Vertebral support device

The present invention relates to intervertebral devices and prostheses that can be implanted in the spinal column, and more particularly to vertebral support devices.

Vertebrae support that is implanted in the vertebrae to support the vertebrae while still giving the vertebrae some freedom of movement and, as a result, preventing joint fusion of these vertebrae, unlike various known osteosynthesis devices. It is advantageous to have a device.

Various types of osteosynthesis devices are described, for example, in WO 02/080788 and Pamphlet 95/10240, as well as US Pat. Nos. 5,603,714 and US Pat. No. 5,437,669. These devices include at least two bone fixation implants, each of which is fixed to the vertebrae and uses fixtures such as clamps to securely attach the bone fixation implant to the connecting element. Then, they are connected to each other by a connecting element (bone-joining bar). By immobilizing the vertebrae in which the device is implanted, this type of device is used to achieve facet joint fusion, reduce spondylolisthesis, or correct scoliosis or other malformations of the spinal column. Will be done. In addition, International Publication No. 03/049629, European Patent No. 0572790, International Publication No. 2005/020829, International Publication No. 00/15125, and US Patent No. 5,501,684 are osteosynthesis devices. Describes different types of vertebral fixation implants that facilitate the attachment of elements, reduction of spondylolisthesis, or correction of spinal malformations to varying degrees. However, these devices do not give the vertebrae freedom of movement and cause joint fusion in the vertebrae in which the device is implanted. This has the disadvantage for the patient that movement is restricted and the stress normally applied to these vertebrae is transmitted to the adjacent vertebrae and adjacent intervertebral discs. WO 02/080788, Pamphlet 03/049629 and Pamphlet 2005/020829 are assigned to the assignee of this application and are effectively incorporated herein by reference.

Other references describe vertebral support devices with bone fixation implants that are connected to each other by flexible connecting elements. For example, US Pat. No. 5,672,175, US Pat. No. 4,743,260 and US Pat. No. 7,083,622 describe a spinal support device having implants connected to each other by flexible bars. These devices allow only lateral movement, thus adjusting the stress generated laterally with respect to the axis of the spine, but not the stress in the flexion or extension direction of the spine. WO 91/16018 (corresponding to European Patent No. 0381588), WO 2004/089244 (corresponding to US Pat. No. 6,966,910), and WO 03/037216 (corresponding to US Pat. No. 6,966,910). US Pat. No. 6,783,527 (corresponding to US Pat. No. 6,783,527) describes a spinal support device that generally includes elastic ligaments in which the connecting elements between implants maintain permanent tension between implants. This type of elastic ligament, used alone, has the disadvantage that it is not possible to maintain space between the vertebrae, it tends to join the vertebrae to which the implant is mounted and the implant to each other, and the connecting element to the implant. It is not possible to adjust the orientation of the or the position of the joint connection. International Publication No. 98/22033 Pamphlet (US Pat. No. 6,267, (Corresponding to specification 764) and International Publication No. 2005/030031 Pamphlet are provided with elastic ligaments fixed to bars connected to implants, which allows the position of joint connections between implants to be measured. Describes the device. However, these devices are still not capable of maintaining space between the vertebrae, adjusting the orientation of the bars is not always possible, and do not provide a central portion to absorb the compressive stresses that occur between the implants. For example, EPO 0669109 describes a support device with an elastic ligament surrounded by an elastic central portion that absorbs compressive stress between implants, while WO 2005/092218 describes stiffness. Describes a device with elastic ligaments that are inserted into spacers and combined with each other to form a string with the ligaments. However, in these devices, the implants are placed directly in the central portion or rigid spacers, which makes it impossible to adjust the orientation or position of the joint connections between the implants. U.S. Pat. No. 5,540,688 (corresponding to EPO 0516567) describes a device with elastic ligaments surrounded by a central damping portion and, in some embodiments, additional surrounding elements. There is. The position of the ligament with respect to the implant is not adjustable, nor is the location of the joint connection. Specification 688 (corresponding to European Patent No. 0516567) describes a device comprising an elastic ligament surrounded by a central damping portion and, in some embodiments, an additional peripheral element. The position of the ligament with respect to the implant is not adjustable, nor is the location of the joint connection. Specification 688 (corresponding to European Patent No. 0516567) describes a device comprising an elastic ligament surrounded by a central damping portion and, in some embodiments, an additional peripheral element. The position of the ligament with respect to the implant is not adjustable, nor is the location of the joint connection.

<p><patcit num="1"><text>International Publication No. 02/080788</text></patcit><patcit num="2"><text>International Publication No. 95/10240</text></patcit><patcit num="3"><text>U.S. Pat. No. 5,603,714</text></patcit><patcit num="4"><text>U.S. Pat. No. 5,437,669</text></patcit><patcit num="5"><text>International Publication No. 03/049629</text></patcit><patcit num="6"><text>European Patent No. 0572790</text></patcit><patcit num="7"><text>International Publication No. 2005/020829 Pamphlet</text></patcit><patcit num="8"><text>International Publication No. 00/15 125 Pamphlet</text></patcit><patcit num="9"><text>U.S. Pat. No. 5,501,684</text></patcit><patcit num="10"><text>U.S. Pat. No. 5,672,175</text></patcit><patcit num="11"><text>U.S. Pat. No. 4,743,260</text></patcit><patcit num="12"><text>U.S. Pat. No. 7,083,622</text></patcit><patcit num="13"><text>International Publication No. 91/16018 Pamphlet (corresponding to the specification of European Patent No. 0381588)</text></patcit><patcit num="14"><text>International Publication No. 2004/089244 Pamphlet (corresponding to US Pat. No. 6,966,910)</text></patcit><patcit num="15"><text>International Publication No. 03/037216 Pamphlet (corresponding to US Pat. No. 6,783,527)</text></patcit><patcit num="16"><text>International Publication No. 98/22033 Pamphlet (corresponding to US Pat. No. 6,267,764)</text></patcit><patcit num="17"><text>International Publication No. 2005/030031 Pamphlet</text></patcit><patcit num="18"><text>European Patent No. 0669109</text></patcit><patcit num="19"><text>International Publication No. 2005/09 2218 Pamphlet</text></patcit><patcit num="20"><text>US Pat. No. 5,540,688 (corresponding to European Patent No. 0516567)</text></patcit></p>

<p> In this context, the invention provides different embodiments with different features and combinations of features that address some shortcomings of other designs. For example, maintain (or restore) the distance between the vertebrae (along the axis of the spinal column) in which the device is implanted (maintain or restore the height between the vertebrae), and at the same time some or all of these vertebrae. Provided are vertebral support devices that can be used to prevent joint fixation (deterministic immobilization and facet joint fusion). Various embodiments of the support device provide flexible joint connections that give these vertebrae some freedom of movement, thereby absorbing some of the stresses that can damage the disc. It is possible to reduce the burden on the intervertebral disc. In some embodiments, correction of spinal malformations can be achieved by maintaining permanent tension between the vertebrae, which limits the separation of the vertebrae and the joints between the implants. It is possible to adjust the position of the connection and the orientation of the support device with respect to the spinal column.</p>

<p> According to various embodiments of the present invention, selected features include at least two bone fixation implants (2) and at least one connecting element (L) that connects the bone fixation implants (2) and has a longitudinal axis (L). A vertebral support device (1) is provided that comprises 3) and is designed so that each of the at least two bone fixation implants (2) is fixed to the vertebra along the insertion axis (DV). The connecting element (3) comprises a rigid element (34) and a damping element (31) having a central elastic portion (32) and a longitudinal elastic portion (33), and the rigid element (34) is a damping element (31). ) To connect the joints.</p><p> The articulation of the rigid element (34) gives freedom of movement to the vertebrae to which the device (1) is mounted. In various embodiments, the damping element (31) adjusts the stress applied to the connecting element (3) during these movements, tending the device (1) to return to its normal form. In various embodiments, the central elastic portion (32) of the damping element (31) works with the rigid element (34) to adjust the compressive stress generated in the connecting element (3) and the longitudinal elastic portion (32). 33) adjusts the elongation stress or flexion stress generated in the connecting element (3). For a number of applications of the various embodiments described in this disclosure, each implant (2) is anchored to the pedicle of the vertebra along an axis called the dorsoventral axis (DV). Therefore, the insertion axis in which the implant (2) is anchored to the vertebra is referred to herein as the "dorsoventral axis (DV)", a term that is further described below. It is only used for convenience of explanation. Therefore, reference to "dorsoventral axis (DV)" herein refers to any insertion axis with respect to the insert and does not limit this insertion axis to any particular position or any particular orientation. Shall be. In addition, the specification uses the term "longitudinal axis" as a general and non-limiting reference to the direction in which an elongated object extends, as will be more fully described below.</p><p> In the selected embodiment, the fixture (20) is the longitudinal axis (L) and implant (2) of the connecting element (3) that extends through the rigid element (34) after it has been tightened. Fix each rigid element (34) to the implant (2) so that the insertion axis (DV) of) determines the fixation angle.</p><p> In the selected embodiment, the longitudinal elastic portion (33) is anchored to the implant (2) by the fixture (330, 331) and / or to the rigid element (34), respectively. To be equipped.</p><p> In the selected embodiment, the central portion (32) of the damping element (31) is the longitudinal axis (L) of the connecting element (3), with the damping element (31) located between the implants (2). They are placed at substantially equidistant distances from each of them.</p><p> In the selected embodiment, the position of the central portion (32) of the damping element (31) between the implants (2) is eccentric on the longitudinal axis (L) of the connecting element (3).</p><p> In the selected embodiment, the damping element (31) is composed of at least one elastic material.</p><p> In the selected embodiment, the damping element (31) comprises at least one elastic weave or blade made of synthetic fibers, and the seam of this weave or the stitch of this blade is the damping element (31) depending on the desired elasticity. ) Is closed to various degrees to adjust the elastic properties.</p><p> In the selected embodiment, the central portion (32) of the damping element (31) has a larger outer diameter to varying degrees than the outer diameter of the pipe (34) of the connecting element (3).</p><p> In the selected embodiment, the tension of the elastic longitudinal portion (33) can be adjusted by a fixture (330, 331).</p><p> In the selected embodiment, the elastic longitudinal portion (33) has a fixture (330, 331) with a longitudinal portion (33) to achieve at least one given tension in the longitudinal portion (33). ) Should be provided at least near at least one of the ends of the elastic longitudinal portion (33), which can be used to identify at least one position where it must be blocked.</p><p> In the selected embodiment, the connecting element (3) comprises two hollow tubes (34), each of which is an elastic longitudinal portion (33) of the damping element (31). ) Provided an internal conduit in which the elastic longitudinal portion (33) has a length substantially longer than the length of the connecting element (3), and the longitudinal portion (33) 2 The two ends project from the hollow tube (34) and are each held fixed to the tube (34) using fixtures (330, 331) in the longitudinal portion (33).</p><p> In the selected embodiment, the rigid element is a solid bar, each of which has an end and a central portion (32) that cooperate with a fixture such as a clamp (20) on the implant (2). ), And the elastic longitudinal portion (33) is parallel to these hollow tubes and has a length substantially longer than the length of the connecting element (3). ..</p><p> In selected embodiments, the solid bar comprises a groove, channel or chute that allows insertion of a longitudinal portion (33), and thus a fixture such as a clamp (20) is a solid bar (34). And not in the longitudinal part (33).</p><p> In the selected embodiment, the groove, channel or chute extends at the fixed end of the solid bar (34) that works with the clamp (20) by a hole that allows the insertion of the longitudinal portion (33). The groove is present and is closed by a surface for supporting a fixture such as a clamp (20).</p><p> In the selected embodiment, the central portion (32) and the longitudinal portion (33) of the damping element (31) form a single block, and the central portion (32) and the longitudinal portion (32) of the damping element (31). The junction with 33) forms a recess, each of which receives one end of one of the rigid elements (34).</p><p> In the selected embodiment, the central portion (32) and longitudinal portion (33) of the damping element (31) are composed of a single weave or blade made of synthetic fibers, the size of the weave stitch or the stitches of the blade. The size is substantially the same in the two parts (32 and 33), so the two parts (32 and 33) have the same elastic properties.</p><p> In the selected embodiment, the central portion (32) and longitudinal portion (33) of the damping element (31) form a single block, but are clogged in two portions (32 and 33) of the weave or blade. Due to the different tightness, the elastic properties of the central portion (32) and the longitudinal portion (33) of the damping element (31) are different.</p><p> In the selected embodiment, the central portion (32) and the longitudinal portion (33) of the damping element (31) are two separate elements, the central portion (32) is hollow and the longitudinal portion. It has an inner diameter that is substantially the same as the outer diameter of (33).</p><p> In the selected embodiment, the central portion (32) and longitudinal portion (33) of the damping element (31) each include a weave or blade made of synthetic fibers, the size of the weave stitch or the size of the blade stitch. Are substantially identical in the two parts (32 and 33), so the two parts (32 and 33) have the same elastic properties.</p><p> In the selected embodiment, the elastic properties of the central portion (32) of the damping element (31) and the elastic properties of the longitudinal portion (33) are clogged in two portions (32 and 33) of the weave or blade. It differs depending on the degree.</p><p> In the selected embodiment, the two weaves or blades of the central portion (32) and the longitudinal portion (33) are sewn together.</p><p> In the selected embodiment, the central portion (32) and the longitudinal portion (33) are each composed of different materials.</p><p> In the selected embodiment, the inner diameter of the central portion (32) is substantially smaller than the inner diameter of the hollow tube (34) of the connecting element (3), and the outer diameter of the longitudinal portion (33) is central. The portion (32) is substantially identical to the inner diameter of the central portion (32), and the hollow tube (34) is substantially identical to the inner diameter of the hollow tube (34).</p><p> In the selected embodiment, the inner diameter of the central portion (32) and the outer diameter of the longitudinal portion (33) are substantially identical to the inner diameter of the hollow tube (34) of the connecting element (3).</p><p> In the selected embodiment, the central portion (32) is located on at least one surface of the connecting element (3) and the connecting element (1) is intended to be implanted when the patient moves. Provide at least one slot (320) or notch to facilitate bending of 3) near the center of the central portion (32) along the longitudinal axis (L).</p><p> In the selected embodiment, the central portion (32) faces each rigid element (34) located on at least one surface of the connecting element (3) and is intended to be embedded with the device (1). Oblique planes (321) that facilitate bending of the connecting element (3) as the patient moves are provided on both sides of the central portion of the central portion (32) along the longitudinal axis (L).</p><p> In the selected embodiment, the two rigid elements (34) have a curved outer shape (341) in the central portion that fits into a complementary shaped recess (322) inside the central portion (32). In preparation for the end of the rigid element (34) in contact (32), the complementarity of this shape allows the connecting element (3) during any movement of the patient in which the device (1) is intended to be implanted. The stiffness element (34) facilitates movement with respect to the central portion (32) as it bends.</p><p> In the selected embodiment, the hollow tube (34), on the one hand, has a curved outer shape portion (341) that fits into a complementary shaped recess (322) inside the central portion (32). Provided at the end of the hollow tube (34) in contact with (32), the complementarity of this shape allows the connecting element (1) to be implanted during any movement of the patient. The rigid element (34) facilitates movement with respect to the central portion (32) as the 3) bends, while the hollow tube (34), on the other hand, has a flared inner profile (342) and a central portion (32). ) To prevent compression and cutting of the longitudinal portion (33) inside the hollow tube during this bending, provided at the end of the hollow tube (34) in contact with).</p><p> In the selected embodiment, the damping element (31) is at least one bend stop (310) that opposes the bending of the connecting element (3) during the movement of the patient in which the device (1) is intended to be implanted. , 311) are provided on at least a portion of at least one surface of the damping element (31).</p><p> In the selected embodiment, the bending stops (310, 311) are formed from an elastic material to some extent resist the bending of the connecting element (3).</p><p> In the selected embodiment, the bending stops (310, 311) are composed of a rigid inelastic material that completely opposes the bending of the connecting element (3).</p><p> In the selected embodiment, the rigid element (34) comprises at least one flat portion (340) on at least one surface thereof and at least at the position of the clamp (20), said flat portion (340). , In cooperation with the clamps (20), prevent the rigid elements (34) from rotating around their longitudinal axis (L).</p><p> In the selected embodiment, the bone fixation implant (2) comprises an anchor (21) used to attach the implant (2) to the vertebra, and each bone fixation implant (2) has a conduit (22). ) Provided a conduit (22) intended to receive the connecting element (3), having a fixture such as a clamp (20) containing means for tightening the connecting element (3) to the inner wall. Utilizing the cooperation of these means for tightening and the conduit (22), the fixation angle between the longitudinal axis (L) of the connecting element (3) and the dorsoventral axis of the vertebra is maintained. ..</p><p> In a selected embodiment, the fixture (330, 331) of the longitudinal portion (33) comprises at least one removable lock, staple, ring, clip, pin or stitch (330) and the longitudinal portion (330). 33) Clamp at least one end.</p><p> In the selected embodiment, the fixtures (330, 331) of the longitudinal portion (33) provide the longitudinal portion (33) along an axis that is substantially perpendicular to the longitudinal axis (L). It comprises at least one removable lock (300) that fits into at least one hole that penetrates, and this hole constitutes a tension mark used to determine the tension of the longitudinal portion (33).</p><p> In the selected embodiment, the fixtures (330, 331) in the longitudinal portion (33) include a fixed stop (331) having an outer diameter larger than the outer diameter of the hollow tube (34).</p><p> The present invention also provides various methods for preparing a vertebral support device having a damping element, such as the various embodiments of the invention described herein. In such a method, the tension of one or more components of the damping component is adjusted prior to embedding the device, depending on the specific requirements of the embedding. This method generally involves the following steps: The step of placing the central part of the damping element between the rigid elements of the damping element. The step of arranging the longitudinal portion of the damping element along the stiffness element of the damping element. The step of adjusting the tension of the longitudinal part of the damping element. The step of fixing the longitudinal portion of the damping element to the rigid element of the damping element.</p><p> In the selected embodiment, the step of adjusting the tension of the longitudinal portion (33) involves marking at least one tension mark in the vicinity of at least one of the ends of the longitudinal portion.</p><p> In the selected embodiment, the step of fixing the longitudinal portion (33) to the rigid element (34) by the fixture (330, 331) is a removable lock, staple, ring, clip, pin or stitch ( 330) includes the step of clamping at least one end of the longitudinal portion (33) by.</p><p> In the selected embodiment, the step of adjusting the tension and the step of fixing the longitudinal portion (33) are longitudinal portions along an axis that is substantially perpendicular to the longitudinal axis (L). (33) Including the step of inserting at least one removable lock (300) into at least one hole drilled in, this hole is used to determine the tension of the longitudinal portion (33). Constructs a tension mark.</p><p> In the selected embodiment, the step of arranging the longitudinal portion along the rigid element comprises inserting the longitudinal portion inside the groove, channel or chute of the rigid element.</p><p> In the selected embodiment, the step of inserting the longitudinal portion inside the groove, channel or chute of the rigid element is at the fixed end of the rigid element (34) at the level of the fixture, such as the clamp (20). Associated with the step of inserting a longitudinal portion inside a hole that extends a groove, channel or chute.</p><p> In the selected embodiment, the step of placing the longitudinal portion relative to the rigid element (34) is inside the conduit of the rigid element (34), including the hollow tube, and in the central portion, which is also hollow. Includes a step of inserting a longitudinal portion inside the pipeline.</p><p> In the selected embodiment, the step for fixing the longitudinal portion (33) is the longitudinal portion (opposite end) with removable locks, staples, rings, clips, pins or stitches (330). A step of installing a fixed stop (331) having an outer diameter larger than the outer diameter of the hollow pipe (34) is included at the end of 33).</p><p> In the selected embodiment, the step of placing the longitudinal portion relative to the rigid element inserts the rigid element including the solid bar and the central portion inside the longitudinal portion (33) including the elastic sheath or sleeve. Includes steps to do.</p><p> In selected embodiments, the method comprises adjusting the placement of the rigid element (34) along the longitudinal axis (L) with respect to the implant (2), followed by a clamp (20), etc. The step of blocking the rigid element in the desired position with the fixture follows.</p><p> In a selected embodiment, the method comprises adjusting the orientation of the longitudinal axis (L) of the rigid element with respect to the axis of the spinal column, followed by the desired orientation with a fixture such as a clamp (20). Followed by the step of blocking the rigid element with.</p><p> The features and advantages of various embodiments and aspects of the present invention will be further apparent to those skilled in the art by reading the following description with reference to the accompanying drawings.</p>

<figref num="1">It is a perspective view of one Embodiment of the vertebra support device by this invention.</figref><figref num="2">FIG. 5 is a longitudinal sectional view of an embodiment of a vertebra support device according to the present invention.</figref><figref num="3A">It is a perspective view of one Embodiment of the vertebra support device by this invention.</figref><figref num="3B">It is sectional drawing of the connecting element illustrated in FIG. 3A.</figref><figref num="4A">FIG. 5 is a longitudinal sectional view of an embodiment of a connecting element of a vertebra support device according to the present invention.</figref><figref num="4B">FIG. 5 is a longitudinal sectional view of another embodiment of the connecting element of the vertebral support device according to the present invention.</figref><figref num="4C">FIG. 5 is a longitudinal sectional view of still another embodiment of the connecting element of the vertebral support device according to the present invention.</figref><figref num="5A">FIG. 5 is a longitudinal sectional view of an embodiment of a connecting element of a vertebra support device according to the present invention.</figref><figref num="5B">FIG. 5 is a longitudinal sectional view of another embodiment of the connecting element of the vertebral support device according to the present invention.</figref><figref num="5C">FIG. 5B is a longitudinal sectional view of a central portion of the damping element illustrated in FIG. 5B.</figref><figref num="6A">It is an elevation view of one Embodiment of the vertebra support device by this invention.</figref><figref num="6B">It is a figure which shows one of many various embodiments of the rigid element constructed by this invention.</figref><figref num="6C">It is a figure which shows the other one among many various embodiments of the rigid element constructed by this invention.</figref><figref num="7A">FIG. 5 is a longitudinal sectional view of an embodiment of a vertebra support device according to the present invention.</figref><figref num="7B">FIG. 5 is a longitudinal sectional view of another embodiment of the vertebra support device according to the present invention.</figref><figref num="8A">It is a perspective view of one Embodiment of the vertebra support device by this invention.</figref><figref num="8B">FIG. 3 is a perspective view of an embodiment of a connecting element of a vertebra support device.</figref><figref num="8C">FIG. 5 is a longitudinal sectional view of an embodiment of a connecting element of a vertebral support device.</figref><figref num="8D">It is a perspective view of the connecting element illustrated in FIG. 8A.</figref><figref num="8E">It is a longitudinal sectional view of the connecting element illustrated in FIG. 8A.</figref><figref num="9">FIG. 5 is a longitudinal sectional view of an embodiment of a vertebra support device according to the present invention in a flexed position.</figref><figref num="10A">It is an elevation view of another embodiment of the vertebra support device according to the present invention.</figref><figref num="10B">FIG. 5 is a longitudinal sectional view of another embodiment of the vertebra support device according to the present invention.</figref><figref num="10C">FIG. 3 is a perspective view of the various types of rigid elements that can be used in this embodiment.</figref><figref num="11A">It is an elevation view of another embodiment of the vertebra support device according to the present invention.</figref><figref num="11B">FIG. 5 is a longitudinal sectional view of another embodiment of the vertebra support device according to the present invention.</figref><figref num="11C">FIG. 3 is a perspective view of the various types of rigid elements that can be used in this embodiment.</figref><figref num="12A">FIG. 3 is an elevation view of an embodiment of a connecting element that can be used in various embodiments of the vertebral support device according to the invention, comprising a rigid element disposed within a longitudinal elastic portion.</figref><figref num="12B">FIG. 5 is a longitudinal cross-sectional view of an embodiment of a connecting element that can be used in various embodiments of a vertebral support device according to the invention, comprising a rigid element disposed within a longitudinal elastic portion.</figref><figref num="12C">It is an elevational view of another embodiment of the connecting element that can be used in various embodiments of the vertebral support device according to the invention, in which the rigid element is disposed within the longitudinal elastic portion.</figref><figref num="12D">FIG. 5 is a longitudinal sectional view of another embodiment of a connecting element that can be used in various embodiments of the vertebral support device according to the invention, in which the rigid element is disposed within the longitudinal elastic portion.</figref><figref num="13A">FIG. 3 is a perspective view of an embodiment of a connecting element that can be used in various embodiments of the vertebral support device according to the invention, comprising a rigid element disposed within a longitudinal elastic portion.</figref><figref num="13B">FIG. 5 is a longitudinal cross-sectional view of an embodiment of a connecting element that can be used in various embodiments of a vertebral support device according to the invention, comprising a rigid element disposed within a longitudinal elastic portion.</figref><figref num="14A">FIG. 5 is a longitudinal sectional view of an embodiment of a vertebra support device according to the invention, wherein the connecting element comprises two damping elements.</figref><figref num="14B">FIG. 3 is a perspective view of another embodiment of a vertebra support device according to the invention, wherein the connecting element comprises two damping elements.</figref><figref num="15A">Any one embodiment of a rigid element for a connecting element that can be used in various embodiments of the vertebral support device according to the invention, comprising a longitudinal slit that allows compression of the longitudinal portion when the fixture is tightened. It is a perspective view of.</figref><figref num="15B">FIG. 15A is an elevation view of a portion of a vertebra support device comprising one embodiment of a connecting element according to FIG. 15A.</figref><figref num="15C">FIG. 15A is a longitudinal sectional view of a portion of a vertebra support device comprising one embodiment of a connecting element according to FIG. 15A.</figref><figref num="16">FIG. 5 is a perspective view of an embodiment of a vertebraic support device according to the invention, wherein each implant comprises a hook for attachment to the vertebra.</figref><figref num="17">FIG. 3 is a perspective view of an embodiment of a vertebral support device according to the invention, comprising a double fixation implant that anchors two connecting elements that are substantially parallel to each other.</figref><figref num="18A">FIG. 5 is a top view of an embodiment of a vertebral support device according to the invention, comprising a double fixation implant that anchors two connecting elements that are substantially collinear to each other.</figref><figref num="18B">FIG. 5 is a longitudinal sectional view of an embodiment of a vertebral support device according to the invention, comprising a double fixation implant that anchors two connecting elements that are substantially collinear to each other.</figref><figref num="19A">It is a perspective view of one embodiment of the weave or blade of the damping element of the vertebra support device according to the present invention.</figref><figref num="19B">It is a side view of another embodiment of the weave or blade of the damping element of the vertebral support device according to the present invention.</figref><figref num="19C">It is a detailed view of still another embodiment of the weave or blade of the damping element of the vertebral support device according to the present invention.</figref><figref num="19D">It is a detailed view of still another embodiment of the weave or blade of the damping element of the vertebral support device according to the present invention.</figref><figref num="20">FIG. 5 is a perspective view of two adjacent vertebrae in which one embodiment of the vertebrae support device according to the invention is installed and the damping element is central to the articular process of the two vertebrae.</figref><figref num="21">It is a perspective view of two adjacent vertebrae in which one embodiment of the vertebrae support device according to the invention is installed and the damping element is centrally located with respect to the intervertebral space between the two vertebrae.</figref><figref num="22A">FIG. 6 is a side view of an embodiment of the combined vertebral support device according to the invention.</figref><figref num="22B">FIG. 5 is a side view of an embodiment of a disassembled vertebra support device according to the present invention.</figref><figref num="23A">FIG. 5 is a side view of an embodiment of a vertebral support device according to the invention in a combined, flexed position.</figref><figref num="23B">FIG. 5 is a side view of an embodiment of a vertebral support device according to the invention in a disassembled, flexed position.</figref><figref num="23C">It is sectional drawing in the longitudinal direction of the same embodiment.</figref><figref num="24A">FIG. 6 is a side view of an embodiment of the combined vertebral support device according to the invention.</figref><figref num="24B">FIG. 5 is a side view of an embodiment of a disassembled vertebra support device according to the present invention.</figref><figref num="24C">It is sectional drawing in the longitudinal direction of the same embodiment.</figref><figref num="25A">FIG. 6 is a side view of an embodiment of the combined vertebral support device according to the invention.</figref><figref num="25B">FIG. 5 is a side view of an embodiment of a disassembled vertebra support device according to the present invention.</figref><figref num="26A">It is a side view of one Embodiment of the vertebra support device by this invention.</figref><figref num="26B">FIG. 5 is a longitudinal sectional view of an embodiment of a vertebra support device according to the present invention.</figref><figref num="26C">It is a perspective view from one angle of view of one embodiment of the joint element of the vertebra support device.</figref><figref num="26D">FIG. 5 is a perspective view of one embodiment of a vertebral support device joint element from another angle of view.</figref><figref num="27A">It is a side view of one Embodiment of the vertebra support device by this invention.</figref><figref num="27B">FIG. 5 is a longitudinal sectional view of an embodiment of a vertebra support device according to the present invention.</figref><figref num="27C">It is a perspective view from one angle of view of one embodiment of the joint element of the vertebra support device.</figref><figref num="27D">FIG. 5 is a perspective view of one embodiment of a vertebral support device joint element from another angle of view.</figref><figref num="28A">It is a side view of one Embodiment of the vertebra support device by this invention.</figref><figref num="28B">FIG. 5 is a longitudinal sectional view of an embodiment of a vertebra support device according to the present invention.</figref><figref num="28C">It is a perspective view from one angle of view of one embodiment of the joint element of the vertebra support device.</figref><figref num="28D">FIG. 5 is a perspective view of one embodiment of a vertebral support device joint element from another angle of view.</figref>

The present invention relates to devices of various embodiments as illustrated in, for example, FIG. 1, FIG. 3A, FIG. 6A, FIG. 7A, FIG. 7B, FIG. 8A, FIG. 9, FIG. 10A, FIG. 10B, FIG. 11A and FIG. 11B. Regarding vertebral support devices such as (1). Vertebra support devices of various embodiments of the invention are configured for implantation in at least two vertebrae that may be adjacent or farther apart, and these at given positions determined upon implantation of the device. It is used to support the vertebrae and still ensure some freedom of movement around this position in these vertebrae. The vertebrae support device (1) according to some embodiments of the present invention comprises at least two bone fixation implants (2), each of which is designed to be fixed to the vertebrae. To. Often, each implant (2) is anchored to the pedicle of the vertebra along an axis called the dorso-ventral (DV) axis. Generally, the dorsoventral (DV) axis is oriented along the dorsoventral axis of the vertebral bone, which can also be referred to as the anterior-posterior axis or the sagittal axis, depending on the terminology adopted. Therefore, the insertion axis in which the implant (2) is fixed to the vertebra is referred to herein as the "dorsoventral axis (DV)". However, since embodiments having different embedding positions and fixed angles are included within the scope of the present invention, such terms are only adopted for convenience of explanation, and by such terms, It will be appreciated by those skilled in the art that the scope of the invention is not limited to implants that are fixed at any particular location or in any particular orientation.

Also, the vertebra support device (1) according to some embodiments of the present invention comprises at least one connecting element (3) attached to the implant (2). In many embodiments, the connecting element (3) comprises at least two rigid elements (34) articulated by at least one elastic damping element (31). A wide variety of embodiments of connecting elements are included within the scope of the invention, including but not limited to the embodiments described herein. For example, the connecting element (3) may include one or more damping elements (31) and one or more rigid elements (34) that are secured to the implant (2). Various embodiments are within the scope of the invention, depending on the embodiment, on at least one elastic central portion (32) and / or device (1) that absorbs the compressive stress applied to the device (1). It can have a damping element (31) with at least one elastic longitudinal portion (33) that absorbs the applied elongation or flexion stress. In various embodiments, the rigid element (34) of the connecting element (3) is secured to the implant (2) by a fixture (20). Many embodiments use clamps such as the clamps (20) shown in FIGS. 2, 6A, 9, 10B and 11B, but with rods in the vertebral fixation implants, as further described below. Other fixtures that are generally available for fixation may be substituted. Various embodiments of the present invention can include a plurality of connecting elements (3). For example, the connecting element (3) can be generally parallel to each other so as to support the two vertebrae on both sides of the sagittal plane, or multiple consecutive adjacencies, as described below. It is possible to align the vertebrae to support each other.

The connecting element (3) can have any elongated shape. Regardless of this shape, the connecting element (3) has two parallel planes (or parallel surfaces) to the dorsal (or dorsal surface), ventral (or ventral), and device (1) implanted along the dorsal surface of the vertebra. ), But the connecting element (3) does not necessarily have four faces (or surfaces). The device (1) can also be implanted along the ventral surface of the vertebra within the scope of the invention, but such placement is generally preferred due to the presence of large blood vessels. Thus, directional references used herein and references to various planes such as the anterior and sagittal planes, including those mentioned above, refer to the device (1) placed along the dorsal surface of the vertebra. Be identified. Appropriate adjustments for directional references with respect to the device (1) implanted along the ventral surface or other location of the vertebra will be readily apparent to those skilled in the art. Therefore, references to the dorsal, ventral or parallel planes for the surface of the component exclusively refer to the outer part of the component having an orientation consistent with the reference system for the device (1) placed along the dorsal surface of the vertebra. It was done.

In general, the connecting element (3) is connected to the implant (2) and has at least one damping element (31), so it can be considered to have a "longitudinal axis (L)". This specification uses the term "longitudinal axis" as a general and non-limiting reference to the direction in which an elongated object extends. For example, in general, the connecting element (3) can be considered to have a "longitudinal axis (L)" corresponding to the direction in which the connecting element (3) extends. For the intended normal position of the vertebra (ie, no flexion, extension, lateral bending, rotation, or other displacement of the vertebra) along which device (1) is placed (or placed). , In the "neutral" or "stationary" position. In many implants, the longitudinal axis (L) is oriented along the axis of the spinal column, but the connecting element (3) may be arranged in any other orientation. As a non-limiting example, the vertebrae may extend almost accordingly to a natural or pathological curvature, and the connecting element (3) may be oriented according to the natural curvature or correction of the pathological curvature. Moreover, the term "longitudinal axis" is not necessarily limited to a single fixed linear direction. For example, as described below, the connecting element (3) can be installed such that the connecting element (3) has a neutral position that is bent at its neutral position, in this case. The connecting element (3) has a "longitudinal axis" that generally corresponds to this bending, or is locally "locally" in various parts such as one or both of the rigid element (34) and the damping element (31). It may be considered to have a "longitudinal axis".

In many embodiments, the damping element (31) articulates the stiffness element (34) to give the patient in which the device (1) is implanted some degree of freedom of movement. The stress applied to the connecting element (3) during the movement of the device is absorbed and the device (1) is tended to return to its neutral position. In various embodiments, the damping element (31) is placed between the two rigid elements (34) so that it absorbs the compressive stresses and strains applied to the connecting element (3) as well as other stresses and strains. It has at least one central elastic section (32) that works with two rigid elements (34). The joint connection of the two rigid elements (34) is centered on the central elastic portion (32), which is located between the rigid elements. An alternative embodiment of the connecting element (3) is a plurality of damping elements (2) located at a given distance from each of the bone fixation implants (2) so as to further increase the freedom of movement, especially with respect to spinal twist. 31) can be provided. Various embodiments of the connecting element (3) may have a plurality of damping elements. 14A, 14B and 16 show two non-limiting examples of possible embodiments of a device (1) with such a connecting element (3) with two damping elements (31). As a non-limiting example, an embodiment having different types of damping elements, and various damping elements (31) arranged at various positions along the longitudinal axis (L) of the connecting element (3). Numerous other variants and any embodiment of the plurality of damping elements (31) are possible within the scope of the invention.

Also, in an exemplary embodiment, the damping element (31) comprises a longitudinal elastic portion (33) having two ends configured to absorb the stress generated in the connecting element (3). In various embodiments, these ends of the longitudinal elastic portion (33) are secured to the implant (2) and / or the rigid element (34) by a fixture (330, 331). The elastic forces of the central part (32) and the longitudinal part (33) are opposite to each other, promoting support of the vertebrae and giving the vertebrae some freedom of movement, putting the vertebrae in a stationary position. Tend to return.

In various embodiments of the invention, the damping element (31) is composed of a weave (or blade) made of synthetic fibers. These particularly advantageous embodiments facilitate the adjustment of the stress and strain exerted by the movement of the vertebra to which the device (1) is attached by the damping element (31), as described below in the device (1). It is possible to facilitate the adjustment of the tension of the damping element (31) in the stationary state in. The seams of this weave or the seams of this blade can be closed to varying degrees to adjust the elastic properties of the damping element (31) depending on the desired elasticity. Also, the damping element (31) of these embodiments can be sewn, which can facilitate the assembly of its components and / or fixation to the rest of the device. .. Alternatively, the elastic element (31) adjusts the stress and strain applied by the movement of the vertebra to which the device (1) is attached, and adjusts the tension of the stationary damping element (31) in the device (1). It can be made of a solid elastic material having properties suitable for. Finally, such elastic materials can also be sewn for assembly in the device and / or for adjusting its tension. Of course, the central portion (32) and the longitudinal portion (33) can be realized as the same weave, blade or solid material as described below, as described herein. It can also be achieved using any combination of materials, or any uniform material that is flexible or elastic. Furthermore, in some embodiments described below, the damping element (31) is not necessarily in direct contact with the surrounding tissue and can therefore be constructed from a biocompatible material. In a preferred embodiment, a biocompatible material is used. 19A, 19B, 19C and 19D show non-limiting examples of such blades or weaves.

In some embodiments of the invention, the longitudinal portion (33) and the central portion (32) are formed as units. In some of these embodiments, the connection between the central portion (32) and the longitudinal portion (33) of the damping element (31) forms a receptacle, each of which is, for example, a rigid element. Receives one end of one of the rigid elements (34), as illustrated in FIGS. 3B and 4A, where (34) is a hollow tube. In some of these embodiments, the central portion (32) and longitudinal portion (33) of the damping element (31) can jointly include a single weave or blade of synthetic fibers. The size of the weave stitches or blade stitches is substantially the same in the two parts (32 and 33), so these two parts (32 and 33) have the same elastic properties. In other embodiments, the central portion (32) and longitudinal portion (33) of the damping element (31) form a single weave or blade of synthetic fibers, while the central portion of the damping element (31). The elastic properties of the (32) and longitudinal portions (33) differ by the degree of clogging of the weave stitches or blade stitches in the two portions (32 and 33) or by different sizes thereof. It is possible to make it. Alternatively, the unit can be formed from a single block of solid elastic material, or has a central portion (32) and a longitudinal portion (33), each containing solid elastic material. It can be configured by fixing them to each other. Alternatively, the unit can include one component consisting of weaves or blades made of synthetic fibers and another component made of solid elastic material. In these alternative forms, these components are either whether these components are connected to each other into a single block by sewing or any other means, or whether these components have different elasticity. Depending on whether it is configured with characteristics

In some embodiments, such as those illustrated in FIG. 2, FIG. 4B, FIG. 4C and others, the central portion (32) and longitudinal portion (33) of the damping element (31) are two separate elements. Is. In some embodiments, the central portion (32) is hollow and has an inner diameter substantially identical to the outer diameter of the longitudinal portion (33). Therefore, the central portion (32) mainly adjusts the compressive stress applied to the connecting element (3), and the longitudinal portion (33) mainly adjusts the elongation stress and torsional stress applied to the connecting element (3). To do. For example, these stresses are brought about by the bending of the connecting element (3), which is damped by these two parts (32 and 33), as illustrated in FIG. In a modification of this embodiment, the central portion (32) and longitudinal portion (33) of the damping element (31) are each composed of weaves or blades made of synthetic fibers and the size of the weave stitches or blade stitches. Are substantially identical in the two parts (32 and 33) and therefore these two parts (32 and 33) have the same elastic properties. In another variant, the elastic properties of the central portion (32) and longitudinal portion (33) of the damping element (31) differ in the degree of clogging of these two portions (32 and 33) by the weave or blade. Each is different. As mentioned above, these two parts may be sewn together, regardless of the size of the synthetic fiber eyes or blades.

For example, in the embodiments shown in FIGS. 4A and 4B, the inner diameter of the central portion (32) and the outer diameter of the longitudinal portion (33) are substantially the inner diameter of the hollow tube (34) of the connecting element (3). Is the same as. Alternatively, the inner diameter of the central portion (32) is smaller than the inner diameter of the hollow tube (34) of the connecting element (3), and the outer diameter of the longitudinal portion (33) is at the central portion (32). It is substantially the same as the inner diameter of the central portion (32), and in the hollow tube (34) it is possible that it is substantially the same as the inner diameter of the hollow tube (34). When intense compressive stress is applied, this alternative form has the inner edge of the end of the hollow tube (34) between the outer surface of the longitudinal portion (33) and the inner surface of the central portion (32). Prevent slipping on.

The rigid element (34) of the connecting element (3), whether linear or not, includes bars, pipes, rods, rails or similar structures having a cylindrical, polygonal or other cross section. It is possible, or in fact, that the device consists of any type of rigid structure adapted to the morphology of the patient's spinal column intended to be implanted. In some embodiments, the rigid element (34) secures the rigid element (34) to the implant (2) so as to prevent rotation of the connecting element (3) around its longitudinal axis (L). It comprises at least one surface (340) configured to work with the fixture. For example, FIG. 6A shows a flat surface "flat portion (340)" on which the corresponding flat surface of the clamp (20) is supported. In various embodiments, the flat portion (340) is the entire dorsal surface of the rigid element (34), or only the portion where the rigid element (34) is secured to the implant (2) by a fixture such as a clamp (20). It is possible to be present in. As illustrated in the drawing, the fixture (20) anchors the connecting element (3) and adjusts the position of the connecting element (3) along the longitudinal axis (L) with respect to the implant (2). It can be placed on the implant (2) to make it possible. Furthermore, the surface (340) may be configured in other shapes such that the surface cooperates with the fixture to prevent axial rotation of the rigid element (34) around its longitudinal axis. It is possible. By fixing the connecting element (3) to the implant (2) along the rigid element (34), with respect to the connecting element (3) as compared to the case where the damping element (31) is fixed directly to the implant (2). The risk of damage is reduced.

In some embodiments of the invention, the rigid element (34) of the connecting element (3) can be a tube (34), each of which is by a fixture (20). It is connected to a bone fixation implant (2) and is articulated by a damping element (31) centered on a central portion (32) that fits into each of the two tubes (34). The central portion (32) of the damping element (31) can have an outer diameter approximately equal to the outer diameter of the pipe (34) of the connecting element (3), but preferably of this central portion (32). The outer diameter is measured by this pipe (34), especially if the compressive stress applied by the pipe (34) is not applied along an axis that is co-linear with the longitudinal axis (L) of the connecting element (3). It is made even larger to improve the handling of the applied compressive stress. Therefore, in many advantageous embodiments, the central portion (32) of the damping element (31) has a larger outer diameter to a different degree than the outer diameter of the pipe (34) of the connecting element (3).

In various embodiments of the invention, the rigid element (34) of the connecting element (3) is an internal channel in which the longitudinal portion (33) is installed or otherwise arranged. Or provide a pipeline. In some embodiments, the channel or conduit, and the longitudinal portion (33), is preferably substantially cylindrical, for example, the connecting element (3) is bent along its outer surface. Other shapes are possible, such as a rectangular cross section to prevent. The longitudinal portion (33) has an outer diameter or size that is substantially equal to or smaller than the inner diameter or size of the channel or conduit within the rigid element (34), or smaller than the inner diameter or size of the channel conduit. Can facilitate the movement of the longitudinal portion (33) within the rigid element (34) and facilitate the handling of (particularly) elongation stress applied to the connecting element (3).

In some embodiments, the stiffness element (34) can include a solid bar. For some of these embodiments, the longitudinal portion (33) can be disposed along these bars, or will be described later with reference to, for example, FIGS. 10A-10C and 11A-11C. As such, it can be inserted into a groove (or chute) located longitudinally on the surface of the bar. In other embodiments, the bar (34) is an elastic longitudinal portion that surrounds the rigid element (34) and the central portion (32), just like a sheath, as illustrated, for example in FIGS. 12A-12D. It can be inserted inside (33). As in other embodiments, the central portion (32) and the longitudinal portion (33) can be a single member or multiple separate members. The rigid element (34) and the central portion (32) are in a state where the longitudinal portion (33) is attached to the rigid element (34), for example, as will be described in detail later with reference to FIGS. 12A to 12D. It can be attached or not attached. If not mounted on each other, the central portion (32) and the rigid element (34) can nevertheless be held together by the longitudinal portion (33) surrounding them, or the central portion (32). ) And the rigid element (34) can be attached by any means such as adhesives, screw fasteners, rivets, tongue joints, or other fittings. In these embodiments, the longitudinal portion (33) can be kept at a predetermined tension and is secured to the rigid element (34) by fixtures (330, 331), eg, as described below. It is possible. In other embodiments not shown, this longitudinal portion (33) of the connecting element (3) is substantially the same as the length of the assembly formed by the connecting element (3), or the length of the assembly. It can have a length slightly shorter than the halfbeak and can be glued, screwed fixtures, compressed its ends, or firmly attached these ends to the rigid element (34).

In some embodiments of the invention as illustrated in FIGS. 6B and 6C, the rigid element (34) facilitates insertion of, for example, a longitudinal portion (33) into the interior of the pipe (34). It is a tube that is open over at least a part of the total length. This hole in the tube (34) constitutes a cross section having a substantially "U" shape if the tube is cylindrical or has a polygonal cross section. The "U" opening allows insertion of a longitudinal portion, which can then be secured to the tube, for example by a fixture (330, 331). In the embodiment illustrated in FIG. 6C, the hollow tube (34) is not open over its entire length and the closure can play a role in cooperating with the fixtures (330, 331). is there. This closure also provides a flat section (340) as shown, or another type of surface that works with a fixture, such as a clamp (20), to clamp the rigid element (34) to the implant (2). It is possible to prepare.

In the embodiment illustrated in FIG. 6B, the hollow tube (34) is open over its entire length and one end of it cooperates with a fixture (330, 331) in the longitudinal portion (33). It is possible to work. In the embodiment illustrated in FIG. 6B, the end of the longitudinal hole is configured to work with a fixture, such as a clamp (20), that anchors the rigid element (34) to the implant (2). It forms a substantially flat surface. In many of these embodiments, the longitudinal portion (33) of the connecting element (3) has a length longer than the sum of the lengths of the two pipes (34) and the central portion (32) and is rigid. The end of the longitudinal portion (33) protruding from the element (34) is secured to the tube (34) by fixtures (330, 331). In some embodiments, the tension of the elastic longitudinal portion (33) can be adjusted by adjusting the relative position of the fixture (330, 331) with respect to the elastic longitudinal portion (33). Therefore, at least one position of the fixture (330, 331) can be adjusted in the factory (by a relatively accurate measurement of tension) or on the operating table by the surgeon, who allows the device to adjust. It is possible to adjust the tension according to the composition of the vertebra to be implanted.

In embodiments such as those illustrated in FIG. 1, the fixture (330, 331) clamps at least one end of the longitudinal portion (33), at least one removable lock, staple, ring. , Clips, pins or stitches (330) can be included. In these embodiments, the end of the longitudinal portion (33) can project from one or both ends of the hollow tube (34), or this tube (34). It is possible to terminate in one or both. For example, FIG. 1 shows a staple (330), but an alternative form is a ring that is fastened around the end of the longitudinal portion (33), or any other removable lock, clip, pin, stitch, or Includes other fixtures and other structures that can engage the end of the longitudinal portion (33) after combining the rest of the device (1) with the longitudinal portion (33). For example, in some embodiments where the rigid element is a hollow tube (34), the fixtures (330, 331) for the longitudinal portion (33) are substantially relative to the longitudinal axis (L). It is possible to include at least one removable lock (330) that fits into at least one hole (330a) that extends transversely through a longitudinal portion (33) along a vertical axis. Is. The hole (330a) can be a tension mark used to determine the tension of the longitudinal portion (33), for example as illustrated in FIGS. 8A, 8D and 8E. The lock (330) can include a lock, staple, ring, clip, pin or stitch, or other type of fixture that is inserted into the hole. The pin may be flared at its end, or at its end it may be fitted into a stop to prevent it from coming out of the hole, or the end of the pin may be for attaching a nut. Any screw thread may be provided, or the pin may be effectively locked into a given hole in the longitudinal portion (33) to keep the longitudinal portion (33) in a predetermined tension. It may have a type of structure. The removable fixture (330) also penetrates a hole (330a) that extends transversely through the longitudinal portion (33), as illustrated in FIGS. 8A, 8D and 8E. Stitching, such as wires or filaments, that penetrates the holes (or perforations) (330b) constructed in the rigid element (34) may be included. It will be appreciated by those skilled in the art that the term "perforation" or "perforation" can mean any type of channel that penetrates the longitudinal portion (33). The two ends of the longitudinal portion (33) can be provided with this type of removable fixture, as illustrated in FIG. 4A, with the removable fixture (330) at one end. It is also possible to use it only and with it a non-detachable lock (331), such as a fixed stop, at the other end. Thus, in some various embodiments, the fixture (330, 331) for the longitudinal portion (33) is the longitudinal portion (33) opposite the end with the removable fixture (330). At the end of, includes a fixed stop (331) that includes an enlarged portion of the longitudinal portion (33), which fixed stop (331) is, for example, as illustrated in FIGS. 1, 2, and 3A. , Has an outer diameter larger than the outer diameter of the hollow tube (34). It is also possible to use the lock (331) at the other end. Thus, in some various embodiments, the fixture (330, 331) for the longitudinal portion (33) is the longitudinal portion (33) opposite the end with the removable fixture (330). At the end of, includes a fixed stop (331) that includes an enlarged portion of the longitudinal portion (33), which fixed stop (331) is, for example, as illustrated in FIGS. 1, 2, and 3A. , Has an outer diameter larger than the outer diameter of the hollow tube (34). It is also possible to use the lock (331) at the other end. Thus, in some various embodiments, the fixture (330, 331) for the longitudinal portion (33) is the longitudinal portion (33) opposite the end with the removable fixture (330). At the end of, includes a fixed stop (331) that includes an enlarged portion of the longitudinal portion (33), which fixed stop (331) is, for example, as illustrated in FIGS. 1, 2, and 3A. , Has an outer diameter larger than the outer diameter of the hollow tube (34).

In the embodiment having a length longer than the sum of the lengths of the rigid element (34) and the central portion (32) and having a longitudinal portion (33) extending beyond the end of the pipe, the tension Adjustment is easy by the fact that the tension varies depending on the length of the longitudinal portion (33) that extends beyond the end of the rigid element (34) (either hollow or solid). Become. However, the longitudinal portion can have a length that does not extend beyond the length of the rigid element (34). In some embodiments, the rigid element (34) comprises a hole (or bore or perforation) (330b) as illustrated in FIGS. 8D and 8E, and the fixture (330, 331) is longitudinal. It may be configured to be inserted into this hole to clamp the longitudinal portion (33) after adjusting the length of the directional portion (33) (and thus the tension of the longitudinal portion (33)). For example, if the rigid element (34) is a hollow tube into which the longitudinal portion (33) is inserted, or so that the rigid element (34) is along the sheath-like longitudinal portion (33). In the case of a solid bar being disposed, the fixture (330) typically penetrates the longitudinal portion (33) and the rigid element (34) and through the longitudinal portion (33) the rigid element. Fix to (34). Furthermore, in order to allow for tension adjustment, in some embodiments of the invention, the elastic longitudinal portion (33) is a longitudinal portion to achieve at least one given tension. Used to identify at least one position by which the fixture (330, 331) of the longitudinal portion (33) must be placed along the longitudinal portion (33) by pulling (stretching). It is possible to have one tension mark. Typically, such tension marks are located near at least one end of the longitudinal portion (33), eg, the longitudinal portion extends beyond the end of the (hollow or solid) rigid element. It may include marks or notches visible on the surface of the longitudinal portion if extended. Also, the rigid element is a hollow tube. In embodiments, the tension mark traverses the longitudinal portion (33) regardless of whether the longitudinal portion (33) is configured to extend beyond the end of the tube (34). It may include a hole that extends through the. In addition, these holes insert fixtures (330, 331) through the longitudinal portion (33) for fixation of the longitudinal portion (33) and for adjusting tension in the longitudinal portion (33). It becomes possible to do.

In another embodiment, each end of the longitudinal portion (33) is provided with a fixed stop (331) as illustrated in FIG. 3B. A factory-configured device (1) is particularly well suited to have a fixed stop (331) at each end, and the tension in the longitudinal portion (33) is the factory device (1). It is possible to set when assembling. In another embodiment, each end of the longitudinal element (33) is provided with a fixing stop (331) and the rigid element (34) is as described above to facilitate assembly of the device. A hollow tube having a U-shaped cross section. For such embodiments, the tension can be set at the factory by arranging the fixation stop (331), and the predetermined tension can be performed at the factory or in the operating room. It is realized at the same time as the assembly when the longitudinal part (33) is inserted into the pipe (34).

The implant (2) may be, for example, a spinal fusion implant as described in WO 03/049629 and WO 2005/020829 filed by the transferee of this application, or, for example, European Patent No. 057290. Other types of bone fixation implants, such as those described in the specification or WO 00/15125 or US Pat. No. 5,501,684, or to fix the bar (or any connecting element) to the spine. It can take many forms, such as other constructs suitable for holding the object. European Patent No. 057290 and International Publication No. 00/15125 and US Pat. No. 5,501,684 are effectively incorporated herein by reference. These various bone fixation implants (2) may be inserted into a screw (21) intended to be screwed into the vertebra, or into a suitable shape of the vertebra or, in particular, a recess formed in the vertebra. Equipped with anchors (21), such as hooks (21) intended for. FIG. 16 shows a non-limiting example of device (1), each implant (2) comprising a hook for fixation, while an alternative embodiment comprises, for example, an implant with a screw and an implant with a hook. It may have various types of anchors, such as device (1). This type of hook is described in detail with reference to Figure 7 of Pamphlet 03/049629 and Figure 4 of Pamphlet 2005/020829.

As mentioned above, in many cases the implant (2) implant axis is substantially parallel to the dorsoventral axis of the vertebra. However, another embedded axis (DV) may be preferred in some installations (which, as mentioned above, can still be referred to herein as the dorsoventral (DV) axis), eg, international publication. Multiaxial bone fixation implants (2), such as those described in Pamphlet 03/049629, Pamphlet 00/15125 and Publication 2005/020829, can be used advantageously. The multiaxial bone fixation implant allows the device (1) to be used regardless of the angle between the fixation axis (DV) of the implant (2) and the longitudinal axis (L) of the connecting element (3). obtain. Also, the multiaxial implant (2) can be used advantageously for the orientation of the longitudinal axis (L) of the connecting element (3) other than the axial direction of the spinal column. Thus, as mentioned above, fixation of the connecting element (3) can be achieved such that the connecting element (3) extends according to the natural or pathological curvature of the spinal column. In many of these embodiments of the invention, the angle between the longitudinal (L) axis of the connecting element (3) and the dorsoventral (DV) axis of the implant (2) is the longitudinal (L) axis and Implant (2) clamp (2) regardless of the actual orientation of the dorsoventral (DV) axis (either along or not along the axial axis of the spinal column and along or not along the anterior-posterior axis of the vertebra, respectively) After fixing the connecting element (3) using 20), it is fixed. Given such a fixation angle, the damping element (31) is driven by the movement of the spine, regardless of the orientation of the fixation axis (DV) of the implant (2) or the longitudinal axis (L) of the connecting element (3). It regulates the stress applied to the assembly and allows the device to maintain or restore the space between the vertebral bones that are implanted between them. Multiaxial implants also give the rod (or bar) some freedom of movement even after the rod (or bar) has been clamped to the implant. May be devised. These types of implants can be used alone or in combination with other types of implants within the scope of the invention. For example, in some embodiments, each stiffness element (34) of the connecting element (3) is clamped to an implant (2) that gives some freedom of movement after the stiffness element is clamped by the clamp (20). May have. For another example, in some embodiments, the rigid element (34) is clamped by the clamp (20) and then of the connecting element (3) fixed to the implant (2) which gives some freedom of movement. It may have one or more rigid elements (34), one or more of the connecting elements (3) other rigid elements (34), the rigid element (34) being clamped by a clamp (20). Later, it may be fixed to the implant (2) which provides a fixation angle between the longitudinal (L) axis of the connecting element (3) and the dorsoventral (DV) axis of the implant (2). In this example, the device (1) can still retain or restore the space between the vertebrae in which the device (1) is implanted, but may provide greater freedom of movement. It may be fixed to an implant (2) that gives a fixation angle between. In this example, the device (1) can still retain or restore the space between the vertebrae in which the device (1) is implanted, but may provide greater freedom of movement. It may be fixed to an implant (2) that gives a fixation angle between. In this example, the device (1) can still retain or restore the space between the vertebrae in which the device (1) is implanted, but may provide greater freedom of movement.

As shown in the drawing, the bone fixation implant (2) comprises an anchor (21) used to attach the implant (2) to the vertebra. The implant (2) is configured to receive the connecting element (3) and has a fixture such as a clamp (20) for fixing the connecting element (3) to the inner wall of the conduit (22). It has a pipeline (22). In general, the fixture (20) is a driven connector, such as a screw, or any type of known element capable of anchoring the connecting element (3) to the implant (2). Is possible. Each fixture (20) has a longitudinal axis (L) of the connecting element (3) that extends through the rigid element (34) and an axis (DV) in which the implant (2) is anchored to the vertebra. ) Holds the rigid element (34) so that the fixed angle is fixed. Fixtures such as clamps (20) shown in the drawings can include mounting screws with a flat portion on the base intended to be in contact with the flat portion (340) of the connecting element (3). is there. As described in WO 03/049629 and WO 2005/020829 incorporated herein, the clamp (20) can be equipped with a ball joint in the base and /. Alternatively, the conduit (22) of the implant (2) that receives the connecting element (3) can be flared and / or include a movable base plate. Structures such as these can give the implant (2) some degree of freedom of movement to the connecting element (3) prior to their fixation. In many embodiments, the flat portion (340) is the connecting element (3) because the clamp (20) is substantially collinear with the implant axis (DV) and is placed on the dorsal surface of the connecting element. Although present on this dorsal surface of the, the flat portion (340) can be arranged in various ways depending on the configuration of the clamp (20) and may even be unnecessary. The clamp (20) is, for example, a hexagonal hole or stud, or a screw or nut groove. Which can have recesses or protrusions to engage the tool to tighten the clamp (20). In an alternative embodiment of the invention, any type of fixture used to secure the implant to the joint, either the implant or the joint, is fitted with a connecting element (34) that penetrates the rigid element (34). Used to the extent that these fixtures allow a constant angle between the longitudinal axis (L) of 3) and the axis (DV) of the implant (2) to which the rigid element (34) is fixed. It is possible to do. The embodiments shown in the drawings facilitate the mounting of the device (1) by the degrees of freedom provided by the clamp (20) prior to tightening, allowing the orientation of the rigid element (34) as described above to be adjusted. It is particularly advantageous because it uses the implant (2) of the above design.

From the above description, the damping element (31) allows the device (1) to maintain its position relative to the implant (2) and also gives the implant (2) some freedom of movement. , Will be understood by those skilled in the art. The damping element (31) makes the support provided by the device (1) in various embodiments relatively flexible, allowing the vertebrae to be held in the desired position and thus the burden on the disc. Mitigates and also ensures freedom of movement for patients intended to implant the device (1).

The collaboration of the central part (32) and the rigid element (34) also makes it possible to maintain the distance between the vertebrae, thus providing space between the vertebrae. Of course, this space can be approximately equal to the original space between the quiescent vertebrae, but this space can be clamped (20), if desired, even if the device is already implanted in the vertebrae. ) By opening, by adjusting the position of the rigid element (34) by separating or pulling the vertebrae from each other using known tools, and by further tightening the clamp (20). Or it can be narrowed.

Moreover, in many embodiments, by immobilizing the rigid element (34) to the implant (2), unlike some other types of flexible support devices, a particular orientation to the connecting element (3). Can be given. Thus, for example, the connecting element (3) can be equipped with a connecting element (3) having a neutral position in which the elastic damping element (31) exerts a permanent force on the vertebra when in a stationary state. In some embodiments, this is achieved by bending the connecting element (3) to its neutral position. This aspect of various embodiments can facilitate the precise adaptation of the device (1) to the curvature of the spinal column, or the correction of vertebral position malformations.

Adjustable fixation of the rigid element (34) to the implant (2) provides additional advantages in various embodiments. For example, the length and position of the rigid element (34) with respect to the implant (2) can be adjusted to change the position of the articulation of the rigid element (34) provided by the damping element (31). .. The articular connection can be centered relative to the intervertebral space (IV) or to the articular process (AP) of the vertebra, as illustrated in FIGS. 21 and 20, respectively. Is located below the central part between the vertebral bodies. In some embodiments, other joint connection positions may be preferred.

In various embodiments of the invention, the damping element (31) is substantially equidistant from each of the implants (2) in which the damping element (31) is located, in the longitudinal direction of the connecting element (3). It is located on the axis (L) and therefore the damping element (31) is centered between the implants (2). However, the connecting element (3) can have an eccentric damping element (31) as illustrated in FIG. 5A, which is suitable for the patient's morphology in which the device (1) is implanted, and It may be advantageous in optimizing the stress applied to the damping element (31). In fact, as mentioned above, the articulation of the connecting element (3) can be centered, for example, with respect to the articular process (AP) rather than with respect to the space between the vertebral bodies (IV). is there. In many embodiments, the rigid element (34) can have different lengths and / or different positions with respect to the implant as illustrated in the non-limiting example of FIG. 5A. Yes, this allows adjustment of the position of the damping element (31) with respect to the vertebrae. 20 and 21 show two non-limiting examples of one embodiment of a device implanted in two adjacent vertebrae. In the example of FIG. 20, the damping element (31) is centered with respect to the intervertebral articular process (AP), and in FIG. 21, the damping element (31) is the intervertebral intervertebral space (IV). ) Is located in the center. Of course, the present invention allows adjustment of various elements of the device (1) at any desired position and in any desired orientation, and FIGS. 20 and 21 are merely exemplary herein. It will be appreciated by those skilled in the art by reading this specification that it is presented as an example.

Various embodiments have a rigid element (34) configured to have an elongated region suitable for engaging a fixture (20) for fixing the rigid element (34) to the implant (2). It is possible. By changing the location where the rigid element (34) is fixed to the implant (2), it is possible to adjust the position of the connecting element (3) with respect to the vertebra when implanting the device (1).

For example, in the embodiment illustrated in FIG. 4C, the central portion (32) faces each rigid element (34) on both sides of the central portion between its longitudinal axes (L) and is of the connecting element (3). It has an oblique surface (321) located on at least one surface. These two bevel planes (321) are directed toward the surface on which these bevel planes (321) are located as the patient in which the device (1) is implanted moves.Facilitates bending of connecting element (3). Facilitating such bending (or bending around the damping element) of the connecting element (3) may be desirable to increase the degree of freedom of the device (1) in at least one direction. For example, in FIG. 4C, an oblique plane (321) resides on the ventral surface of the central portion (32), which facilitates bending of the connecting element in the direction of this ventral surface, and the device (1) When implanted on the dorsal surface of the vertebra, it results in allowing the patient to bend more easily forward. In the drawings in which these bevel planes (321) are illustrated, they are located on only one plane, but it is desirable that the bevel planes (321) give the device more freedom of movement in all directions. In some cases, it can be present over the entire outer edge of the central portion. Further, the angle of the oblique surface can be changed according to the required degree of freedom. Similarly, in other embodiments, the bending of the connecting element is such that the central portion (32) is located on at least one surface of the connecting element (3), as illustrated in FIGS. 5A and 6A. This can be facilitated by having at least one slot (320) or notch near the center of the central portion (32) along the directional axis (L). This slot or notch (320) can be placed around all or part of the outer edge of the central portion (32) and can be bent over the entire thickness of the central portion (32) or bent. It is possible to extend over only a portion of the thickness of the central portion (32) if less effort is desired.

Also, bending of the connecting element (3) in at least one direction is illustrated, for example, in FIG. 5C in some embodiments of the invention, as illustrated in FIG. 5B, FIG. 7A or FIG. Thus, the curved outer channel (341), which fits into the complementary shaped recess (322) inside the central portion (32), is in contact with the rigid element (34) and the central portion (32). It can be facilitated by providing it at the end of the rigid element (34). This shape complementarity facilitates the movement of the rigid element (34) with respect to the central portion (32) as the connecting element (3) bends.

When the rigid element (34) is a hollow tube, these rigid elements (34) have flared inner bores at the ends that are in contact with the central portion (32), for example, as illustrated in FIG. 5B. Alternatively, it may be provided with a channel (342). FIG. 9 shows the device (1) when the connecting element (3) bends during any movement of the patient, by having a flared inner bore or channel (342) of the hollow tube (34). It also clearly demonstrates the benefits provided by the fit between the curved outer channel (341) and the inner complementary recess (322) of the central portion (32). The complementarity of these two channels (341, 342) and this shape facilitates the movement of the hollow tube (34) with respect to the central portion (32).

Conversely, in some cases it is desirable to limit the bending of the connecting element (3) in at least one direction. In this case, in various embodiments, the damping element (31) can include at least one bending stop (310, 311) on at least a portion of its at least one surface. In this case, the bending stop (310, 311) opposes the bending of the connecting element (3) in the direction of the surface on which the stop is located. In addition, it may be provided with a first type of bending stop (310) located on all surfaces of the connecting element (3) (ie, all around the connecting element (3)) to limit bending in all directions. It is possible, or it is possible to provide another type of bending stop (311) that is located on only one surface of the connecting element (3) and limits bending along that surface. These bending stops (310, 311) are extensions of the central portion (32) that project from the rigid element (34) or are fixed relative to the central portion (32) in separate elements. It is possible to provide. In some embodiments, the bend stop (310, 311) can include an elastic material that opposes the bending of the connecting element (3) to some extent, or completely opposes the bending of the connecting element (3). It is possible to include rigid inelastic materials.

FIG. 7A shows an embodiment of a device (1) for supporting three vertebrae. The device (1) in these types of embodiments comprises three implants (2), each of which is anchored to one of the vertebrae and has three rigid elements (34) (non-limiting). As an example, it is designed to be connected to each other by a connecting element (3) having two damping elements (31) between the three rigid elements (34) and the hollow tube shown in this embodiment. In this embodiment, the central stiffness element (34) located between the two damping elements (31) is different from the other stiffness elements. For example, the central stiffness element (34) in this embodiment is relatively long and comprises two ends designed to fit the damping element (31). Another type of embodiment that can be used to support three consecutive adjacent vertebrae comprises a central implant (2) configured to secure two separate connecting elements (3). This embodiment comprises the double fixation implant, two conventional implants (2), two connecting elements (3), each of which has a damping element (31). .. In double-fixed implants, the in-line connecting element (3) can be fixed end to end, and in double-fixed implants, the non-line connecting element (3) is fixed in parallel. It is possible. FIG. 17 shows a non-limiting example of one embodiment of a double-fixed implant (2). In this example, the head of the implant comprises two recesses (or channels or conduits) intended for each rigid element (34) of the connecting elements (3) that are substantially parallel to each other. Optionally, these connecting elements can have various orientations by providing a multi-axis fixing means, such as a ball joint or a movable base. 18A and 18B show another non-limiting example of one possible embodiment of a double-fixed implant (2), such that the implant head receives two collateral connecting elements (3). Be done. The head is of two collinear connecting elements (3)

FIG. 7B shows another embodiment of the device (1) for supporting the three vertebrae. However, in this embodiment, device (1) is used for joint fixation (complete immobilization and facet joint fusion) in the first space between certain vertebrae and for another space between other vertebrae. Flexible support is possible. In an exemplary embodiment, the connecting element (3) comprises a first rigid element (34a) (including a hollow tube as a non-limiting example) connecting the implants (2a) and (2b). This connecting element (3) does not have a damping element between the implants (2a) and (2b) in order to firmly fix each vertebra and allow joint fixation. However, the damping element (31) is located between the implants (2b) and (2c) and is secured to the third implant (2c) by a second rigid element (34b) (non-limiting example). Also included in the hollow tube). This configuration, which allows for facet joint fusion between one vertebra and provides support for another, causes the plate of the first facet to be damaged beyond maintenance and therefore. It is especially effective when facet joint fusion is required, while the plate of the second cavity is damaged but can be maintained. In this embodiment, the second plate is flexibly supported and, in some cases, prevents or delays its complete loss.

In the embodiments illustrated in FIGS. 7A and 7B, the longitudinal elastic portion (33) extends throughout the connecting element (3). In addition, FIGS. 8A-8E allow joint fixation of the first intervertebral space (complete intervertebral immobilization and joint fusion) and flex the vertebrae on both sides of another intervertebral space. Embodiments of a vertebrae support device for implantation in three vertebrae to support the vertebrae are shown, in which the longitudinal portion (33) extends over only a portion of the rigid element (34). .. In this case, the rest of the rigid element (34) may be solid as illustrated in FIGS. 8C and 8E, but the rigid element (34) is longitudinal with respect to the rigid element (34). It may be hollow as long as it has at least one hole in its at least one surface to secure the portion (33). This hole is capable of receiving fixtures (330, 331), as detailed below. In order for the vertebral space to be articulated, the connecting element (3) does not need to have a damping element (31) and the longitudinal portion (33) still has some degree of freedom in the device ( It may be sufficient to extend only between the implants (2) that are flexibly supported by 1) and fixed to the vertebrae. Thus, in these embodiments, the connecting element (3) is the first rigid element (34a), which can be solid or hollow, between the first implant and the second implant. It comprises a second rigid element (34b) configured to accommodate the longitudinal elastic element (33) (as a non-limiting example, it is hollow in an exemplary embodiment). The damping element (31) is disposed between the first rigid element (34a) and the second rigid element (34b). The end of the first rigid element (34a) in the vicinity of the damping element (31) is hollow and inserted into this hollow end of the rigid element (34a), as illustrated in FIGS. 8C and 8E. It is possible to provide fixtures (330, 331) for fixing the longitudinal portion (33).

In the embodiments illustrated in FIGS. 8B and 8C, the fixation stop (331) secures the longitudinal portion (33) of the rigid element (34a) to this hollow end. This stop (331) is larger than the diameter of the internal channel of the hollow portion of the first rigid element (34a) and is present in at least one surface (or one wall) of the rigid element (34a). It has a diameter larger than the diameter of 330b). In the embodiments illustrated in FIGS. 8D and 8E, the removable lock (330) secures the longitudinal portion (33) within the hollow portion of the first rigid element (34a). In an exemplary embodiment, the removable lock (33) has a hole (330b) (or bore or perforation) extending through the wall of the rigid element (34) and in the longitudinal portion (33). Includes stitching (eg, wire or filament) that penetrates at least one hole (330a). Thus, in this example, the removable lock includes a wire or filament (330) that penetrates the rigid element (34a) and the longitudinal portion (33). The longitudinal portion (33) can be provided with a plurality of holes (330a) that allow its tension to be adjusted as previously described. Similarly, the other end of the longitudinal portion (33) extends through the longitudinal portion (33) as illustrated in FIG. 8A and as suggested by FIGS. 8D and 8E. It is possible to provide a fixture of the same type as that used in other embodiments described herein, such as a wire (330) that penetrates the hole (330a). In another embodiment described above, the end of the longitudinal portion (33) extends through the longitudinal portion (33) if it does not extend beyond the end of the rigid element. It can be fixed by a removable lock (330) that penetrates the hole (330a) and the hole (or perforation) (330b) that extends through the rigid element (34).

10A, 10B and 10C, and 11A, 11B and 11C, the rigid element is a solid bar, or at least partially solid, between some or all of its length. , Various embodiments are shown. In these embodiments, each solid bar (34) comprises a groove, channel or chute with an increasing depth from its central end along one of its surfaces, which is the central portion ( Collaborate with 32). In the embodiments of FIGS. 10A-10C, in practice, in the area mounted on the implant (2), the rigid element (34) comprises a hollow tube, as is particularly seen in FIG. 10C. At this point, the groove, channel or chute is surrounded in the transverse direction by a surface that provides support for fixing the rigid element. As in the embodiments presented above, this supporting surface can include a flat portion (340) intended to work with the clamp (20) of the connecting element (3) and implant (2). Is. In this way, the surface forms a structural part that supports the clamp (20), and the groove, channel or chute continues through the hole, allowing the insertion of the longitudinal portion (33).

In the embodiments of FIGS. 11A-11C, the groove, channel or chute is unenclosed and the rigid element (34) has a U-shaped cross section over its entire length, as seen particularly in FIG. 11C. , The depth of the chute varies between the two ends of the rigid element (34). In this embodiment, as seen in FIG. 11B, the groove, channel or chute is inserted at its end into the groove, channel or chute without projecting the longitudinal portion (33) from the groove, channel or chute. Has a depth that allows Thus, the side walls of the groove, channel or chute form a surface that provides support for the fixation of the rigid element (34) without crushing the elastic longitudinal portion (33).

In the embodiments illustrated in FIGS. 10A-10C and 11A-11C, the longitudinal portion (33) is part of its overall length between the rigid elements (34) and another of its overall length. The portion is placed inside the rigid element (34), thus providing a surface to support the clamp (20), which clamp (20) does not crush the longitudinal portion (33). As described above, by a fixture (330, 331) adapted to the structure of the longitudinal portion, for example, the longitudinal portion is kept at a predetermined tension and the longitudinal portion extends beyond the rigid element. , It is possible to fix the longitudinal part. The supporting surface of the fixed end of the rigid element (34) is in the direction of the clamp (20) as shown in FIGS. 10A-10C or inside the implant (2) shown in FIGS. 11A-11C. It is possible to orient in the direction of another inner surface of the conduit.

In some embodiments, the longitudinal portion (33) can include some kind of sheath (or sleeve) into which the rigid element (34) is inserted at least partially. In these embodiments, the rigid element can include a solid bar, which has a lower risk of damaging or degrading the central portion (32) as compared to a hollow tube. The central portion (32) and the longitudinal portion (33) can be realized as two separate elements, as illustrated in FIGS. 12A and 12B. In an exemplary embodiment, the longitudinal portion (33) covers the central portion (32) and at least partially the rigid element (34). By fixing this longitudinal portion (33) to the rigid element (34) with fixtures (330, 331), the coupling of the aggregates is ensured. In various embodiments, the central portion (32) can be attached to the rigid element. In other embodiments, the central portion (32) and the longitudinal portion (33) can be single units, as illustrated in FIGS. 12C and 12D. Also, the rigid element (34) and the central portion (32) can be attached or detached from each other.

12A-12D are removable fixations comprising wires or filaments penetrating the bar (34) and longitudinal portion (33), eg, similar to the embodiments described above with reference to FIGS. 8D and 8E. The fixation of the longitudinal portion (33) to the bar (34) by the tool (330) is shown. Other embodiments can be configured to receive any other type of fixture (330, 331) that is removable or non-detachable. Preferably, the longitudinal portion is in a predetermined tension in the stationary state. In these embodiments of FIGS. 12A-12D, the longitudinal portion is shorter than the aggregate of connecting elements (3) formed by the rigid element (34) and the central portion (32), and thus the rigid element (34). ) Can receive the clamp (20) without mediation. Therefore, FIGS. 12A-12D show a non-limiting example of fixing the longitudinal portion (33) by the removable fixture (330) penetrating the rigid element (34) and the longitudinal portion (33). In other embodiments, the longitudinal portion (33) is longer than the assembly of connecting elements (3), for example by means of fasteners (330, 331) such as staples or rings described above. It is possible to keep it stretched with a predetermined tension from both the sides and ends of the. 13A and 13B are non-limiting of such embodiments, wherein the longitudinal portion (33) is secured by a removable fixture (330) secured to each surface of the end of the connecting element (3). An example is shown. In this example, the sheath formed by the longitudinal portion (33) extends beyond the two ends of the assembly of connecting elements (3) formed by the central portion (32) and the rigid element (34). The two ends of the sheath are squeezed and compressed by a removable fixture (330), such as the staples shown in FIGS. 13A and 13B. In this case, the fixtures (330, 331) are at the ends of the longitudinal portion (33) and at one end of the rigid element (34) or at both sides of the rigid element (34). It can be fixed with. The tension applied to the longitudinal portion (33) by the fixture (330, 331) is visible, for example, at the end where the fixture (330, 331) should be located at the outer edge of the longitudinal portion (33). By using the tension mark, it can be confirmed in the factory or in the operating room. In another embodiment, the longitudinal portion (33) can be extended directly by the clamp (20) of the implant (2). For example, in one embodiment, the longitudinal portion (33) is a sheath through which a rigid element (34) is passed, as described, for example, from FIGS. 12A to 12D or 13A and 13B. Implants (2) to the extent that the portion (33) is long enough (or can be stretched sufficiently) to extend from one implant (2) to another (2). The clamp (20) allows the sheath to be held directly at a given tension. 15A, 15B and 15C are another non-limiting example of possible embodiments in which the longitudinal portion is fixed and thus extended (maintained in an extended state) by the clamp (20) of the implant (2). An example is shown. In this example, the longitudinal portion (33) is a hollow rigid element (34) with longitudinal slits at at least one end, as illustrated in FIGS. 15B and 15C, especially as seen in FIG. 15A. It is inserted inside. In FIGS. 15B and 15C, the implant clamps (20) compress the portion of the rigid element (34) with slits when they are tightened, which results in compression of the longitudinal portion (33). It is shown that the longitudinal portion (33) can be kept at a predetermined tension. Staples or rings can be used as fasteners (330, 331), but are described herein as others, such as fixed stops at the ends of longitudinal portions that cooperate with the recesses of the bar. Alternatives are possible. Alternatively, in some embodiments, the longitudinal portion

In various embodiments, the fixture of the longitudinal portion, which can be placed at a predetermined tension, comprises a compression element (330c) intended to be inserted into the passage within the rigid element (34). It is possible to do. Therefore, these compression elements (330c) inserted into the hollow tube of the rigid element (34) compress the longitudinal portion (33) and secure the longitudinal portion to the rigid element (34). Hold. For example, as illustrated in FIG. 22B, these compression elements (330c) have an end thickness that faces the end of the longitudinal portion (33) along the longitudinal axis (L). It can consist of a pair of spacers that are greater than the thickness of the centrally facing end of the longitudinal portion (33). In various variants, these compression elements (330c) can consist of a portion of a tapered ring, which is a conical portion, a passage for inserting a longitudinal portion into its central portion. And has holes throughout the length of the conical portion, which allows it to be deformed when inserted into the hollow tube of the rigid element (34). In some of these variants described above, only one example of a compression element (330c) can be present at each end of the longitudinal portion (33).

Also, in various embodiments, the vertebral support device (1) comprises a joint element (35) that forms a joint connection between the rigid elements (34) of the connecting element (3). In various embodiments, such as those illustrated in FIGS. 22A and 22B, these joint elements (35) are substantially flat cylinders with a passageway through which the longitudinal portion (33) passes through in the center. Has the shape of. Of course, the exact shape of these joint elements (35) can be something other than a cylinder in various implementation variants. In the embodiments of FIGS. 22A and 22B, the vertebral support device (1) comprises two joint elements (35) located on either side of the central portion (32), each of which is central. It has a bearing surface (355) that fits into a portion (32) and a collaborative surface (356) that fits into a rigid element (34). In some variations of the implementation, the joint element (35) can be configured by assigning a portion that is continuous with the rigid element (34). In this case, these joint elements (35) do not have a collaborative surface (356) that fits into the rigid element (34), but the central part (32) due to the joint connection of the device (1) By pairing with, it becomes an extension of the rigid element (34) with the bearing surface (355) that maintains the integrity of the central portion (32). The bearing surface (355), which cooperates with the central portion (32), can be substantially flat, as illustrated in the examples of FIGS. 22A and 22B, and the central portion (35) as the patient moves. It can be complementary to the surface (325) of the central portion (32) in contact with the bearing surface (355) so as to avoid damage to 32). In the illustrated example, this bearing surface (355) has a dimension greater than the dimension of the surface (325) of the central portion (32) with which it is in contact, and thereby the central portion (32). The protection of integrity is strengthened. In various embodiments, it is fitted to the central portion (32), as shown, for example, in FIGS. 23A, 23B and 23C. The bearing surface (355) comprises a recess having a shape and dimensions designed to receive at least a portion of the central portion (32). In variations of the various implementations, the wall of this recess is such that the two joint elements (35) are pressed against each other on at least one surface of the device, eg, the back, and thus in at least one direction. It can be extended by an extension (not shown) configured to be in contact with the extension of the wall of another joint element (35) so as to limit its movement. According to various embodiments, the collaborative surface (356) fitted to the rigid element (34) is at the end of the rigid element (34) with which it is in contact, as can be seen, especially in the example of FIG. 23B. It is possible to have recesses with shapes and dimensions that are complementary to the shape and dimensions, or it is possible to be flat and form a contact area for the rigid element (34). In various embodiments, the bearing surface (355) fitted to the central portion (32) is complementary to the surface (325) of the central portion (32) with which it is in contact. For example, as can be seen, in particular in FIGS. 24A, 24B and 24C, the bearing surfaces (355) of the two joint elements (35) are substantially curved and the central portion (32) in which they are in contact. It can be complementary to the surface (325). In the illustrated example, the bearing surface (355) is concave and the complementary surface (325) of the central portion (32) is convex, for example substantially as part of a sphere. In the modified form, it is possible to anticipate that the concave and convex areas have an inverted configuration. It can be extended by the extension (not shown) formed. According to various embodiments, the collaborative surface (356) fitted to the rigid element (34) is at the end of the rigid element (34) with which it is in contact, as can be seen, especially in the example of FIG. 23B. It is possible to have recesses with shapes and dimensions that are complementary to the shape and dimensions, or it is possible to be flat and form a contact area for the rigid element (34). In various embodiments, the bearing surface (355) fitted to the central portion (32) is complementary to the surface (325) of the central portion (32) with which it is in contact. For example, as can be seen, in particular in FIGS. 24A, 24B and 24C, the bearing surfaces (355) of the two joint elements (35) are substantially curved and the central portion (32) in which they are in contact. It can be complementary to the surface (325). In the illustrated example, the bearing surface (355) is concave and the complementary surface (325) of the central portion (32) is convex, for example substantially as part of a sphere. In the modified form, it is possible to anticipate that the concave and convex areas have an inverted configuration. It can be extended by the extension (not shown) formed. According to various embodiments, the collaborative surface (356) fitted to the rigid element (34) is at the end of the rigid element (34) with which it is in contact, as can be seen, especially in the example of FIG. 23B. It is possible to have recesses with shapes and dimensions that are complementary to the shape and dimensions, or it is possible to be flat and form a contact area for the rigid element (34). In various embodiments, the bearing surface (355) fitted to the central portion (32) is complementary to the surface (325) of the central portion (32) with which it is in contact. For example, as can be seen, in particular in FIGS. 24A, 24B and 24C, the bearing surfaces (355) of the two joint elements (35) are substantially curved and the central portion (32) in which they are in contact. It can be complementary to the surface (325). In the illustrated example, the bearing surface (355) is concave and the complementary surface (325) of the central portion (32) is convex, for example substantially as part of a sphere. In the modified form, it is possible to anticipate that the concave and convex areas have an inverted configuration. To. In the illustrated example, the bearing surface (355) is concave and the complementary surface (325) of the central portion (32) is convex, for example substantially as part of a sphere. In the modified form, it is possible to anticipate that the concave and convex areas have an inverted configuration. To. In the illustrated example, the bearing surface (355) is concave and the complementary surface (325) of the central portion (32) is convex, for example substantially as part of a sphere. In the modified form, it is possible to anticipate that the concave and convex areas have an inverted configuration.

In various embodiments, the rigid elements (34) can have curved portions at least in part of their overall length. For example, as illustrated in FIGS. 25A and 25B, the rigid element (34) may include a curved hollow tube (34c) to transmit the curvature to the connecting element (3) when in a stationary state. It is possible. Thus, for example, even if the bone fixation implant (2) is obliquely fixed in the vertebral bone, for example in the pedicle, at least at the end of the rigid element (34) located in the implant (2), Due to the curvature of the rigid element (34), the joint connection between the two rigid elements (34) becomes linear and aligned at rest instead of being continuously stressed even at rest due to the tilt of the rigid element. It becomes possible. Of course, these embodiments can be combined with, for example, an implant (2) embodiment having a clamp (20) with a ball joint at the base, but these two types of configurations have rigid elements (34). It is possible to have almost the same effect on the joint connection between).

In various embodiments, the vertebral support device (1) lacks the central portion (32), as illustrated, for example, in FIGS. 26A and 26B, 27A and 27B, or 28A and 28B. It is possible to have joint elements (35) that fit together at. For the modifications of the mounting embodiments described above, the joint element (35) comprises a collaborative surface (356) and a bearing surface (355) that are fitted to the rigid element (34). In this type of variant, the device allows for constant clearance between the vertebrae, but no longer uses the elastic central portion (32) to dampen and eliminate compressive stresses. On the other hand, the joint elements (35) are fitted together to provide better support for the curvature complementation of at least one bearing surface (355) of each joint element (35) for various movements. Form joint connections that give freedom. Thus, each joint element comprises at least one curved bearing surface (355), which is complementary to the other curved bearing surface (355), thereby complementing these complementary curved bearings. The surfaces (355) fit together to form joint connections that provide good support between the vertebrae even when the patient is moving. The longitudinal portion (33) creates tension to withstand such elongation, especially between the two curved bearing surfaces (355) of the joint element (35), as can be seen in FIGS. 26B, 27B and 28B. Tend to maintain contact with. According to various variants, these curved bearing surfaces (355) may have different shapes, as shown in FIGS. 26C and 26D, 27C and 27D, or 28C and 28D. It is possible. As an example, in the variant shown in FIG. 26D, the curved bearing surface (355) of the joint element (35) has the shape of a part of a sphere (or a spherical cap) and is one of two surfaces. Is concave (see Figure 26C) and the other is convex (see Figure 26D). Bay because the curvature of each bearing surface (355) is oriented in all directions This shape of the curved bearing surface (355) gives freedom of movement in all directions. On the other hand, the curvature of the curved bearing surface (355) can be oriented in a single direction, for example in the variant shown in FIG. 27D, for example the radius of curvature of the curved surface is longitudinal. Oriented along an axis perpendicular to the direction axis (L). This type of variant is used to give freedom of movement in one particular axis (in two directions) and to limit articulation in the other axis. In this type of variant, these joint elements (34) relative to the rigid element (34), in such a manner that the joint connections made by the joint elements (35) remain oriented along the orientation selected at the time of implantation. In order to prevent the rotation of 35), it is possible to provide, for example, a stop element (not shown) of the collaborative surface (356) that fits into the rigid element (34). Finally, in variants of other implementations, as can be seen, especially in FIGS. 28C and 28D, the joint elements are of two joint elements (35) relative to each other in the area or surface where they fit together. It comprises at least one stop surface (357) that acts as a stop that limits movement. For example, as in the illustrated example, this stop surface (357) can consist of a flat area of a portion of the curved bearing surface (355). Thus, this stopping element limits movement in a given axis in one direction, which axis and this direction can be selected during the embedding process. As mentioned earlier, once this device (1) is embedded, this axis and this direction are kept constant by a stop element (not shown) that prevents the joint element (35) from rotating relative to the rigid element (34). Is possible. Oriented along an axis perpendicular to. This type of variant is used to give freedom of movement in one particular axis (in two directions) and to limit articulation in the other axis. In this type of variant, these joint elements (34) relative to the rigid element (34), in such a manner that the joint connections made by the joint elements (35) remain oriented along the orientation selected at the time of implantation. In order to prevent the rotation of 35), it is possible to provide, for example, a stop element (not shown) of the collaborative surface (356) that fits into the rigid element (34). Finally, in variants of other implementations, as can be seen, especially in FIGS. 28C and 28D, the joint elements are of two joint elements (35) relative to each other in the area or surface where they fit together. It comprises at least one stop surface (357) that acts as a stop that limits movement. For example, as in the illustrated example, this stop surface (357) can consist of a flat area of a portion of the curved bearing surface (355). Thus, this stopping element limits movement in a given axis in one direction, which axis and this direction can be selected during the embedding process. As mentioned earlier, once this device (1) is embedded, this axis and this direction are kept constant by a stop element (not shown) that prevents the joint element (35) from rotating relative to the rigid element (34). Is possible. Oriented along an axis perpendicular to. This type of variant is used to give freedom of movement in one particular axis (in two directions) and to limit articulation in the other axis. In this type of variant, these joint elements (34) relative to the rigid element (34), in such a manner that the joint connections made by the joint elements (35) remain oriented along the orientation selected at the time of implantation. In order to prevent the rotation of 35), it is possible to provide, for example, a stop element (not shown) of the collaborative surface (356) that fits into the rigid element (34). Finally, in variants of other implementations, as can be seen, especially in FIGS. 28C and 28D, the joint elements are of two joint elements (35) relative to each other in the area or surface where they fit together. It comprises at least one stop surface (357) that acts as a stop that limits movement. For example, as in the illustrated example, this stop surface (357) can consist of a flat area of a portion of the curved bearing surface (355). Thus, this stopping element limits movement in a given axis in one direction, which axis and this direction can be selected during the embedding process. As mentioned earlier, once this device (1) is embedded, this axis and this direction are kept constant by a stop element (not shown) that prevents the joint element (35) from rotating relative to the rigid element (34). Is possible. As can be seen in 28C and FIG. 28D, the joint elements are at least one stop in the area or surface where they fit together, which acts as a stop that limits the movement of the two joint elements (35) relative to each other. It has a surface (357). For example, as in the illustrated example, this stop surface (357) can consist of a flat area of a portion of the curved bearing surface (355). Thus, this stopping element limits movement in a given axis in one direction, which axis and this direction can be selected during the embedding process. As mentioned earlier, once this device (1) is embedded, this axis and this direction are kept constant by a stop element (not shown) that prevents the joint element (35) from rotating relative to the rigid element (34). Is possible. As can be seen in 28C and FIG. 28D, the joint elements are at least one stop in the area or surface where they fit together, which acts as a stop that limits the movement of the two joint elements (35) relative to each other. It has a surface (357). For example, as in the illustrated example, this stop surface (357) can consist of a flat area of a portion of the curved bearing surface (355). Thus, this stopping element limits movement in a given axis in one direction, which axis and this direction can be selected during the embedding process. As mentioned earlier, once this device (1) is embedded, this axis and this direction are kept constant by a stop element (not shown) that prevents the joint element (35) from rotating relative to the rigid element (34). Is possible.

The various embodiments presented herein are used to indicate possible variations of the invention and to show that the invention can be used in a number of different embodiments. Some particularly advantageous embodiments of the present invention make it possible to adjust the tension of the longitudinal portion (33) during assembly of the device (1). Of course, this assembly can be performed in the factory or on the operating table by the surgeon. In the factory, it is possible to measure the tension accurately and, if necessary, at at least one end of the longitudinal portion (33) so that the surgeon recognizes the value of the tension he is adjusting. It is possible to record the tension on the arranged tension marker. Therefore, the present invention also relates to a method for preparing the device (1).

This method can be performed in the factory prior to embedding and the device is assembled and supplied. Alternatively, this method can be performed by a surgeon who receives a (at least partially) unassembled device (1) and with the desired tension this device (1). To assemble. Any embodiment of the longitudinal portion (33) tension adjustment described herein can be adapted for use in this method. This method involves the following steps: The step of placing the central part (32) between the rigid elements (34). The step of operatively placing the longitudinal portion (33) with respect to the rigid element (34). Steps to adjust the tension of the longitudinal part (33). The step of fixing the longitudinal portion (33) to the rigid element (34).

In implementing this method, one embodiment includes marking at least one tension mark on the longitudinal portion (33) and adjusting the tension on the longitudinal portion (33). Another embodiment uses one or more fixtures (330, 331) to at least one of the longitudinal portions (33) in the step of fixing the longitudinal portion (33) to the rigid element (34). Includes steps to secure one end. Another embodiment has at least one removable lock in at least one hole (330a) in the longitudinal portion (33) along an axis that is substantially perpendicular to the longitudinal axis (L). Includes inserting (330). Such a hole (330a) can form a tension mark, another embodiment comprising using such a tension mark to determine the tension of the longitudinal portion (33). , Another embodiment comprises fixing the fixture (330, 331) in the corresponding hole (or perforation) (330b) in the wall of the hollow tube (34). A removable lock (330) inside at least one hole (330a) present in the longitudinal portion (33) and in a hole (330b) (or perforation) in the wall of the tube (34). Such fixation by inserting the device (1) can be appropriately performed by the surgeon, for example, by inserting the wire (330) through these holes and tying the wire during implantation of the device (1). ..

In another embodiment for a device (1) having a rigid element (34) including a solid bar with a groove, channel or chute, the longitudinal portion (33) operates with respect to the rigid element (34). The placement of the rigid element (34) further comprises inserting a longitudinal portion (33) inside the groove, channel or chute. As in the embodiment of FIGS. 10A-10C, this step of inserting a longitudinal portion (33) inside a groove, channel or chute is a rigid element at the level of a clamp (20) that connects the implant to the connecting element. It can be associated with the step of inserting the longitudinal portion (33) inside the hole extending the groove, channel or chute at the fixed end of (34). In embodiments where the rigid element comprises a hollow tube, the step of operatively placing the longitudinal portion (33) relative to the rigid element (34) is the internal and central portion of the conduit of the rigid element (34). It further includes the step of inserting the longitudinal portion (33) inside the conduit of 32). In these embodiments, operatively disposing the longitudinal portion (33) relative to the rigid element (34) is the longitudinal portion (33) opposite the end with the removable fixture (330). ) Can further include a step of fixing a fixation stop (331) having an outer diameter larger than the diameter of the hollow tube (34). In another embodiment, operatively placing the longitudinal portion (33) relative to the rigid element (34) places a solid bar inside the longitudinal portion (33) with an elastic sheath or sleeve. It further includes inserting a rigid element (34) and a central portion (32).

Different steps of different methods can be performed prior to implanting the device in the vertebrae. In addition, these steps may constitute at least part of the method for assembling the device prior to embedding. Alternatively, these steps form at least part of the various methods for embedding the device. Upon implantation, the surgeon performing such a procedure performs a step of adjusting the position of the rigid element (34) along the longitudinal axis (L) with respect to the implant (2), followed by a clamp. (20) makes it possible to carry out the step of blocking the rigid element (34) at the desired position. Implantation of implants in the vertebrae and adjustment of the orientation of rigid elements with respect to the axis of the spinal column using multiaxial implants are described in detail in WO 03/049629 and Pamphlet 2005020829. There is. Therefore, the implant (2) can be placed by screwing the threaded portion (21) into the vertebra or by fixing the hook (21) in the proper shape of the vertebra or in particular the recess formed in the vertebra. The steps for embedding need not be detailed herein. For many implant procedures, it may be preferable to fix the implant (2) in the vertebrae without damage to the articular process (AP). In fact, various embodiments of the device (1) are intended to reduce the strain on the intervertebral disc while ensuring freedom of movement in the adjacent vertebrae instead of causing joint fixation. Therefore, in a number of procedures, it may be preferable to keep the articular processes (APs) intact and prevent their joint fusion. Therefore, when implanting a bone fixation implant (2) in the vertebra (eg, in the vertebra), the surgeon wants to fix the implant (2) in the vertebra without damaging the articular process (AP). You may take the following measures.

In addition, the central placement of the damping element (31) with respect to the vertebra can be changed during implantation. Implants are fixed at the level of the pedicles of two adjacent vertebrae, especially as seen in the non-limiting examples of FIGS. 20 and 21. In addition, the damping element (31) can be centered with respect to the articular process (AP) between these two vertebrae, especially as seen in FIG. Can be centered relative to the intervertebral space (IV). This central placement is operatively relative to the implant (2) by adjusting the position of the rigid element (34) with respect to the implant (2) along the longitudinal axis (L). ) Is fixed by the surgeon. This step can also be associated with the step of selecting various stiffness elements (34) having a length adapted to the selected center position. Also, during implantation, the surgeon can adjust the space between the vertebrae with known tools, such as forceps. In addition, the device according to the invention makes it possible to ensure freedom of movement for the patient while maintaining this space.

When the surgeon implants the implant in the spine, places a rigid element on the implant, and adjusts the tension in the longitudinal portion, the surgeon will give one of the rigid elements (34) to one of the implants (2). You can choose to clamp only one and then adjust the space between the spinal bones before clamping the second stiffness element (34) to the second implant (2). Therefore, this method of implantation centers on the step of using a clamp (20) to secure one of the rigid elements (34) to one of the implants (2) and the damping element (31) to the vertebrae. A step of placing on the vertebrae, a step of pulling the vertebrae apart (eg using diastolic forceps known in the art), and a clamp (20) to secure the second rigid element (34) between the vertebrae. May include a step of keeping the desired space in. As mentioned above, the clamp (20) is provided with a tightening means, and in any embodiment in which the clamp (20) is located on the implant (2) with a longitudinal channel, the tightening means provides a rigid element (20). 34) can be inserted or retained in the head of the implant (2) without being initially blocked, and once the position of the rigid element (34) has been adjusted. It is possible to block the rigid element (34). The step of adjusting the space between the vertebrae is facilitated by translating the rigid element relative to the clamp (along the longitudinal axis) and tightening the clamp.

As described above, the embodiment using the multi-axis anchor (2) can adjust the orientation of the rigid element (34). The method associated can include adjusting the orientation of the longitudinal axis (L) of the stiffness element (34) with respect to the axis of the spinal column, followed by the stiffness element (34) in the desired orientation. Followed by the steps to fix. In some embodiments, adjustment of the position of the rigid element and its orientation can be achieved when implanting the device in the vertebra. As mentioned earlier, it is possible to perform fixation in the selected orientation after the step of adjusting the orientation, but this orientation is centered on the selected position, even after tightening the implant clamp. It can be secured in a free or restricted state and is still within the scope of the present invention.

With the above disclosure, many of the various features of the various exemplary embodiments presented herein do not deviate from the scope or intent of the invention, and are known to each other and to others in the art. Those skilled in the art will appreciate that the invention can be combined with features and can include a number of other embodiments. As a result, the embodiments described above should only be considered as exemplary and the invention should not be limited to the details presented above.