FR2726759A1 - Osteosynthesis implant for fusing adjacent vertebrae - Google Patents
Osteosynthesis implant for fusing adjacent vertebrae Download PDFInfo
- Publication number
- FR2726759A1 FR2726759A1 FR9413685A FR9413685A FR2726759A1 FR 2726759 A1 FR2726759 A1 FR 2726759A1 FR 9413685 A FR9413685 A FR 9413685A FR 9413685 A FR9413685 A FR 9413685A FR 2726759 A1 FR2726759 A1 FR 2726759A1
- Authority
- FR
- France
- Prior art keywords
- blades
- cage
- interbody fusion
- lumbar interbody
- graft
- Prior art date
- Legal status (The legal status 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 status listed.)
- Granted
Links
Classifications
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- 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
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- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4684—Trial or dummy prostheses
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- 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
- A61B17/1604—Chisels; Rongeurs; Punches; Stamps
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- 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
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- A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
- A61F2/447—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages substantially parallelepipedal, e.g. having a rectangular or trapezoidal cross-section
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- 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
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0017—Angular shapes
- A61F2230/0026—Angular shapes trapezoidal
-
- 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
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0028—Shapes in the form of latin or greek characters
- A61F2230/0047—Pi-shaped
-
- 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
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0063—Three-dimensional shapes
- A61F2230/0082—Three-dimensional shapes parallelepipedal
-
- 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
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00011—Metals or alloys
- A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni alloys
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- Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- Transplantation (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Veterinary Medicine (AREA)
- Heart & Thoracic Surgery (AREA)
- Public Health (AREA)
- General Health & Medical Sciences (AREA)
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- Neurology (AREA)
- Molecular Biology (AREA)
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- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Physical Education & Sports Medicine (AREA)
- Dentistry (AREA)
- Prostheses (AREA)
Abstract
Description
L'invention concerne les cages intersomatiques lombaires utilisées pour obtenir la fusion de vertèbres.The invention relates to lumbar intersomatic cages used to obtain fusion of vertebrae.
Dans les cas de discopathies, où il est important de rétablir une hauteur discale, d'étroitesse du canal lombaire, où l'on effectue une fragilisation de l'arc postérieur nécessitant une stabilisation antérieure, et d'instabilités vertébrales, nécessitant la fusion de l'ensemble vertébral instable, il était connu, jusqu'alors, de recourir à une arthrodèse intervertébrale, obtenue par la mise en place d'une greffe osseuse postéro-latérale cette greffe étant posée sur les apophyses articulaires, sur les apophyses transverses et sur les lames intervertébrales.Dans les cas d'absence des lames vertébrales par suite de laminectomie, les greffes étaient mises uniquement en place dans les gouttières postéro-latérales ; ce qui imposait une immobilisation du rachis par des moyens matériels permettant, à la greffe, de fusionner sur un ensemble immobilisé. II était possible, également, d'effectuer une arthrodèse intersomatique par voie antérieure, qui obligeait de recourir à un abord chirurgical abdominal ou lombaire pour réaliser une greffe par la voie antérieure.In cases of disc disease, where it is important to restore a disc height, narrowing of the lumbar canal, where a weakening of the posterior arch is required, requiring anterior stabilization, and vertebral instabilities, requiring the fusion of the unstable vertebral whole, it was known, until then, to resort to an intervertebral arthrodesis, obtained by the installation of a posterolateral bone graft this graft being posed on the articular processes, on the transverse processes and on the intervertebral laminae. In the case of absence of the vertebral laminae following laminectomy, the grafts were placed only in the posterolateral grooves; which required immobilization of the spine by material means allowing, at the graft, to merge on an immobilized unit. It was also possible to perform an intersomatic arthrodesis by the anterior route, which required an abdominal or lumbar surgical approach to perform a graft by the anterior route.
L'inconvénient de la greffe postéro-latérale est qu'elle nécessite l'adjonction de matériel métallique de fusion et que, malgré tout, elle ne permet pas de rétablir une hauteur discale suffisante.The disadvantage of the posterolateral graft is that it requires the addition of metallic fusion material and that, despite everything, it does not allow a sufficient disc height to be restored.
L'abord antérieur direct permet, par contre, de rétablir une bonne hauteur discale et un écartement intervertébral satisfaisant. Si l'on veut fusionner un disque dont on veut rétablir la hauteur et si l'on veut décomprimer les structures nerveuses, il est habituel de recourir à une double voie d'abord antérieur, pour redonner la hauteur discale et pour fusionner, et postérieur pour libérer les structures nerveuses.The direct anterior approach, on the other hand, makes it possible to restore good disc height and satisfactory intervertebral spacing. If we want to merge a disc whose height we want to restore and if we want to decompress the nervous structures, it is usual to use a double anterior approach, to restore the disc height and to merge, and posterior to release nerve structures.
L'une des techniques utilisées actuellement, principalement pour obtenir la fusion des corps vertébraux après discectomie lombaire, en pathologie dégénérative, met en oeuvre des cages intersomatiques cylindriques creuses, à fenêtres latérales, moletées extérieurement, fermées par un couvercle vissé, destinées à recevoir un remplissage osseux. Cette cage se monte dans des logements réalisés dans les plateaux vertébraux, après mise en place d'un dispositif de distraction temporaire ; la cage doit être positionnée de façon que deux fenêtres opposées se trouvent en contact avec les plateaux, afin de rendre possible la fusion osseuse de ceux-ci.Une telle technique oblige à remplir la cage de particules osseuses prélevées sur un os spongieux, puis à refermer celle-ci, à réaliser, par forage, les logements dans les plateaux vertébraux, après avoir rétabli, entre ceux-ci, un écartement optimum en utilisant un moyen de distraction temporaire assez traumatisant, à vérifier la profondeur des logements à l'aide d'un fantôme d'essai à mettre les cages en place en utilisant le guide déjà utilisé pour le perçage, en s'assurant que deux fenêtres opposées de chaque cage soient bien disposées contre les plateaux. Quant au matériau utilisé jusqu'alors pour réaliser les cages, il s'agissait, le plus généralement, du polyéthylène, du carbone, de l'acier inoxydable ou du chrome cobalt.Le carbone présente l'inconvénient de générer une migration de particules ; le polyéthylène d'offrir une certaine susceptibilité au glissement ; I'acier inoxydable et le chrome cobalt de produire des artefacts lors des radiographies de contrôle.One of the techniques currently used, mainly to obtain the fusion of the vertebral bodies after lumbar discectomy, in degenerative pathology, uses hollow cylindrical intersomatic cages, with lateral windows, knurled on the outside, closed by a screwed cover, intended to receive a bone filling. This cage is mounted in housings made in the vertebral endplates, after installation of a temporary distraction device; the cage must be positioned so that two opposite windows are in contact with the trays, in order to make possible the bone fusion of these.This technique requires filling the cage with bone particles taken from a cancellous bone, then close this one, to realize, by drilling, the housings in the vertebral plates, after having reestablished, between them, an optimum spacing using a fairly traumatic temporary distraction means, to check the depth of the housings using of a test phantom to put the cages in place using the guide already used for drilling, making sure that two opposite windows of each cage are well placed against the trays. As for the material hitherto used to make the cages, it was, most generally, polyethylene, carbon, stainless steel or cobalt chromium. Carbon has the disadvantage of generating a migration of particles; polyethylene to offer a certain susceptibility to slipping; Stainless steel and cobalt chromium to produce artifacts during control x-rays.
Comme on le voit, la mise en oeuvre d'une telle technique est délicate et traumatisante, sans que, compte-tenu de la forme cylindrique des cages et de la largeur des fenêtres latérales de celles-ci, une bonne stabilité de la fusion ainsi obtenue puisse être garantie dans le temps.As can be seen, the implementation of such a technique is delicate and traumatic, without, taking into account the cylindrical shape of the cages and the width of the side windows thereof, good stability of the fusion as well obtained can be guaranteed over time.
La présente invention a pour but de remédier à ces inconvénients. Cette invention, telle qu'elle se caractérise, résout le problème consistant à créer une cage intersomatique pour fusion de vertèbres, avec laquelle, d'une part, le tissu osseux de greffe puisse être directement prélevé, et, d'autre part, un rehaussement du disque intervertébral et une bonne stabilité puissent être obtenus, après réalisation d'une arthrodèse vertébrale par voie postérieure et introduction de la dite cage intersomatique dans le disque intervertébral, sans risque de lésion nerveuse, tant au niveau de la Dure Mère qu'au niveau des racines, avec possibilité d'utilisation dans les arthrodèses sous
Astragalienne ou Tibio-Astragalienne.The object of the present invention is to remedy these drawbacks. This invention, as it is characterized, solves the problem of creating an interbody cage for fusion of vertebrae, with which, on the one hand, the bone graft tissue can be directly removed, and, on the other hand, a enhancement of the intervertebral disc and good stability can be obtained, after performing a vertebral arthrodesis by the posterior route and introduction of the said interbody cage into the intervertebral disc, without risk of nerve damage, both at the level of the hard mother and level of the roots, with the possibility of use in arthrodesis under
Astragalienne or Tibio-Astragalienne.
La cage intersomatique lombaire pour fusion de vertèbres par introduction de greffons osseux dans un espace intervertébral selon l'invention se caractérise en ce qu'elle est constituée, principalement, de deux lames parallèles, reliées par un talon à orifice fileté de fixation à un organe de préhension, et en ce qu'elle permet le prélèvement direct du greffon. Ces lames sont rectangulaires, trapézoïdales, ou en forme de parallélogramme.The lumbar interbody fusion cage for fusion of vertebrae by introducing bone grafts into an intervertebral space according to the invention is characterized in that it consists mainly of two parallel blades, connected by a heel with a threaded orifice for attachment to an organ gripping, and in that it allows direct graft removal. These blades are rectangular, trapezoidal, or in the shape of a parallelogram.
Selon un mode de réalisation de la cage intersomatique, I'une au moins des deux lames comporte une lumière médiane.According to one embodiment of the intersomatic cage, at least one of the two blades has a central lumen.
Les deux lames comportent latéralement, en parties supérieure et inférieure, des dentures de type harpon ou en sapin, permettant d'éviter le déplacement de l'implant dans le canal vertébral.The two blades have laterally, in the upper and lower parts, harpoon or fir-type teeth, making it possible to avoid displacement of the implant in the vertebral canal.
L'extrémité libre de l'une au moins des lames comporte un tranchant.The free end of at least one of the blades has a cutting edge.
Selon un mode de réalisation particulier, la longueur des lames est inégale.According to a particular embodiment, the length of the blades is uneven.
Préférentiellement, la distance séparant les lames est déterminée pour que la surface de greffon osseux, en contact avec la surface de chaque plateau vertébral inférieur et supérieur préalablement taillée, représente environ 50 % de la surface totale de la cage en contact avec la dite surface taillée.Preferably, the distance separating the blades is determined so that the surface of the bone graft, in contact with the surface of each lower and upper vertebral plateau previously cut, represents approximately 50% of the total surface of the cage in contact with said cut surface. .
L'ostéotome permettant de tailler, dans les plateaux verté braux, une surface d'appui pour la cage intersomatique vertébrale et le greffon, est constitué de deux lames parallèles, à biseau tranchant, reliées par un talon à orifice fileté de fixation à un organe de préhension.The osteotome used to cut a bearing surface for the vertebral intervertebral cage and the graft in braided vertebral trays, is made up of two parallel blades, with a sharp bevel, connected by a heel with a threaded orifice for attachment to an organ. gripping.
La largeur et la hauteur des lames parallèles à biseau tranchant de l'ostéotome correspondent respectivement à l'épaisseur et à la hauteur à fond de denture de la cage intersomatique.The width and height of the parallel blades with a sharp bevel of the osteotome correspond respectively to the thickness and to the height at the bottom of the toothing of the interbody cage.
Selon un mode de réalisation particulier, les greffons sont prélevés sur la crête iliaque à l'aide d'un instrument constitué de deux lames parallèles, de longueur inégale, à biseau tranchant, reliées par un talon à orifice fileté de fixation à un organe de préhension.According to a particular embodiment, the grafts are removed from the iliac crest using an instrument consisting of two parallel blades, of unequal length, with a sharp bevel, connected by a heel with a threaded orifice for fixing to a gripping.
Les avantages obtenus, grâce à cette invention, consistent essentiellement en ceci qu'elle permet d'éviter de recourir à des arthrodèses postéro-latérales, ainsi qu'à un abord antérieur pour obtenir la soudure des vertèbres en avant ; elle permet de fusionner l'espace intervertébral par un abord postérieur, unique et identique à celui utilisé pour trouver les lésions discales, les compressions radiculaires , enfin, elle permet le prélèvement direct et aisé d'un greffon dans la crête iliaque postérieure, de façon à l'introduire immédiatement dans le logement réalisé dans l'espace intervertébral et de rendre ainsi l'intervention plus rapide et avec moins de manipulations.The advantages obtained, thanks to this invention, consist essentially in that it makes it possible to avoid resorting to posterolateral arthrodeses, as well as to an anterior approach to obtain the welding of the vertebrae in front; it makes it possible to merge the intervertebral space by a posterior approach, unique and identical to that used to find disc lesions, radicular compressions, finally, it allows direct and easy removal of a graft in the posterior iliac crest, so to introduce it immediately into the housing made in the intervertebral space and thus make the intervention faster and with less manipulation.
D'autres caractéristiques et avantages apparaîtront dans la description qui va suivre d'un mode de réalisation de la cage intersomatique et de ses instruments d'accompagnement, donné à titre d'exemple non limitatif au regard des dessins annexés sur lesquels - la figure 1 représente une vue de face de l'ostéotome à plateaux vertébraux, - la figure 2 représente une vue de côté de l'ostéotome selon la figure 1, - la figure 3 représente une vue de dessus de l'ostéotome selon les figures 1 et 2, - la figure 4 représente une vue de face de l'instrument de prélèvement et de calibrage de greffon sur crête iliaque, - la figure 5 représente une vue de côté de l'instrument de prélèvement de greffon selon la figure 4, - la figure 6 représente une vue de dessus de l'instrument de prélèvement de greffon selon les figures 4 et 5, - la figure 7 représente une vue de face de la cage intersomatique, - la figure 8 représente une vue de côté de la cage intersomatique selon la figure 7, - la figure 9 représente une vue de dessus de la cage intersomatique selon les figures 7 et 8, - la figure 10 représente une vue en perspective du fantôme d'essai destiné à contrôler l'espace réalisé dans les vertèbres avec le ciseau à impacter ou ostéotome, - la figure 11 représente deux cages intersomatiques implantées dans un espace intervertébral, en vue de face postérieure, - la figure 12 représente les deux cages intersomatiques selon la figure 11, en vue latérale.Other characteristics and advantages will appear in the following description of an embodiment of the interbody cage and its accompanying instruments, given by way of non-limiting example with regard to the appended drawings in which - Figure 1 shows a front view of the osteotome with vertebral endplates, - Figure 2 shows a side view of the osteotome according to Figure 1, - Figure 3 shows a top view of the osteotome according to Figures 1 and 2 , - Figure 4 shows a front view of the graft harvesting and grading instrument on the iliac crest, - Figure 5 shows a side view of the graft harvesting instrument according to Figure 4, - Figure 6 represents a top view of the graft harvesting instrument according to FIGS. 4 and 5, - FIG. 7 represents a front view of the intersomatic cage, - FIG. 8 represents a side view of the intersomatic cage selo n FIG. 7, - FIG. 9 represents a top view of the interbody cage according to FIGS. 7 and 8, - FIG. 10 represents a perspective view of the test phantom intended to control the space produced in the vertebrae with the impact chisel or osteotome, - Figure 11 shows two interbody cages implanted in an intervertebral space, in posterior view, - Figure 12 shows the two interbody cages according to Figure 11, in side view.
Les figures représentent, dans l'ordre, un ostéotome 10 à lames parallèles 11, 12 , à biseau tranchant 13, 14, reliées par un talon 15 à orifice fileté 16 ; un instrument de prise de greffe 20, constitué de deux lames 21, 22 de longueur inégale, à biseau tranchant respectif 23, 24, reliées par un talon 25 à orifice fileté 26, dont la plus petite lame comporte des rainures longitudinales parallèles traversantes 27, 28 ; une cage intersomatique 30 à lames parallèles 31, 32, comportant, respectivement, des lumières médianes 33, 34 et des dentures latérales de type harpon ou en sapin 35, 36, reliées par un talon 37 à orifice fileté 38 ; un fantôme d'essai 40, à extrémité arrondie 41 et à orifice fileté 42.The figures represent, in order, an osteotome 10 with parallel blades 11, 12, with a sharp bevel 13, 14, connected by a heel 15 with a threaded orifice 16; a graft-taking instrument 20, consisting of two blades 21, 22 of unequal length, with respective cutting bevel 23, 24, connected by a heel 25 with a threaded orifice 26, the smallest blade of which has parallel transverse longitudinal grooves 27, 28; an intersomatic cage 30 with parallel blades 31, 32, comprising, respectively, median slots 33, 34 and lateral teeth of harpoon or fir type 35, 36, connected by a heel 37 with threaded orifice 38; a test phantom 40, with rounded end 41 and with threaded orifice 42.
En examinant plus en détail les figures 1 à 3, à la lumière des figures 11 et 12, on remarque que l'implantation de cages inter somatiques 30 dans un espace intervertébral exige que, après distraction temporaire des deux vertèbres 60, 70, deux ostéotomies 61, 71 et 62, 72 soient préalablement réalisées dans chacun des plateaux vertébraux concernés, en utilisant l'ostéotome 10 à lames tranchantes 11, 12, dont la hauteur (D) et la largeur (L) correspondent respectivement à l'épaisseur (E) et à la hauteur (H) à fond de denture 35, 36 de celles d'une cage intersomatique 30 les deux lames tranchantes 11, 12 sont utilisées comme des ciseaux, mis en oeuvre simultanément à l'aide d'un préhenseur non représenté, puisque bien connu de l'homme de l'art, destiné à venir se visser dans l'orifice fileté 16 du talon 15 reliant la base des deux lames tranchantes 11, 12.By examining Figures 1 to 3 in more detail, in the light of Figures 11 and 12, it is noted that the implantation of inter somatic cages 30 in an intervertebral space requires that, after temporary distraction of the two vertebrae 60, 70, two osteotomies 61, 71 and 62, 72 are previously carried out in each of the vertebral plates concerned, using osteotome 10 with sharp blades 11, 12, the height (D) and width (L) of which correspond respectively to the thickness (E ) and at the height (H) at the bottom of the teeth 35, 36 of those of an interbody cage 30 the two cutting blades 11, 12 are used like scissors, implemented simultaneously using a gripper not shown , since well known to those skilled in the art, intended to be screwed into the threaded orifice 16 of the heel 15 connecting the base of the two sharp blades 11, 12.
En se rapportant maintenant aux figures 4 à 6, on remarque que le prélèvement de matière osseuse sur crête iliaque, destinée à être utilisée comme greffon dans les deux cages intersomatiques 30, s'effectue en une seule fois, à l'aide d'instrument de prise de greffe 20, dont les deux lames inégales 21, 22, à biseau tranchant respectif 23, 24 situé dans un même plan (P), forment un angle d'environ 30 avec les lames. La distance séparant les deux lames 21, 22, la longueur de la petite lame 22 et la largeur de l'instrument correspondent respectivement à la distance séparant les deux lames 31, 32, à la profondeur et au double de la largeur de la cage intersomatique 30. Cet instrument de prise de greffe 20 est, lui aussi, mis en oeuvre en utilisant des moyens bien connus de l'homme de l'art.Referring now to FIGS. 4 to 6, it can be seen that the removal of bone material on the iliac crest, intended to be used as a graft in the two intersomatic cages 30, is carried out at once, using an instrument. graft taking 20, of which the two uneven blades 21, 22, with respective cutting bevel 23, 24 situated in the same plane (P), form an angle of about 30 with the blades. The distance separating the two blades 21, 22, the length of the small blade 22 and the width of the instrument correspond respectively to the distance separating the two blades 31, 32, to the depth and to twice the width of the interbody cage 30. This graft-taking instrument 20 is also used using means well known to those skilled in the art.
En examinant maintenant les figures 7 à 10, à la lumière des fi gures 11 et 12, on remarque que, après avoir vérifié, à l'aide du fantôme d'essai 40, la bonne exécution des ostéotomies préalablement réalisées dans les vertèbres à l'aide de l'ostéotome 10, les dites cages intersomatiques 30 sont garnies de greffons 8, 9 préalablement prélevés directement sur crête iliaque, ou à l'aide de l'instrument de prise de greffe 20, puis introduites à force, à l'aide d'un préhenseur approprié, bien connu lui aussi, dans les logements obtenus par ostéotomie dans les plateaux vertébraux.Now examining FIGS. 7 to 10, in the light of FIGS. 11 and 12, it is noted that, after having verified, using the test phantom 40, the correct performance of the osteotomies previously performed in the vertebrae at l with the help of the osteotome 10, the said intersomatic cages 30 are furnished with grafts 8, 9 previously taken directly from the iliac crest, or using the graft-taking instrument 20, then force-fed, using an appropriate gripper, also well known, in the housings obtained by osteotomy in the vertebral endplates.
Les deux cages intersomatiques 30 ayant été ainsi introduites à bonne profondeur, il suffit de relâcher l'effort de distraction temporaire préalablement appliqué, pour obtenir incrustation des dentures 35, 36 dans les plateaux vertébraux et une mise en contact étroite du dit greffon avec les surfaces osseuses vertébrales correspondantes.The two intersomatic cages 30 having been thus introduced at a good depth, it suffices to release the temporary distraction force previously applied, to obtain inlaying of the teeth 35, 36 in the vertebral plates and bringing the said graft into close contact with the surfaces. corresponding vertebral bones.
Ces cages intersomatiques 30, fabriquées en titane, sont très résistantes à l'extraction, compte-tenu de la présence, sur les côtés des lames 31, 32, de dentures de type harpon 35, 36.These intersomatic cages 30, made of titanium, are very resistant to extraction, taking into account the presence, on the sides of the blades 31, 32, of harpoon-type teeth 35, 36.
Cette pièce s'utilise donc comme un coin dans l'espace intervertébral ; sa forme rectangulaire permet d'obtenir un rehaussement du disque intervertébral et une bonne stabilité.This piece is therefore used as a corner in the intervertebral space; its rectangular shape makes it possible to obtain an enhancement of the intervertebral disc and good stability.
A souligner que, selon un mode de réalisation simplifié, la cage intersomatique 30 est utilisée directement pour prélever le greffon sur la crête iliaque, ceci grâce à des tranchants 390, 391 réalisés à l'extrémité libre des lames parallèles 31, 32, par ana logie avec ceux 23, 24 dont sont munies les lames 21, 22 de l'instrument de prise de greffe 20.Note that, according to a simplified embodiment, the intersomatic cage 30 is used directly to remove the graft from the iliac crest, this thanks to cutting edges 390, 391 produced at the free end of the parallel blades 31, 32, by ana housed with those 23, 24 with which the blades 21, 22 of the graft-taking instrument 20 are provided.
II est à préciser que cette cage 30, réalisée, de préférence, en titane TA6V4ELI, peut recevoir un traitement de surface sur tout ou partie de celle-ci, par microbillage, sablage, revêtement, projection de titane microporeux, nitruration, anodisation, ou tout autre traitement biocompatible. It should be noted that this cage 30, preferably made of TA6V4ELI titanium, can receive a surface treatment on all or part of it, by micro-blasting, sandblasting, coating, projection of microporous titanium, nitriding, anodizing, or any other biocompatible treatment.
Préférentiellement, la surface du greffon, en contact avec la surface taillée du plateau vertébral, représente environ 50% de la dite surface d'appui totale de la cage.Preferably, the surface of the graft, in contact with the cut surface of the vertebral plate, represents approximately 50% of said total bearing surface of the cage.
Il a été donné, comme exemple de réalisation de la cage intersomatique 30, une cage à lames 31, 32 rectangulaires et traversées par des lumières médianes 33, 34, mais rien ne s'oppose à ce que, dans certains cas, les lames aient une forme différente, telle que trapézoïdale, trapézoïdale rectangle, ou de parallélogramme, par exemple, et à ce que les lumières médianes 33, 34 soient supprimées, totalement ou d'un côté seulement.As an example of embodiment of the intersomatic cage 30, a cage with rectangular blades 31, 32 and crossed by medial lumens 33, 34 has been given, but there is nothing to prevent the blades from having in certain cases a different shape, such as trapezoidal, trapezoidal rectangle, or parallelogram, for example, and that the medial lumens 33, 34 are removed, totally or only on one side.
Quant aux extrémités des lames 31, 32 de la cage, elles peuvent être, ou non, décalées longitudinalement l'une par rapport à l'autre, être munies, toutes deux, d'un tranchant 390, 391 incliné vers l'extérieur ou/et vers l'intérieur, ou, pour l'une des deux, comporter une extrémité libre arrondie. As for the ends of the blades 31, 32 of the cage, they may or may not be offset longitudinally with respect to each other, may both be provided with a cutting edge 390, 391 inclined towards the outside or / and inwards, or, for one of the two, have a rounded free end.
Claims (12)
Priority Applications (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
FR9413685A FR2726759B1 (en) | 1994-11-16 | 1994-11-16 | CAGE FOR LUMBAR VERTEBRA MELTING BY INTERPOSING BONE GRAFT |
EP95940320A EP0793463A1 (en) | 1994-11-16 | 1995-11-15 | Implant for the fusion of two adjacent bony bodies, particularly two consecutive vertebrae |
PCT/FR1995/001507 WO1996014809A1 (en) | 1994-11-16 | 1995-11-15 | Implant for the fusion of two adjacent bony bodies, particularly two consecutive vertebrae |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
FR9413685A FR2726759B1 (en) | 1994-11-16 | 1994-11-16 | CAGE FOR LUMBAR VERTEBRA MELTING BY INTERPOSING BONE GRAFT |
PCT/FR1995/001507 WO1996014809A1 (en) | 1994-11-16 | 1995-11-15 | Implant for the fusion of two adjacent bony bodies, particularly two consecutive vertebrae |
Publications (2)
Publication Number | Publication Date |
---|---|
FR2726759A1 true FR2726759A1 (en) | 1996-05-15 |
FR2726759B1 FR2726759B1 (en) | 1997-05-30 |
Family
ID=38657968
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
FR9413685A Expired - Fee Related FR2726759B1 (en) | 1994-11-16 | 1994-11-16 | CAGE FOR LUMBAR VERTEBRA MELTING BY INTERPOSING BONE GRAFT |
Country Status (1)
Country | Link |
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FR (1) | FR2726759B1 (en) |
Cited By (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
FR2764795A1 (en) * | 1997-06-19 | 1998-12-24 | Sarl Sra | Inervertebral spinal fixation cage |
FR2799639A1 (en) * | 1999-10-18 | 2001-04-20 | Dimso Sa | Inter-vertebral disc prosthesis has opposing main faces with parallel profiled teeth with non-rectilinear profile |
FR2816201A1 (en) * | 2000-11-07 | 2002-05-10 | Medicrea | Intervertebral spacing cage and fitting instrument has convex curved edges with lengthwise grooves between notched surfaces |
DE4302397C2 (en) * | 1992-01-28 | 2003-08-21 | Pentax Corp | Artificial vertebral spacer |
EP1634549A2 (en) * | 2004-09-14 | 2006-03-15 | McKinley, Laurence M. | System and method for spinal fusion |
Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3848601A (en) * | 1972-06-14 | 1974-11-19 | G Ma | Method for interbody fusion of the spine |
EP0307241A2 (en) * | 1987-09-11 | 1989-03-15 | John W. Brantigan | Surgical prosthetic implant |
WO1994017759A1 (en) * | 1993-02-10 | 1994-08-18 | Spine-Tech, Inc. | Spinal stabilization surgical tool set |
FR2710519A1 (en) * | 1993-09-29 | 1995-04-07 | Robine Dominique | Intervertebral lumbar cage (CH) |
-
1994
- 1994-11-16 FR FR9413685A patent/FR2726759B1/en not_active Expired - Fee Related
Patent Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3848601A (en) * | 1972-06-14 | 1974-11-19 | G Ma | Method for interbody fusion of the spine |
EP0307241A2 (en) * | 1987-09-11 | 1989-03-15 | John W. Brantigan | Surgical prosthetic implant |
WO1994017759A1 (en) * | 1993-02-10 | 1994-08-18 | Spine-Tech, Inc. | Spinal stabilization surgical tool set |
FR2710519A1 (en) * | 1993-09-29 | 1995-04-07 | Robine Dominique | Intervertebral lumbar cage (CH) |
Cited By (9)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
DE4302397C2 (en) * | 1992-01-28 | 2003-08-21 | Pentax Corp | Artificial vertebral spacer |
FR2764795A1 (en) * | 1997-06-19 | 1998-12-24 | Sarl Sra | Inervertebral spinal fixation cage |
FR2799639A1 (en) * | 1999-10-18 | 2001-04-20 | Dimso Sa | Inter-vertebral disc prosthesis has opposing main faces with parallel profiled teeth with non-rectilinear profile |
WO2001028463A1 (en) * | 1999-10-18 | 2001-04-26 | Stryker Spine | Intervertebral disk prosthesis with toothed surfaces |
US7637950B2 (en) | 1999-10-18 | 2009-12-29 | Stryker Spine | Intervertebral implant with toothed faces |
FR2816201A1 (en) * | 2000-11-07 | 2002-05-10 | Medicrea | Intervertebral spacing cage and fitting instrument has convex curved edges with lengthwise grooves between notched surfaces |
WO2002038086A1 (en) * | 2000-11-07 | 2002-05-16 | Medicrea | Intervertebral cage and instrument for setting same between two vertebrae |
EP1634549A2 (en) * | 2004-09-14 | 2006-03-15 | McKinley, Laurence M. | System and method for spinal fusion |
EP1634549A3 (en) * | 2004-09-14 | 2006-05-17 | McKinley, Laurence M. | System and method for spinal fusion |
Also Published As
Publication number | Publication date |
---|---|
FR2726759B1 (en) | 1997-05-30 |
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