanium, has a plane and elongated shape with an expansion in its central area. The edges with the exception of the central area are provided with a saw tooth profile. The shape of the presented supporting device is similar to that of an open ring, with the supporting device being adaptable with respect to its diameter to various applications by means of bending up the end portions of the supporting device.
[0007] A height-variable vertebral body substitution with a sleeve and with a first counter-bearing body which is displaceable in an axial direction or a second counter-bearing, respectively, is known from DE 44 09 392 A1. For moving the counter-bearing bodies relative to each other, a threaded means is provided. A similar principle is shown in DE 44 23 257 A1.
[0008] An adjustability via a thread is also mentioned in DE 195 19 101 A1, wherein tooth-shaped recesses are provided at the ends of the sleeve portions of the vertebral body substitution, in order to realize a radial locking relative to the vertebrae. The cylindrical portions of the vertebral body substitution have a plurality of recesses in order to improve the growing through with body material. The implantation of the vertebral body substitution according to DE 195 19 101 A1, however, is extremely critical because a corresponding spreading apart of the vertebrae must be effected for this purpose. In addition, the metal mass of the known implant is too great, with the corresponding, disadvantageous post-operative consequences.
[0009] DE 195 09 317 A1 shows an implant intended for being implanted as a placeholder between vertebral bodies of the vertebral column, with two end-located plate-shaped implant parts being provided interacting with an intermediate central implant part, which is rotatably connected with the end-located plate-shaped implant part. The shown implant parts are configured as tubular sleeves or as frontal rings. Bone cement may be introduced through provided openings. These openings, however, are only then optimally suited for being charged with bone cement, when they are brought to coincide, which, however, is problematical with the chosen adjusting principle.
[0010] With respect to the adjustability, reference is also made to the document U.S. Pat. No. 5,236,460, which shows a telescopic arrangement of an implant, wherein a curing material can be introduced into the telescopic space by means of a special tool. The document EP 0 637 439 A1, on the other hand, shows an implant including a wedge gear for the height adjustment. In addition, locking teeth can in this case be pivoted out so as to claw the implant between the vertebrae after its placement.
[0011] The document U.S. Pat. No. 5,290,312 concerns a height-variable vertebral body implant having two U-shaped cages with the inner cage being embraced and guided by the outer cage. The therein shown cages, however, are fixed point-wise and only unilaterally in the vertebra via screws. Moreover, for the spreading-apart operation, a forceps or similar instrument must be used, since the implant itself does not feature any such adjustment means, so that minimally invasive surgeries are not possible.
[0012] Taking the indicated prior art into consideration, the object of the invention consists in proposing a further developed height-variable vertebral body implant, as well as an actuating instrument set for same, which features an excellent stability with a minimum amount of material, and which is not only applied as a usual placeholder but which may also be used for spreading apart vertebrae and for permanently correcting abnormal postures, so that the surgical handling is very simple. Moreover, the vertebral body implant is intended to have optimized openings for the introduction of bone cement, whereby the fusion, as well, has to be guaranteed. The implant is also intended to be suited for minimally invasive surgeries.
[0013] The task of the invention is solved by a subject matter according to the definition as per claim 1, with the dependent claims comprising at least appropriate configurations and advanced developments.
[0014] The invention is comprised of the claim-wise defined feature combination, in that the front sides of the cages guided within each other have integral vertebral support surfaces, as well as tooth-like locking projections extending in the longitudinal direction. Hereby, said projections, while locking the implant, penetrate into the vertebral surface, too deep a penetration with the consequence of a bone destruction, however, being prevented by the tongue-like or continuous vertebral support surfaces. Inwardly directed curved portions of the inner and outer cage result in an essential stability increase and prevent the otherwise open U-shaped or C-shaped cages from yielding to buckling.
[0015] The specific adjustment means according to the invention is inventive. For this purpose, the inner cage has, preferably in the zone of the part connecting the legs, an elongated hole extending in the longitudinal direction and including a toothing. In cooperation with a specific instrument comprising a complementary toothing, a relative movement and an adjustment of the cages relative to each other may be achieved in this case. In surgical use, the implant is placed with the cage telescoped back, the introduction of the instrument allowing the desired spreading apart but also the retraction. When the end position has been reached, this position is fixed by means of at least one locking screw.
[0016] For this purpose, a second elongated hole is realized in the inner cage adjacent to the first elongated hole.
[0017] According to a further concept, the cages have vertebral support surface webs each mounted on the top of the inner cage or the base of the outer cage. These webs are configured in such a manner that they can also be separated by the surgeon or parts of it can be detached by him.
[0018] On the manufacturing side, the milling/erosion technology is preferably applied, so that the stability of the implant increases.
[0019] It is to be noted that the term U-shaped has also to be understood as a polygon shape, a semi-circular or circular cylindrical shape or the like, i.e. that which matters for the inventive cages is the possibility of the telescopic guidance inside one another and the mutual support of the side walls, whereby it is ensured that a continuous lateral opening is obtained.
[0020] With the inventive subject matter such as described above, one hence starts from a first, inner cage that is embraced and guided by a second, outer U-shaped cage. The legs of the inner and the outer cage are aligned in such a manner that a continuous lateral opening is obtained. This continuous lateral opening faces the surgeon during the operation and enables both the introduction of the tool for the described height-adjustment or the locking operation, respectively, as well as the optimal placement of bone cement.
[0021] In order to increase the stability of the vertebral implant, the legs of the inner and the outer cage each comprise on their leg ends an inwardly directed curved portion. Hereby, in spite of the mentioned continuous lateral opening, the desired predetermined positional coordination is maintained upon the action of pressure forces and/or rotational forces without necessitating further stabilizing means.
[0022] In addition, there is the possibility that at least in the area of the curved portions of the mutually opposite surfaces of the cages, a preferably punched locking toothing is present so as to preclude any displacement or undesired rotation of the cages relative to each other.
[0023] In the area of that part of the U-shaped or C-shaped cages, which connects the legs, bores for accommodating at least one locking screw are arranged, with the corresponding bore of the outer cage comprising a thread.
[0024] The height-variability of the vertebral body implant, as explained, is realized in a preferred embodiment in that the inner cage, preferably in the area of that part connecting the legs, comprises a first elongated hole extending in the longitudinal direction and comprising a toothing, so as to achieve in cooperation with the instrument a relative movement and a corresponding adjustment between the cages. A further, second elongated hole is preferably provided adjacent to the first elongated hole, and serves for locking or intermediately fixing the adjustment position by means of a locking screw.
[0025] In order to facilitate the penetration of the locking projections until the abutment of the vertebral support surfaces relative to the neighboring vertebrae without causing serious bone damages, the locking projections, which are, for example, of a triangular shape, are ground to a cutting edge.
[0026] The locking projections and vertebral support surfaces or webs, which are each provided on one of the front faces of the first and the second cage, are purposefully arranged in an alternating manner so as to ensure the desired planar position of the implant.
[0027] The material for the cages is preferably selected in a manner that a certain residual elasticity remains maintained which comes close to the properties of the vertebral bones, so that a favorable bone growth is given.
[0028] In one embodiment of the invention, the cages may be realized stackable via a connecting part. In this case, the possibility exists of providing, starting from an in turn specific middle part, cages which can be telescoped on both sides.
[0029] The base surfaces and/or cover surfaces of the cages may feature an angular position or form deviating from the parallel line and adapted to the anatomic conditions.
[0030] In shaping, there exists the possibility of configuring the cages in a curved shape, which are then adjustable along a ring segment guiding path.
[0031] Normally, a locking of the implant by its spreading apart relative to the respective neighboring vertebrae bodies is sufficient, however, the possibility is provided in shaping of additionally anchoring the implant, e.g. by screws, so that all forces arising with the natural movement sequences of the human body, may be safely diverted.
[0032] The inventive actuating instrument set for the presented height-variable vertebral body implant comprises a longitudinally extended guidance rod having a thread end. The instrument having an outer toothing is configured hollow-cylindrical for receiving the guidance rod, and features, on the end opposite the toothing, a handle comprising a knurled screw acting upon the guidance rod.
[0033] In addition, a gripping forceps is provided having clamping jaws engaging in corresponding recesses that are provided on the implant cages.
[0034] Navigation aids may be mounted on the gripping forceps for positional or image identification. Likewise, means for an easier positioning of a screw driver including a screw holder and/or the guidance rod may be arranged.
[0035] By means of the implant and the actuating instrument set, an endoscopically assisted placement of the implant is possible in a minimally invasive surgical procedure.
[0036] The patient is in a prone position with a surgical access ensuing via the respective spread-apart ribs.
[0037] The implant is prepared as follows. First, at least one locking screw is introduced in the at least one thread bore provided in the outer cage. In this case, that bore is chosen that is located in the zone of a further, second elongated hole formed in the inner cage. This locking screw, however, remains loose for the time being, so that the desired displaceability of the cages is maintained, Then, the guidance rod is inserted in the thread bore of the outer cage, and namely into that situated in a position below the zone of the first elongated hole. Subsequently, the instrument having the outer toothing is slid over the guidance rod, and, thereupon, the rotatory movement is converted into a translatory movement by a rotation of the handle and an engagement of the toothing.
[0038] With the cage telescoped back and employing the gripping or holding forceps, the implant may then be placed. A corresponding representation on the gripping forceps indicates the extension direction of the gripping forceps, and hence the cranial implantation side, as well. The implant hence may be integrated in the above-described meaning into the corporectomide effect, and may there be correspondingly aligned relative to the body axis. Through the spreading-apart by means of the instrument including the outer toothing, the implant is then fixed and the securing operation of the respective height position is then effected via the knurled screw present on the instrument, so as to subsequently tighten the at least one locking screw by means of a screw driver.
[0039] In a preferred embodiment, the screws used or to be inserted are realized in different colors, preferably red, yellow and green, so as to predetermine an actuating sequence through this resulting traffic light function and to preclude confusions.
[0040] It is in the interest of the invention to arrange not only one but several locking screws. Also, it is reasonable to provide an identification marking on the guidance rod enabling the surgeon to identify the exact position of the instrument including the toothing, so as to preclude an undesired shearing-off or a damage of elongated hole/toothing section. For this purpose, the handle of the instrument may be configured continuous in prolongation of the hollow-cylindrical shape, and a notch or the like may be formed on the guidance rod, which exits from the handle end with the nominal position and thus becomes visible or palpable.
[0041] It has turned out that surprisingly, the tooth-like locking projection, but likewise the vertebral support surfaces sufficiently secure the implant against the forces acting during the tightening of the locking screws.
[0042] In the following, the invention will be explained in more detail with reference to an exemplary embodiment, as well as by means of the Figures.
[0043] These show:
[0044] FIGS. 1 ; 2 a first embodiment of an outer cage and an inner cage in various views, and tongue-like vertebral support surfaces;
[0045] FIGS. 3 ; 4 a second embodiment of an outer cage and an inner cage in various views, comprising webs of the same dimensions as vertebral support surfaces;
[0046] FIGS. 5 ; 6 a third embodiment, however, comprising a C-shaped outer cage and a C-shaped inner cage in various views, comprising webs as vertebral support surfaces;
[0047] FIG. 7 a view of an instrument comprising an outer toothing;
[0048] FIG. 8 a representation of the guidance rod;
[0049] FIG. 9 representations for handling the gripping forceps;
[0050] FIG. 10 representations for handling the actuating instrument set; and
[0051] FIG. 11 representations for a height-adjustment by means of the instrument comprising the outer toothing.
[0052] As can be seen from the Figures, the first inner cage 1 basically comprises recesses or break-throughs 2 provided in its legs. At the front face of the first inner cage 1, vertebral support surfaces 3 or webs 31, as well as tooth-like locking projections 4, are provided alternately extending in the longitudinal direction relative to these support surfaces 3 or webs 31.
[0053] The locking projections can comprise a cutting edge 16 at their tips for facilitating the penetration into the respective opposite surface of the vertebra. On an inwardly directed curved portion 5, a recess (not shown) may be provided, which can be latched or clawed by means of bending with a tongue (not shown) of the outer cage 8.
[0054] As can be seen from the Figures, the area and the shape of the implant have been optimized in such a manner that, for one, a small material amount is given and, for another, however, the mechanical stability meets the requirements, in particular the post-operative requirements. For example, the visible abutment edge 9, as well as the defined radii, too, which are obtained by a preferred treatment by way of milling or eroding, have a stability increasing effect. In the zone of the part 11 connecting the legs 10, a longitudinally extending elongated hole 12 including a toothing 13 is realized. A second elongated hole 14 is arranged essentially running in parallel and adjacent to the first elongated hole 12, and serves the purpose of locking the selected setting or adjustment position by means of a locking screw located in a thread bore of the second cage 8.
[0055] In the zone of the curved portions, at or on the opposite surfaces of the first inner cage 1 and of the outer second cage 8, a toothing may be provided which effectively prevents an undesired displacement or rotation of the cages relative to each other.
[0056] In FIGS. 1 and 2 , the vertebral support surfaces 3 are realized tongue-like and essentially opposite, with the interspaces exhibiting the mentioned locking projections 4.
[0057] In the second exemplary embodiment as per FIGS. 3 and 4 , webs 31 of a relatively small width are present instead of the tongues, whereby, for example, three webs in toto are assumed and one of the webs connects the two legs 10 on the opening side.
[0058] In the exemplary embodiment as per FIGS. 5 and 6 , a C-shaped outer and inner cage, respectively, are assumed.
[0059] The webs, for one, increase the stability of the cages against an undesired spreading apart and, for another, provide for the fact that the surface pressure towards the vertebral body is reduced or minimized.
[0060] The instrument shown in FIG. 7 has an outer toothing 32 configured complementary to the toothing 13 in the first elongated hole 12. Moreover, the instrument is realized in the nature of a hollow cylinder 33 and exhibits a handle 34 on its end opposite the outer toothing 32.
[0061] A bore 35 including a thread is in turn provided on the handle, which bore serves for receiving a knurled screw 36.
[0062] A guidance rod 37 provided according to FIG. 8 has a thread end 38, as well as a knurled handling portion 39. The hollow cylinder 33 of the instrument having the outer toothing 32 and the outer diameter of the guidance rod 37 are mutually matched in such a manner that the instrument can be moved in the first elongate hole 12 quasi centered relative to the toothing 13.
[0063] FIG. 9 shows in various views the lower zone of a gripping forceps 40 having clamping jaws 41. The arrow indicates the extension direction of the cage and hence the cranial implantation side, as well.
[0064] The upper image part as per FIG. 10 allows the recognition of the second elongated hole 14 with a therein inserted locking screw 42, and the lower portion of a screw driver 43. The locking screw 42 is loosely screwed in. According to the middle image as per FIG. 10 , the guidance rod 37 is turned into the thread bore 44 that is situated in the outer cage below the zone of the elongated hole 12. Subsequently, as can be seen from the lower image part, the instrument having the outer toothing is slid over the guidance rod and is transported into a position where the outer toothing engages with the toothing 13 of the first elongated hole 12.
[0065] As can be seen from the representation as per FIG. 11 , the inner cage can now be displaced relative to the outer cage in a translatory manner by turning the instrument having the outer toothing.
[0066] In summary, it is achieved with the proposed vertebral body implant to securely support the vertebral column without the amount of the foreign body material required for the supporting action exceeding a critical threshold. The manipulation of the implant itself is uncomplicated and essentially facilitated by the height-variability relative to the prior art. Due to the realization of the implant cages guided within each other from a metallic material machined by milling and/or eroding, the manufacture costs may be kept within limits.
[0067] List of Reference Numerals
[0068] 1 inner cage
[0069] 2 recesses, break-throughs
[0070] 3 vertebral support surface
[0071] 4 locking projections
[0072] 5 curved portion
[0073] 8 outer cage
[0074] 9 abutment edge
[0075] 10 leg
[0076] 11 connecting part of the legs
[0077] 12 first elongated hole
[0078] 13 toothing
[0079] 14 second elongated hole
[0080] 16 cutting edge
[0081] 31 webs
[0082] 32 outer toothing
[0083] 33 hollow cylinder
[0084] 34 handle
[0085] 35 bore in the handle
[0086] 36 knurled screw
[0087] 37 guidance rod
[0088] 38 thread end
[0089] 39 knurled handling portion
[0090] 40 gripping forceps
[0091] 41 clamping jaws
[0092] 42 locking screw
[0093] 43 screw driver
[0094] 44 thread bore
Claims
1. A height-variable vertebral body implant having a first, essentially U-shaped or C-shaped cage, as well as vertebral support surfaces formed on said cage, with the first cage being an inner cage (1), which is embraced and guided in a telescopic manner by a second, outer U-shaped or C-shaped cage (8), with the legs (10) of the inner and the outer cage (1; 8) being furthermore aligned in such a manner that a continuous lateral opening is obtained, and the inner and the outer cage (1; 8) can be mutually fixed in a predetermined final position, moreover in each case one of the frontal sides of the cages (1; 8) possessing vertebral support surfaces (3) and/or webs (31), as well as tooth-like locking projections (4) extending in the longitudinal direction, and the legs (10) of the inner and the outer cage (1; 8) each comprising on their leg ends an inwardly directed stability-increasing curved portion (5), with the inner cage (1) in the zone (11) of that part connecting the legs (10) comprising an elongated hole (12) extending in the longitudinal direction and including a unilateral toothing (13),
characterized in that
in cooperation with an instrument comprising a complementary toothing, a relative movement and an adjustment between the cages (1; 8) is effected.
2. The height-variable vertebral body implant according to claim 1,
characterized in that
at least in the zone of the curved portions (5), the opposite surfaces of the inner and the outer cage (1; 8) comprise a lock-in toothing and a thread bore is formed in the outer cage in a position below the zone of the elongated hole.
3. The height-variable vertebral body implant according to any one of the preceding claims,
characterized in that
the tooth-like locking projections (4) are ground to a cutting edge (16) for facilitating the penetration into the vertebral surfaces.
4. The height-variable vertebral body implant according to any one of the preceding claims,
characterized in that
the vertebral support surface (3) and/or webs (31) and locking projections (4) each provided on the frontal side of the first and second cage (1; 8) are arranged alternatingly.
5. The height-variable vertebral body implant according to any one of the preceding claims,
characterized in that
the cages are comprised of a metallic milled/eroded part, preferably of titanium material.
6. The height-variable vertebral body implant according to any one of the preceding claims,
characterized in that
the first and the second cage (1; 8) comprises a polygonal, preferably rectangular, circular or semicircular cross-section.
7. The height-variable vertebral body implant according to any one of the preceding claims,
characterized in that
at least the outer, first cage comprises recesses or break-throughs (2).
8. The height-variable vertebral body implant according to any one of the preceding claims,
characterized in that
several webs (31) are provided running in parallel, forming support surfaces, and having also different widths.
9. The height-variable vertebral body implant according to any one of the preceding claims,
characterized in that
the webs are realized at least in part detachable and comprise predetermined breaking points for this purpose.
10. The height-variable vertebral body implant according to any one of the preceding claims,
characterized by
a residual elasticity of the cage material for an improved bone growth.
11. The height-variable vertebral body implant according to any one of the preceding claims,
characterized in that
the cages are realized stackable via a connecting part.
12. The height-variable vertebral body implant according to any one of the preceding claims,
characterized in that
the base and/or cover surfaces of the cages comprise an angular position deviating from the parallel line and adapted to the anatomical conditions.
13. The height-variable vertebral body implant according to any one of the preceding claims,
characterized in that
the cages have a curved shape and are adjustable along a ring segment guidance path.
14. The height-variable vertebral body implant according to any one of the preceding claims,
characterized by
an additional anchoring on or in the respective vertebral body surfaces.
15. A actuating instrument set for a height-variable vertebral body implant according to any one of claims 2 through 14,
characterized in that
a guidance rod having a thread end is provided, the instrument having an outer toothing moreover is configured hollow-cylindrical for receiving the guidance rod and comprises on the end opposite the toothing a handle having a knurled screw acting upon the guidance rod.
16. The actuating instrument set according to claim 15,
characterized by
a gripping forceps for gripping and orienting or aligning the implant.
17. The actuating instrument set according to claim 16,
characterized in that
navigation aids and/or means for an easier positioning of a screw driver including a screw holder and/or the guidance rod are arranged.
18. The actuating instrument set according to any one of claims 15 through 17,
characterized in that
for the height-adjustment, the guidance rod is first inserted in the thread bore of the outer cage, subsequently, the instrument including the outer toothing is slid over the guidance rod, and hereupon the rotatory movement is converted into a translatory movement by turning the handle and by an engagement of the toothing.
19. The actuating instrument set according to claim 18,
characterized in that
by means of the knurled screw, a given height-position of the implant is preliminarily fixed on the instrument so as to finally secure the height position thereafter with at least one locking screw, for this purpose, a further thread bore being provided in the outer cage, and a second elongated hole in the inner cage being provided adjacent to the first elongated hole.