Articular disc prosthesis for transforaminal insertion

The present disclosure generally relates to the field of orthopedics and spinal surgery, and in some embodiments, the present disclosure is used with, and with, a facet prosthesis for use in the total or partial replacement of a natural disc. Regarding methods and tools to do so.

This application claims the benefit of US Patent Provisional Application No. 60 / 446,963 filed on February 12, 2003. U.S. Patent Application No. 60 / 446,963 is incorporated herein by reference for all legitimate purposes.

Treatment of diseases, injuries or dysfunctions that affect the motor segments of the spine, and especially those that affect disc tissue, removes some or all of degenerated discs, torn discs, or other defective discs. That has been known for a long time. If it contains disc tissue that has been removed or otherwise not in the spinal motor segment, accurate measurements are made to ensure the exact spacing of the vertebrae previously separated by the disc tissue removed.

<p> In some examples, two adjacent vertebrae are fixed to each other using transplanted bone tissue, artificial fixation components or other compounds or devices. However, spinal fusion has increased interest in the medical community by the fact that the biomechanical stiffness of intervertebral fusion causes the adjacent spinal motor segments to deteriorate quickly. More specifically, unlike natural intervertebral discs, spinal fixation prevents the fixed vertebrae from pivoting and rotating with respect to each other. Such lack of motility increases stress on adjacent spinal motor segments.</p><p> Also, several conditions can occur within adjacent spinal motor segments, including disc degeneration, herniated discs, instability, spinal stenosis, spondylolisthesis and spondylolisthitis. Therefore, many patients may require additional types of surgery as a result of additional disc removal and / or spinal fusion. Therefore, an alternative to spinal fusion is desired.</p>

<p> In particular, the present disclosure relates to the correction of displaced vertebral bodies, or at least partial correction, commonly referred to as spondylolisthesis. It comprises a first insertion member for lateral insertion into the first vertebra and a second insertion member for lateral insertion into the second vertebra, wherein the second vertebra is said to be the first. The first and second insertion members that are adjacent to one vertebra and have a spinal slip relationship and are configured to rotate to rotate the first and second vertebrae with respect to each other. Devices are provided to assist in the correction of spondylolisthesis by a lateral approach, with connecting members for connecting.</p><p> In another embodiment, a device is provided to assist in the correction of spondylolisthesis by a lateral approach. This device includes a first bone screw for lateral insertion into the first vertebra, a second bone screw for lateral insertion into the second vertebra, and the first and second bones. A rod that connects the bone screws of the bone, and is configured to rotate the rod and thereby receive a surgical instrument to rotate the first and second vertebrae with respect to each other. ..</p><p> In yet another embodiment, the step of removing the intervertebral disc to demarcate the intervertebral space between the first and second vertebrae, which are in a spondylolisth relationship with each other, and the first insertion member to the first vertebrae. The step of laterally inserting, the step of laterally inserting the second insertion member into the second vertebra, and the first and second insertion members engaging the connecting member with the first and second insertion members. Correcting spondylolisthesis by a lateral approach, including the step of passing the connecting member between the vertebrae and the step of applying a rotational force to the connecting member to rotate the first and second vertebrae with respect to each other. A method for is provided.</p>

For purposes of gaining a better understanding of the principles of the present invention, reference is made to embodiments or examples in which a particular language is used to illustrate and describe the drawings. Nevertheless, it will be understood that it is not intended thereby limiting the scope of the invention. Any modification and further modification of the embodiments described, and further use of the principles of the invention described herein, are intended to be routinely made to those skilled in the art to which the invention relates. Similarly, the individual features of the separately described embodiments can be combined to form additional embodiments. Examples of malformations such as spondylolisthesis will also be discussed. However, it is understood that the various prostheses described herein can be configured for use not only between the vertebrae of spondylosis, but also between the nearly aligned vertebrae.

<u style="single">I lateral correction</u> Often deformities such as spondylolisthesis, one or more vertebral bodies may be displaced relative to other vertebrae or sacrum. In such deformations, it is desirable to reduce the amount of displacement by rearranging the vertebral body displaced from its previous position. Reducing spondylolisthesis can be a technique-intensive technique that requires great care to prevent nerve damage and damage to the surrounding soft tissue.

Referring to FIG. 1, a side view of a portion of the spinal column 10 showing a group of adjacent superior and inferior vertebrae V1, V2, V3, V4 separated by natural discs D1, D2, D3 is shown. There is. The four vertebrae diagrams are intended as an example only. Another example would be the sacrum and one vertebra. As shown in the drawing, vertebra V2 is offset from vertebra V1 in the direction indicated by arrow 22. Similarly, vertebra V3 is offset in the direction indicated by arrow 23 and vertebra V4 is offset in the direction indicated by arrow 24. It is hoped that the positions of the vertebrae V2, V3 and V4 will be corrected by moving them in the opposite directions of arrows 22, 23 and 24, respectively.

Referencing Figure 2 here for further illustration, the inferior vertebra V_LAnd upper vertebra V_UTwo of the displaced vertebrae shown by are discussed. In one embodiment, two vertebrae V_L, V_USome and all of the natural discs placed between the discs are usually removed via discectomy or similar surgical procedures, the details of which are known to those of skill in the art. Removal of diseased or degenerated discs, superior and inferior vertebrae V_U, V_LIt results in a deformation of the intervertebral space S between.

In this embodiment, the prosthesis is inserted into the intervertebral space S, similar to the prosthesis disclosed in U.S. Patent Application No. 10 / 042,589 filed January 9, 2002, which is incorporated herein by reference. It is desirable to do. However, some changes are needed in the artificial joints referenced above. For the following explanation, the artificial joints discussed and described may be the same as those disclosed in the patent application referenced above, with the exceptions discussed and suggested below.

Spondylolisthesis was not previously corrected by a lateral surgical approach. However, in some cases, correction of spondylolisthesis is preferably by a lateral approach due to the presence of blood vessels and / or nerve sac. It should be understood that in some embodiments, the lateral approach is particularly suitable for correcting spondylolisthesis in the lumbar region of the spine, but other regions of the spine are also contemplated.

With reference to Figures 3a and 3b, the correction of spondylolisthesis is, for example, vertebra V_U, V_LA lateral approach can be addressed by providing a pair of bone screws 30, 32 for insertion into each. In one embodiment, the bone screws 30 and 32 are bicortical. However, it should be understood that bone screws may be unicortical as an alternative. In addition, the bone screws 30 and 32 may be made of various materials such as absorbent material, titanium, and PEEK. The PEEK embodiment is advantageous because of the radiation permeability resulting from the use of PEEK material. It should be further understood that the bone screws 30, 32 may otherwise be in the form of other mechanical structures, for example in the form of pins or rivets. In addition, bone screws 30 and 32 are vertebrae V._U, V_LIt is not limited to having a threaded portion for engaging with.

Bone screws 30, 32 may be connected to each other via rods 34 configured to rotate around both bone screws. It should be understood that various connecting members may be used in addition to the rod 34. For example, non-uniform connecting members may be used to connect the bone screws 30, 32. The non-uniform connecting member may provide multiple slots and / or grooves that can be engaged to assist in its rotation around the bone screw. Rod 34 is a vertebra V with bone screws 30 and 32_U, V_LIt may be connected prior to insertion into it, or otherwise it may be connected following the placement of the screw. Upper vertebra V by applying a rotational force to the rod 34 in the direction of arrow 36_UBut the lower vertebra V_LIs returned to the desired position. The rotational force can be applied by, for example, a rotatable wrench (not shown) that can be used by the surgeon. Upper vertebra V_UBut the lower vertebra V_LIt should be understood that the displacement can be at least minimized, although it may not reach the perfect correction position.

Although not shown, in another embodiment, the vertebrae V of spondylosis_U, V_LHowever, it is intended that it can be treated from both sides. That is, a pair of bone screws, which are almost the same as the bone screws 30 and 32, face the vertebrae V from the opposite side of the bone screws 30 and 32 in the direction facing the bone screws 30 and 32._U, V_LIt may be inserted inside. In such a configuration, the rod 34 can be replaced by a ratchet system that engages with each of the pair of bone screws, as well as the vertebra V._U, V_LHowever, they may be rotated relative to each other to position the vertebrae in the desired position relative to each other.

In addition, the rod 34 may be equipped with any number and type of engaging means to receive any number and type of rotary tool used by the surgeon. For example, a keyed connection can provide greater stability when engaging the rod 34 with the corresponding rotating tool. In another example, a fastening tool may be used and a corresponding fastening notch may be formed within the rod 34 to receive the fastening tool. Such a configuration can assist in achieving the force required for rotation.

In addition, additional rods 34 and bone screws 30, 32 are spondylotic vertebrae V._U, V_LAre intended to be used to rotate back to the desired position with respect to each other. Additional rods 34 and bone screws 30, 32 may provide additional stability during processing.

Also, although shown as an almost lateral insertion, the vertebrae V with bone screws 30 and 32_U, V_LThe inward insertion may be slightly tilted with respect to the lateral direction. Such angles of bone screws 30, 32 during insertion, from which the surgeon can vertebral V_U, V_LIt is possible to provide a preferable gripping angle at which the rotation of the two can be started with respect to each other.

With reference to FIGS. 4a, 5 and 6, one embodiment of a facet joint prosthesis 40 for insertion into the facet space S (FIG. 2) to assist in the correction of spondylolisthesis It is shown. The articulated artificial joint 40 extends substantially along the longitudinal axis L and comprises a first joint component 42 and a second joint component 44. Joint components 42, 44 are adjacent vertebral bodies V_U, V_LCollaborate to form an artificial joint 40 sized and shaped to be placed within the intervertebral space S (Fig. 2).

Artificial joints 40 provide relative pivotal and rotational movements between adjacent vertebral bodies to maintain or restore movements similar to those of normal living organisms supplied by natural intervertebral discs. .. More specifically, the joint components 42, 44 include several axes, including lateral or lateral pivotal movements around the longitudinal axis L, and anterior-posterior pivotal movements around the lateral axis T. Are allowed to move around each other. In one embodiment of the disclosure, the joint components 42, 44 are allowed to pivot relative to each other around any axis in the plane intersecting the longitudinal axis L and the transverse axis T. Please understand that.

Also, the joint components 42, 44 are allowed to pivot relative to each other around the axis of rotation R. The prosthesis 40 is illustrated and described as supplying a particular combination of joint movements, but other combinations of joint movements, such as relative parallel or linear movements, are also possible, such movements. It should be understood that it is intended to be within the scope of this disclosure.

The joint components 42, 44 of the artificial joint 40 are made of a wide variety of materials, but in one embodiment of the present disclosure, the joint components 42, 44 are cobalt-chromium-molybdenum metal alloys (ASTM F-). It is made of 799 or F-75). However, in an alternative embodiment of the present disclosure, the joint components 42, 44 are made of a polymeric material such as titanium or stainless steel, polyethylene, or other material such as other biocompatible materials apparent to those skilled in the art. It may be formed.

The joint components 42, 44 have support surfaces 46, 48, respectively, which may be placed in direct contact with the vertebrae, preferably a bone growth-promoting substance such as hydroxyapatite formed of calcium phosphate. It is covered with. Also, the supporting surfaces 46, 48 of the joint components 42, 44 may be roughened before being coated with a bone growth promoter to further strengthen the growing bone, respectively. Such surface roughening may be achieved using, for example, acid etching, knurling, bead coating adhesion, or other roughening methods performed by those skilled in the art.

The joint component 42 comprises a support plate 50 having a joint joint surface 52 and an opposing support surface 46. Support plate 50 is an adjacent vertebral body V_LThe size and shape correspond to the size and shape of the vertebral endplate in (Fig. 2). Support plate 50 is an adjacent vertebral body V_U, V_LReceives or engages the corresponding portion of the surgical instrument (not shown) to assist in the operation and insertion of the prosthesis 40 within the intervertebral space S (FIG. 2) between (FIG. 2). Provide one or more notches 54 or other indicators for. Surgical instruments (not shown) hold joint components 42, 44 in a predetermined direction and spatially relative to each other during the operation and insertion of the prosthesis 40, after being accurately placed between adjacent vertebrae. It is preferably configured to release the joint components 42, 44.

In one embodiment of the present disclosure, the joint component 42 comprises a protrusion 56 having a convex shape. The protrusions may be configured as spherical balls (half of which are shown). It should be understood that protrusions 56 of other shapes, such as cylindrical, elliptical or other arcuate or possibly non-arcous shapes, are also contemplated. It should be understood that the rest of the joint component 42 may take a planar or non-planar shape, for example a square or conical shape extending around the protrusion 56.

A flange member or keel 58 extends from the support surface 46 and is configured to be placed within a preformed opening within the adjacent vertebral endplate. Similar to the support surface 46, the keel 58 may be coated with a bone growth-promoting substance such as a hydroxyapatite coating formed of calcium phosphate. The keel 58 may also be roughened before being coated with a bone growth promoter to further strengthen the growing bone. In one embodiment, the keel 58 extends along the lateral axis T and is located approximately centered along the support surface 46. However, it should be understood that other positions and orientations of keel 58 are also conceived.

In one embodiment, the keel 58 extends laterally along approximately a portion of the joint component 42. Such an embodiment corresponds, for example, to the insertion of the prosthesis 40 using a lateral approach opposite to the anterior approach. In a further embodiment, the keel 58 may be configured in a slanted, tapered or other shape to facilitate the functional requirements of the keel. In yet another embodiment, the keel 58 may be configured as a winged keel with lateral portions (not shown) extending across the main body portion of the keel 58.

In one embodiment, the keel 58 comprises three openings 60 through the keel. Three openings are adjacent vertebral bodies V_U, V_LFacilitates bone growth through the opening to enhance fixation with (Figure 2). However, it should be understood that any number of openings 60, including a single opening or two or more openings, may be defined through the keel 58. It should also be understood that the opening 60 does not necessarily have to extend completely through the keel 58 and may optionally extend partially through it. It should also be further understood that the keel 58 does not necessarily have to define an opening 60 through which it is partially or wholly passed. It should also be appreciated that although the opening 60 is illustrated to have a circular shape, other sizes and shapes of the opening 60 are also contemplated.

In one embodiment, the joint component 44 comprises a support plate 70 having a joint joint surface 72 and an opposing support surface 48. The support plate 70 is an adjacent vertebral body V_UIt is sized and shaped to roughly correspond to the size and shape of the vertebral endplates. The support plate 70 comprises one or more notches 74 or other indicators for receiving or engaging the corresponding portion of the surgical instrument, as discussed above with reference to the joint component 42. be able to.

In one embodiment, the articulated surface 72 comprises a recess 76. In one embodiment, the recess 76 has a concave shape and is configured as a spherical socket. However, it should be understood that other indentation 76 shapes such as, for example, cylindrical, oval or other arcuate shapes or perhaps non-arctic shapes are also contemplated. The rest of the articulated surface 72 can be configured to facilitate insertion and / or use of the artificial bone if it is tilted or otherwise.

Concave indentation 76 is shown to have a nearly smooth, continuous surface, but the surface depressions or cavities placed between the abutting joint components 42, 44, such as particulate dust, etc. It should be understood that the material may be defined along a portion of the indentation 76 to provide a means for cleaning the material. In such cases, the convex cylindrical surface of the protrusions 56 may otherwise define a nearly smooth, continuous articulated surface. In another embodiment, the convex protrusions 56 and the concave indentations 76 define surface depressions to facilitate the removal of particulate matter placed between the abutting joint components 42, 44. You may.

A flange member or keel 68 configured similar to keel 58 of the joint component 42 extends from the support surface 48. In one embodiment, the keel 68 extends along the lateral axis T and is offset from the center of the support surface 48. Such an embodiment is suitable for insertion of the prosthesis 40 using a lateral approach. However, it should be understood that other shapes, positions and orientations of keel 68 are also conceived. For example, in FIGS. 4b and 4c, keels 58 and 68 are on the lateral axis T to assist in circumventing obstacles placed during the insertion of veins, arteries, bones, or other artificial joints 40. It may be tilted relative to it. The keel 68 may also be tilted, tapered, or shaped in a way that facilitates the functional requirements of the keel. In yet another embodiment, the keel 68 may be configured as a winged keel with a lateral portion extending across the main body portion of the keel.

In one embodiment, and with reference to FIG. 5, the keel 68 comprises three openings 70 extending through it. The three openings facilitate bone growth through the openings to enhance fixation with adjacent vertebrae. However, it should be understood that any number of openings 70, including a single opening or two or more openings, may be defined through the keel 68. It should also be understood that the opening 70 does not necessarily have to extend completely through the keel 68, but may optionally extend partially through it. It should also be further understood that the keel 68 does not necessarily have to define an opening 70 that extends through it partially or wholly. It should also be appreciated that although the opening 70 is illustrated to have a circular shape, other sizes and shapes of the opening 70 are also contemplated. As discussed above, the supporting surfaces 46, 48, which are in direct contact with the vertebrae, are preferably coated with a bone growth-promoting substance. In particular, the surfaces of the support surface 48 and keel 68 are adjacent vertebral bodies V._UIt may be coated with hydroxyapatite to facilitate bone engagement with. Again, as discussed above, the surfaces of the support surface 48 and keel 68 may be roughened prior to the attachment of the hydroxyapatite coating.

In some embodiments, one or both of the keels 58, 68 may include a sharp front edge as indicated by the edge 68a in FIG. Having such an edge facilitates insertion of the keel into the associated vertebral body. The margin 68a may also be sharp enough so that the adjacent vertebral body does not require a slot to receive the keel 68, which is discussed in more detail below.

With reference to FIG. 7, the superior and inferior vertebrae V, partially corrected to accommodate the insertion of spondylosis into the intervertebral space of the displaced prosthesis 40._U, V_LMay be prepared to receive an artificial joint 40 (shown in cross section in FIG. 7a) between them. In particular, elongated openings or slots 80, 82 have upper and lower vertebrae V, respectively._L, V_UIt may be formed along the vertebral endplate of the vertebral bone with a predetermined width and a predetermined depth. Slots 80 and 82 are displaced vertebrae V_LAnd / or V_UMay be offset laterally from each other to accommodate. In one embodiment, the elongated slots 80, 82 are rectangular in shape and the vertebrae V._U, V_LIt extends laterally along. In certain embodiments, slots 80, 82 are formed by carving with a chisel or curettage with a curette. However, other methods of forming slots 80, 82, such as by drilling or widening holes with a reamer, are also contemplated by those skilled in the art. Also, in some embodiments of the prosthesis 40, the keels 58 and / or 68 can form their own corresponding slots 80, 82, respectively.

Referring to FIG. 8, in one embodiment, the superior and inferior vertebrae V_U, V_LIs completely corrected and therefore an alternative prosthesis 90 can be used to correct spondylolisthesis. The articulated joint 90 is similar to the artificial joint 40 except for the orientation of various elements of the articulated joint 90. For example, fully corrected upper and lower vertebrae V_U, V_LTo accommodate inward insertion, the articulated joint 90 is a laterally extending keel 92 located approximately centrally on the superior articular component 94 of the articulated joint and the inferior articular component. It may be equipped with a laterally extending keel 96 located approximately in the center on the 98. The upper joint component 94 may also include a substantially centrally located recess 100 that corresponds to a substantially centered protrusion 102 extending from the lower joint component 98. In one embodiment, the superior and inferior joint components 94,98 are fully corrected superior and inferior vertebrae V._U, V_LWhen placed between, they are almost flush with each other.

Fully corrected superior and inferior vertebrae V to accommodate insertion of displaced prosthesis 90_U, V_LMay be prepared to receive a prosthesis 90 in the meantime. In particular, elongated openings or slots 104, 106 have upper and lower vertebrae V, respectively._U, V_LIt may be formed along the vertebral endplate of the vertebral bone with a predetermined width and a predetermined depth. Slots 104, 106 are fully corrected superior and inferior vertebrae V_U, V_LMay be approximately aligned with each other to correspond to. In one embodiment, the elongated slots 104, 106 are rectangular, respectively, the vertebrae V._U, V_LIt extends laterally through. In certain embodiments, slots 104, 106 are formed by carving with a chisel or curettage with a curette. However, as will be appreciated by those skilled in the art, other methods of forming slots 104, 106, such as drilling or reamer expansion, have also been contemplated. Also, in some embodiments of the prosthesis, keels 92 and / or 96 can form their own corresponding slots 104, 106, respectively.

With reference to FIG. 9, in an alternative embodiment, a gliding prosthesis 110 can be used to assist a lateral approach for the treatment of spondylolisthesis. The sliding joint 110 extends substantially along the longitudinal axis L and comprises a first sliding component 112 and a second sliding component 114. Sliding components 112, 114 work together to form a sliding joint 110 sized and shaped to be placed in the intervertebral space between adjacent vertebral bodies.

The sliding joint 110 supplies movement between adjacent vertebral bodies to maintain or restore movement similar to that of normal biomechanical movement provided by the natural intervertebral disc. More specifically, the slidable components 112, 114 are allowed to translate relative to each other in the axial plane. The slidable components 112, 114 of the prosthesis 110 may be made of a wide variety of materials, but in one embodiment, the slidable components 112, 114 are cobalt-chromium-molybdenum metal alloys (ASTM). It is made of F-799 or F-75). However, in an alternative embodiment of the present disclosure, the gliding components 112, 114 are other such as a polymeric material such as titanium or stainless steel, polyethylene, or other biocompatible materials apparent to those of skill in the art. It may be formed of a material. The surfaces of the slidable components 112, 114, which are placed in direct contact with the vertebrae, are preferably coated with a bone growth-promoting substance, such as a hydroxyapatite coating made of calcium phosphate. Also, the surfaces of the slidable components 112, 114 may be roughened, respectively, before being coated with a bone growth-promoting substance to further strengthen the growing bone. Such surface roughening may be achieved using, for example, acid etching, knurling, bead coating adhesion, or other roughening methods performed by those skilled in the art.

The slidable component 112 comprises a support plate 116 having a slidable surface 118 and an opposing support surface 120. The support plate 116 is preferably sized and shaped to substantially correspond to the size and shape of the vertebral endplates of adjacent vertebrae. The support plate 116 receives or engages with the corresponding portion of a surgical instrument (not shown) to assist in the operation and insertion of the prosthesis 110 within the intervertebral space between adjacent vertebrae. It comprises one or more notches 122 or other indicators of. Surgical instruments (not shown) held the slidable components 112, 114 in a predetermined direction and spatially relative to each other during the operation and insertion of the prosthesis 110 and were precisely placed between adjacent vertebrae. Later, it is preferably configured to release the slidable components 112, 114.

A flange member or keel 124 extends from the support surface 120 and is configured to be placed within a preformed opening within the adjacent vertebral endplate. In one embodiment, the keel 124 extends vertically from the support surface 120 and is located approximately centered along the support surface 120. However, it should be understood that other positions and orientations of keel 124 are also conceived. In one embodiment, the keel 124 extends laterally along approximately a portion of the support plate 114. Such an embodiment corresponds to the insertion of the prosthesis 110 using a lateral approach. In a further embodiment, the keel 124 may be configured in a slanted, tapered or other shape to facilitate the functional requirements of the keel. In yet another embodiment, the keel 124 may be configured as a winged keel with lateral portions extending across the main body portion of the keel 124.

The keel 124 comprises an opening 126 extending through the keel. This facilitates bone growth through the opening to enhance fixation with adjacent vertebrae. However, it should be understood that any number of openings 126, including a single opening or three or more openings, may be defined through the keel 124. It should also be understood that the opening 104 does not necessarily have to extend completely through the keel 124 and may otherwise extend partially through it. It should also be further understood that the keel 124 does not necessarily have to define an opening 126 that extends through it partially or wholly. It should also be appreciated that although the opening 126 is illustrated to have a circular shape, other sizes and shapes of the opening 126 are also contemplated. As discussed above, the surface of the slidable component 112, which is in direct contact with the vertebrae, is preferably coated with a bone growth promoter. In particular, the surfaces of the support surface 120 and keel 124 may be coated with hydroxyapatite to facilitate bone engagement with adjacent vertebrae. Again, as discussed above, the surfaces of the support surface 120 and keel 124 may be roughened prior to the attachment of the hydroxyapatite coating.

In one embodiment, the slidable component 114 comprises a support plate 128 having a slidable surface 130 and an opposing support surface 132. The support plate 128 is preferably sized and shaped to substantially correspond to the size and shape of the vertebral endplates of adjacent vertebrae. The support plate 128 is of one or more notches 134 or other types for receiving or engaging the corresponding portion of the surgical instrument, as described above with reference to the slidable element 112. It can be equipped with indicators.

A flange member or keel 136 configured similar to the keel 124 of the slidable element 112 extends from the support surface 132. In one embodiment, the keel 136 extends vertically from the support surface 132 and is centered along the support surface 132 to accommodate the displacement of the vertebrae due to spondylosis. Also, the staggered position of the keel 136 assists in circumventing obstacles placed during the insertion of veins, arteries, bones, or other joints 110. It should be further understood that other positions, shapes, orientations and quantities of keel 136 are also contemplated. It should also be appreciated that the keel 136 may be arranged, shaped or oriented differently, or for similar or additional reasons, more keel 136 may be used.

In one embodiment, the keel 136 extends laterally along approximately a portion of the support plate 128. Such an embodiment corresponds to the insertion of the prosthesis 110 using a lateral approach opposite to other approaches, such as the anterior approach. In a further embodiment, the keel 136 may be configured in a slanted, tapered or other shape to facilitate the functional requirements of the keel. In yet another embodiment, the keel 136 may be configured as a winged keel with lateral portions extending across the main body portion of the keel 136.

The keel 136 comprises three openings 138 extending through the keel. This facilitates bone growth through the opening to enhance fixation with adjacent vertebrae. However, it should be understood that any number of openings 138, including a single opening or three or more openings, may be defined through the keel 136. It should also be understood that the opening 138 does not necessarily have to extend completely through the keel 136, but may otherwise extend partially through it. It should also be further understood that the keel 136 does not necessarily have to define an opening 138 that extends through it partially or wholly. It should also be appreciated that although the opening 138 is illustrated to have a circular shape, other sizes and shapes of the opening 138 are also contemplated. As discussed above, the surface of the slidable component 114 in direct contact with the vertebrae is preferably coated with a bone growth promoter. In particular, the surfaces of the support surface 132 and keel 136 may be coated with hydroxyapatite to facilitate bone engagement with adjacent vertebrae. Again, as discussed above, the surfaces of the support surface 132 and keel 136 may be roughened prior to the attachment of the hydroxyapatite coating.

In some embodiments, one or both of the keels 124, 136 may include a sharp front edge as indicated by the edges 124a, 136a. Having such an edge facilitates insertion of keels 124, 136 into the associated vertebral body. The edges 124a, 136a may also be sharp enough so that the vertebral body does not require a slot to receive the keels 124, 136, respectively, which will be discussed in more detail below.

Referring to FIG. 10, upper and lower vertebrae V to accommodate insertion of artificial joint 110 in the intervertebral space._U, V_LHowever, the prosthesis 110 may be prepared to be received between them. In particular, elongated openings or slots 142, 144 have upper and lower vertebrae V, respectively._U, V_LIt may be formed along the vertebral endplate of the vertebral bone with a predetermined width and a predetermined depth. Slots 142, 144 are displaced vertebrae V_LAnd / or V_UThey may be arranged laterally offset from each other in order to correspond to. In one embodiment of the present disclosure, the elongated slots 142, 144 have a rectangular shape and the vertebrae V._U, V_LIt extends laterally along. In certain embodiments, slots 142, 144 are formed by carving with a chisel or being cured with a curette. However, as will be appreciated by those skilled in the art, other methods of forming slots 142, 144, for example by drilling or reamer expansion, have also been contemplated. Also, in some embodiments of the prosthesis, keels 124 and / or 136 can form their own corresponding slots 142, 144, respectively.

Referring to FIG. 11, in one embodiment, the superior and inferior vertebrae V_U, V_LIs completely corrected and therefore an alternative prosthesis 150 may be used to correct spondylolisthesis. The articulated joint 150 is almost the same as the artificial joint 110 except for the direction of the keel. For example, fully corrected upper and lower vertebrae V_U, V_LTo accommodate insertion into the joint 150, the articulated joint 150 is approximately centered on the upper articular component 154 of the articulated joint and approximately centrally located on the inferior articular component 158. It may be provided with a centrally located keel 156. In one embodiment, the superior and inferior joint components 154, 158 are fully corrected superior and inferior vertebrae V._U, V_LWhen placed between, they are almost flush with each other.

Fully corrected superior and inferior vertebrae V to accommodate insertion of displaced prosthesis 150_U, V_LMay be prepared to accept the prosthesis 150 in the meantime. In particular, elongated openings or slots 160, 162 have upper and lower vertebrae V._U, V_LIt may be formed along the vertebral endplate of the vertebral bone with a predetermined width and a predetermined depth. Slots 160, 162 are fully corrected superior and inferior vertebrae V_U, V_LThey may be approximately aligned with each other to fit. In one embodiment, the elongated slots 160, 162 are rectangular, respectively, the vertebrae V._U, V_LIt extends laterally through. In certain embodiments, slots 160, 162 are formed by carving with a chisel or by curing with a curette. However, as will be appreciated by those skilled in the art, other methods of forming slots 160, 162, for example by drilling or widening holes with a reamer, have also been contemplated. Also, in some embodiments of the prosthesis, keels 152 and / or 156 can form their own corresponding slots 160, 162, respectively.

With reference to FIGS. 12 and 13, in a manner that goes beyond the conventional fixation configuration, consistent with the exercise preservation embodiment discussed above, the fixation plate and cage are provided with one or more keels in the lateral direction. Can be inserted. With particular reference to FIG. 12, the lateral artificial bone 170 comprises a cage 172, an upper keel 174 and a lower keel 176. The cage 172 is connected to the upper and lower keels 174 and 176 through support plates 178 and 180, respectively. Cage 172 can feature many features of the LT-CAGE Tapered Lumbar Fixture®, supplied by Medtronic Sofamor Danek, Memphis, TN, biomaterials and / or other bone growth-promoting materials. Can be used to include. Lateral keels 174, 176 can also assist in maintaining corrected vertebrae displacement during fixation.

Referring to FIG. 13, the artificial bone 190 includes a plate 192, an upper keel 194, a lower keel 196, an upper support plate 198 and a lower support plate 200. The plate 192 can be used to maintain the desired distance between the two support plates 198, 200 and facilitate fixation. Since the plate 192 can be relatively thin, the rest of the intervertebral space can be filled with biomaterials, bone materials and / or other bone growth promoting materials.

<u style="single">II Forward correction</u> In some cases, correction of spondylolisthesis may be desirable with an anterior approach. With reference to FIGS. 14 to 16, a facet joint type artificial joint 210 according to an alternative embodiment of the present invention is shown. The artificial joint 210 extends substantially along the longitudinal axis L and includes a first joint component 212 and a second joint component 214. Joint components 212, 214 are adjacent vertebral bodies V_U, V_LCollaborate to form articulated joints 210 sized and shaped to be placed within the intervertebral space between a pair of adjacent vertebral bodies, such as the intervertebral space S.

The prosthesis 210 maintains or restores movement similar to that of a normal living body mechanical movement provided by the natural intervertebral disc, in order to maintain or restore the adjacent vertebral body V._U, V_LProvides relative pivotal and rotational movements between. More specifically, the joint components 212, 214 include several axes, including lateral or lateral pivotal movements around the longitudinal axis L, and anterior-posterior pivotal movements around the lateral axis T. Are allowed to move around each other. In one embodiment of the present disclosure, the joint components 212, 214 are allowed to pivot relative to each other around any axis in the plane intersecting the longitudinal axis L and the transverse axis T. Please understand that. Also, the joint components 212, 214 are allowed to rotate relative to each other around the axis of rotation R. Artificial joint 210 is illustrated and described as providing a particular combination of joint movements, but other combinations of joint movements, such as relative parallel or linear movements, are also possible and are within the scope of the present disclosure. Please understand that it is intended to be in.

The joint components 212, 214 of the artificial joint 210 are made of a wide variety of materials, but in one embodiment of the present disclosure, the joint components 212, 214 are cobalt-chromium-molybdenum metal alloys (ASTM F-). It is made of 799 or F-75). However, in an alternative embodiment of the present disclosure, the joint components 212, 214 are made of a polymeric material such as titanium or stainless steel, polyethylene, or other material such as other biocompatible materials apparent to those skilled in the art. It may be formed. The surfaces of the joint components 212, 214, which are placed in direct contact with the vertebrae, are coated with a bone growth-promoting substance such as hydroxyapatite formed of calcium phosphate, for example. Also, the surfaces of the joint components 212, 214 placed in direct contact with the vertebral bone may be roughened before being coated with a bone growth promoter to further strengthen the growing bone. Such surface roughening may be achieved using, for example, acid etching, knurling, bead coating adhesion, or other roughening methods performed by those skilled in the art.

The joint component 212 comprises a support plate 216 having a joint joint surface 218 and an opposing support surface 220. The support plate 216 is sized and shaped to roughly correspond to the size and shape of the vertebral endplates of adjacent vertebrae. The support plate 216 accepts and engages the corresponding portion of the surgical instrument (not shown) to assist in the operation and insertion of the prosthesis 210 within the intervertebral space between adjacent vertebrae. It comprises one or more notches 222 or other types of indicators. Surgical instruments (not shown) hold joint components 212, 214 in a predetermined direction and spatially relative to each other during the operation and insertion of the articulated prosthesis 210 and are precisely placed between adjacent vertebrae. After that, it is preferably configured to release the joint components 212, 214.

In one embodiment, the joint component 218 comprises a protrusion 224 having a convex shape. The protrusions may be configured as spherical balls (half of which are shown). It should be understood that the shape of other protrusions 224, for example cylindrical, elliptical or other arcuate or possibly non-arcous, is also contemplated. It should be understood that the rest of the articulated surface 218 may take a planar or non-planar shape, for example a square or conical shape extending around the protrusion 224.

In one embodiment, the convex articulated surface of the protrusion 224 is blocked by a surface depression or cavity 226 extending along the protrusion 224. In one embodiment, the surface recessed portion 226 is configured as a groove. However, it should be understood that other types of surface depressions are also contemplated, including the absence of depressions. One purpose of the groove 226 is to facilitate the removal of material placed between the abutments of the joint components 212, 214. More specifically, the groove 226 assists in cleaning substances such as particulate material placed between the abutting articulated surfaces of the components 212, 214.

A flange member or keel 230 extends from the support surface 220 and is configured to be placed within a preformed opening within the adjacent vertebral endplate. In one embodiment, the keel 230 extends vertically from the support surface 220 and is located approximately centered along the support surface 220. However, it should be understood that other positions and orientations of the keel 230 are also conceived.

In one embodiment, the keel 230 extends approximately along the entire length of the support plate 216. Such an embodiment corresponds to the insertion of an articulated joint 210 using an anterior approach. In a further embodiment, the keel 230 may be configured in a slanted, tapered or other shape to facilitate the functional requirements of the keel. In yet another embodiment, the keel 230 may be configured as a winged keel with lateral portions (not shown) extending across the main body portion of the keel 230.

The keel 230 comprises a pair of openings 232 extending through it. This facilitates bone growth through the opening to strengthen fixation with adjacent vertebrae. However, it should be understood that any number of openings 232, including a single opening or three or more openings, may be defined through the keel 230. It should also be understood that the opening 232 does not necessarily have to extend completely through the keel 230 and may optionally extend partially through it. It should also be further understood that the keel 230 does not necessarily have to define an opening 232 through which it is partially or wholly passed. It should also be appreciated that although the opening 232 is illustrated to have a circular shape, other sizes and shapes of the opening 232 are also contemplated. As discussed above, the surface of the joint component 212, which is in direct contact with the vertebrae, is preferably coated with a bone growth promoter. In particular, the surfaces of the support surface 220 and keel 230 may be coated with hydroxyapatite to facilitate bone engagement with adjacent vertebrae. Again, as discussed above, the surfaces of the support surface 220 and keel 230 may be roughened prior to the attachment of the hydroxyapatite coating. In one embodiment, the joint component 214 comprises a support plate 240 having a joint joint surface 242 and an opposing support surface 244. The support plate 240 is sized and shaped to roughly correspond to the size and shape of the vertebral endplates of adjacent vertebrae. The support plate 240 comprises one or more notches 246 or other indicators for receiving or engaging the corresponding portion of the surgical instrument, as discussed above with reference to the joint component 212. ..

In one embodiment, the articulated surface 242 comprises a recess 250 having a concave shape, such as the shape of a spherical socket. However, it should be understood that other indentation 250 shapes such as, for example, cylindrical, oval or other arcuate shapes or perhaps non-arctic shapes are also contemplated. The rest of the articulated surface 242 is inclined or otherwise configured to facilitate insertion and / or use of the articulated joint 210.

The concave indentation 250 is shown to have a nearly smooth, continuous surface, but the surface depressions or cavities placed between the abutting joint elements 212, 214, such as particulate dust, etc. It should be understood that it may be defined along a portion of the indentation 250 to provide a means for cleaning the material. In such cases, the convex joint surface of the ball 224 may otherwise define a nearly smooth, continuous joint surface. In another embodiment, each of the convex protrusion 224 and the concave recess 250 defines a surface depression to facilitate the removal of particulate matter placed between the abutting articulated surfaces. You may.

A flange member or keel 260 configured similar to the keel 230 of the joint component 212 extends from the support surface 244. In one embodiment, the keel 260 extends vertically from the support surface 244 and is located approximately centrally along the support surface 244. However, it should be understood that other positions and orientations of the keel 260 are also conceived. It should be understood that the joint component 214 may include two or more keels 260 extending from the support surface 244.

In one embodiment, the keel 260 extends along approximately the entire length of the support plate 240. Such an embodiment corresponds to the insertion of the prosthesis 210 using the anterior approach. In a further embodiment, the keel 260 may be shaped to facilitate tilting, tapering, or functional requirements of the keel. In yet another embodiment, the keel 260 may be configured as a winged keel with a lateral portion (not shown) extending across a main body portion of the keel 260.

The keel 260 comprises a pair of openings 262 extending through it. This facilitates bone growth through the opening to enhance fixation with adjacent vertebrae. However, it should be understood that any number of openings 262, including a single opening or three or more openings, may be defined through the keel 260. It should also be understood that the opening 262 does not necessarily have to extend completely through the keel 260 and may optionally extend partially through it. It should also be further understood that the keel 260 does not necessarily have to define an opening 262 through which it is partially or wholly passed. It should also be appreciated that although the opening 262 is illustrated to have a circular shape, other sizes and shapes of the opening 262 are also contemplated. As discussed above, the surface of the joint component 214 in direct contact with the vertebrae is preferably coated with a bone growth promoter. In particular, the surfaces of the support surface 244 and keel 260 may be coated with hydroxyapatite to facilitate bone engagement with adjacent vertebrae. Again, as discussed above, the surfaces of the support surface 244 and keel 260 may be roughened prior to the attachment of the hydroxyapatite coating.

In some embodiments, one or both of the keels 230, 260 may include a sharp anterior edge as indicated by the edge 260a in FIG. Having such an edge facilitates the insertion of the keel into the associated vertebral body. The margin 260a may also be sharp enough so that the vertebral body does not require a slot to receive the keel 260, which is discussed in more detail below.

Recognizing that the task of completely correcting and aligning spondylosis segments is not achievable or desirable by surgeons to work with displaced vertebrae such as the vertebrae V1 to V5 in Figure 1 associated with spondylolisthesis. Has been done. Therefore, the basic joints described in US Pat. No. 10,042,589, which are co-pending herein, have relevant displacements to accommodate the displacements of the vertebrae. That is, the joints of the artificial joint 210 are made to correspond to the amount of displacement between the two adjacent vertebrae of spondylosis. In some embodiments, such displacement places one or more protrusions 224 off-center on the joint surface 218 of the joint component 212 and the joint surface 242 of the joint component 214. This can be done by placing one or more indentations 250 off-center above. This allows uncorrected or partially corrected deviations to be moved.

More specifically, with reference to FIGS. 14 and 17, the protrusions 224 are misaligned with respect to the articulated surface 218. For example, the inferior vertebra (V in Figure 17)_L) Is displaced posteriorly (indicated by the arrow P in FIG. 17), the joint component 212 is configured such that the protrusion 224 is displaced anteriorly with respect to the articular joint surface 218. Will be done. Continuing this example, therefore, the upper vertebra V_UAnterior (indicated by arrow A in Figure 17) inferior vertebra V_LThe joint component 214 is configured so that the indentation 250 is offset posteriorly with respect to the joint surface 242. In this way, they engage with each other through the protrusions 224 and the indentations 250, but the upper and lower vertebrae V in FIG._U, V_LThe joint components 212, 214 can be configured such that they are still offset from each other to accommodate the offset relationship.

Referring here to FIG. 16, in another embodiment, the articulated joint 210 is added to and / or subluxation to accommodate a more prominent displacement relative to FIG. 17 (indicated by arrow 272). The support plate 216 may be modified to include an extension section 270 to provide stability. The protrusion 224 may be placed on the extension section 270 to allow for a more prominent displacement between the joint components 212, 214.

With reference to FIGS. 2 and 17, the superior and inferior vertebrae V to accommodate the insertion of artificial joint 210 in the intervertebral space S._U, V_LHowever, the prosthesis 210 may be prepared to be received between them. In particular, elongated openings or slots 280, 282 have upper and lower vertebrae V, respectively._U, V_LIt may be formed along the vertebral endplate of the vertebral bone with a predetermined width and a predetermined depth. In one embodiment of the present disclosure, the elongated slots 280, 282 have a rectangular shape and the vertebrae V._U, V_LIt extends from the upper side 284 of the to the rear side. In certain embodiments, slots 280, 282 are formed by carving with a chisel or curettage with a curette. However, as will be appreciated by those skilled in the art, other methods of forming slots 280, 282, for example by drilling or enlarging the holes with a reamer, have also been planned. Also, in some embodiments of the prosthesis 210, the keels 230 and / or 260 can form their own corresponding slots 280, 282, respectively. The preparation and exemplary sizes of slots 280, 282 are described in more detail in US Pat. No. 10,042,589, which is incorporated herein by time. With reference to FIGS. 18-20, in other embodiments, one or both of the joint components 212, 214 may comprise a different number of keels and / or improved keels. With particular reference to FIG. 18, the two keels shown at 290 and 292 extend from the support surface 244 and are configured to be placed within a preformed opening within the adjacent vertebral endplate. In one embodiment, both keels 290, 292 extend vertically from the support surface 244, are parallel, and are evenly spaced along the central portion of the support surface 244.

With particular reference to FIG. 19, the two keels shown at 294 and 296 extend from the support surface 224 and are configured to be placed within a preformed opening within the adjacent vertebral endplate. In one embodiment, both keels 294, 296 extend vertically from the support surface 224, are parallel, and are equally spaced along the central portion of the support surface 224. It should be understood that other arrangements and orientations of keels 290, 292, 294 and 296 are also conceived.

With particular reference to FIG. 20, the keel 298 is similar to the keel 260 in FIG. 14 except that the keel 298 extends laterally facing the support surface 244, i.e. comprises a winged portion 300. Extends from. The winged portion 300 has a vertebral body V on the support surface 244_UIt provides several functions, including maintaining tight contact and substantially preventing any longitudinal movement of joint component 214. Similarly, the keel 302 extends from the support surface 224 and comprises a winged portion 304 facing the support surface 224. Winged part 304 vertebrates support surface 224_UIt provides several functions, including maintaining tight contact and substantially preventing any longitudinal movement of the joint component 212.

Referring to FIGS. 21-23, the superior and inferior vertebrae V to accommodate the insertion of the alternative prosthesis 210 into the intervertebral space S described above_U, V_LCan be prepared to receive each of the articulated joints 210 between them. With particular reference to FIG. 21, multiple slots 310 and 312 have an upper vertebra V for the shape of the prosthesis 210 in FIG._UFormed along the vertebral endplates, a single slot 314 has a lower vertebral V_LIt is formed along the vertebral endplates of. With particular reference to FIG. 22, for the shape of the prosthesis 210 of FIG. 19, multiple slots 316, 318 and 320, 322, respectively, have an upper vertebra V._UAnd lower vertebra V_LIt is formed along the vertebral endplates of. With particular reference to FIG. 23, for the shape of the prosthesis 210 in FIG. 20, the winged slots 324 and 326 are the upper vertebrae V, respectively._UAnd lower vertebra V_LIt is formed along the vertebral endplates of. Preparation of slots 310, 312, 314, 316, 318, 320, 322, 324, 326 can be accomplished in a manner similar to that discussed above with respect to FIG. A standard chisel can be used for the winged slots 324, 326, or otherwise a unique wing-shaped chisel can be used.

Referring to FIG. 24, in addition to the artificial joint 210, a woven orthodontic implant 330 has two vertebrae V._U, V_LIt can be used to act as an artificial ligament between. One embodiment of the woven implant 330 is disclosed in US Pat. No. 10,082,579, which is incorporated by reference. Implant 330 has two vertebrae V_U, V_LThe natural ligaments function to function to help stabilize and further anchor together, helping to prevent further displacement (or returning to the method in which the displacement was preoperatively). To prevent).

See Figures 25 and 26, Vertebra V_LPartial destruction as indicated by the cross-section within the bone element 332 that connects to the posterior element such as the articular process 334 against is also intended to be treated during the correction of spondylolisthesis by the anterior approach. .. For further clarity, it should be understood that the destroyed bone element 332 is highlighted in Figure 25. Partial destruction is vertebral body V through bone element 332_LIt can be repaired by screwing a lug screw 336 with a threaded portion 336a and an unthreaded portion 336b into the inner opening 338 and into the articular process 334. In some embodiments, all or part of the opening 338 can be pre-drilled with a drill or chisel (not shown). A lug screw 336 is inserted and accessed through the anterior direction and multiple screws can be used to repair multiple protrusions. Vertebra V by capturing the destroyed posterior element and fastening the lug screw 336_LIs repaired.

<u style="single">III Transvertebral foramen prosthesis</u> In some cases, potential damage to important anatomical structures such as nerve roots, dura mater, ligamentum flavum and interspinous ligaments makes it difficult to invade and remove impaired disc space. Often. Conservation of ligament structures, for example, is crucial for restoring biomechanical stability of the segment and its adjacent counterparts. In these situations, the transdisc approach allows clearance of the entire disc space by opening a nerve hole on one side. After proper clearance, posterior interprocessal extension can achieve further expansion of the intervertebral compartment. This technique has been used for transvertebral foramen lumbar interbody fusion, or fusion techniques such as TILF, but has not previously been used with exercise-conserving implants.

With reference to FIG. 27, in the transforaminal approach, the disc V is approached as indicated by arrow 400. This approach is between the posterior and lateral approaches, and in some cases only one side of the disc needs to be exposed (right or left) for the procedure.

With reference to FIGS. 28-30, a facet joint artificial joint 410 according to another form of the present disclosure is shown. The articulated joint 410 extends approximately along the longitudinal direction L and comprises a first joint component 412 and a second joint component 414. The joint components 412, 414 work together to form an articulated joint 410 sized and shaped to be placed in the intervertebral space between adjacent vertebral bodies.

Artificial joint 410 provides relative pivotal and rotational movements between adjacent vertebral bodies to maintain or restore movements similar to those of normal biomechanical movements supplied by the natural intervertebral disc. More specifically, the joint components 412, 414 have several axes, including lateral or lateral pivotal movements around the longitudinal axis L, and anterior-posterior pivotal movements around the lateral axis T. Are allowed to move around each other. In one embodiment of the disclosure, the joint components 412, 414 are allowed to pivot relative to each other around any axis in a plane that intersects the longitudinal axis L and the transverse axis T. Please understand that. Also, the joint components 412, 414 are preferably allowed to pivot relative to each other around the axis of rotation R. Although the articulated joint 410 is illustrated and described as providing a particular combination of joint movements, other combinations of joint movements are also possible and are intended to be within the scope of the present disclosure. Please understand that. It should be understood that other types of joint movements, such as relative parallel or linear movements, are also contemplated.

The joint components 412, 414 of the artificial joint 410 are made of a wide variety of materials, but in one embodiment of the present disclosure, the joint components 412, 414 are cobalt-chromium-molybdenum metal alloys (ASTM F-). It is made of 799 or F-75). However, in an alternative embodiment of the present disclosure, the joint components 412, 414 are made of a polymeric material such as titanium or stainless steel, polyethylene, or other material such as other biocompatible materials apparent to those skilled in the art. It may be formed. The surfaces of the joint components 412, 414, which are placed in direct contact with the vertebrae, are preferably coated with a bone growth-promoting substance such as hydroxyapatite formed of calcium phosphate. Also, the surfaces of the joint components 412, 414, which are placed in direct contact with the vertebrae, may preferably be roughened before being coated with a bone growth promoter to further strengthen the growing bone. Such surface roughening may be achieved using, for example, acid etching, knurling, bead coating adhesion, or other roughening methods that one of ordinary skill in the art may come up with.

The joint component 412 comprises a support plate 416 having a joint joint surface 418 and an opposing support surface 420. The support plate 416 is sized and shaped to roughly correspond to the size and shape of the vertebral endplates of adjacent vertebral bodies. In one embodiment, the support plate 416 is shaped to facilitate a transforaminal insertion approach. Similarly, the support plate 416 comprises curved side portions 422a, 422b defined as a substantially elongated portion of the support plate 416 extending between the articulated surface 418 and the support surface 420. Although not shown, the support plate 416 is the corresponding portion of the surgical instrument (also not shown) to assist in the operation and insertion of the prosthesis 410 in the intervertebral space between adjacent vertebrae. Provide one or more notches or other indicators for receiving or engaging with it. Surgical instruments (not shown) hold joint components 412, 414 in a predetermined direction and spatially relative to each other during operation and insertion of the prosthesis 410, and posterior joints that are precisely placed between adjacent vertebrae. It is preferably configured to release the components 412, 414.

In one embodiment, the articulated surface 418 comprises a protrusion 424 having a convex shape. The protrusions may be configured as spherical balls (half of which are shown). It should be understood that other shapes of protrusions 424, such as cylindrical, oval or other arcuate shapes or perhaps non-arctic shapes, are also contemplated. It should be understood that the rest of the articulated surface 418 may take a planar or non-planar shape, for example a square or conical shape extending around the protrusion 424.

A flange member or keel 426 extends from the support surface 410 and is configured to be placed within a preformed opening within the adjacent vertebral endplate. In one embodiment, the keel 426 extends vertically from the support surface 420 and is located approximately centered along the support surface 420. However, it should be understood that other positions and directions of keel 426 are also conceived.

In one embodiment, the keel 426 extends laterally along approximately a portion of the support plate 416. The keel 426 is bent in much the same direction as arrow 400 in FIG. The curvature of the keel 426 is almost the same as the curvature of the side portions 422a and 422b and is in agreement. Such an embodiment is adapted for insertion of the prosthesis 410 using a transforaminal approach opposite to the anterior or lateral approach discussed above. In a further embodiment, the keel 426 may be tilted, tapered, or shaped in a way that facilitates the functional requirements of the keel. In yet another embodiment, the keel 426 may be configured as a winged keel with a lateral portion (not shown) extending across the main body portion of the keel 426.

The keel 426 comprises three openings 428 extending through it. This facilitates bone growth through the opening to enhance fixation with adjacent vertebrae. However, it should be understood that any number of openings 428, including a single opening or three or more openings, may be defined through the keel 426. It should also be understood that the opening 428 does not necessarily have to extend completely through the keel 426, but may optionally extend partially through it. It should also be further understood that the keel 426 does not necessarily have to define an opening 428 through which it is partially or wholly passed. It should also be appreciated that although the opening 428 is illustrated to have a circular shape, other sizes and shapes of the opening 428 are also contemplated. As discussed above, the surface of the joint component 412, which is in direct contact with the vertebrae, is preferably coated with a bone growth promoter. In particular, the surfaces of the support surface 420 and keel 426 may be coated with hydroxyapatite to facilitate bone engagement with adjacent vertebral bodies. Again, as discussed above, the surfaces of the support surface 420 and keel 426 may be roughened prior to the attachment of the hydroxyapatite coating.

In one embodiment, the joint component 414 comprises a support plate 430 having a joint joint surface 432 and an opposing support surface 434. The support plate 430 is sized and shaped to roughly correspond to the size and shape of the vertebral endplates of adjacent vertebrae. In one embodiment, the support plate 430 is shaped to facilitate a transvertebral foramen insertion approach. Similarly, the support plate 416 comprises curved side portions 436a, 436b defined as an overall elongated portion of the support plate 430 extending between the articulated surface 432 and the support surface 434. Although not shown, the support plate 430 has one or more notches or other for receiving or engaging the corresponding portion of the surgical instrument, as described above with reference to the joint element 412. It has an index of the type of.

In one embodiment, the articulated surface 432 has a concave shape and comprises a recess 440 configured as a spherical socket. However, it should be understood that other shapes of the indentation 440, such as cylindrical, oval or other arcuate shapes or perhaps non-arctic shapes, are also contemplated. The rest of the articulated surface 432 can be configured to facilitate insertion and / or use of the artificial bone if it is tilted or otherwise. The concave indentation 440 is shown to have a nearly smooth, continuous articulated surface, but the abutting articulated elements 412, to provide a means for cleaning substances such as particulate dust, It should be understood that surface depressions or cavities, located between the 414 articulated surfaces, may be defined along a portion of the indentation 440. In such cases, the convex joint surface of the ball 424 may otherwise define a nearly smooth, continuous joint surface. In another embodiment, the convex protrusions 424 and the concave recesses 440 also define surface depressions to facilitate the removal of particulate matter placed between the abutting articulated surfaces. Good.

A flange member or keel 450 configured similar to keel 426 of joint component 412 extends from the support surface 434. In one embodiment, the keel 450 can be centered and placed either directly or side by side with the keel 450. The keel 450 is bent in the direction of arrow 400 in FIG. 27, similar to keel 426. The curvature of the keel 450 is substantially similar and consistent with the curvature of the lateral portions 436a, 436b. Such an embodiment is adapted for insertion of the prosthesis 410 using a transforaminal approach different from the anterior or lateral approach discussed above. In some embodiments, the position of the keel 450 is offset from the center to assist in bypassing veins, arteries, bones, or other obstacles that are placed during the insertion of the prosthesis 410. May be done.

The keel 450 may also be arranged, shaped or oriented differently, or more keels 450 may be used for similar or additional reasons. The keel 450 may be tilted, tapered, or otherwise shaped to facilitate the functional requirements of the keel. In yet another embodiment, the keel 450 may be configured as a winged keel with a lateral portion (not shown) extending across the main body portion of the keel.

In one embodiment, the keel 450 comprises three openings 452 extending through it. This facilitates bone growth through the opening to enhance fixation with adjacent vertebrae. However, it should be understood that any number of openings 452, including a single opening or three or more openings, may be defined through the keel 450. It should also be understood that the opening 452 does not necessarily have to extend completely through the keel 450 and may optionally extend partially through the keel. It should also be further understood that the keel 450 does not necessarily have to define an opening 452 that partially or wholly passes through the keel. It should also be appreciated that although the opening 452 is illustrated to have a circular shape, other sizes and shapes of the opening 452 are also contemplated. As discussed above, the surface of the joint component 414, which is in direct contact with the vertebrae, is preferably coated with a bone growth promoter. In particular, the surfaces of the support surface 434 and keel 450 may be coated with hydroxyapatite to facilitate bone engagement with adjacent vertebrae. Again, as discussed above, the surfaces of the support surface 434 and keel 450 may be roughened prior to the attachment of the hydroxyapatite coating. In some embodiments, one or both of the keels 426, 450 may include a sharp front edge as shown by the edges 460, 462 of FIG. 28c. Having such an edge facilitates insertion of the keel into the associated vertebral body. The edges 460, 462 may also be sharp enough so that the adjacent vertebral bodies do not require slots to receive the keels 426, 450, which will be discussed in more detail below.

With reference to FIGS. 31a and 31b, the superior and inferior vertebrae V to accommodate the insertion of the prosthesis 410._U, V_LMay be prepared to accept the prosthesis 410 in the meantime. With particular reference to FIG. 31a, for the shape of the prosthesis 410 of FIGS. 28-30, a plurality of slots 470, 472 have upper vertebrae V._UAnd lower vertebra V_LIt is formed along the vertebral endplates of. Slots 470, 472 may be created by the keel 426, 450 itself, or may be prepared in advance.

Referring to FIG. 32, the prosthesis 410 has upper and lower vertebrae V._U, V_LIt is desirable to prepare one or more slots 470, 472 before being inserted between. Slots 470, 472 may be bent according to curved keels 426, 450 to facilitate movement of the prosthesis 410 during insertion, as indicated by slot 472.

With reference to FIGS. 33-35, the milling guide 500 is used as an alternative to chisel cutting, which can only cut linear slots, with the upper and lower vertebrae V._U, V_LIt can also be used with a milling tool 502 for cutting inwardly curved slots 470, 472 (indicated by 472 in FIG. 32). The milling guide 500 and milling tool 502 can be formed of any material, including biocompatible materials such as titanium. The milling guide 500 comprises an elongated curved member 503 that defines a curved opening 504 to accommodate the desired curved shape for slots 470, 472. Of course, the curvature of the milling guide 500, and thus the curved opening 504, may vary depending on the desired curvature of slots 470, 472. In one embodiment, the milling guide 500 is formed of a flexible material that maintains its correct shape during reshaping so that the curvature of the curved opening 504 can be changed without the need to replace the milling guide. Has been done. The milling guide 500, and therefore the curved opening 504, is also sufficient so that such an extension of the slots can be achieved simultaneously if slots 470, 472 need to be continuous through the posterior element of the vertebra. The length.

With particular reference to FIGS. 34a and 34b, in one embodiment the milling tool 502 comprises a milling bit 510 arranged to be rotationally and translated within a curved opening 504. In one embodiment, the milling bit 510 is the superior and inferior vertebrae V._U, V_LA 2-grooved bit that can extend inward at the same time.

The milling bit 510 is also configured to receive a parallel force so that it can be moved back and forth within the curved opening 504. Referring to FIG. 34b, in one embodiment, the milling bit handle 530 is connected to the housing 522 (part of which is shown) in any conventional manner. The handle 530 extends from the housing 522 through a slot 532 formed in the near end 534 of the milling guide 500 to the surgeon (not shown). In this way, the handle 530 can be translated by the surgeon, thereby translating the milling bit 510 through the curved opening 504. In this way, the handle 530 is configured to impart translational motion to the milling bit 510. A pair of support assemblies 512, 514 are placed adjacent to the housing 522 to guide the milling bits 510 along the curved openings to accommodate the movement of the milling bits 510 within the curved opening 504. May be good.

Housing 522 houses a rotating assembly that is, in one embodiment, a gear assembly 524. The gear assembly 524 comprises a drive gear 526 that is connected to a rotatable shaft 528 and extends annularly around it. The shaft 528 is rotatable via an external source represented by the power supply 516 (FIG. 35). In one embodiment, the shaft 528 is housed within the handle 530.

The gear assembly 524 further comprises a bit gear 530 connected to the milling bit 510 and extending annularly around it. The bit gear 530 is arranged on the milling bit 510 so that the bit gear is perpendicular to the drive gear 526 and is in contact with the drive gear. That is, the rotation of the shaft 528 imparts rotation to the milling bit 510 via the gear assembly 524. A pair of annular shoulders 534, 536 also allows the milling bit to easily move back and forth through a curved opening 504 without sliding up or down as shown in Figure 34b. It is connected to 510. It should be understood that the gear assembly 524 is merely an example of the assembly used to impart rotational motion to the milling bit 510. Other types of rotation-giving assemblies, such as pneumatic type systems, are contemplated as within this disclosure.

With reference to FIG. 34c, in one such embodiment, the pneumatic system 538 may be employed to impart rotation to the milling bit 510. In one embodiment, a Medtronic Midas Rex® Legend® motor is used to power the pneumatic system (represented by P). A conventional valve 539 is used to control the airflow and pressure supplied to rotate the milling bit 510. In yet another embodiment, the manual or combinational power supplies are intended to be the preferred power supplies 516 (FIG. 34b) and P (FIG. 34c).

With reference to FIGS. 34a and 34b, a guide handle 540 is further provided so that the milling guide 500 can move independently of the milling bit 510. Thus, in one embodiment, the milling guide 500 can be held via the guide handle 540 while the milling bit 510 can be moved through the handle 530 within the curved opening 504. In some embodiments, the handle 530 extends through the guide handle 540 as shown in FIG. 34b. As a result, referring to FIG. 35, the milling bit 510 is configured to rotate in the direction indicated by arrow R1 and translate through an opening 504 curved in the direction indicated by arrow R2. There is.

During the operation, the vertebral body V so that the milling guide 500 and the milling tool 502 receive the lower part of the artificial joint 410._LCan be used to cut slots such as slot 472 to prepare. The surgeon first selects the desired amount of curvature to impart to slot 472 and then selects or configures the corresponding milling guide 500. The surgeon then puts the Milling Guide 500 on the superior and inferior vertebrae V_U, V_LPlaced in the intervertebral space between, milling bits 510 are placed on the superior and inferior vertebrae V_U, V_LFrom the transforaminal approach to the vertebral body V_LApproach. Properly placed, the surgeon then uses the milling bit 510 to the superior and inferior vertebrae V._U, V_LThe milling tool 502 is actuated via the power supply 516 to initiate the cutting inside.

The milling guide 500 may be held by the surgeon or via an external instrument so that the milling guide is stationary while the milling bit 510 is translating through the milling guide. The curvature of the milling guide 500 is the inferior vertebra V in Figure 32._LUpper and lower vertebrae V to cut transforaminal slots such as slot 472 shown within and prepare the upper and lower vertebrae to receive the facet prosthesis 410._U, V_LGuide the milling bit 510 through the intervertebral foramen.

In an alternative embodiment, the keel of the prosthesis 410 may take an alternative shape and configuration to assist in the curved, transforaminal approach used to insert the joint. With reference to FIGS. 36-38, the keels shown by reference numerals 550 and 560 extend from the support surfaces 434 and 420, respectively. The keels 550 and 560 are relatively short compared to the keels 450 and 426 of FIGS. 28-30 and therefore extend along the short portions of the support surfaces 434 and 420, respectively. The relatively short keels 550 and 560 help such keels follow openings 470 and 472, respectively. In addition, the relatively short keels and the ease with which such keels can follow openings 470, 472, respectively, allow the keels to be configured as either straight or curved keels. Increases design options for artificial joint 410. Keels 550 and 560 also have superior and inferior vertebrae V_U, V_LIt may be tapered to assist in inserting the keel in.

<u style="single">IV Anterior tilt prosthesis</u> Another approach that can be used to avoid potential damage to important anatomical structures such as nerve roots, dura mater, ligamentum flavum and interspinous ligament is the anterior tilt approach. For example, the intervertebral space between vertebrae L4 and L5, and the linear anterior approach to the upper disc level, during the insertion of a total disc replacement implant, because major vessels are attached to the anterior side of the spinal column. There may be a high surgical risk.

With reference to FIGS. 39 to 41, a facet joint artificial joint 600 according to another form of the present disclosure is shown. The artificial joint 600 extends substantially along the longitudinal axis L and comprises a first joint component 602 and a second joint component 604. The joint components 602, 604 work together to form an artificial joint 600 sized and shaped to be placed in the intervertebral space between adjacent vertebral bodies.

The prosthesis 600 provides relative pivotal and rotational movements between adjacent vertebral bodies to maintain or restore movements similar to those of normal biomechanical movements provided by natural intervertebral discs. More specifically, the joint components 602, 604 include several axes, including lateral or lateral pivotal movements around the longitudinal axis L, and anterior-posterior pivotal movements around the lateral axis T. Are allowed to move around each other. Understand that in one embodiment, the joint components 602, 604 are allowed to pivot relative to each other around any axis in the plane intersecting the longitudinal axis L and the transverse axis T. I want to be. Also, the joint components 602, 604 are allowed to rotate relative to each other around the axis of rotation R. Although the articulated joint 600 is illustrated and described as providing a particular combination of joint movements, other combinations of joint movements are also possible and such movements are within the scope of the present disclosure. Please understand that it is intended to be. It should be understood that other types of joint movements, such as relative parallel or linear movements, are also contemplated.

The joint components 602 and 604 of the artificial joint 600 are made of a wide variety of materials, but in one embodiment of the present disclosure, the joint components 602 and 604 are cobalt-chromoly-molybdenum metal alloys (ASTM F-). It is made of 799 or F-75). However, in an alternative embodiment of the present disclosure, the joint components 602, 604 are other materials, such as a polymeric material such as titanium or stainless steel, polyethylene, or other biocompatible materials apparent to those skilled in the art. May be formed with. The surfaces of the joint components 602, 604, which are placed in direct contact with the vertebrae, are preferably coated with a bone growth-promoting substance, such as a hydroxyapatite coating formed of calcium phosphate. Also, the surfaces of the joint components 602, 604, which are placed in direct contact with the vertebrae, may preferably be roughened before being coated with a bone growth promoter to further strengthen the growing bone. Such surface roughening may be achieved using, for example, acid etching, knurling, bead coating adhesion, or other roughening methods performed by those skilled in the art.

The joint component 602 comprises a support plate 610 having a joint joint surface 612 and an opposing support surface 614. The support plate 610 is sized and shaped to substantially correspond to the size and shape of the vertebral endplates of adjacent vertebrae. In one embodiment, the support plate 610 is triangularly shaped to facilitate a tilted insertion approach from either the left or right side of the spinal column and comprises side portions P1, P2 and P3. The side portions P1, P2 and P3 may take various shapes, including curved shapes (shown by P2) or straight shapes (shown by P1 and P3).

The support plate 610 receives or engages the corresponding portion of a surgical instrument (also not shown) to assist in the operation and insertion of the prosthesis 600 in the intervertebral space between adjacent vertebrae. It has one or more notches 616 or other types of indicators to do. Surgical instruments (not shown) hold joint components 602, 604 in a predetermined direction and in a predetermined spatial relationship to each other during operation and insertion of the prosthesis 600 and are precisely placed between adjacent vertebrae. It is preferably configured to release the posterior joint components 602, 604.

In one embodiment, the articulated surface 612 comprises a protrusion 620 having a convex shape. The protrusions may be configured as spherical balls (half of which are shown). It should be understood that protrusions 620 of other shapes, such as cylindrical, oval or other arcuate or possibly non-arcous shapes, are also contemplated. It should be understood that the rest of the articulated surface 612 may take a planar or non-planar shape, for example a square or conical shape extending around the protrusion 620.

A flange member or keel 640 extends from the support surface 614 and is configured to be placed within a preformed opening within the adjacent vertebral endplate. In one embodiment, the keel 640 extends vertically from the support surface 614 and is located approximately centered along the support surface 614. However, it should be understood that other positions and orientations of the keel 640 are also intended. Also, more keel 640 may be used for similar or additional reasons.

In one embodiment, the keel 640 extends along approximately a portion of the support plate 610. The keel 640 is straight, but extends along the direction towards the notch 616 and is parallel to one of the side portions P1 of the support plate 610. In this embodiment, the keel 640 is arranged between the lateral axis T and the lateral axis L. Such an embodiment is adapted for insertion of the prosthesis 600 using an orthorhombic approach, which is the opposite of the anterior, lateral or transforaminal approach discussed above. In a further embodiment, the keel 640 may be tilted, tapered, or in some other shape to facilitate the functional requirements of the keel. In yet another embodiment, the keel 640 may be configured as a winged keel with a lateral portion (not shown) extending across the main body portion of the keel 640.

The keel 640 comprises a pair of openings 646 extending through it. This facilitates bone growth through the opening to enhance fixation with adjacent vertebrae. A gap 648 can also be formed within the keel 640 to further facilitate bone growth through it. The gap 648 also provides a reference point so that X-rays can be used to evaluate the position and integrity of the support plate 602 during the insertion of the prosthesis 600. It should be appreciated that any number of openings 646 and gaps 648, including a single opening or gap, or several openings or gaps, may be defined through the keel 640. It should also be understood that the opening 646 and the gap 648 do not necessarily extend completely through the keel 640 and may otherwise extend partially through it. It should also be further understood that the keel 640 does not necessarily have to define an opening 646 or a gap 648 that partially or wholly passes through the keel. It should also be appreciated that although the opening 646 is illustrated to have a circular shape, other sizes and shapes of the opening 646 are also contemplated. As discussed above, the surface of the joint component 602 in direct contact with the vertebra may be coated with a bone growth promoter. In particular, the surfaces of the support surface 614 and keel 640 may be coated with hydroxyapatite to facilitate bone engagement with adjacent vertebrae. Again, as discussed above, the surfaces of the support surface 614 and keel 640 may be roughened prior to the attachment of the hydroxyapatite coating.

In one embodiment, the joint component 604 comprises a support plate 650 with a joint joint surface 652 and an opposing support surface 654. The support plate 650 is sized and shaped to roughly correspond to the size and shape of the vertebral endplates of adjacent vertebrae. In one embodiment, the support plate 610 is triangularly shaped to facilitate a tilted insertion approach from either the left or right side of the spinal column and comprises side portions P4, P5 and P6. The side portions P4, P5 and P6 may take various shapes, including curved shapes (shown by P5) or straight shapes (shown by P4 and P6). The support plate 650 is one or more notches 656 or other type of indicator for receiving or engaging the corresponding portion of the surgical instrument, as discussed above with reference to the joint component 602. Can be provided.

In one embodiment, the articulated surface 652 comprises a recess 660 having a concave shape, such as the shape of a spherical socket. However, it should be understood that other shapes of indentations 660, such as, for example, cylindrical, oval or other arcuate or possibly non-arcous shapes, are also contemplated. The rest of the articulated surface 652 can be configured to facilitate insertion and / or use of the artificial bone if it is tilted or otherwise.

The concave recess 660 is shown to have a nearly smooth, continuous surface, but the surface depressions or cavities placed between the abutting surfaces of the joint components 602, 604 are particulate. It should be understood that demarcations may be made along a portion of the indentation 660 to provide a means for cleaning substances such as dust. In such cases, the convex joint surface of the ball 620 may otherwise define a nearly smooth, continuous joint surface. In another embodiment, the convex protrusions 620 and the concave recesses 660 may also define surface depressions to facilitate the removal of particulate matter placed between the abutting articulated surfaces. Good.

A flange member or keel 670 configured similar to the keel 640 of the joint component 602 extends from the support surface 654. In one embodiment, the keel 670 is centrally located and placed either directly or side by side with the keel 640. The keel 640 is straight, but extends along the direction towards the notch 656 and is parallel to one of the side portions P4 of the support plate 650. Such an embodiment fits the insertion of the prosthesis 600 using a tilted approach that is different from the anterior, lateral, transvertebral foramen approach discussed above. In some embodiments, the position of the keel 670 is offset from the center to assist in bypassing veins, arteries, bones, or other obstacles that are placed during the insertion of the prosthesis 600. May be good.

It should be further understood that other positions, shapes, orientations and quantities of the keel 670 are intended. It should also be understood that more keel 670 may be used for similar or additional reasons. The keel 670 may also be tilted, tapered, or otherwise shaped to facilitate the functional requirements of the keel. In yet another embodiment, the keel 670 may be configured as a winged keel with a lateral portion (not shown) extending across the main body portion of the keel 670. In one embodiment, the keel 670 comprises a pair of openings 676 extending through the keel. This facilitates the growth of bone through it in order to strengthen its fixation with adjacent vertebrae. A gap 678 may also be formed within the keel 670 to further facilitate bone growth through it. The gap 678 also provides a reference point so that X-rays can be used to evaluate the position and integrity of the support plate 604 during the insertion of the prosthesis 600. It should be appreciated that any number of openings 676 and 678, including a single opening or gap, or several openings or gaps, may be defined through the keel 670. It should also be understood that the openings 676 and the gap 678 do not necessarily extend completely through the keel 670 and may otherwise extend partially through the keel. It should also be further understood that the keel 670 does not necessarily have to define an opening 676 or a gap 678 through the keel partially or wholly. It should also be appreciated that although the opening 676 is illustrated to have a circular shape, other sizes and shapes of the opening 676 are also contemplated. As discussed above, the surface of the joint component 602 in direct contact with the vertebrae is preferably coated with a bone growth promoter. In particular, the surfaces of the support surface 654 and keel 670 may be coated with hydroxyapatite to facilitate bone engagement with adjacent vertebrae. Again, as discussed above, the surfaces of the support surface 654 and keel 670 may be roughened prior to the attachment of the hydroxyapatite coating.

In some embodiments, one or both of the keels 640, 670 may include a sharp front edge, as indicated by the edges 680, 682. Having such an edge facilitates insertion of the keels 640, 670 into the associated vertebral body. The edges 680, 682 may also be sharp enough so that the vertebral body does not require a slot to receive the keels 640, 670, which will be discussed in more detail below.

With reference to FIGS. 42-44a, the superior and inferior vertebrae V to accommodate the insertion of the artificial joint 600 in the intervertebral space._U, V_LCan be prepared to receive an artificial joint 600 between them. With particular reference to FIG. 43, for the shape of the prosthesis 600 of FIGS. 38-40, a large number of slots 690, 692 have the upper vertebrae V, respectively._UAnd lower vertebra V_LIt is formed along the vertebral endplates of. Slots 690, 692 may be created by the keels 640, 670 itself, or may be pre-prepared by one or more of the methods discussed above. As can be seen from FIGS. 42-44, if one or more vessels 694 interfere with the linear anterior approach, the tilted approach allows for anterior / lateral insertion. The design of the implant 600 is also vertebral V_U, V_LEnsure a sufficient contact surface for contact with the vertebral endplates.

With reference to FIG. 44b, in one embodiment, the prosthesis 600 is inserted into the intervertebral space via a device such as a guide described in Simultaneously Pending U.S. Patent Application No. 10 / 430,473, which is incorporated herein by reference. can do. An example of the insertion process for inserting an artificial joint 600 is the vertebra V._U, V_LMedian M is detected using an imaging device and pin 695 is along the median upper vertebra V_UInserted inside. The tilt guide member 696 is then connected to the pin 695 via a flange 697, and the handle (not shown) associated with the tilt guide member 696 is then adjusted to the appropriate position. The tilt pin 698 of the tilt guide member is then the superior vertebra V to secure the tilt guide member._UDriven in, thereby marking the insertion reference point and implant insertion direction for the prosthesis 600. A guide (not shown) is then used to implant the prosthesis 600 into the intervertebral space by an anterior tilt approach, the details of which are discussed more fully in co-pending U.S. Patent Application No. 10 / 430,473. To.

<u style="single">V. Movable support artificial joint</u> In another embodiment, the artificial joint described above is modified to allow translation as well as rotational movement. For example, with reference to FIGS. 45-47, movable support prostheses for anterior insertion are generally indicated by reference numeral 700. It should be understood that the Movable Support Artificial Joint 700 has been described with respect to anterior insertion for clarity only, and therefore various insertion directions are intended for Movable Support Artificial Joints.

The prosthesis 700 extends approximately along the longitudinal axis L and comprises a first joint component 702 and a second joint component 704. Joint components 702 and 704 are adjacent vertebral bodies V_S, V_ICollaborate to form an artificial joint 700 sized and shaped to be placed within the intervertebral space between a pair of vertebral bodies, such as the intervertebral space S1 between (FIG. 48).

The prosthesis 700 is an adjacent vertebral body V to maintain or restore movement by the natural intervertebral disc, but with an additional element of translation, much like normal biomechanical movement._S, V_IProvides relative pivotal and rotational movements between. More specifically, the joint components 702, 704 include several axes, including lateral or lateral pivotal movements around the longitudinal axis L, and anterior-posterior pivotal movements around the lateral axis T. Are allowed to move around each other. It should be understood that in one embodiment, the joint components 702, 704 are allowed to pivot with respect to each other around any axis in the plane intersecting the longitudinal axis L and the transverse axis T. Also, the joint components 702, 704 are allowed to rotate relative to each other around the axis of rotation R. Also, the joint components 702, 704 are allowed to translate with respect to each other, as described further.

The joint components 702, 704 of the prosthesis 700 are made of a wide variety of materials, but in one embodiment the joint components 702, 704 are cobalt-chromium-molybdenum metal alloys (ASTM F-799 or F). It is formed by -75). However, in an alternative embodiment, the joint components 702, 704 are formed of a polymeric material such as titanium or stainless steel, polyethylene, or other material such as other biocompatible materials known to those of skill in the art. May be good. The surfaces of the joint components 702, 704 placed in direct contact with the vertebrae may be coated with a bone growth-promoting substance such as hydroxyapatite formed of calcium phosphate. Also, the surfaces of the joint components 702, 704, which are placed in direct contact with the vertebrae, may be roughened before being covered with a bone growth promoter to further strengthen the growing bone. Such surface roughening may be achieved using, for example, acid etching, knurling, bead coating adhesion, or other roughening methods performed by those skilled in the art.

The joint component 702 comprises a support plate 706 with a joint joint surface 708 and an opposing support surface 710. The support plate 706 is sized and shaped to roughly correspond to the size and shape of the vertebral endplates of adjacent vertebral bodies. The support plate 706 receives or receives a corresponding portion of a surgical instrument (also not shown) to assist in the operation and insertion of the articulated joint 700 in the intervertebral space between adjacent vertebrae. It comprises one or more notches 712 or other indicators to engage with it. Surgical instruments (not shown) preferably hold components 702, 704 in a predetermined direction and in a predetermined spatial relationship to each other during operation and insertion of the articulated joint 700 and between adjacent vertebrae. It is configured to release components 702, 704 after being placed correctly in.

In one embodiment, and with reference to FIGS. 49a and 49b, a depression 714 is formed within the articulated surface 708. The peripheral edge 716 defining the indentation 714 along the articulated surface 708 is concentric with the indentation surface 718, but the perimeter is smaller than the indentation surface due to the expanding circular side surface 720 of the indentation 714 (Fig. 48b). Has a diameter. Although described for having a circular shape, the indentation 714 may take any number of shapes, such as a square, triangular or rectangular shape.

With reference to FIGS. 50a and 50b, the indentation 714 (FIG. 49b) is designed to accommodate the modular protrusion 722. The protrusion 722 includes a flange portion 724 shaped to correspond to the shape of the recess 714. Similarly, the flange portion 724 includes a peripheral edge portion 726 having an extension ending in a substantially planar engaging surface 728. The engaging surface 728 is configured to engage the substantially flat recessed surface 718 (FIG. 49b). However, although shown as a nearly planar engaging surface 728, it should be understood that the engaging surface 728 and the recessed surface 718 may take any number of corresponding shapes. The diameter of the engaging surface 728 is smaller than the diameter of the recessed surface 718, thereby allowing the modular projection member 722 to translate with respect to the joint component 702.

The rest of the modular protrusion 722 may be configured as a spherical ball (half of which is shown). It should be understood that protrusions 730 of other shapes, such as cylindrical, oval or other arcuate or possibly non-arcous shapes, are also contemplated. It should be understood that the rest of the articulated surface 708 may take a planar or non-planar shape, for example a square or conical shape extending around the protrusion 224.

In one embodiment, the convex articulated surface of the protrusion 730 is blocked by a surface depression or cavity 732 extending along the protrusion 730. In one embodiment, the surface recessed portion 732 is configured as a groove. However, it should be understood that other types of surface depressions are also contemplated, including the absence of depressions. One purpose of the groove 732 is to facilitate the removal of material placed between the abutments of the joint components 702, 704. More specifically, the groove 732 assists in cleaning materials such as particulate material placed between the abutting articulated surfaces of the components 702, 704.

With reference to FIGS. 45 and 49b, a flange member or keel 740 extends from the support surface 710 and is adjacent to the vertebral endplate (V in FIG. 47)._IEtc.) are configured to be placed in a preformed opening. In one embodiment, the keel 740 extends approximately vertically from the support surface 710 and is located approximately centrally along the support surface 710. However, it should be understood that other positions and orientations of the keel 740 are also conceived.

In one embodiment, the keel 740 extends approximately along the entire length of the support plate 706. Such an embodiment corresponds to the insertion of an articulated joint 700 using an anterior approach. However, as discussed above, other approaches such as the lateral approach, transvertebral foramen approach, and anterior tilt approach are also contemplated for the insertion of the prosthesis 700. In a further embodiment, the keel 740 may be configured in a slanted, tapered or other shape to facilitate the functional requirements of the keel. In yet another embodiment, the keel 740 may be configured as a winged keel with lateral portions (not shown) extending across the main body portion of the keel 740.

The keel 740 comprises a pair of openings 742 that extend through the keel. This facilitates bone growth through it to enhance fixation with adjacent vertebrae. However, it should be understood that any number of openings 742, including a single opening or three or more openings, may be defined through the keel 740. It should also be understood that the opening 742 does not necessarily have to extend completely through the keel 740 and may optionally extend partially through the keel. It should also be further understood that the keel 740 does not necessarily have to define an opening 742 that partially or wholly passes through the keel. It should also be appreciated that although the opening 742 is illustrated to have a circular shape, other sizes and shapes of the opening 742 are also contemplated. As discussed above, the surface of the joint component 702 in direct contact with the vertebrae is preferably coated with a bone growth promoter. In particular, the surfaces of the support surface 710 and keel 740 may be coated with hydroxyapatite to facilitate bone engagement with adjacent vertebrae. Again, as discussed above, the surfaces of the support surface 710 and keel 740 may be roughened prior to the attachment of the hydroxyapatite coating.

Referring to FIGS. 45-47, in one embodiment, the joint component 704 comprises a support plate 750 having a joint joint surface 752 and an opposing support surface 754. The support plate 750 is sized and shaped to roughly correspond to the size and shape of the vertebral endplates of adjacent vertebrae. The support plate 750 is one or more notches 756 or other type of indicator for accepting or engaging the corresponding portion of the surgical instrument, as discussed above with reference to the joint component 702. To be equipped.

In one embodiment, the articulated surface 752 comprises a recess 758 (FIG. 47) having a concave shape, such as the shape of a spherical socket. However, it should be understood that indentations 758 of other shapes, such as cylindrical, oval or other arcuate shapes or perhaps non-arctic shapes, are also contemplated. The rest of the articulated surface 752 can be configured to facilitate insertion and / or use of the articulated joint 700 if it is tilted or otherwise. The concave recess 758 is shown to have an overall smooth, continuous surface, but the surface depressions or cavities placed between the abutting surfaces of the articular elements 702, 704 are particulate. It should be understood that it may be defined along a portion of the indentation 758 to provide a means for cleaning substances such as dust. In such a case, the convex joint surface of the protrusion 730 may otherwise define a continuous joint surface that is smooth overall. In another embodiment, a convex protrusion 730 and a concave recess 758 define a surface depression to facilitate the removal of particulate matter placed between the abutting articulated surfaces. May be good.

A flange member or keel 760 configured similar to keel 740 of joint component 702 extends from the support surface 754. In one embodiment, the keel 760 extends vertically from the support surface 754 and is located approximately centered along the support surface 754. However, it should be understood that other positions and orientations of the keel 760 are also conceived. It should be understood that the joint component 704 may include two or more keels 760 extending from the support surface 754.

In one embodiment, the keel 760 extends approximately along the entire length of the support plate 750. Such an embodiment corresponds to the insertion of an artificial joint 700 using an anterior approach. However, as discussed above, other approaches such as the lateral approach, transvertebral foramen approach, and anterior tilt approach are also contemplated for the insertion of the prosthesis 700. In a further embodiment, the keel 760 may be tilted, tapered, or otherwise shaped to facilitate the functional requirements of the keel. In yet another embodiment, the keel 760 may be configured as a winged keel with a lateral portion (not shown) extending across the main body portion of the keel 760.

The keel 760 comprises a pair of openings 762 extending through it. This facilitates bone growth through it to strengthen fixation with adjacent vertebrae. However, it should be understood that any number of openings 762, including a single opening or three or more openings, may be defined through the keel 760. It should also be understood that the opening 762 does not necessarily have to extend completely through the keel 760 and may optionally extend partially through the keel. It should also be further understood that the keel 760 does not necessarily have to define an opening 762 that partially or wholly passes through the keel. It should also be appreciated that although the opening 762 is illustrated to have a circular shape, other sizes and shapes of the opening 762 are also contemplated. As discussed above, the surface of the joint component 704 in direct contact with the vertebrae is preferably coated with a bone growth promoter. In particular, the surfaces of the support surface 754 and keel 760 may be coated with hydroxyapatite to facilitate bone engagement with adjacent vertebrae. Again, as discussed above, the surfaces of the support surface 754 and keel 760 may be roughened prior to the attachment of the hydroxyapatite coating.

In some embodiments, one or both of the keels 740, 760 may include a sharp front edge as indicated by the edge 760a in FIGS. 45 and 46. Having such an edge facilitates insertion of the keels 740, 760 into the associated vertebral body. The margin 760a may also be sharp enough so that the vertebral body does not require a slot to receive the keel 760, which is discussed in more detail below.

Referring to FIG. 45, the movable support prosthesis 700 is assembled by inserting a modular projection 772 member into a recess 714 formed within the joint joint surface 708 of the joint component 702. During assembly, the artificial joints 700 are adjacent to each other in the vertebral body V._S, V_IPrepared to be inserted into the intervertebral space S1 between (FIG. 48).

Referring to FIG. 48, the adjacent vertebral body V to accommodate the insertion of the prosthesis 700 in the intervertebral space S1._S, V_IMay be prepared to receive a prosthesis 700 between them. For the shape of the artificial joint 700 in FIGS. 45 to 47, slots 770 and 772 have vertebrae V, respectively._SAnd vertebra V_IIt is formed along the vertebral endplates of. Slots 770, 772 may be created by the keels 740, 760 itself, or may be pre-prepared by one or more of the methods discussed above.

Upon insertion into the intervertebral space S1, the prosthesis 700 translates the joint component 704 into parallel motion with respect to the joint component 702 due to engagement of the joint component 704 of the modular projection 722 with the concave recess 758. forgive. For example, in FIG. 51, the modular protrusion 722 is shown in the posterior position (resulting in the posterior movement of the joint component 704 in the posterior direction P), whereas in FIG. 52, the modular protrusion 722 is shown. It is indicated by the anterior position (resulting in the anterior movement of the joint component 704 in the anterior direction A). Figures 51 and 52 are, of course, merely examples of the translations made possible by the implementation of the modular protrusion 722 and the corresponding indentation 714, and therefore the joint component 702 of the modular protrusion 722, and thus the joint component 704. The amount of translation with respect to is may vary, including in directions other than P and A.

Also, the arrangement of the modular projection member 722 in the recess 714 of the joint component 702 allows the modular projection to rotate at high speed with respect to the joint component 702. Thus, in such an embodiment, the modular projection member 722 imparts rotation (via engagement with the indentation 758) to the joint component 704 independently of the translational motion imparted to the joint component 704. Add the advantage of being able to. Such an independent relationship between translation and rotational movement adds to the momentum received by the artificial joint 700 compared to artificial joints in which translation depends on rotational movement and vice versa.

The present disclosure is described for some preferred embodiments. Any improvements or amendments that will become apparent to those skilled in the art after reading this disclosure are believed to be within the spirit and scope of this application. For example, the joint components of the articulated joint described above may be reversed without departing from certain aspects of the present disclosure. Therefore, some modifications, changes and alternatives are contemplated in the aforementioned disclosures, and in some examples some features of this disclosure are adopted without the corresponding use of other features. Please understand that.

It should also be understood that all spatial symbols such as "vertical" and "horizontal" are for illustrative purposes only and may vary within the scope of the present disclosure. It will therefore be appreciated that the appended claims are broadly construed to be consistent with the scope of the present disclosure.

<figref num="1">It is a side view of a part of the spinal column.</figref><figref num="2">It is a side view of a pair of adjacent vertebral endplates of FIG.</figref><figref num="3">FIG. 3a is a side view of a pair of adjacent vertebral endplates of FIG. 2 with a rod and screw configuration, and FIG. 3b is a longitudinal partial cross-sectional view of a pair of adjacent vertebral bodies of FIG. 3a.</figref><figref num="4">FIG. 4a is an isometric view of a joint-joint artificial joint for lateral insertion according to one embodiment of the present disclosure, and FIG. 4b is a joint-joint artificial joint for lateral insertion according to another embodiment of the present disclosure. It is an isometric view of the artificial joint, and FIG. 4c is a front view of the joint-joint type artificial joint for lateral insertion in FIG. 4b.</figref><figref num="5">It is a vertical view of the artificial joint of FIG. 4a.</figref><figref num="6">It is a side view of the artificial joint of FIG. 4a.</figref><figref num="7">It is a lateral partial sectional view of the artificial joint of FIG. 4a arranged between a pair of vertebral endplates.</figref><figref num="8">FIG. 3 is a lateral partial cross-sectional view of an alternative articulated artificial joint placed between a pair of vertebral endplates.</figref><figref num="9">FIG. 3 is an isometric view of an alternative articulated joint according to another embodiment of the present disclosure.</figref><figref num="10">It is a lateral partial sectional view of the artificial joint of FIG. 9 arranged between a pair of vertebral endplates.</figref><figref num="11">FIG. 3 is a lateral partial cross-sectional view of an alternative articulated artificial joint placed between a pair of vertebral endplates.</figref><figref num="12">FIG. 3 is an isometric view of an artificial intervertebral disc according to another embodiment of the present disclosure.</figref><figref num="13">FIG. 3 is an isometric view of an alternative artificial intervertebral disc according to another embodiment of the present disclosure.</figref><figref num="14">FIG. 3 is an isometric view of an alternative articulated artificial joint for anterior insertion according to another embodiment of the present disclosure.</figref><figref num="15">It is a vertical view of the artificial joint of FIG.</figref><figref num="16">It is a side view of the artificial joint of FIG.</figref><figref num="17">It is a side view of the artificial joint of FIG. 14 arranged between a pair of vertebral endplates.</figref><figref num="18">FIG. 3 is a longitudinal view of an alternative articulated artificial joint for anterior insertion according to another embodiment of the present disclosure.</figref><figref num="19">FIG. 3 is a longitudinal view of an alternative articulated artificial joint for anterior insertion according to yet another embodiment of the present disclosure.</figref><figref num="20">FIG. 3 is a longitudinal view of an alternative articulated artificial joint for anterior insertion according to yet another embodiment of the present disclosure.</figref><figref num="21">FIG. 18 is a longitudinal view of a pair of vertebral endplates with slots for receiving artificial joints in FIG.</figref><figref num="22">FIG. 19 is a longitudinal view of a pair of vertebral endplates with slots for receiving artificial joints in FIG.</figref><figref num="23">FIG. 20 is a longitudinal view of a pair of vertebral endplates with slots for receiving artificial joints in FIG.</figref><figref num="24">FIG. 6 is a lateral partial cross-sectional view of an artificial joint of FIG. 14 placed between a pair of vertebral endplates and an orthopedic implant.</figref><figref num="25">FIG. 4 is a lateral partial cross-sectional view of FIG. 14 placed between a pair of vertebral endplates and lug screws.</figref><figref num="26">FIG. 5 is a schematic top view of the configuration shown in FIG.</figref><figref num="27">It is a top surface schematic view of a vertebral body showing a route for transforehead insertion.</figref><figref num="28">FIG. 3 is an isometric view of an alternative articulated artificial joint for transvertebral foramen insertion according to another embodiment of the present disclosure.</figref><figref num="29">It is a side view of the artificial joint of FIG. 28.</figref><figref num="30">It is a vertical view of the artificial joint of FIG. 28.</figref><figref num="31">FIG. 31a is a lateral partial cross-section of the artificial joint of FIG. 28 placed between the pair of vertebral end plates, and FIG. 31b is a longitudinal partial cross-section of the artificial joint of FIG. 28 placed between the pair of vertebral end plates. It is a figure.</figref><figref num="32">It is a top view which shows the transvertebral foramen slot formed in the vertebral end plate.</figref><figref num="33">FIG. 5 is a top schematic showing a milling device inserted and shown above the vertebral endplate.</figref><figref num="34a">It is a side view of the milling apparatus of FIG. 33 shown arranged between a pair of adjacent vertebral endplates.</figref><figref num="34b">It is a detailed view of the milling tool of the milling apparatus of FIG. 34a.</figref><figref num="34c">It is a detailed view of the alternative milling tool.</figref><figref num="35">It is the schematic of the milling apparatus of FIG. 33.</figref><figref num="36">FIG. 3 is an isometric view of an alternative articulated artificial joint for transvertebral foramen insertion according to another embodiment of the present disclosure.</figref><figref num="37">It is a side view of the artificial joint of FIG. 36.</figref><figref num="38">It is a vertical view of the artificial joint of FIG. 36.</figref><figref num="39">FIG. 3 is an isometric view of an alternative articulated artificial joint for anterior tilt insertion according to another embodiment of the present disclosure.</figref><figref num="40">It is a vertical view of the artificial joint of FIG. 39.</figref><figref num="41">It is a side view of the artificial joint of FIG. 39.</figref><figref num="42">FIG. 3 is a lateral partial cross-sectional view of the artificial joint of FIG. 39 arranged between a pair of vertebral endplates.</figref><figref num="43">It is a longitudinal partial cross-sectional view of the artificial joint of FIG. 39 arranged between a pair of vertebral endplates.</figref><figref num="44a">FIG. 9 is a schematic top view showing a slot formed in the end plate of the vertebral bone for receiving the artificial joint of FIG. 39.</figref><figref num="44b">FIG. 39 is a schematic diagram showing an alignment process associated with the insertion of an artificial joint in FIG. 39.</figref><figref num="45">FIG. 3 is an exploded view of an alternative artificial joint according to yet another embodiment of the present disclosure.</figref><figref num="46">It is an isometric view of the artificial joint of FIG. 45.</figref><figref num="47">It is a vertical view of the artificial joint of FIG. 46.</figref><figref num="48">It is a longitudinal view of a pair of adjacent vertebral endplates.</figref><figref num="49">FIG. 49a is a longitudinal view of the joint component of the artificial joint of FIG. 45, and FIG. 49b is a cross-sectional view of the joint component of FIG. 49a along lines 49b-49b.</figref><figref num="50">50a is a plan view of the modular protrusion member of the artificial joint of FIG. 45, and FIG. 50b is a cross-sectional view of the modular protrusion member of FIG. 50a along line 50b-50b.</figref><figref num="51">FIG. 5 is a plan view of the modular projection member of FIG. 50a inserted into the joint component of FIG. 49a.</figref><figref num="52">FIG. 5 is a plan view of the modular protrusion member of FIG. 50a inserted into the joint component of FIG. 49a, showing the modular protrusion members at different positions with respect to FIG. 51.</figref>