EP0996383A1 - Apparatus for interlocking two contiguous, in particular lumbar, vertebrae - Google Patents
Apparatus for interlocking two contiguous, in particular lumbar, vertebraeInfo
- Publication number
- EP0996383A1 EP0996383A1 EP98922912A EP98922912A EP0996383A1 EP 0996383 A1 EP0996383 A1 EP 0996383A1 EP 98922912 A EP98922912 A EP 98922912A EP 98922912 A EP98922912 A EP 98922912A EP 0996383 A1 EP0996383 A1 EP 0996383A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- screw
- implant
- head
- translaminar
- ball joint
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
- A61B17/7064—Devices acting on, attached to, or simulating the effect of, vertebral facets; Tools therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7032—Screws or hooks with U-shaped head or back through which longitudinal rods pass
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7035—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
- A61B17/704—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other the longitudinal element passing through a ball-joint in the screw head
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2/4405—Joints for the spine, e.g. vertebrae, spinal discs for apophyseal or facet joints, i.e. between adjacent spinous or transverse processes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B2017/7073—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant with intervertebral connecting element crossing an imaginary spinal median surface
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30476—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
- A61F2002/30507—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism using a threaded locking member, e.g. a locking screw or a set screw
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30537—Special structural features of bone or joint prostheses not otherwise provided for adjustable
- A61F2002/30538—Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting angular orientation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0004—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
- A61F2250/0006—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting angular orientation
Definitions
- the present invention relates to a spinal osteosynthesis device for securing two contiguous vertebrae, in particular the lumbar vertebrae, with a view to their bone fusion, comprising means for securing the vertebrae at their respective pedicular and laminar facets.
- a healthy intervertebral disc constitutes a viscoelastic joint unit. It allows mobility around a longitudinal axis, and its rotational movements are guided back by the articular facets, biplanes at the lumbar level. Mobility in the sagittal plane occurs in particular during flexion movements. Its control involves, in addition to the disc viscoelasticity, the limiting mechanical action of the antero-median and frontal portion of the articular facets, thus opposing the forces of intersomatic shearing. The posterolateral and sagittalized portion of the facets intervenes, in turn, during lateral movements, performed in the frontal plane.
- each segment of lumbar mobility is presented as a triarticular complex in inter-relation.
- This complex involves, taking the L4-L5 segment as an example: the L4-L5 disc, the upper articular facets of the underlying L5 vertebra and the lower articular facets of the overlying vertebra.
- the upper facets are directly appended posterior to the vertebral pedicle of L5, an integral part of the functional complex.
- the lower facets are grafted distally to the infero-lateral part of the L4 blades. Their mean plane is orthogonal to the lamar axis.
- These elements constitute an even functional unit arranged symmetrically on either side of the mid-sagittal plane.
- This set includes successive elements: disc, pedicle, upper and lower joint - blade.
- the posterior arch of the overlying vertebra locks back the rotational mobility of the anterior segment of the underlying vertebra.
- the function of the upper pediculo-articular assembly is to oppose the anterior translation of the posterior arch. In certain pathological situations, a release of these "locks" occurs. Segmental mobility deprived of self-control goes beyond its physiological framework. A reaction process tries to remedy this failure. In the event of bankruptcy, the use of surgery becomes a necessary analgesic alternative.
- a posterior osteosynthesis is carried out of the spinal segment considered by resorting to a series of pedicle screws connected together by rods or plates, this solution having imposed itself in the indications of posterolumbar lumbar arthrodeses. side. Immobilization of the joints of the fixed segment facilitates the fusion induced by a complementary bone graft. This monoplanar synthesis neutralizes the only frontal plane.
- pedicle implants are located in the sagittal plane.
- the cephalic screws of the assembly are inserted into vertebral pedicles belonging to the functional segment adjacent to the neutralization, which are unnecessarily damaged, which constitutes a significant drawback of this type of device.
- the stabilization obtained is relative, since the assembly acts as a flying buttress.
- the interarticulo-lamar graft site is reduced because it is occupied by the plates or stems.
- radiological monitoring of the fusion is difficult given the overlays.
- learning a reliable pedicle sight is also deemed difficult.
- articular facets are joined by means of short transfixing screws.
- Such screws have certain advantages: a very satisfactory stabilization is thus obtained, controlling the mobility around a longitudinal axis. This principle applies in particular in cases of instability of disc origin. In addition, stabilization is truly mono-segmental, the neurological risk of the procedure is very low, thanks to the use of a viewfinder, the use of intraoperative radiological control is not necessary. Inter-transverse decortication to prepare the graft bed is not compulsory, the operating time is reasonable, learning the technique is relatively simple, and finally the economic impact of this osteosynthesis is reasonable.
- the present invention therefore aims to provide an osteosynthesis device for securing the mobility segment of two contiguous vertebrae, in particular lumbar, avoiding the above drawbacks of the two known types of embodiment described.
- the spinal osteosynthesis device for securing two contiguous vertebrae comprises, for each pair of pedicle and laminar facets, a transpedicular implant, a translaminar implant and locking means for mechanically joining these two implants in such a way angularly adjustable.
- the invention thus achieves a combination of two translamary (or translaminar) and pedicle implants mechanically linked by a bolt system adjustable in several directions.
- the pedicle implant is a screw comprising a threaded rod and a head containing an orientable ball joint and suitable for making the connection with the translaminar implant. Thanks to this device, only the pedicles concerned in this monosegmental neutralization are instrumented, which constitutes a first important advantage of the invention.
- the pedicle implant reinforces the anchoring in the portion mobility segment, which is thus armed and exerts a counter-support. Finally, a defect (defect) in the joint or lamina following an enlarged release gesture does not prevent the use of this osteosynthesis procedure.
- the invention also relates to an arthroplasty device between two articular facets of two contiguous vertebrae L4, L5, one of the facets lying in the extension of a pedicle of a L5 vertebra while the other facet is adjacent to a blade of the other L4 vertebra.
- this device comprises a pedicle implant secured to a concave artificial facet, and a translaminar implant secured to a convex artificial facet.
- FIG. 1 is a side elevational view, in a sagittal plane, on a substantially enlarged scale of a spinal segment consisting of two lumbar vertebrae, equipped with a first embodiment of the osteosynthesis device targeted by the invention.
- FIG. 2 is a view of the osteosynthesis device of FIG. 1 in a horizontal plane, that is to say a plane transverse to that of FIG. 1.
- FIG. 3 is a view of the spinal segment of Figures 1 and 2 and its osteosynthesis device in a posterior frontal plane.
- FIG. 4 is a view in longitudinal section on an enlarged scale of a pedicle screw and of its orientable ball joint forming part of the osteosynthesis device of FIGS. 1 to 3.
- Figure 5 is a cross-sectional view along 5/5 of Figure 4.
- Figure 6 is a partial cross-sectional view of a second embodiment of the osteosynthesis device according to the invention.
- Figure 7 is a sectional view in partial elevation of a third embodiment of the osteosynthesis device according to the invention.
- Figure 8 is a schematic top view of a fourth embodiment of the device according to the invention.
- Figure 9 is an elevational view in partial section on an enlarged scale of a fourth embodiment of the spinal osteosynthesis device according to the invention.
- Figure 10 is an elevational and partial sectional view in a horizontal plane of a complete paired device, including that of Figure 9 and implanted in a vertebra.
- FIG. 11 is an elevation view in a frontal plane, on a reduced scale, of the device of FIG. 10.
- Figure 12 is an elevational view in partial section of a translaminar viewfinder for performing the aim for the placement of the translaminar implant.
- FIGS. 13A and 13B are partial schematic elevation views of two variants of the viewfinder of FIG. 12.
- the spinal osteosynthesis device shown in the drawings is intended to mechanically join two contiguous vertebrae, in particular two lumbar vertebrae L4 and L5 (FIG. 1) at their articular facets F (Fig. 2), pedicular and laminar, in order to allow their subsequent bone fusion.
- This device comprises, for each of the two pairs of articular facets, a transpedicular implant 1 constituted by a screw comprising a threaded rod 2 as well as a head 3, a translamary (or translaminar) implant constituted by a screw 4, and means for allow a mechanical connection between the translaminar screw 4 and the pedicle screw 1, such as a swivel ball 5, drilled through and through, housed in the head 3, as well as means for hooking the upper part of the screw 4 on the blade, namely a cylindrical head 9 or, more advantageously, a washer 65 with pins 66 and a compression nut 70 ( Figures 9-10).
- the head 3 is tubular, provided at its end with a part
- a lateral opening 6 through which can penetrate an end 7 with a trocar point of the threaded rod of the translaminar screw 4.
- This insertion of the end 7 makes it possible to screw the latter in a diametral bore 11 of the ball joint 5, which is extended by a diametrical tubular section 12 coaxial with its bore 11.
- the latter is therefore dimensioned to receive the threaded end 7 of the corresponding screw 4 after proper angular orientation of the ball 5, which is supported on a spherical seat 13 formed in the head 3.
- the seat 13 extends at the base of the smooth non-tapped interior wall 3a of the head 3, as well as around an axial hole formed in the threaded rod 2.
- This hole is profiled, for example polygonally (hexagon) in order to be able to receive a tool (not shown) for screwing the implant 1 into the pedicle of the vertebra L5.
- the head 3 is equipped with a means for blocking the ball joint 5 in a determined angular orientation.
- this means consists of a threaded plug 15 in which is arranged a profiled hole 16 for screwing by means of a tool not shown.
- the plug 15 can be screwed into the threaded tubular wall 17 (limited on one side by the opening 6) until the face of the plug 15 facing the ball 5 comes to bear on the latter.
- the plug 15 has a conical profile 18 terminated by a conical or spherical bearing
- the ball 5 with its lateral section 12 can be oriented in a horizontal plane PH which is that of FIGS. 2 and 4, between a frontal plane PF and a sagittal plane PS with a predetermined angular movement A of the axis OX of its bore 11.
- the ball 5 is also orientable in the frontal plane PF (plane of FIGS. 3 and 5) between the horizontal plane PH and the sagittal plane PS, with a predetermined angular movement B of its axis OX.
- the limits of the angular movement A correspond to the abutment, in the plane PH of the wall of the tubular section 12 against the profile conical 18, of the plug 15, these parts being of course adequately sized.
- the angular movement A in the horizontal plane PH can be approximately 33 °, while the angular movement in the frontal plane PF can be approximately 65 °.
- the amplitude of these angular deflections is determined by the dimensions of the opening 6 of the head 3 in the horizontal and frontal planes, by the thickness of the wall of the section 12 and the depth of insertion of the pin 14 in the head. 3.
- the edge of the opening 6 contiguous to the threaded rod 2 is delimited by an angular sector 21 for tightening the screw 1, for example with a hexagon, the distance between the upper face of the sector 21 and the center O of the ball joint 5 may be around 2mm, this value not being limiting.
- the surgeon removes the articular facet mass from the vertebra L5 beforehand, in order to allow the head 3 of the screw 1 to be housed in its place.
- the pedicle implant 1 is placed according to a codified technique, know by catheterizing the pedicle of the L5 vertebra from the isthmo-articulo-transverse junction.
- the surgeon introduces through the opening 6 the spherical ball joint 5 with its section 12, which takes place just in front of the upper facet-sagittal junction belonging to the segment to be instrumented.
- a viewfinder comes to fit on the ball 5 and makes it possible to automatically guide the introduction of the translamary implant 4 crossing the thorny 22 of the vertebra L4.
- the second implant 4 penetrates at the junction of the blade 23 and the thorny 22 to move in the direction of the blade, forward, outward and downward, guided in this by a specific ancillary not shown, towards the center of the lower facet of the posterior arch of this mobility segment.
- the implant 4 thus automatically joins the orientable ball joint 5 in the bore 11 from which it penetrates.
- the lock constituted by the ball joint system 5 is then actuated, joining the two implants 1 and 4.
- the same process is repeated on the controlateral side, in order to set up the second pair of implants 1 and 4 ( Figure 2).
- the device is adapted to allow osteosynthesis to be carried out by a vertebral rod 24.
- the pedicle implant 1 comprises a cage 25 which can be screwed onto a flange 26 of a plug 15 formed of the part 18 and of the pin 14.
- a cylindrical part 27 inside the cage 25 is provided with a pin 28 adapted to be introduced into the blind hole 50 of the plug 15 and has a semi-recess cylindrical for receiving the spinal rod 24.
- the part 27 is introduced, free to rotate about its axis of revolution, above the plug 15.
- the device is completed by a second cylindrical part 30 having a semi-cylindrical recess allowing it to cover the rod 24, above the part 27 and inside the cage 25.
- the part 30 is provided with a pivot 29 passing through a hole in the bottom 31 of the cage 25, and which thus ensures a connection between the latter and the part 30.
- This pivot connection allows automatic positioning of the two parts 25 and 30 above the rod 24, during assembly.
- the cage 25 is screwed onto the upper flange of the plug 15, thus locking the positioning of the rod 24 inside the assembly.
- the transition from the embodiment of FIG. 4 to that of FIG. 6 implies the change of the plug 15, but retaining the translamary assembly already in place.
- a pathological event can lead to a surgical resumption to extend the osteosynthesis by resorting to the implantation of screws 1 in the pedicles of adjacent vertebrae; these screws are connected, in particular, by rods 24, lying in a plane posterior to the translaminar implants. Under these conditions, and without removing the implant 4, the head of the pedicle screw 1 will be capped with the cage 25 acting as an extension and the plug 15 replaced so that the rod 24 comes to bear before being blocked .
- This adaptability of the invention will allow the possible use of pedicle implants, the properly intraspongeuse portion of which may have undergone a surface treatment capable of making the anchorage more reliable, thanks to an osteogenic induction.
- FIG. 7 comprises an extension 40 which can cover the head 3 of the screw 1.
- This extension 40 consists of three parts: a nut 43 which is screwed onto the external thread 17 of the head 3, a body 44 engaged by its floating base, freely rotatable, in the nut 43, and a threaded pin 33 for fixing the spinal rod 24 in a channel 45 in U of the body 44.
- This assembly makes it possible to correctly orient the body 44 at the end tightening the nut 43.
- FIG. 8 illustrates another possible embodiment of the invention.
- the pedicle axis orthogonally supports a concave upper articular facet, which articulates with a lower articular facet, convex, whose vertebral blade 32 constitutes the orthogonal axis supporting it
- the same principles of the technique can be used for consider performing a prosthetic facet arthroplasty.
- the pedicle implant 34 comprises in this embodiment (FIG. 8) a threaded rod surmounted not by a head, but by a concave facet prosthesis 35.
- the transiaminary implant 4 receives at its end a convex facet 36, prosthetic, in place of the locked portion in the ball joint 5. This assembly is carried out on the two pairs of facets, the natural facets having previously been removed as shown on the left-hand side of FIG. 8.
- the two prosthetic facets 35, 36 are adapted on the support (or rod), respectively transpedicular 34 and translaminar 4, once in place in the manner of a cephalic sphere adapted on a prosthetic femoral rod.
- the connection can be obtained for example by clipping the facets 35, 36 on respective pins 37, 38 of the implants, coming to fit into conjugated holes 39, 41 of the facets 35, 36.
- the spinal osteosynthesis device comprises a pedicle screw 51 having a conventional thread adapted to the pedicle P, and its head 52 is provided with a seat 53 formed by a projecting collar allowing the screw 51 to be in support optimum on the basis of the pedicle P of the vertebra.
- the head 52 is extended by a polygonal imprint 54, for example hexagonal, which is in turn extended by a tubular part 55 containing the ball joint 5.
- the end 55a of the tubular part 55 is threaded and can be capped by a nut 56 making it possible to protect the screw 51. If necessary, this nut 56 can be removed in order to replace it with an element making it possible to mount, if necessary, an adapter capable of receiving interpedicular fixing rods.
- the ball 5 can be blocked by a threaded plug 57 which is screwed into the corresponding threaded opening of the tubular part 55.
- the ball 5 is pierced right through by a threaded hole 58 extended diametrically by an outer barrel 59 orientable in a lateral opening 61, of elongated shape, formed in the tubular part 55.
- a second opening 60 of oblong shape, is also formed in a location diametrically opposite to that of the opening 61.
- translamary screw 62 can pass right through the ball 5 and its barrel 59, as well as the opposite openings 61 and 60, so that its end 63 formed by a trocar tip, can be anchored distally in the vertebra at the pedicle-solid articular transverse junction.
- the translamary (or translaminar) screw 62 is constituted by a threaded axis over its entire length, the end opposite to its trocar tip 63 has a profiled imprint 64, for example hexagonal (hexagon), used to hold this screw thanks to a specific instrument not shown, ensuring its penetration through the blade.
- the end 64 is also provided with a washer 65 with pins 66 which can be slid along the threaded axis 62 to come into contact with the rear face of the thorny.
- the end of the screw 62 is completed by a locking nut 65, which when the translamary screw 62 is put in place (FIGS. 10 and 11), is applied to the washer 65 and locks the screw 62 in place, exerting a booster effect if necessary.
- FIGS. 12, 13A and 13B The ancillary instrumentation intended for installing the osteosynthesis device according to the invention, in particular that of FIGS. 9 to 11, is partially illustrated in FIGS. 12, 13A and 13B.
- This instrumentation includes a cross-section viewfinder 67 which comprises: a) a handle 68, in T, with tubular body 80, extended by a jacket 69 adapted to cap the head 55 and the hexagonal imprint 54 of the pedicle screw; the handle 68 is removably mounted on the body 80; b) an arm 71 articulated on the handle 68, the distal free end 72 of which is provided with a sheath 79 adapted to be able to support the translaminar implant 62 and allow its introduction into the barrel 59 of the ball joint 5 through a lumen elongated 73 arranged in the wall of the jacket 69 (FIG.
- the lumen 73 extends parallel to the axis of the pedicle screw 51, so as to allow the barrel 59 of the ball 5 to be directed around its plane of mobility, frontal, thanks to its end which passes through the lumen 73 , while the end of the jacket 69 comes to bear on the seat 53.
- the height of the light 73 can vary, as visible in FIG. 13B which shows a variant 74 of this light, shorter than the light 73, in shirt 75.
- the arm 71 comprises a proximal part 76 fixed to the handle 68, articulated on the distal part 72 around an axis 77 and to which is fixed a point 78 sized to be able to come into contact with the upper edge of the vertebral blade.
- the orientation in the horizontal plane, of the barrel 59 can be achieved by rotation of the pedicle screw 51 about its axis, thanks to the removable handle 68 which can be replaced if necessary, over the shirt 69.
- the articulation around the axis 77 of the arm 71 allows, thanks to the mobility of the sheath 79, crossed by the threaded translamary axis 62, engaged in the barrel 59, to follow the orientation given to the threaded barrel 59 according to the anatomical topography of the lamar view.
- the distal part 72 is correctly positioned as soon as the tip 78 is supported on the upper edge of the vertebral blade.
- the translamary screw 62 can then be introduced into the barrel 59, the ball joint 5 and pass through the opposite openings 61, 60, as well as an elongated lumen 81 formed in the jacket 69 opposite the lumen 73, in order to come file in the vertebra.
- the angle taken by the threaded barrel 59 adapts automatically, so that there is a correspondence as a function of the type of adjustment given by the sheath 79 to the barrel 59.
- the point 78 hung on the proximal part 76 prevents any crossing of the blade in the canal space following the translaminar aiming. The latter is carried out by means of a threaded spindle, introduced by the drilling barrel 59.
- the translaminar screw 62 crosses the lateral part of the vertebra to ensure better anchoring. Its threaded axis is cut flush with the clamping nut 65, so that this assembly ensures perfect blocking of the axial mobility of the vertebral segment and cancels it in the horizontal plane.
- the two translaminar screws 62 join the pedicle screw 51 seen from the rear at the level of the head. FIG. 11 clearly shows the blocking effect which also operates in the frontal plane.
- the two translaminar screws 62 are thus secured to the pedicle via the pedicle implant 51. The latter is put in place via a screwdriver (not shown), which adapts to the viewfinder 68, 69 and can slide inside the vertical part (tubular body 80) of this viewfinder.
- the attachment of the ball joint 5 with the implants 1 and 4 could be carried out by any means equivalent to the threaded plug 15, which can be produced in a manner different from that shown.
- the plug 15 can be crimped on the ball 5, the recess 16 being removed.
- the angular fixing of the ball joint 5 can then be obtained by a pin screwed into the solid plug 15, through a threaded bore ( Figure 4).
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Abstract
The disclosed device comprises means for joining two contiguous vertebrae at their respective pedicular and laminar facets. The invention specifically comprises, for each pair of articular facets, a pedicular implant (1) consisting of a screw (2) with a head (3) containing an inset ball-and-socket joint (5) rotating in the horizontal and frontal planes. The device further comprises a translaminar implant (4) which extends from the cord (22) of the vertebra (L4) through the plate; the end (7) of said implant (4) is inserted into the entire length of a threaded bore (11) completely intersecting the rotating ball-and-socket joint (5). The mechanical locking of the two implants thereby ensures that the two articular facets are joined, and are homologous due to the predetermined position of the ball-and-socket joint and the translaminar implant (4). The paired device allows the procedure to be restricted to only the pedicles of the vertebra concerned by the monosegmental immobilization, thereby ensuring rotatory as well as translatory immobilization. In other words, rotation is neutralized by the two translaminar screws, while translation is secured by the pedicular axis.
Description
DISPOSITIF POUR SOLIDARISER DEUX VERTEBRES CONΗGUES, NOTAMMENT LOMBAIRESDEVICE FOR SOLIDARIZING TWO CONGULATED VERTEBRES, ESPECIALLY LUMBARS
La présente invention a pour objet un dispositif d'ostéosyn- t èse rachidienne pour solidariser deux vertèbres contiguës, notamment lombaires, en vue de leur fusion osseuse, comprenant des moyens pour solidariser les vertèbres au niveau de leurs facettes pédiculaires et laminaires respectives.The present invention relates to a spinal osteosynthesis device for securing two contiguous vertebrae, in particular the lumbar vertebrae, with a view to their bone fusion, comprising means for securing the vertebrae at their respective pedicular and laminar facets.
On sait qu'un disque intervertébral sain constitue une unité articulaire viscoélastique. Il autorise une mobilité autour d'un axe longitudinal, et ses mouvements de rotation sont guidés en arrière par les facettes articulaires, biplanes au niveau lombaire. La mobilité dans le plan sagittal intervient notamment lors des mouvements de flexion. Son contrôle fait intervenir, outre la viscoélasti- cité discale, l'action mécanique limitative de la portion antéro-médiane et frontalisée des facettes articulaires, s'opposant ainsi aux forces de cisaillement intersomatiques. La portion postéro-latérale et sagittalisée des facettes intervient, quant à elle, lors de mouvements de latéralité, réalisés dans le plan frontal.It is known that a healthy intervertebral disc constitutes a viscoelastic joint unit. It allows mobility around a longitudinal axis, and its rotational movements are guided back by the articular facets, biplanes at the lumbar level. Mobility in the sagittal plane occurs in particular during flexion movements. Its control involves, in addition to the disc viscoelasticity, the limiting mechanical action of the antero-median and frontal portion of the articular facets, thus opposing the forces of intersomatic shearing. The posterolateral and sagittalized portion of the facets intervenes, in turn, during lateral movements, performed in the frontal plane.
En définitive, chaque segment de mobilité lombaire se présente comme un complexe triarticulaire en inter-relation. Ce complexe fait intervenir, en prenant le segment L4-L5 à titre d'exemple : le disque L4-L5, les facettes articulaires supérieures de la vertèbre L5 sous-jacente et les facettes articulaires inférieures de la vertèbre sus-jacente. Les facettes supérieures sont directement appendues postérieurement au pédicule vertébral de L5, partie intégrante du complexe fonctionnel. Les facettes inférieures se greffent distalement à la partie inféro-latérale des lames de L4. Leur plan moyen est orthogonal à l'axe lamaire.Ultimately, each segment of lumbar mobility is presented as a triarticular complex in inter-relation. This complex involves, taking the L4-L5 segment as an example: the L4-L5 disc, the upper articular facets of the underlying L5 vertebra and the lower articular facets of the overlying vertebra. The upper facets are directly appended posterior to the vertebral pedicle of L5, an integral part of the functional complex. The lower facets are grafted distally to the infero-lateral part of the L4 blades. Their mean plane is orthogonal to the lamar axis.
Ces éléments constituent un ensemble fonctionnel pair disposé symétriquement de part et d'autre du plan médio-sagittal. Cet ensemble comporte des éléments successifs : disque, pédicule, articulaire supérieure et inférieure - lame.
L'arc postérieur de la vertèbre sus-jacente verrouille en arrière la mobilité rotatoire du segment antérieur de la vertèbre sous-jacente. L'ensemble pédiculo-articulaire supérieur a pour fonction de s'opposer à la translation antérieure de l'arc postérieur. Dans certaines situations anatomo- pathologiques, se produit une libération de ces "verrous". La mobilité segmentaire privée d'auto-contrôle dépasse son cadre physiologique. Un processus réactionnel tente de pallier à cette défaillance. En cas de faillite, le recours à la chirurgie devient une alternative antalgique nécessaire.These elements constitute an even functional unit arranged symmetrically on either side of the mid-sagittal plane. This set includes successive elements: disc, pedicle, upper and lower joint - blade. The posterior arch of the overlying vertebra locks back the rotational mobility of the anterior segment of the underlying vertebra. The function of the upper pediculo-articular assembly is to oppose the anterior translation of the posterior arch. In certain pathological situations, a release of these "locks" occurs. Segmental mobility deprived of self-control goes beyond its physiological framework. A reaction process tries to remedy this failure. In the event of bankruptcy, the use of surgery becomes a necessary analgesic alternative.
Selon un premier type de solution proposé, on réalise une ostéosynthèse postérieure du segment rachidien considéré en recourant à une série de vis pédiculaires reliées entre elles par des tiges ou des plaques, cette solution s'étant imposée dans les indications d'arthrodèses lombaires postéro-latérales. L'immobilisation des articulations du segment fixé facilite la fusion induite par une greffe osseuse complémentaire. Cette synthèse monoplanaire neutralise le seul plan frontal.According to a first type of solution proposed, a posterior osteosynthesis is carried out of the spinal segment considered by resorting to a series of pedicle screws connected together by rods or plates, this solution having imposed itself in the indications of posterolumbar lumbar arthrodeses. side. Immobilization of the joints of the fixed segment facilitates the fusion induced by a complementary bone graft. This monoplanar synthesis neutralizes the only frontal plane.
Elle est en fait une variante des ostéosynthèses postérieures conçues initialement pour les corrections de scolioses à l'aide de tiges dont les ancrages ont été fiabi lises.It is in fact a variant of the posterior osteosyntheses initially designed for the correction of scoliosis using rods whose anchors have been made reliable.
Ces implants pédiculaires se situent dans le plan sagittal. Les vis cephaliques du montage sont insérées dans des pédicules vertébraux appartenant au segment fonctionnel adjacent à la neutralisation, lesquels s'en trouvent inutilement détériorés, ce qui constitue un inconvénient sensible de ce type de dispositif.These pedicle implants are located in the sagittal plane. The cephalic screws of the assembly are inserted into vertebral pedicles belonging to the functional segment adjacent to the neutralization, which are unnecessarily damaged, which constitutes a significant drawback of this type of device.
Un autre inconvénient de ces réalisations réside dans les problèmes fréquents de néo-charnière qu'elles induisent, notamment du fait des dégradations facettaires au-dessus du niveau fusionné, causées par le matériel d'ostéosynthèse.Another drawback of these achievements lies in the frequent problems of neo-hinge which they induce, in particular due to the facet degradations above the fused level, caused by the osteosynthesis material.
Par ailleurs la stabilisation obtenue est relative, car le montage agit comme un arc-boutant. L'adjonction d'éléments inter- pédiculaires extra-osseux transversaux rigidifie le montage en solidarisant les implants, prévenant les phénomènes "d'essuie-glace".
Le site inter-articulo-lamaire de greffe est réduit, car il est occupé par les plaques ou tiges. Par ailleurs le suivi radiologique de la fusion est difficile compte tenu des superpositions. Enfin l'apprentissage d'une visée pédiculaire fiable est également réputé difficile. Selon un second type de solution proposé, on solidarise des facettes articulaires au moyen de courtes vis transfixiantes.Furthermore, the stabilization obtained is relative, since the assembly acts as a flying buttress. The addition of transverse extra-osseous inter-pedicular elements stiffens the assembly by securing the implants, preventing "wiper" phenomena. The interarticulo-lamar graft site is reduced because it is occupied by the plates or stems. Furthermore, radiological monitoring of the fusion is difficult given the overlays. Finally, learning a reliable pedicle sight is also deemed difficult. According to a second type of solution proposed, articular facets are joined by means of short transfixing screws.
Ce système, dont la faiblesse mécanique est évidente, a été amélioré par l'insertion de vis plus longues, à partir de la base des épineuses à travers la lame, puis en inter-facettaire, aboutissant au bord antérieur de la transverse, à sa jonction pédiculaire.This system, whose mechanical weakness is obvious, has been improved by the insertion of longer screws, starting from the base of the thorny plants through the blade, then inter-facet, ending at the anterior edge of the transverse, at its pedicle junction.
De telles vis présentent des avantages certains : on obtient ainsi une stabilisation très satisfaisante, contrôlant la mobilité autour d'un axe longitudinal. Ce principe s'applique notamment dans les cas d'instabilité d'origine discale. De plus la stabilisation est véritablement mono-segmentaire, le risque neurologique de la procédure est très faible, grâce à l'utilisation d'un viseur, le recours à un contrôle radiologique per-opératoire n'est pas nécessaire. La décortication inter-transversaire pour préparer le lit de la greffe n'est pas obligatoire, le temps opératoire est raisonnable, l'apprentis- sage de la technique est relativement simple, et enfin l'incidence économique de cette ostéosynthèse est raisonnable.Such screws have certain advantages: a very satisfactory stabilization is thus obtained, controlling the mobility around a longitudinal axis. This principle applies in particular in cases of instability of disc origin. In addition, stabilization is truly mono-segmental, the neurological risk of the procedure is very low, thanks to the use of a viewfinder, the use of intraoperative radiological control is not necessary. Inter-transverse decortication to prepare the graft bed is not compulsory, the operating time is reasonable, learning the technique is relatively simple, and finally the economic impact of this osteosynthesis is reasonable.
En revanche ces fixations lombaires par vis translaminaire présentent des inconvénients.On the other hand these lumbar fixations by translaminar screw present disadvantages.
Tout d'abord une telle technique requiert au préalable que les lames soient intactes, et que les facettes aient été respectées lors d'une décompression. De plus la prise en rappel au travers de la base du processus transverse est très courte. La vis translaminaire ne s'oppose pas efficacement à une force de translation, ce qui explique les défaillances évolutives. Enfin, l'application de cette seconde technique aux cas d'arthropathies facettaires impose l'absence de désorientation de l'interligne
facettaire d'origine dégénérative. Cette procédure ne peut être appliquée lorsqu'il existe une hypermobilité translationnelle combinée autour des axes transversaux et antéro-postérieurs (et notamment les spondylolisthésis dégénératifs). La décortication facettaire est délicate, car il faut préserver l'os sous-chondral. Les bons résultats de cette technique supposent le respect des indications qui sont, par ailleurs, très étroites.First of all, such a technique requires beforehand that the blades are intact, and that the facets have been respected during a decompression. In addition, the abseiling through the base of the transverse process is very short. The translaminar screw does not effectively oppose a translational force, which explains the evolutionary failures. Finally, the application of this second technique to cases of facet arthropathies requires the absence of disorientation of the line spacing facet of degenerative origin. This procedure cannot be applied when there is a translational hypermobility combined around the transverse and anteroposterior axes (and in particular degenerative spondylolisthesis). Facet decortication is delicate, because it is necessary to preserve the subchondral bone. The good results of this technique suppose the respect of the indications which are, moreover, very narrow.
La présente invention a donc pour but de proposer un dispositif d'ostéosynthèse permettant de solidariser le segment de mobilité de deux vertèbres contiguës, en particulier lombaires, en évitant les inconvénients ci-dessus des deux types de réalisation connus décrits.The present invention therefore aims to provide an osteosynthesis device for securing the mobility segment of two contiguous vertebrae, in particular lumbar, avoiding the above drawbacks of the two known types of embodiment described.
Conformément à l'invention, le dispositif d'ostéosynthèse rachidienne pour solidariser deux vertèbres contiguës comprend, pour chaque paire de facettes pédiculaire et laminaire, un implant transpédi- culaire, un implant translaminaire et des moyens de verrouillage pour solidariser mécaniquement ces deux implants de manière réglable angulairement.In accordance with the invention, the spinal osteosynthesis device for securing two contiguous vertebrae comprises, for each pair of pedicle and laminar facets, a transpedicular implant, a translaminar implant and locking means for mechanically joining these two implants in such a way angularly adjustable.
L'invention réalise ainsi une combinaison de deux implants translamaire (ou translaminaire) et pédiculaire mécaniquement liés par un système de verrou ajustable dans plusieurs directions.The invention thus achieves a combination of two translamary (or translaminar) and pedicle implants mechanically linked by a bolt system adjustable in several directions.
Suivant un mode de réalisation avantageux, l'implant pédiculaire est une vis comportant une tige filetée et une tête contenant une rotule orientable et adaptée pour réaliser la liaison avec l'implant translaminaire. Grâce à ce dispositif, seuls les pédicules concernés dans cette neutralisation monosegmentaire sont instrumentés, ce qui constitue un premier avantage important de l'invention.According to an advantageous embodiment, the pedicle implant is a screw comprising a threaded rod and a head containing an orientable ball joint and suitable for making the connection with the translaminar implant. Thanks to this device, only the pedicles concerned in this monosegmental neutralization are instrumented, which constitutes a first important advantage of the invention.
De plus l'interdépendance entre les implants lamaires (laminaires) et pédiculaires combine les avantages mécaniques des deux systèmes, à savoir neutralisation rotatoire et translationnelle.In addition, the interdependence between laminar and laminar implants combines the mechanical advantages of the two systems, namely rotary and translational neutralization.
L'implant pédiculaire renforce l'ancrage dans la portion
antérieure du segment de mobilité, qui est ainsi armé et exerce un contre- appui. Enfin un défaut (défect) articulaire ou lamaire consécutif à un geste de libération élargie n'empêche pas le recours à cette procédure d'ostéosynthèse. L'invention a aussi pour objet un dispositif d'arthroplastie entre deux facettes articulaires de deux vertèbres contiguës L4, L5, l'une des facettes se situant dans le prolongement d'un pédicule d'une vertèbre L5 tandis que l'autre facette est adjacente à une lame de l'autre vertèbre L4.The pedicle implant reinforces the anchoring in the portion mobility segment, which is thus armed and exerts a counter-support. Finally, a defect (defect) in the joint or lamina following an enlarged release gesture does not prevent the use of this osteosynthesis procedure. The invention also relates to an arthroplasty device between two articular facets of two contiguous vertebrae L4, L5, one of the facets lying in the extension of a pedicle of a L5 vertebra while the other facet is adjacent to a blade of the other L4 vertebra.
Selon l'invention, ce dispositif comprend un implant pédiculaire solidaire d'une facette artificielle concave, et un implant translaminaire solidaire d'une facette articulaire artificielle convexe.According to the invention, this device comprises a pedicle implant secured to a concave artificial facet, and a translaminar implant secured to a convex artificial facet.
D'autres particularités et avantages de l'invention apparaîtront au cours de la description qui va suivre, faite en référence aux dessins annexés qui en illustrent plusieurs formes de réalisation à titre d'exemples non limitatifs.Other features and advantages of the invention will become apparent during the description which follows, given with reference to the appended drawings which illustrate several embodiments thereof by way of nonlimiting examples.
La figure 1 est une vue en élévation latérale, dans un plan sagittal, à échelle sensiblement agrandie d'un segment rachidien constitué de deux vertèbres lombaires, équipé d'une première forme de réalisation du dispositif d'ostéosynthèse visé par l'invention. La figure 2 est une vue du dispositif d'ostéosynthèse de la figure 1 dans un plan horizontal, c'est-à-dire un plan transversal à celui de la figure 1.Figure 1 is a side elevational view, in a sagittal plane, on a substantially enlarged scale of a spinal segment consisting of two lumbar vertebrae, equipped with a first embodiment of the osteosynthesis device targeted by the invention. FIG. 2 is a view of the osteosynthesis device of FIG. 1 in a horizontal plane, that is to say a plane transverse to that of FIG. 1.
La figure 3 est une vue du segment rachidien des figures 1 et 2 et de son dispositif d'ostéosynthèse dans un plan frontal postérieur. La figure 4 est une vue en coupe longitudinale à échelle agrandie d'une vis pédiculaire et de sa rotule orientable faisant partie du dispositif d'ostéosynthèse des figures 1 à 3.Figure 3 is a view of the spinal segment of Figures 1 and 2 and its osteosynthesis device in a posterior frontal plane. FIG. 4 is a view in longitudinal section on an enlarged scale of a pedicle screw and of its orientable ball joint forming part of the osteosynthesis device of FIGS. 1 to 3.
La figure 5 est une vue en coupe transversale suivant 5/5 de la figure 4. La figure 6 est une vue en coupe transversale partielle d'une seconde forme de réalisation du dispositif d'ostéosynthèse selon l'invention.
La figure 7 est une vue en coupe et élévation partielle d'une troisième forme de réalisation du dispositif d'ostéosynthèse selon l'invention.Figure 5 is a cross-sectional view along 5/5 of Figure 4. Figure 6 is a partial cross-sectional view of a second embodiment of the osteosynthesis device according to the invention. Figure 7 is a sectional view in partial elevation of a third embodiment of the osteosynthesis device according to the invention.
La figure 8 est une vue de dessus schématique d'une quatrième forme de réalisation du dispositif selon l'invention. La figure 9 est une vue en élévation et coupe partielle à échelle agrandie d'un quatrième mode de réalisation du dispositif d'ostéosynthèse rachidienne selon l'invention.Figure 8 is a schematic top view of a fourth embodiment of the device according to the invention. Figure 9 is an elevational view in partial section on an enlarged scale of a fourth embodiment of the spinal osteosynthesis device according to the invention.
La figure 10 est une vue en élévation et coupe partielle dans un plan horizontal d'un dispositif pair complet, incluant celui de la figure 9 et implanté dans une vertèbre.Figure 10 is an elevational and partial sectional view in a horizontal plane of a complete paired device, including that of Figure 9 and implanted in a vertebra.
La figure 11 est une vue en élévation dans un plan frontal, à échelle réduite, du dispositif de la figure 10.FIG. 11 is an elevation view in a frontal plane, on a reduced scale, of the device of FIG. 10.
La figure 12 est une vue en élévation et coupe partielle d'un viseur translaminaire permettant d'effectuer la visée pour la pose de l'implant translaminaire.Figure 12 is an elevational view in partial section of a translaminar viewfinder for performing the aim for the placement of the translaminar implant.
Les figures 13A et 13B sont des vues en élévation schématiques partielles de deux variantes du viseur de la figure 12.FIGS. 13A and 13B are partial schematic elevation views of two variants of the viewfinder of FIG. 12.
Le dispositif d'ostéosynthèse rachidienne représenté aux dessins est destiné à solidariser mécaniquement deux vertèbres contiguës, en particulier deux vertèbres lombaires L4 et L5 (figure 1 ) au niveau de leurs facettes articulaires F (Fig.2), pédiculaires et laminaires respectives, afin de permettre leur fusion osseuse ultérieure.The spinal osteosynthesis device shown in the drawings is intended to mechanically join two contiguous vertebrae, in particular two lumbar vertebrae L4 and L5 (FIG. 1) at their articular facets F (Fig. 2), pedicular and laminar, in order to allow their subsequent bone fusion.
Ce dispositif comprend, pour chacune des deux paires de facettes articulaires, un implant transpédiculaire 1 constitué par une vis comportant une tige filetée 2 ainsi qu'une tète 3, un implant translamaire (ou translaminaire) constitué par une vis 4, et des moyens pour permettre une liaison mécanique entre la vis translaminaire 4 et la vis pédiculaire 1 , tels qu'une rotule 5 orientable, percée de part en part, logée dans la tête 3, ainsi que des moyens d'accroché de la partie supérieure de la vis 4 sur la lame, à savoir une tête cylindrique 9 ou, plus avantageusement, une rondelle 65 à picots 66 et un écrou de compression 70 (figures 9-10).
La tête 3 est tubulaire, pourvue à son extrémité d'une pièceThis device comprises, for each of the two pairs of articular facets, a transpedicular implant 1 constituted by a screw comprising a threaded rod 2 as well as a head 3, a translamary (or translaminar) implant constituted by a screw 4, and means for allow a mechanical connection between the translaminar screw 4 and the pedicle screw 1, such as a swivel ball 5, drilled through and through, housed in the head 3, as well as means for hooking the upper part of the screw 4 on the blade, namely a cylindrical head 9 or, more advantageously, a washer 65 with pins 66 and a compression nut 70 (Figures 9-10). The head 3 is tubular, provided at its end with a part
18 sertie en usine ; dans sa paroi est agencée une ouverture latérale 6 par laquelle peut pénétrer une extrémité 7 à pointe trocart de la tige filetée de la vis translaminaire 4. Cette insertion de l'extrémité 7 permet de visser celle-ci dans un alésage diamétral 11 de la rotule 5, laquelle est prolongée par un tronçon tubulaire diamétral 12 coaxial à son alésage 11. Ce dernier est donc dimensionné pour recevoir l'extrémité filetée 7 de la vis correspondante 4 après orientation angulaire convenable de la rotule 5, qui prend appui sur un siège sphérique 13 ménagé dans la tête 3. Le siège 13 s'étend à la base de la paroi intérieure lisse non taraudée 3a de la tête 3, ainsi qu'autour d'un trou axial formé dans la tige filetée 2. Ce trou est profilé, par exemple de manière polygonale (6 pans) pour pouvoir recevoir un outil non représenté de vissage de l'implant 1 dans le pédicule de la vertèbre L5.18 factory set; in its wall is arranged a lateral opening 6 through which can penetrate an end 7 with a trocar point of the threaded rod of the translaminar screw 4. This insertion of the end 7 makes it possible to screw the latter in a diametral bore 11 of the ball joint 5, which is extended by a diametrical tubular section 12 coaxial with its bore 11. The latter is therefore dimensioned to receive the threaded end 7 of the corresponding screw 4 after proper angular orientation of the ball 5, which is supported on a spherical seat 13 formed in the head 3. The seat 13 extends at the base of the smooth non-tapped interior wall 3a of the head 3, as well as around an axial hole formed in the threaded rod 2. This hole is profiled, for example polygonally (hexagon) in order to be able to receive a tool (not shown) for screwing the implant 1 into the pedicle of the vertebra L5.
La tête 3 est équipée d'un moyen de blocage de la rotule 5 dans une orientation angulaire déterminée. Dans l'exemple représenté, ce moyen est constitué par un bouchon fileté 15 dans lequel est agencé un trou profilé 16 de vissage au moyen d'un outil non représenté.The head 3 is equipped with a means for blocking the ball joint 5 in a determined angular orientation. In the example shown, this means consists of a threaded plug 15 in which is arranged a profiled hole 16 for screwing by means of a tool not shown.
Le bouchon 15 peut être vissé dans la paroi tubulaire taraudée 17 (limitée d'un côté par l'ouverture 6) jusqu'à ce que la face du bouchon 15 tournée vers la rotule 5 vienne en appui de blocage sur celle-ci. Avantageusement, du côté en vis-à-vis de la rotule 5, le bouchon 15 présente un profil conique 18 terminé par une portée conique ou sphériqueThe plug 15 can be screwed into the threaded tubular wall 17 (limited on one side by the opening 6) until the face of the plug 15 facing the ball 5 comes to bear on the latter. Advantageously, on the side facing the ball 5, the plug 15 has a conical profile 18 terminated by a conical or spherical bearing
19 d'appui sur la surface de la rotule 5.19 bearing on the surface of the ball 5.
La rotule 5 avec son tronçon latéral 12 est orientable dans un plan horizontal PH qui est celui des figures 2 et 4, entre un plan frontal PF et un plan sagittal PS avec un débattement angulaire prédéterminé A de l'axe OX de son alésage 11. D'autre part la rotule 5 est également orientable dans le plan frontal PF (plan des figures 3 et 5) entre le plan horizontal PH et le plan sagittal PS, avec un débattement angulaire prédéterminé B de son axe OX. Les limites du débattement angulaire A correspondent à la mise en butée, dans le pian PH de la paroi du tronçon tubulaire 12 contre le profil
conique 18, du bouchon 15, ces pièces étant bien entendu dimensionnées de manière adéquate.The ball 5 with its lateral section 12 can be oriented in a horizontal plane PH which is that of FIGS. 2 and 4, between a frontal plane PF and a sagittal plane PS with a predetermined angular movement A of the axis OX of its bore 11. On the other hand, the ball 5 is also orientable in the frontal plane PF (plane of FIGS. 3 and 5) between the horizontal plane PH and the sagittal plane PS, with a predetermined angular movement B of its axis OX. The limits of the angular movement A correspond to the abutment, in the plane PH of the wall of the tubular section 12 against the profile conical 18, of the plug 15, these parts being of course adequately sized.
Le débattement angulaire A dans le plan horizontal PH peut être de 33° environ, tandis que le débattement angulaire dans le plan frontal PF peut être de 65° environ. L'amplitude de ces débattements angulaires est déterminée par les dimensions de l'ouverture 6 de la tête 3 dans les plans horizontal et frontal, par l'épaisseur de la paroi du tronçon 12 et la profondeur d'enfoncement du pion 14 dans la tête 3.The angular movement A in the horizontal plane PH can be approximately 33 °, while the angular movement in the frontal plane PF can be approximately 65 °. The amplitude of these angular deflections is determined by the dimensions of the opening 6 of the head 3 in the horizontal and frontal planes, by the thickness of the wall of the section 12 and the depth of insertion of the pin 14 in the head. 3.
Le bord de l'ouverture 6 contigu à la tige filetée 2 est délimité par un secteur angulaire 21 de serrage de la vis 1 , par exemple à six pans, la distance entre la face supérieure du secteur 21 et le centre O de la rotule 5 peut être d'environ 2mm, cette valeur n'étant pas limitative.The edge of the opening 6 contiguous to the threaded rod 2 is delimited by an angular sector 21 for tightening the screw 1, for example with a hexagon, the distance between the upper face of the sector 21 and the center O of the ball joint 5 may be around 2mm, this value not being limiting.
La mise en place par le chirurgien de ce système combinant un implant pédiculaire 1 , un implant translaminaire 4 et assurant un verrouillage interlamino-pédiculaire grâce à la rotule orientable 5, s'effectue de la manière suivante.The installation by the surgeon of this system combining a pedicle implant 1, a translaminar implant 4 and ensuring interlamino-pedicle locking by means of the swivel joint 5, is carried out as follows.
Bien entendu, le chirurgien enlève au préalable le massif facettaire articulaire de la vertèbre L5, afin de permettre de loger à sa place la tête 3 de la vis 1. a) L'implant pédiculaire 1 est mis en place selon une technique codifiée, à savoir en cathétérisant le pédicule de la vertèbre L5 à partir de la jonction isthmo-articulo-transverse. b) Le chirurgien introduit par l'ouverture 6 la rotule sphérique 5 avec son tronçon 12, qui prend place juste en avant de la jonction fronto- sagittale facettaire supérieure appartenant au segment à instrumenter. c) Un viseur vient s'adapter sur la rotule 5 et permet de guider automatiquement l'introduction de l'implant translamaire 4 traversant l'épineuse 22 de la vertèbre L4. Ce guidage s'effectue jusqu'à ce que son extrémité 7 puisse venir se visser dans l'alésage 11 de la rotule 5 préalablement orientée correctement dans les plans horizontal et frontal, selon des angles compris dans les valeurs précitées.
d) Le deuxième implant 4 pénètre à la jonction de la lame 23 et de l'épineuse 22 pour se diriger en suivant la direction de la lame, en avant, en dehors et en bas, guidé en cela par un ancillaire spécifique non représenté, en direction du centre de la facette inférieure de l'arc postérieur de ce segment de mobilité. L'implant 4 rejoint ainsi automatiquement la rotule orientable 5 dans l'alésage 11 de laquelle il pénètre. e) Le verrou constitué par le système de la rotule 5 est alors actionné, solidarisant les deux implants 1 et 4. f) Le même processus est repris du côté contro-latéral, afin de mettre en place la seconde paire d'implants 1 et 4 (figure 2).Of course, the surgeon removes the articular facet mass from the vertebra L5 beforehand, in order to allow the head 3 of the screw 1 to be housed in its place. A) The pedicle implant 1 is placed according to a codified technique, know by catheterizing the pedicle of the L5 vertebra from the isthmo-articulo-transverse junction. b) The surgeon introduces through the opening 6 the spherical ball joint 5 with its section 12, which takes place just in front of the upper facet-sagittal junction belonging to the segment to be instrumented. c) A viewfinder comes to fit on the ball 5 and makes it possible to automatically guide the introduction of the translamary implant 4 crossing the thorny 22 of the vertebra L4. This guidance is carried out until its end 7 can be screwed into the bore 11 of the ball 5 previously oriented correctly in the horizontal and front planes, at angles included in the above values. d) The second implant 4 penetrates at the junction of the blade 23 and the thorny 22 to move in the direction of the blade, forward, outward and downward, guided in this by a specific ancillary not shown, towards the center of the lower facet of the posterior arch of this mobility segment. The implant 4 thus automatically joins the orientable ball joint 5 in the bore 11 from which it penetrates. e) The lock constituted by the ball joint system 5 is then actuated, joining the two implants 1 and 4. f) The same process is repeated on the controlateral side, in order to set up the second pair of implants 1 and 4 (Figure 2).
Selon un second mode de réalisation possible, illustré à la figure 6, le dispositif est adapté pour permettre d'effectuer une ostéosynthèse par une tige vertébrale 24. A cet effet l'implant pédiculaire 1 comporte une cage 25 pouvant venir se visser sur une collerette 26 d'un bouchon 15 formé de la pièce 18 et du pion 14. Une pièce cylindrique 27 intérieure à la cage 25 est munie d'un pion 28 adapté pour être introduit dans le trou borgne 50 du bouchon 15 et présente un évidement semi-cylindrique de réception de la tige rachidienne 24.According to a second possible embodiment, illustrated in FIG. 6, the device is adapted to allow osteosynthesis to be carried out by a vertebral rod 24. For this purpose the pedicle implant 1 comprises a cage 25 which can be screwed onto a flange 26 of a plug 15 formed of the part 18 and of the pin 14. A cylindrical part 27 inside the cage 25 is provided with a pin 28 adapted to be introduced into the blind hole 50 of the plug 15 and has a semi-recess cylindrical for receiving the spinal rod 24.
La pièce 27 est introduite, libre en rotation autour de son axe de révolution, au-dessus du bouchon 15.The part 27 is introduced, free to rotate about its axis of revolution, above the plug 15.
Le dispositif est complété par une seconde pièce cylindrique 30 ayant un évidement semi-cylindrique lui permettant de coiffer la tige 24, au-dessus de la pièce 27 et à l'intérieur de la cage 25. La pièce 30 est pourvue d'un pivot 29 traversant un trou du fond 31 de la cage 25, et qui assure ainsi une liaison entre cette dernière et la pièce 30.The device is completed by a second cylindrical part 30 having a semi-cylindrical recess allowing it to cover the rod 24, above the part 27 and inside the cage 25. The part 30 is provided with a pivot 29 passing through a hole in the bottom 31 of the cage 25, and which thus ensures a connection between the latter and the part 30.
Cette liaison par pivot permet un positionnement automatique des deux pièces 25 et 30 au-dessus de la tige 24, lors du montage. La cage 25 vient se visser sur la collerette supérieure du bouchon 15, verrouillant ainsi le positionnement de la tige 24 à l'intérieur du montage. Le passage de la réalisation de la figure 4 à celle de la figure 6 implique le changement du bouchon 15, mais en conservant le
montage translamaire déjà en place.This pivot connection allows automatic positioning of the two parts 25 and 30 above the rod 24, during assembly. The cage 25 is screwed onto the upper flange of the plug 15, thus locking the positioning of the rod 24 inside the assembly. The transition from the embodiment of FIG. 4 to that of FIG. 6 implies the change of the plug 15, but retaining the translamary assembly already in place.
Un événement pathologique peut conduire à une reprise chirurgicale pour étendre l'ostéosynthèse en recourant à l'implantation de vis 1 dans les pédicules de vertèbres adjacentes ; ces vis sont reliées, par, notamment, des tiges 24 , se situant dans un plan postérieur aux implants translaminaires. Dans ces conditions, et sans retirer l'implant 4, la tête de la vis pédiculaire 1 sera coiffée de la cage 25 faisant office de prolongateur et le bouchon 15 remplacé de façon à ce que la tige 24 vienne en appui avant d'être bloquée. Cette adaptabilité de l'invention autorisera l'éventuelle utilisation d'implants pédiculaires dont la portion proprement intraspongieuse pourra avoir subi un traitement de surface propre à fiabiliser l'ancrage, grâce à une induction ostéogénique.A pathological event can lead to a surgical resumption to extend the osteosynthesis by resorting to the implantation of screws 1 in the pedicles of adjacent vertebrae; these screws are connected, in particular, by rods 24, lying in a plane posterior to the translaminar implants. Under these conditions, and without removing the implant 4, the head of the pedicle screw 1 will be capped with the cage 25 acting as an extension and the plug 15 replaced so that the rod 24 comes to bear before being blocked . This adaptability of the invention will allow the possible use of pedicle implants, the properly intraspongeuse portion of which may have undergone a surface treatment capable of making the anchorage more reliable, thanks to an osteogenic induction.
La réalisation de la figure 7 comprend un prolongateur 40 pouvant coiffer la tête 3 de la vis 1. Ce prolongateur 40 est constitué de trois pièces : un écrou 43 qui vient se visser sur le filetage extérieur 17 de la tête 3, un corps 44 engagé par sa base de manière flottante, librement rotative, dans l'écrou 43, et un pion fileté 33 de fixation de la tige rachidienne 24 dans un canal 45 en U du corps 44. Ce montage permet d'orienter correctement le corps 44 en fin de serrage de l'écrou 43.The embodiment of FIG. 7 comprises an extension 40 which can cover the head 3 of the screw 1. This extension 40 consists of three parts: a nut 43 which is screwed onto the external thread 17 of the head 3, a body 44 engaged by its floating base, freely rotatable, in the nut 43, and a threaded pin 33 for fixing the spinal rod 24 in a channel 45 in U of the body 44. This assembly makes it possible to correctly orient the body 44 at the end tightening the nut 43.
La figure 8 illustre un autre mode de réalisation possible de l'invention. Considérant que l'axe pédiculaire supporte orthogonalement une facette articulaire supérieure, concave, qui s'articule avec une facette articulaire inférieure, convexe, dont la lame vertébrale 32 constitue l'axe orthogonal la supportant, les mêmes principes de la technique peuvent être repris pour envisager de réaliser une arthroplastie facettaire prothétique.FIG. 8 illustrates another possible embodiment of the invention. Considering that the pedicle axis orthogonally supports a concave upper articular facet, which articulates with a lower articular facet, convex, whose vertebral blade 32 constitutes the orthogonal axis supporting it, the same principles of the technique can be used for consider performing a prosthetic facet arthroplasty.
L'implant pédiculaire 34 comporte dans cette réalisation (Fig.8) une tige filetée surmontée non pas d'une tête, mais d'une prothèse facettaire concave 35. L'implant transiaminaire 4 reçoit à son extrémité une facette convexe 36, prothétique, en lieu et place de la portion verrouillée dans la
rotule 5. Ce montage s'effectue sur les deux paires de facettes, les facettes naturelles ayant préalablement été enlevées comme représenté sur la partie gauche de la figure 8.The pedicle implant 34 comprises in this embodiment (FIG. 8) a threaded rod surmounted not by a head, but by a concave facet prosthesis 35. The transiaminary implant 4 receives at its end a convex facet 36, prosthetic, in place of the locked portion in the ball joint 5. This assembly is carried out on the two pairs of facets, the natural facets having previously been removed as shown on the left-hand side of FIG. 8.
Les deux facettes prothétiques 35, 36 sont adaptées sur le support (ou tige), respectivement transpédiculaire 34 et translaminaire 4, une fois en place à la façon d'une sphère céphalique adaptée sur une tige fémorale prothétique. La solidarisation peut être obtenue par exemple par clipsage des facettes 35, 36 sur des pions respectifs 37, 38 des implants, venant s'emboîter dans des trous conjugués 39, 41 des facettes 35, 36. Dans le mode de réalisation illustré aux figures 9 à 11 , le dispositif d'ostéosynthèse rachidienne comprend une vis pédiculaire 51 présentant un filetage conventionnel adapté au pédicule P, et sa tête 52 est munie d'une assise 53 formée d'une collerette saillante permettant à la vis 51 d'être en appui optimum sur la base du pédicule P de la vertèbre. Au dessus de l'assise 53, la tête 52 se prolonge par une empreinte polygonale 54, par exemple hexagonale, laquelle est à son tour prolongée par une pièce tubulaire 55 contenant la rotule 5. L'extrémité 55a de la pièce tubulaire 55 est filetée et peut être coiffée par un écrou 56 permettant de protéger la vis 51 . En cas de besoin, cet écrou 56 peut être retiré afin d'y substituer un élément permettant de monter, en cas de nécessité, un adaptateur susceptible de recevoir des tiges de fixation interpédiculaires.The two prosthetic facets 35, 36 are adapted on the support (or rod), respectively transpedicular 34 and translaminar 4, once in place in the manner of a cephalic sphere adapted on a prosthetic femoral rod. The connection can be obtained for example by clipping the facets 35, 36 on respective pins 37, 38 of the implants, coming to fit into conjugated holes 39, 41 of the facets 35, 36. In the embodiment illustrated in Figures 9 at 11, the spinal osteosynthesis device comprises a pedicle screw 51 having a conventional thread adapted to the pedicle P, and its head 52 is provided with a seat 53 formed by a projecting collar allowing the screw 51 to be in support optimum on the basis of the pedicle P of the vertebra. Above the seat 53, the head 52 is extended by a polygonal imprint 54, for example hexagonal, which is in turn extended by a tubular part 55 containing the ball joint 5. The end 55a of the tubular part 55 is threaded and can be capped by a nut 56 making it possible to protect the screw 51. If necessary, this nut 56 can be removed in order to replace it with an element making it possible to mount, if necessary, an adapter capable of receiving interpedicular fixing rods.
La rotule 5 peut être bloquée par un bouchon fileté 57 venant se visser dans l'ouverture taraudée correspondante de la pièce tubulaire 55. La rotule 5 est percée de part en part par un trou fileté 58 prolongé diamétralement par un canon extérieur 59 orientable dans une ouverture latérale 61 , de forme allongée, ménagée dans la pièce tubulaire 55. Une seconde ouverture 60 de forme oblongue, est également ménagée en un emplacement diamétralement opposé à celui de l'ouverture 61. Ainsi la vis translamaire 62 peut traverser de part en part la rotule 5 et son canon 59, ainsi que les ouvertures opposées 61 et 60, de telle sorte que son extrémité 63 formée par une pointe trocart, peut venir s'ancrer distalement dans la
vertèbre à la jonction transverse pédicule-massif articulaire.The ball 5 can be blocked by a threaded plug 57 which is screwed into the corresponding threaded opening of the tubular part 55. The ball 5 is pierced right through by a threaded hole 58 extended diametrically by an outer barrel 59 orientable in a lateral opening 61, of elongated shape, formed in the tubular part 55. A second opening 60 of oblong shape, is also formed in a location diametrically opposite to that of the opening 61. Thus the translamary screw 62 can pass right through the ball 5 and its barrel 59, as well as the opposite openings 61 and 60, so that its end 63 formed by a trocar tip, can be anchored distally in the vertebra at the pedicle-solid articular transverse junction.
La vis translamaire (ou translaminaire) 62 est constituée par un axe fileté sur toute sa longueur, dont l'extrémité opposée à sa pointe trocart 63 présente une empreinte profilée 64, par exemple hexagonale (6 pans), servant au maintien de cette vis grâce à un instrument spécifique non représenté, assurant sa pénétration au travers de la lame. L'extrémité 64 est également munie d'une rondelle 65 à picots 66 pouvant être glissée le long de l'axe fileté 62 pour venir au contact de la face postérieure de l'épineuse. L'extrémité de la vis 62 est complétée par un écrou 65 de blocage, qui lorsque la vis translamaire 62 est mise en place (figures 10 et 11), vient s'appliquer sur la rondelle 65 et bloquer la vis 62 en place, en exerçant si besoin un effet de rappel.The translamary (or translaminar) screw 62 is constituted by a threaded axis over its entire length, the end opposite to its trocar tip 63 has a profiled imprint 64, for example hexagonal (hexagon), used to hold this screw thanks to a specific instrument not shown, ensuring its penetration through the blade. The end 64 is also provided with a washer 65 with pins 66 which can be slid along the threaded axis 62 to come into contact with the rear face of the thorny. The end of the screw 62 is completed by a locking nut 65, which when the translamary screw 62 is put in place (FIGS. 10 and 11), is applied to the washer 65 and locks the screw 62 in place, exerting a booster effect if necessary.
L'instrumentation ancillaire destinée à la pose du dispositif d'ostéosynthèse selon l'invention, en particulier celui des figures 9 à 11 , est illustrée partiellement aux figures 12, 13A et 13B. Cette instrumentation comprend un viseur transiaminaire 67 qui comporte : a) une poignée 68, en T, à corps tubulaire 80, prolongée par une chemise 69 adaptée pour chapeauter la tête 55 et l'empreinte hexagonale 54 de la vis pédiculaire ; la poignée 68 est montée amovible sur le corps 80 ; b) un bras 71 articulé sur la poignée 68, dont l'extrémité libre distale 72 est munie d'une gaine 79 adaptée pour pouvoir supporter l'implant translaminaire 62 et permettre son introduction dans le canon 59 de la rotule 5 à travers une lumière allongée 73 agencée dans la paroi de la chemise 69 (figure 13A). La lumière 73 s'étend parallèlement à l'axe de la vis pédiculaire 51 , de façon à permettre au canon 59 de la rotule 5 d'être dirigé autour de son plan de mobilité, frontal, grâce à son extrémité qui traverse la lumière 73, tandis que l'extrémité de la chemise 69 vient en appui sur l'assise 53. La hauteur de la lumière 73 peut varier, comme visible à la figure 13B qui montre une variante 74 de cette lumière, plus courte que la lumière 73, dans la chemise 75.The ancillary instrumentation intended for installing the osteosynthesis device according to the invention, in particular that of FIGS. 9 to 11, is partially illustrated in FIGS. 12, 13A and 13B. This instrumentation includes a cross-section viewfinder 67 which comprises: a) a handle 68, in T, with tubular body 80, extended by a jacket 69 adapted to cap the head 55 and the hexagonal imprint 54 of the pedicle screw; the handle 68 is removably mounted on the body 80; b) an arm 71 articulated on the handle 68, the distal free end 72 of which is provided with a sheath 79 adapted to be able to support the translaminar implant 62 and allow its introduction into the barrel 59 of the ball joint 5 through a lumen elongated 73 arranged in the wall of the jacket 69 (FIG. 13A). The lumen 73 extends parallel to the axis of the pedicle screw 51, so as to allow the barrel 59 of the ball 5 to be directed around its plane of mobility, frontal, thanks to its end which passes through the lumen 73 , while the end of the jacket 69 comes to bear on the seat 53. The height of the light 73 can vary, as visible in FIG. 13B which shows a variant 74 of this light, shorter than the light 73, in shirt 75.
Le bras 71 comprend une partie proximale 76 fixée à la
poignée 68, articulée sur la partie distale 72 autour d'un axe 77 et à laquelle est fixée une pointe 78 dimensionnée pour pouvoir venir au contact du bord supérieur de la lame vertébrale.The arm 71 comprises a proximal part 76 fixed to the handle 68, articulated on the distal part 72 around an axis 77 and to which is fixed a point 78 sized to be able to come into contact with the upper edge of the vertebral blade.
L'orientation dans le plan horizontal, du canon 59, peut être réalisée par rotation de la vis pédiculaire 51 autour de son axe, grâce à la poignée amovible 68 qui peut être remise en place si nécessaire, par dessus la chemise 69. L'articulation autour de l'axe 77 du bras 71 permet, grâce à la mobilité de la gaine 79, traversée par l'axe fileté translamaire 62, engagé dans le canon 59, de suivre l'orientation donnée au canon fileté 59 en fonction de la topographie anatomique de la visée lamaire.The orientation in the horizontal plane, of the barrel 59, can be achieved by rotation of the pedicle screw 51 about its axis, thanks to the removable handle 68 which can be replaced if necessary, over the shirt 69. The articulation around the axis 77 of the arm 71 allows, thanks to the mobility of the sheath 79, crossed by the threaded translamary axis 62, engaged in the barrel 59, to follow the orientation given to the threaded barrel 59 according to the anatomical topography of the lamar view.
La partie distale 72 est correctement positionnée dès que la pointe 78 a pris appui sur le bord supérieur de la lame vertébrale. La vis translamaire 62 peut alors être introduite dans le canon 59, la rotule 5 et traverser les ouvertures opposées 61 , 60, ainsi qu'une lumière allongée 81 ménagée dans la chemise 69 à l'opposé de la lumière 73, afin de venir se ficher dans la vertèbre. L'angle pris par le canon fileté 59 s'adapte automatiquement, de sorte qu'il existe une correspondance en fonction du type d'ajustement donné par la gaine 79 au canon 59. La pointe 78 appendue sur la partie proximale 76 prévient toute traversée de la lame dans l'espace canalaire au décours de la visée translaminaire. Cette dernière s'effectue grâce à une broche filetée, introduite par le canon de perçage 59.The distal part 72 is correctly positioned as soon as the tip 78 is supported on the upper edge of the vertebral blade. The translamary screw 62 can then be introduced into the barrel 59, the ball joint 5 and pass through the opposite openings 61, 60, as well as an elongated lumen 81 formed in the jacket 69 opposite the lumen 73, in order to come file in the vertebra. The angle taken by the threaded barrel 59 adapts automatically, so that there is a correspondence as a function of the type of adjustment given by the sheath 79 to the barrel 59. The point 78 hung on the proximal part 76 prevents any crossing of the blade in the canal space following the translaminar aiming. The latter is carried out by means of a threaded spindle, introduced by the drilling barrel 59.
La vis translaminaire 62 traverse la partie latérale de la vertèbre pour assurer un meilleur ancrage. Son axe fileté est coupé au ras de l'écrou de serrage 65, de sorte que cet ensemble assure un parfait blocage de la mobilité axiale du segment vertébral et l'annule dans le plan horizontal. Les deux vis translaminaires 62 (figures 10 et 11 ) , rejoignent la vis pédiculaire 51 vue par l'arrière au niveau de la tête. La figure 11 montre bien l'effet de blocage qui opère également dans le plan frontal. Les deux vis translaminaires 62 sont ainsi arrimées au pédicule par l'intermédiaire de l'implant pédiculaire 51. Cette dernière est mise en place par l'intermédiaire
d'un tournevis (non représenté), qui s'adapte au viseur 68, 69 et peut venir se glisser à l'intérieur de la partie verticale (corps tubulaire 80) de ce viseur.The translaminar screw 62 crosses the lateral part of the vertebra to ensure better anchoring. Its threaded axis is cut flush with the clamping nut 65, so that this assembly ensures perfect blocking of the axial mobility of the vertebral segment and cancels it in the horizontal plane. The two translaminar screws 62 (FIGS. 10 and 11) join the pedicle screw 51 seen from the rear at the level of the head. FIG. 11 clearly shows the blocking effect which also operates in the frontal plane. The two translaminar screws 62 are thus secured to the pedicle via the pedicle implant 51. The latter is put in place via a screwdriver (not shown), which adapts to the viewfinder 68, 69 and can slide inside the vertical part (tubular body 80) of this viewfinder.
L'invention est susceptible de diverses variantes d'exécution. Ainsi la solidarisation de la rotule 5 avec les implants 1 et 4 pourrait être réalisée par tout moyen équivalent au bouchon fileté 15, lequel peut être réalisé de manière différente de celle représentée. De même, dans le dispositif de la figure 4, le bouchon 15 peut être serti sur la rotule 5, l'évidement 16 étant supprimé. La fixation angulaire de la rotule 5 peut alors être obtenue par un axe vissé dans le bouchon plein 15, à travers un alésage taraudé (figure 4).
The invention is susceptible of various variant embodiments. Thus, the attachment of the ball joint 5 with the implants 1 and 4 could be carried out by any means equivalent to the threaded plug 15, which can be produced in a manner different from that shown. Similarly, in the device of Figure 4, the plug 15 can be crimped on the ball 5, the recess 16 being removed. The angular fixing of the ball joint 5 can then be obtained by a pin screwed into the solid plug 15, through a threaded bore (Figure 4).
Claims
1. Dispositif d'ostéosynthèse rachidienne pour la fusion osseuse de deux vertèbres contiguës, notamment lombaires (L4, L5), comprenant des moyens pour solidariser les vertèbres au niveau de leurs facettes (F) pédiculaires et laminaires respectives, caractérisé en ce qu'il comprend, pour chaque paire de facettes pédiculaire et laminaire, un implant transpédiculaire (1), un implant transiaminaire (4) et des moyens de verrouillage (5, 15...) pour solidariser mécaniquement ces deux implants de manière réglable angulairement. 1. Spinal osteosynthesis device for bone fusion of two contiguous vertebrae, in particular lumbar (L4, L5), comprising means for securing the vertebrae at their respective pedicular and laminar facets (F), characterized in that it comprises, for each pair of pedicle and laminar facets, a transpedicular implant (1), a transiaminary implant (4) and locking means (5, 15 ...) for mechanically joining these two implants in an angularly adjustable manner.
2. Dispositif selon la revendication 1 , caractérisé en ce que l'implant transpédiculaire est une vis (1 ) comportant une tige filetée (2), et une tête (3) contenant une rotule (5) orientable et adaptée pour réaliser la liaison avec l'implant translaminaire (4).2. Device according to claim 1, characterized in that the transpedicular implant is a screw (1) comprising a threaded rod (2), and a head (3) containing a ball joint (5) orientable and suitable for making the connection with the translaminar implant (4).
3. Dispositif selon la revendication 2, caractérisé en ce que la tête (3) est tubulaire et dans sa paroi est agencée une ouverture latérale3. Device according to claim 2, characterized in that the head (3) is tubular and in its wall is arranged a lateral opening
(6) par laquelle peut pénétrer une extrémité (7) de l'implant translaminaire (4) pour être solidarisée avec la rotule (5) logée dans la tête de la vis (4).(6) through which an end (7) of the translaminar implant (4) can penetrate to be secured with the ball joint (5) housed in the head of the screw (4).
4. Dispositif selon la revendication 3, caractérisé en ce que la rotule (5) présente un alésage diamétral taraudé (11) adapté pour recevoir l'extrémité filetée (7) d'une vis (4) constituant l'implant translaminaire, et la tête (3) de la vis pédiculaire (1 ) est équipée d'un moyen de blocage de la rotule dans une orientation angulaire déterminée, par exemple un pion fileté (14) pouvant être vissé dans la tête (3) de vis (1) et venir s'appliquer sur la rotule (5). 4. Device according to claim 3, characterized in that the ball joint (5) has a tapped diametral bore (11) adapted to receive the threaded end (7) of a screw (4) constituting the translaminar implant, and the head (3) of the pedicle screw (1) is equipped with means for locking the ball joint in a determined angular orientation, for example a threaded pin (14) which can be screwed into the head (3) of screws (1) and come to apply on the ball joint (5).
5. Dispositif selon la revendication 4, caractérisé en ce que la rotule (5) est prolongée par un tronçon tubulaire diamétral (12), coaxial à son alésage taraudé (11).5. Device according to claim 4, characterized in that the ball joint (5) is extended by a diametrical tubular section (12), coaxial with its threaded bore (11).
6. Dispositif selon les revendications 4 et 5, caractérisé en ce que la rotule (5) est orientable d'une part dans un plan horizontal (PH) entre un plan frontal (PF) et un plan sagittal (PS) avec un débattement angulaire prédéterminé (A) de l'axe de son alésage (11 ), et d'autre part dans
un plan frontal (PF) entre le plan horizontal (PH) et le plan sagittal (PS) avec un débattement prédéterminé (B) de l'axe de son alésage, le débattement (A) dans le plan horizontal étant par exemple de 33 degrés environ tandis que le débattement (B) dans le plan frontal est de 65 degrés environ, l'amplitude de ces débattements angulaires étant déterminée par les dimensions de l'ouverture (6) de la tête (3) de la vis (1 ) dans le plan horizontal et dans le plan frontal.6. Device according to claims 4 and 5, characterized in that the ball joint (5) is orientable on the one hand in a horizontal plane (PH) between a frontal plane (PF) and a sagittal plane (PS) with an angular movement predetermined (A) of the axis of its bore (11), and secondly in a frontal plane (PF) between the horizontal plane (PH) and the sagittal plane (PS) with a predetermined clearance (B) of the axis of its bore, the clearance (A) in the horizontal plane being for example 33 degrees approximately while the clearance (B) in the frontal plane is approximately 65 degrees, the amplitude of these angular deflections being determined by the dimensions of the opening (6) of the head (3) of the screw (1) in the horizontal plane and in the frontal plane.
7. Dispositif selon l'une des revendications 2 à 6, caractérisé en ce que la rotule (5) prend appui sur un siège sphérique (13) formé dans la tige filetée (2), et la tête (3) de ia vis comporte une forme profilée (21) adaptée pour pouvoir recevoir un outil de vissage.7. Device according to one of claims 2 to 6, characterized in that the ball joint (5) is supported on a spherical seat (13) formed in the threaded rod (2), and the head (3) of ia screw comprises a profiled shape (21) adapted to be able to receive a screwing tool.
8. Dispositif selon l'une des revendications 4 à 7, caractérisé en ce qu'il comprend un élément prolongateur (25) coiffant la tête (3) de la vis pédiculaire (1) et pouvant être traversé par une tige d'ostéosynthèse rachidienne (24), ce prolongateur étant fixé sur un bouchon (15) de blocage et contenant des pièces (27, 30) de positionnement de la tige.8. Device according to one of claims 4 to 7, characterized in that it comprises an extension element (25) covering the head (3) of the pedicle screw (1) and which can be crossed by a spinal osteosynthesis rod (24), this extension being fixed on a blocking plug (15) and containing parts (27, 30) for positioning the rod.
9. Dispositif selon l'une des revendications 4 à 7, caractérisé en ce qu'il comprend un élément prolongateur (40) pouvant coiffer la tête (3) de la vis pédiculaire (1 ), et présentant un canal en U de réception d'une tige vertébrale (24) fixée dans ce canal, ce prolongateur comportant un corps (44) monté flottant sur un écrou (43) de fixation à la tête (3) de la vis pédiculaire (1).9. Device according to one of claims 4 to 7, characterized in that it comprises an extension element (40) capable of covering the head (3) of the pedicle screw (1), and having a U-shaped channel for receiving 'a vertebral rod (24) fixed in this channel, this extender comprising a body (44) mounted floating on a nut (43) for fixing to the head (3) of the pedicle screw (1).
10. Dispositif selon la revendication 4, caractérisé en ce que du côté en vis-à-vis de la rotule (5), le pion (14) est vissé dans une pièce (18) et est pourvu d'un profil conique terminé par une portée sphérique ou conique (19) d'appui de blocage sur la rotule.10. Device according to claim 4, characterized in that on the side facing the ball joint (5), the pin (14) is screwed into a part (18) and is provided with a conical profile terminated by a spherical or conical bearing surface (19) for blocking support on the ball joint.
11. Dispositif d'arthroplastie entre deux facettes articulaires de deux vertèbres contiguës (L4, L5) l'une des facettes se situant dans le prolongement d'un pédicule d'une vertèbre (L5) tandis que l'autre facette est adjacente à une lame (32) de l'autre vertèbre (L4), caractérisé en ce qu'il comprend un implant pédiculaire (34) solidaire d'une facette artificielle
concave (35), et un implant translaminaire (4) solidaire d'une facette articulaire artificielle convexe (36), la solidarisation des facettes avec les implants étant réalisée par exemple par clipsage.11. Device for arthroplasty between two articular facets of two contiguous vertebrae (L4, L5) one of the facets lying in the extension of a pedicle of a vertebra (L5) while the other facet is adjacent to a blade (32) of the other vertebra (L4), characterized in that it comprises a pedicle implant (34) secured to an artificial facet concave (35), and a translaminar implant (4) integral with a convex artificial articular facet (36), the joining of the facets with the implants being carried out for example by clipping.
12. Dispositif selon la revendication 3, caractérisé en ce que dans la paroi de la tête tubulaire (55) est agencée une seconde ouverture latérale (60), oblongue, pouvant être traversée en même temps que la première ouverture (61) par une extrémité (63) de l'implant translaminaire (62).12. Device according to claim 3, characterized in that in the wall of the tubular head (55) is arranged a second lateral opening (60), oblong, which can be crossed at the same time as the first opening (61) by one end (63) of the translaminar implant (62).
13. Dispositif selon la revendication 12, caractérisé en ce que la vis translaminaire (62) est formée par un axe fileté dont une extrémité présente une empreinte profilée (64) pour permettre le maintien de cette vis par un outil spécifique, et cette extrémité est munie d'une rondelle (65) ainsi que d'un écrou (70) de blocage, la rondelle pouvant être pourvue de picots (66) d'ancrage dans la face postérieure de l'épineuse, la seconde extrémité de la vis étant constituée d'une pointe trocart (63) d'ancrage distal dans une vertèbre.13. Device according to claim 12, characterized in that the translaminar screw (62) is formed by a threaded axis of which one end has a profiled imprint (64) to allow the maintenance of this screw by a specific tool, and this end is provided with a washer (65) and with a locking nut (70), the washer being able to be provided with pins (66) for anchoring in the rear face of the thorny machine, the second end of the screw being constituted a trocar tip (63) for distal anchoring in a vertebra.
14. Instrumentation ancillaire destinée à la pose du dispositif d'ostéosynthèse selon l'une quelconque des revendications 1 à 13, caractérisée en ce qu'elle comprend un viseur translaminaire qui comporte : a) une poignée tubulaire (68, 80), prolongée par une chemise (69) adaptée pour chapeauter la tête (55) de la vis pédiculaire (51 ) et sur laquelle la poignée est montée de manière amovible, b) un bras (71) articulé sur la poignée, dont l'extrémité libre distale (72) est adaptée pour pouvoir supporter l'implant translaminaire (62) et permettre son introduction dans un canon (59) de la rotule (5) à travers une lumière14. Ancillary instrumentation intended for fitting the osteosynthesis device according to any one of claims 1 to 13, characterized in that it comprises a translaminar viewfinder which comprises: a) a tubular handle (68, 80), extended by a jacket (69) adapted to cap the head (55) of the pedicle screw (51) and on which the handle is removably mounted, b) an arm (71) articulated on the handle, the distal free end of which ( 72) is adapted to be able to support the translaminar implant (62) and allow its introduction into a barrel (59) of the ball joint (5) through a lumen
(73) de la chemise.(73) of the shirt.
15. Instrumentation selon la revendication 14, caractérisée en ce que le bras (71 ) articulé du viseur comporte une partie proximale (76) fixée à la poignée (68), articulée sur la partie distale (72) et à laquelle est fixée une pointe (78) dimensionnée pour pouvoir venir au contact du bord supérieur de la lame vertébrale.
15. Instrumentation according to claim 14, characterized in that the articulated arm (71) of the viewfinder comprises a proximal part (76) fixed to the handle (68), articulated on the distal part (72) and to which is fixed a point (78) sized to be able to come into contact with the upper edge of the vertebral blade.
16. Instrumentation selon la revendication 15, caractérisée en ce qu'elle comprend en outre un tournevis pouvant être introduit en translation à l'intérieur de la poignée tubulaire (68) du viseur après que la chemise (69) de ce dernier ait coiffé la tête (53) de la vis pédiculaire (51 ) afin de visser ladite vis.
16. Instrumentation according to claim 15, characterized in that it further comprises a screwdriver which can be introduced in translation inside the tubular handle (68) of the viewfinder after the jacket (69) of the latter has capped the head (53) of the pedicle screw (51) in order to screw said screw.
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
IES970323 IES970323A2 (en) | 1997-04-30 | 1997-04-30 | Spinal osteosynthesis device for mechanically interconnecting two adjacent vertebrae, in particular lumbar vertebrae |
IE970323 | 1997-04-30 | ||
PCT/FR1998/000880 WO1998048717A1 (en) | 1997-04-30 | 1998-04-30 | Apparatus for interlocking two contiguous, in particular lumbar, vertebrae |
Publications (1)
Publication Number | Publication Date |
---|---|
EP0996383A1 true EP0996383A1 (en) | 2000-05-03 |
Family
ID=11041461
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP98922912A Withdrawn EP0996383A1 (en) | 1997-04-30 | 1998-04-30 | Apparatus for interlocking two contiguous, in particular lumbar, vertebrae |
Country Status (3)
Country | Link |
---|---|
EP (1) | EP0996383A1 (en) |
IE (1) | IES970323A2 (en) |
WO (1) | WO1998048717A1 (en) |
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-
1997
- 1997-04-30 IE IES970323 patent/IES970323A2/en not_active IP Right Cessation
-
1998
- 1998-04-30 EP EP98922912A patent/EP0996383A1/en not_active Withdrawn
- 1998-04-30 WO PCT/FR1998/000880 patent/WO1998048717A1/en not_active Application Discontinuation
Non-Patent Citations (1)
Title |
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Also Published As
Publication number | Publication date |
---|---|
IES80150B2 (en) | 1998-06-03 |
IES970323A2 (en) | 1998-06-03 |
WO1998048717A1 (en) | 1998-11-05 |
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18D | Application deemed to be withdrawn |
Effective date: 20001101 |